In Spain, at the onset of the pandemic, contact between the newborn and the mother was prohibited and breastfeeding was discouraged. However, international guidelines were soon adopted suggesting that the benefits of breastfeeding and mother-to-child contact outweighed the risk of COVID-19 transmission. And already on March 17, 2020, the Spanish Society of Neonatology (SENeo) recommendedIf possible, mothers with mild or no symptoms should share a room with their asymptomatic newborns, whether infection is suspected or already confirmed. When in contact with the baby, the mother should observe strict hygiene measures. These include frequent hand washing with soap and water for at least 20 seconds, wearing a surgical mask or cloth mask while breastfeeding or whenever the distance between mother and baby is less than 6 feet (about two meters), and good breast hygiene. (after contact with maternal respiratory secretions) and breast pump (when feeding expressed).

SENeo notes that breastfeeding may be a potential route of transmission of antibodies from mother to newborn. Accordingly, it is suggested to continue breastfeeding because of all its potential benefits. In practice, however, this is not always possible because mothers are often placed in hospital wards for patients with COVID-19, and therefore direct breastfeeding can be difficult. This means that newborn babies will be deprived of mother’s milk and will not contact their parents if their mother has symptoms of COVID-19 or a confirmed diagnosis. Also, the level of adherence to SENeo protocols in different institutions may depend on the organizational constraints of the hospitals. (Miguel A. Marín Gabriel et al., 2020).

SENeo says that the newborn should be separated from the mother and placed in the neonatal ward only if the mother has pronounced symptoms, regardless of whether she has a confirmed infection or the results are only expected.

In cases where conditions do not allow direct breastfeeding, it is recommended to feed the baby with expressed breast milk without pasteurization.

If the mother contracted COVID-19 (or there is suspicion of such infection) after leaving the hospital, SENeo also recommends continuing breastfeeding, observing the above hygiene measures.

Ruth Del Río, Emilia Dip Pérez, Miguel Ángel Marín Gabriel (Acta Paediatr, 2020) studied adherence to the World Health Organization (WHO) guidelines on exclusive breastfeeding during the COVID-19 pandemic. The study involved 15 Spanish hospitals — members of the Neo-COVID-19 study group from March 13 to May 31, 2020.The final sample included 242 mothers who tested positive for COVID-19 and 248 live newborns, including 6 pairs of twins and one a twin whose brother was not hospitalized.

During the study period, thirteen infants tested positive for COVID-19, but the authors considered them false positive. At the same time, 108 (43.5%) of 248 infants did not receive direct skin-to-skin contact after birth, including 11 of 13 twins. In addition, 114 (45.9%) were separated from their mothers, including all twins. The partner was allowed to attend 39.2% of singleton and 42.8% of twin births.

At the same time, the level of exclusive breastfeeding at discharge was much higher in those dyads where infants received skin-to-skin contact immediately after birth, and also where mothers received partner support during childbirth (correlation coefficients 0.828 and 0.833, respectively).

At the same time, exclusive breastfeeding at discharge could be maintained much less frequently in cases where mothers were separated from their babies at birth (correlation coefficient -0.862).

In more detail, you can consider the indicated connections in Fig. one

Figure: 1 Percentage of newborns who received exclusive breastfeeding at discharge during the 12 weeks of the study, correlated with skin-to-skin contact, mother-child separation, and partner presence during labor

Thus, some hospitals did not accept WHO and UNICEF recommendations , and as expected this resulted in a clear reduction in exclusive breastfeeding at discharge. Also, a significant decrease in the level of exclusive breastfeeding at the eighth week of the study period, the authors associate with the fact that 40% of births took place in hospital centers that did not apply the recommendations of WHO and UNICEF .

However, in August 2020, a study by Augusto Pereira et al., 2020 was published, which describes the results of the observation of 22 COVID-19 substances and their newborns observed at the Puerta de Hierro Hospital in Madrid.

Unlike some other agencies that do not adhere to WHO, UNICEF and SENeo guidelines, the Breastfeeding Committee at Puerta de Hierro Hospital in Madrid has approved breastfeeding for newborns with COVID-19 with appropriate personal protective measures and with the informed consent of the mother. This allowed 65% of the mothers in the study to make skin-to-skin contact with their newborns, and about 55% of them were able to attach their babies to their breasts within the first hour. As a result, 20 out of 22 mothers chose to breastfeed their babies. Dyad observation lasted an average of 1.8 months. During this period, no newborns became infected. Moreover, 11 (50%) of 22 mothers with COVID-19 had symptoms.

Thus, the authors of this study concluded that breastfeeding is safe for milder forms of COVID-19 or its asymptomatic course, taking into account compliance with hygiene measures.

Thus, Spain has the protocols of the Spanish Society of Neonatology (SENeo), which contain measures roughly similar to those recommended by WHO and UNICEF . Unfortunately, these protocols are not always followed by medical institutions, as a rule, due to their organizational capabilities, which leads to a significant decrease in the level of breastfeeding.