The isolation measures introduced in the UK on 23 March 2020 to reduce the spread of COVID-19 have brought about a rapid change in the living conditions of pregnant women, young mothers and their babies.
The UK government and healthcare organizations have recommended maintaining contact between mothers and babies and encouraging and supporting breastfeeding, including when the mother is infected with COVID-19, provided that she is well enough and precautions are taken to to minimize the risk of infection of the infant during feeding (Royal College of Midwives, 2020; Royal College of Obstetricians and Gynaecologists, 2020; Royal College of Paediatrics and Child Health, 2020).
In particular, the Royal College of Obstetricians and Gynecologists ( RCOG) in its recommendations dated 07.24.2020 (Coronavirus (COVID-19) Infection in Pregnancy. Information for Healthcare Professionals. Version 11) draws attention (with links to studies) that the long-term and well-established benefits of breastfeeding are likely to outweigh any potential risks of transmission through breast milk.
Women suspected of having COVID-19 or with a confirmed diagnosis should stay with their babies in the same room, practice skin-to-skin care and breastfeeding if the mother wants to do so, and the newborn does not need additional medical attention during this time.
To make a decision on how to care and feed, a woman is encouraged to discuss the risks and benefits with neonatologists and family members. In turn, healthcare providers should inform the family that COVID-19 infection is not a contraindication for breastfeeding, and provide support, advice and guidance on breastfeeding to women wishing to breastfeed.
When a woman is not well enough to take care of her own baby, or when direct breastfeeding is not otherwise possible, it is important to support her and help her to express manually or with a breast pump and / or provide access to donated breast milk.
RCOG cites hand washing, avoiding coughing and sneezing while nursing, and wearing a face mask or waterproof mask while nursing and grooming as measures to prevent transmission of the virus to the newborn. It is emphasized that babies should not wear face masks as they may suffocate.
However, the intention to minimize the spread of the virus has inevitably led to a reorganization of health services. Some meetings of specialists with pregnant women and new mothers have moved to the online format. Restrictions have also been introduced on the presence of partners during face-to-face meetings and childbirth, which affects, in particular, the rate of breastfeeding, according to a study in Spain .
In the UK, a study has begun, The Covid-19 New Mum Survey, aimed at collecting information on maternal experience and mood, as well as feeding methods for infants in the unique circumstances of initial isolation, and then in subsequent stages, when restrictions will be relaxed.
As part of the study, women aged 18 years or older currently residing in the UK (regardless of their country of birth) who have children under 12 months of age are asked to complete an online survey about their childbirth experience and feeding practices. infants.
In October 2020, A. Vazquez-Vazquez et al., 2020, in their preliminary report, analyzed data provided by mothers who completed the survey during the week from May 27 to June 3, 2020. The main purpose of this analysis was to describe and compare the experiences of women who gave birth before and during isolation.
During this period, 1365 women were included in the analysis, who provided data on their experience of childbirth and on the methods of feeding their babies. Of these, 1049 (77%) gave birth before isolation and 316 (23%) during isolation.
Skin-to-skin contact and feeding of the newborn
The data (Table 1) showed that, despite the difficulties caused by the pandemic, UK hospitals continue to implement measures such as promoting early skin-to-skin contact between mother and baby and breastfeeding.
However, about a third of women who planned to breastfeed reported that they did not receive assistance with latching on their baby, and a quarter felt that they did not receive sufficient support when feeding in the hospital. The authors of the study believe that this may be due to the increased burden on the healthcare system, as well as pressure on healthcare workers to discharge mothers earlier to minimize the risk of infection.
Feeding at the time of the survey
|Type of feeding at the time of the survey||Child born before isolation, n = 1049 (%)||The child was born during isolation, n = 316 (%)|
|Exclusive breastfeeding||323 (31)||214 (40)|
|Formula feeding||130 (12)||43 (14)|
|Mixed feeding (breast milk + formula)||80 (8)||59 (19)|
|Breastfeeding + complementary foods||335 (32)||0|
|Mix + complementary foods||138 (13)||0|
|Mixed feeding + complementary foods||43 (4)||0|
Table 2 Feeding at the time of the survey
Infant feeding data at the time of the survey are shown in Table 2. Due to the younger age of babies born during isolation, they were still mostly breastfed exclusively, while some older babies born before isolation complementary foods were gradually introduced.
13% of women in both groups reported changes in infant feeding during isolation. Of the nursing mothers, 60% reported no change in the frequency of feeding, 30% reported an increase in the number of breastfeeding, 10% reported a decrease. Also, 68% of lactating mothers reported no change in the duration of feedings, while 17% of the duration of feedings increased, and 15% — decreased. Those who stopped breastfeeding during the isolation period — 4%.
At the same time, the most common reason for changing feeding plans for mothers who gave birth during the isolation period was the lack of support for breastfeeding (21 mothers). This was especially true of the lack of help with practical problems such as latching to the breast, as a result of which the mother expressed milk, injected formula or stopped breastfeeding. Also, 6 women reported that they had breastfeeding problems associated with a short frenum of the tongue in their babies, which could not be corrected by surgery due to the pandemic.
Of the mothers who gave birth during isolation, 45% believed that they did not receive sufficient support and assistance in feeding their child from the moment of birth until the moment they filled out the questionnaire. With that, 59% reported receiving professional help with breastfeeding in the first few days after giving birth.
At the same time, 57% of mothers who gave birth before isolation reported decreased support for feeding during this period. It was also reported that support for childcare generally declined during the pandemic for 69% of participants.
It is noteworthy that women from both groups named the main source of support for their partners (60%). Also highlighted as sources of support were healthcare professionals (50%), online support groups (e.g. Facebook) (47%), followed by friends and family (37%), and breastfeeding support groups such as NCT, La Leche league (32%). 28 women were also identified as a source of support for breastfeeding counselors.
However, reliance on support from online groups was significantly lower for women who gave birth during isolation. Perhaps this is due to the fact that they needed more practical help to establish breastfeeding, since their children were very young at that time.
Mixture manufacturer pressure
Christoffer van Tulleken et al., 2020 collected country-by-country data on compliance with the International Code of Marketing of Breast-milk Substitutes (hereinafter referred to as the Code) during the COVID-19 pandemic. They found that large manufacturers of breast milk substitutes deliberately distort the facts about the safety of breastfeeding, offer unnecessary hygiene measures, and separate mothers from their babies. Such advice undermines breastfeeding and thus increases the risk of infant death. To date, numerous violations of the Code and laws related to COVID-19 have been documented.
Specifically, in a recent online survey of 1,360 UK mothers who breastfeed during national isolation related to COVID-19 (Brown A, unpublished), 80% reported contact with formula makers, typically , in social networks. At the same time, the Code prohibits formula manufacturers from directly contacting mothers. However, alas, this does not stop the manufacturers of mixtures, judging by the survey data.
Thus, in the UK, the recommendations of WHO and UNICEF are followed , skin-to-skin contact is maintained immediately after childbirth, as well as breastfeeding, regardless of whether the mother is sick with COVID-19 or not. This helps keep breastfeeding rates relatively high. However, even here, the pandemic has had an impact. On the one hand, mothers now have more opportunities to devote themselves to caring for their children due to isolation (as evidenced, in particular, by the percentage increase in the frequency and number of breastfeeding). On the other hand, they receive less support, and also face other circumstances, which were caused by the measures associated with the pandemic (in particular, the inability to trim the short frenum of the child’s tongue)