As early as March 13, 2020, the WHO published recommendations according to which mothers with suspected or confirmed COVID-19 were recommended skin-to-skin contact with their newborns and direct breastfeeding, subject to appropriate preventive measures immediately after birth. The WHO argued, citing research, that the benefits of such contact and breastfeeding far outweigh the dubious possibility of transmitting infection to a child.
However, the Russian Federation purposefully decided to follow the path of China… The Interim Guidelines for the Prevention, Diagnosis and Treatment of New Coronavirus Infection (COVID-19), Version 5 of April 8, 2020, stipulates, inter alia, that if a mother has COVID-19, mother-child contact is not recommended, to the breast the child does not apply, it is carried out of the delivery room as quickly as possible. Depending on the clinical condition of the woman, it is possible to maintain lactation for the subsequent breastfeeding of the child after the mother recovers (section «Management of newborns in the context of the COVID-19 coronavirus pandemic»). Accordingly, the mother and the child were immediately separated until the mother recovered, even feeding with expressed milk was out of the question. At the moment, Version 8.1 of these recommendations from October 1, 2020 is already in effect. At the same time, the wording of this paragraph has not changed much. Added only clarification,
The methodological recommendations in the first version were approved by the Ministry of Health of the Russian Federation on April 24, 2020. In May 2020, Version 2 of this document was approved, according to which nothing has changed in the field of breastfeeding in comparison with Version 1.
In accordance with paragraph 7 of Art. 8.6 Methodical recommendations, breastfeeding during the isolation of the child from the mother is not recommended. However, it is necessary to carry out measures to preserve lactation in the mother.
In paragraph 8 of Art. 8.6 The guidelines recognize the benefits of breastfeeding, suggesting that breast milk may provide protective factors for the newborn after maternal COVID-19 infection. In this regard, it is proposed in cases of hospitalization of a mother and a child in the same institution, to keep feeding the child with native (i.e. fresh, without pasteurization) expressed breast milk of the mother. When organizing the expression of milk by a mother, the following rules must be carefully observed:
- Expression of milk is performed by the mother in her room using an individual clinical breast pump.
- The milk is collected in sterile bottles that are tightly connected to the breast pump.
- Breasts should be washed with soap before expressing.
- In between pumping, the breast should be closed to prevent saliva and mucus from the respiratory tract from entering the breast.
- Before expressing milk, the woman washes her hands and changes the surgical mask to a new one.
- Spreads an antiseptic on the surface where the breast milk collection bottle will be placed before and after expressing.
- Hermetically connects a sterile bottle to the breast pump, then expresses milk into it with a breast pump.
- When pumping is complete, detaches the bottle from the pump and quickly replaces the cap.
- Treats the bottle with an antiseptic and places the bottle in a clean plastic bag, then closes the bag.
- After that, all parts of the breast pump are processed according to the current recommendations for the processing of breast pumps. Upon completion of all actions, you must wash your hands.
Expressed native milk should not be pasteurized.
It is worth noting that this is a huge list compared to the recommendations of the WHO or CDC , which did not include the corresponding recommendations, not because they did not know about such a possibility, but because they consider them pest (for example, washing breasts with soap and water every time you pump, according to WHO ) or ineffective (for example, disinfecting the outer surfaces of bottles, according to the CDC ).
As for the transportation of expressed breast milk from the mother’s isolation zone to the newborn’s ward / ward, clause 8 of Art. 8.6 Methodical recommendations also contain strict rules in this regard:
- The nurse takes milk from the woman’s room.
- The nurse uses appropriate PPE to enter and work in the nursing ward, just as when caring for the patient.
- The nurse disinfects the plastic bag containing the bottle with an antiseptic outside of the patient’s room and places it in a biological sample container outside the patient’s room, following the same principles as for delivering biological media to the laboratory. The container is delivered to the exit gateway from the quarantine area and is left there in the transfer window.
- Another nurse outside the quarantine area collects the transport container of expressed milk from the transfer window and carries it to the baby’s compartment. Leaves the container in the designated area.
In accordance with paragraph 9 of Art. 8.6 of the guidelines, resumption of breastfeeding is possible after receiving two negative tests for the SARS-CoV-2 virus in both the mother and the child. If everything is more or less clear with the mother, then about 2 negative tests in a child, as a condition for resuming breastfeeding, is a very strange norm.
Thus, after the adoption of the Guidelines of April 24, 2020 (with subsequent amendments in May 2020), the Russian Federation has consolidated the model of breastfeeding in COVID-19, which resembles the initial strict recommendations of the CDC , only even more stringent . However, the CDC changed its recommendations as soon as new data on the safety of breastfeeding became available, provided that preventive measures were followed. The Ministry of Health of the Russian Federation ignored such data.
On August 3, 2020, the sections of the Interregional Public Organization «Association of Natural Feeding Consultants» (AKEV), including members of the AKEV Medical Council, sent an open letter to the Ministry of Health of the Russian Federation.
In their letter, the authors referred to the fact that the recommendations for organizing feeding with expressed milk, enshrined in Art. 8.6 Methodical recommendations, in modern realities can not be implemented by any perinatal center or maternity hospital in the country. In fact, women at best express themselves to maintain lactation and pour the valuable breast milk down the sink while their baby is receiving the formula.
In addition, these recommendations contradict the Constitution and the Family Code of the Russian Federation, since a woman immediately after childbirth becomes a mother and should be able to fully exercise the rights and obligations for a child until they reach 18 years of age.
In light of the available research, the real risks to the health of mothers and newborns due to lack of mother-to-child contact and the prohibition of breastfeeding are higher than the potential risk of contracting COVID-19.
In connection with the above, the authors of the letter asked to amend the Methodological Recommendations. Including allowing mothers to stay with their newborns, even if the mother has confirmed COVID-19 (except for severe cases) and ensure the right to breastfeeding while observing preventive measures approved by WHO .
As of 10:00 on August 17, 2020, more than 3200 caring citizens have already signed the open letter.
Unfortunately, the Ministry of Health of the Russian Federation replied to this letter with a formal reply (letter No. 15-4 / 741 dated 08/18/2020), attaching a letter to the Federal State Budgetary Institution “National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov «(hereinafter referred to as FGBU) No. 01-02 / 412-О of 08/10/2020. In this letter, the FGBU refers to the fact that, despite the available literature data on the low risk of infection of the newborn through breast milk, they are insufficient and do not have a high level of evidence.
It is not clear why, in general, breast milk, which is intended for a child by nature precisely as a source of antibodies, immunoglobulins and other protective factors, should somehow prove its safety for a newborn. Moreover, it has long been established that feeding with ARVI is not only possible, but also necessary, and COVID-19 is one of the varieties of ARVI. Moreover, the available data on the safety of breast milk in COVID-19 are accepted by almost all countries of the world (including the USA , Great Britain , Italy , France , the United Arab Emirates , etc.), but in our country this level of evidence is not high according to the FGBU.
In addition, the FGBU emphasizes that in the exercise of parental rights, parents have no right to harm the physical and mental health of children (clause 1 of article 65 of the RF IC). The principle of the priority of child health protection means that children, regardless of their family and social well-being, are subject to special protection, including care for their health and appropriate legal protection in the field of health protection, and have priority rights in the provision of medical care. Another priority under Art. 12 323-FZ is a priority of prevention in the field of health protection, which includes, among other things, the implementation of sanitary and anti-epidemic (preventive) measures.
It is very great that there are references to these standards. Breastfeeding is indeed the prevention of necrotizing enterocolitis (NEC, which can lead to intestinal perforation and sepsis), various intestinal infections and infectious diseases, diabetes mellitus, obesity and many other diseases. In addition, a mother infected with COVID-19 transfers antibodies to the specified virus to the child. As for the possibility of infection through the mother’s respiratory drops, it has already been proven by many studies: if the preventive measures recommended by WHO are followed , the probability of such infection is minimal.
However, the FGBU interprets these norms in its own way. By prohibiting contact between an infected mother and a newborn, it is intended to protect the child from COVID-19 (which children, if they do, are usually asymptomatic or with mild symptoms, according to the WHO and CDC ), thus putting him at risk of other, more serious diseases …
In addition, in its letter, the FGBU did not comment in any way on the actual impossibility of providing expressed milk feeding in perinatal centers and maternity hospitals in the country, and did not assess the ratio of the risks of breastfeeding by mothers without symptoms or with mild symptoms in compliance with preventive measures approved by WHO , with the risks of forced separation babies with their mothers and feeding them with formula.
Unfortunately, as of November 21, 2020, nothing has changed in the Russian Federation regarding breastfeeding for mothers with suspected or confirmed COVID-19. If a mother wants to have a 100% guarantee that she will not be separated from her newborn baby, she is forced to refuse to conduct PCR testing for COVID-19 against her. And if a mother comes to the hospital already in childbirth, this is possible. At the same time, it is now unrealistic to get to prenatal hospitalization without such testing, so many women postpone until the last, which can lead to complications.
Since August 2020, many more facts have appeared that it is safe for mothers to be together without symptoms or with mild symptoms with their babies, as well as to breastfeed directly in compliance with preventive measures. In particular, such methods began to be used in medical institutions in America and even China , which Russia was initially guided by in this matter. I would like to believe that in our country the situation will soon change towards a more loyal attitude towards mothers and their newborn babies.