Dear BraveMom,

As an RN and IBCLC, I wanted to share the most up-to-date information regarding COVID-19’s impact on pregnancy, childbirth, and breastfeeding. I thought it would be helpful to compile some opinions from leading health organizations so you’re empowered to make informed decisions for your family.

There is so much still unknown, but I hope that having some key views in one place will help your decision-making process. You’ll likely encounter certain restrictions and medical guidelines that must be considered, as well as disagreement amongst medical providers -- you’ll even see differing views below! But remember to trust your mama instincts and follow the recommendations of your health care team!

How can I protect myself from COVID-19 if I’m pregnant?

Staying healthy during pregnancy is a top priority for most families. Along with eating a healthy diet, staying hydrated, and exercising regularly, here is some information about how to protect yourself from COVID-19 while pregnant:

From the Centers for Disease Control and Prevention (CDC):

“Based on what we know at this time, pregnant people might be at an increased risk for severe illness from COVID-19 compared to non-pregnant people...

The best ways to protect yourself and to help reduce the spread of the virus that causes COVID-19 are to:

• Limit your interactions with other people as much as possible.
• Take precautions to prevent getting COVID-19 when you do interact with others...
• If you decide to engage in public activities, continue to protect yourself by practicing everyday preventive actions.
• Keep these items on hand and use them when venturing out: a cloth face covering, tissues, and a hand sanitizer with at least 60% alcohol, if possible.
• If possible, avoid others who are not wearing cloth face coverings or ask others around you to wear cloth face coverings...

Actions to take if you are pregnant

• Do not skip your prenatal care appointments...
• Make sure that you have at least a 30-day supply of your medicines.
• Talk to your healthcare provider about how to stay healthy and take care of yourself during the COVID-19 pandemic.
• If you don’t have a healthcare provider, contact your nearest community health center or health department.
• Call your healthcare provider if you have any questions related to your health (don't forget to check in with yourself about your emotional health).
• Seek care immediately if you have a medical emergency.

From the World Health Organization (WHO):

• “Washing your hands frequently with an alcohol-based hand rub or soap and water.
• Keeping space between yourselves and others and avoiding crowded spaces.
• Avoiding touching your eyes, nose and mouth.
• Practicing respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.”

Can I touch, room-in, and hold my baby after birth if I have COVID-19? 

As stories of babies being separated from their mothers soon after birth come to light, many expectant mamas are concerned. Research shows the vast benefits of skin-to-skin contact, so whether or not to separate a mother from her newborn should be carefully considered. 

From the American Academy of Pediatrics (AAP): 

“This is a controversial question, and experts are divided on the best course of action. While there is some information showing that most newborns who are exposed to mothers who have COVID-19 do well, some infants can get very sick. The risk to the infant in this situation is simply unknown at this time. While difficult, the safest course of action from the perspective of minimizing the likelihood of the infant becoming infected is to separate mother and infant, at least temporarily. This may provide time for the mother to become less infectious.

Temporary separation may be accomplished by admitting the infant to an area separate from mother and separate from unaffected infants. Gowns, gloves, standard procedural masks, and eye protection (face shields or goggles) should be used while caring for these newborns.

However, separation of mother and infant has downsides. If after discussion with the clinical care team, the mother chooses to room-in, or if rooming-in is necessary because the healthcare facility cannot provide care for the infant in a separate area, specific steps should be taken to minimize the risk of the newborn acquiring postnatal SARS-CoV-2 infection. The mother should maintain a distance of at least 6 feet from her infant when possible. A non-infected caregiver should help provide hands-on care to the infant whenever possible. When the mother provides hands-on care, she should wear a mask and perform hand-hygiene. Use of an isolette may facilitate distancing and provide the infant an added measure of protection from respiratory droplets.”

From the American College of Obstetricians and Gynecologists (ACOG):

“Infants born to patients with known COVID-19 at the time of delivery should be considered infants with suspected COVID-19. As such, infants with suspected COVID-19 should be tested, isolated from other healthy infants, and cared for according to the Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19)...

To reduce the risk of transmission of the virus that causes COVID-19 from the patient to the newborn, facilities may consider temporarily separating (eg, separate rooms) patients who have confirmed COVID-19 or are persons under investigation from their newborns until the patient’s transmission-based precautions are discontinued. ACOG recognizes that separation of patients from their newborns may be linked to additional risks including, but not limited to, undue stress on the patient and disruption of breastfeeding. The determination of whether to keep patients with known or suspected COVID-19 and their infants together or separated after birth should be made on a case-by-case basis, using shared decision-making between the patient and the clinical team.”

From the CDC:

"Much is still unknown about the risks of COVID-19 to newborns.

• Newborns can be infected with the virus that causes COVID-19 after being in close contact with an infected person.

• Some babies have tested positive for the virus shortly after birth. It is unknown if these babies got the virus before, during, or after birth.

• Most newborns who have tested positive for COVID-19 had mild or no symptoms and have recovered fully. However, there are a few reports of newborns with severe illness.

• A small number of other problems, such as preterm (early) birth and other problems with pregnancy and birth, have been reported in babies born to mothers who tested positive for COVID-19. We do not know if these problems were related to the virus.

CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the birth hospitalization is within the mother’s room. Temporary separation of the newborn from a mother with suspected or confirmed COVID-19 should be considered to reduce the risk of spreading the virus to the newborn. The risks and benefits of temporary separation of the mother from her newborn should be discussed with the mother by her healthcare team. Decisions about temporary separation should be made with respect to the mother’s wishes. If the mother chooses a temporary separation to reduce risk of spreading the virus and would like to breastfeed, she should express breast milk and have a healthy caregiver who is not at high-risk for severe illness from COVID-19 bottle feed the newborn the expressed breast milk if possible.

If the mother with suspected or confirmed COVID-19 does not choose temporary separation in the hospital, she should take precautions to avoid spreading the virus to the newborn, including washing her hands and wearing a cloth face covering when within 6 feet of her newborn. The newborn should be kept ≥6 feet away from the mother, as much as possible, including the use of physical barriers (e.g., placing the newborn in an incubator).

Mothers who are discharged from the hospital but have not met criteria to discontinue isolation may choose to continue to separate from the newborn at home to reduce the risk of spreading the virus, if a healthy caregiver is available. If a healthy caregiver is not available, a mother with COVID-19 can still care for her infant if she is well enough while using precautions (for example, hand washing, wearing a cloth face covering)."

From the WHO:

“Immediate and continued skin-to-skin care, including kangaroo mother care, improves the temperature control of newborns and is associated with improved survival among newborn babies. Placing the newborn close to the mother also enables early initiation of breastfeeding which also reduces mortality.
The numerous benefits of skin-to-skin contact and breastfeeding substantially outweigh the potential risks of transmission and illness associated with COVID-19.”

Can I breastfeed my baby if I have COVID-19?

Like skin-to-skin contact, the benefits of breastfeeding are endless, but in this challenging period, many new mothers are worried about keeping their babies safe while nursing.

From the AAP:

“The AAP strongly supports breastfeeding as the best choice for infant feeding. To date, breast milk is considered to be an unlikely source of transmission of SARS-CoV-2. Mothers may express breast milk after appropriate breast and hand hygiene, and this may be fed to the infant by other uninfected caregivers. If the mother requests to nurse her infant, she should comply with strict preventive precautions, including the use of a mask and breast and hand hygiene.”

From the ACOG:

“Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and health care professionals. Currently, the primary concern is not whether the virus can be transmitted through breast milk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding. A mother with confirmed COVID-19 or who is a symptomatic person under investigation should take all possible precautions to avoid spreading the virus to her infant, including breast and hand hygiene and wearing a face mask, if possible, while breastfeeding. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is not sick feed the expressed breast milk to the infant.”

From the CDC:

“Breast milk provides protection against many illnesses and is the best source of nutrition for most infants. Learn more about breastfeeding.

• You, along with your family and healthcare providers, should decide whether and how to start or continue breastfeeding.
  
  
• We do not know for sure if mothers with COVID-19 can spread the virus to babies in their breast milk, but the limited data available suggest this is not likely.
  
  
• If you have COVID-19 and choose to breastfeed:
• Wear a cloth face covering while breastfeeding and wash your hands before each feeding.
  
• If you have COVID-19 and choose to express breast milk:
• Use a dedicated breast pump.
• Wear a cloth face covering during expression and wash your hands before touching any pump or bottle parts and before expressing breast milk.
• Follow recommendations for proper pump cleaning [Español] after each use, cleaning all parts that come into contact with breast milk.
• If possible, expressed breast milk should be fed to the infant by a healthy caregiver who does not have COVID-19, is not at high-risk for severe illness from COVID-19, and is living in the same home...
  

Separation from the newborn may make it harder for some new mothers to start or continue breastfeeding. Frequent hand expression or pumping, ideally with a hospital-grade pump, is necessary to establish and build milk supply during temporary separation. Pumping every 2-3 hours (at least 8-10 times in 24 hours, including at night), especially in the first few days, signals the breasts to produce milk and prevents blocked milk ducts and breast infections. Mothers who are unable to establish milk production in the hospital after birth, or who have to temporarily stop breastfeeding, can relactate with skilled assistance from a lactation support provider. Additional information on relactation is available.”

From the WHO:

“Women with confirmed or suspected COVID-19 can breastfeed if they wish to do so. They should:

• Wash hands frequently with soap and water or use alcohol-based hand rub and especially before touching the baby;
• Wear a medical mask during any contact with the baby, including while feeding;
• Sneeze or cough into a tissue. Then dispose of it immediately and wash hands again;
• Routinely clean and disinfect surfaces that mothers have touched.

It is important to replace medical masks as soon as they become damp and dispose of them immediately. Masks should not be reused or touched in the front.”

UPDATE: COVID-19 Vaccines

Since this blog was originally published, two COVID-19 vaccines have become available. Although they weren’t included in the clinical trials, pregnant and lactating individuals are not being prevented from getting the vaccine. Pregnant and lactating parents are encouraged to discuss the vaccine with their personal health care providers to make informed decisions regarding vaccination and personal risk category (e.g., if they are frontline health care workers). Below are statements from the leading pregnancy and breastfeeding organizations regarding pregnancy, lactation, and the coronavirus vaccine.

From the Academy of Breastfeeding Medicine

“During lactation, it is unlikely that the vaccine lipid would enter the bloodstream and reach breast tissue. If it does, it is even less likely that either the intact nanoparticle or mRNA transfer into milk. In the unlikely event that mRNA is present in milk, it would be expected to be digested by the child and would be unlikely to have any biological effects.”

From ACOG

“Based on what is known about how these vaccines are made, experts believe they are likely to be safe in pregnancy. But since no testing has been done with women who are pregnant, researchers do not know if there are any risks.”

“ACOG recommends that breastfeeding women get a COVID-19 vaccine. There is no need to stop breastfeeding if you want to get a vaccine.”

From Infant Risk Center

“Similar to other medications, pregnant and/or breastfeeding women have not been included in studies to determine how well COVID-19 vaccines work or how safe they are. Based on what we understand from similar vaccines, we believe the risks that come with vaccination will probably be low. Therefore, while we wait for more information, each mother and provider should discuss what choice fits their situation best. The risk and benefit of the vaccine should be compared to each mother’s individual risk for getting COVID-19 as well as how well she is expected to tolerate the disease.”

“As for breastfeeding, little or none of these vaccine components would ever reach the milk compartment, or even be transferred into human milk.  Even if they were, they would simply be digested like any other protein by the infant.  It is our opinion, that the present group of vaccines are probably going to be quite safe for breastfeeding mothers.  The infant may even gain a small amount of maternal IgG in the breastmilk, which may even be beneficial. “

From the CDC

“Evidence suggests that pregnant women are potentially at increased risk for severe COVID-19-associated illness and death compared to non-pregnant women, underscoring the importance of disease prevention in this population. Given the predominance of women of child-bearing potential among the healthcare workforce, a substantial number of HCP are estimated to be pregnant or breastfeeding at any given time. Currently, there are no data on the safety and efficacy of COVID-19 vaccines in these populations to inform vaccine recommendations. Further considerations around use of COVID-19 vaccines in pregnant or breastfeeding HCP will be provided once data from phase III clinical trials and conditions of FDA Emergency Use Authorization are reviewed.”

Final thoughts

It’s understandable if you’re feeling anxious and frustrated about your pregnancy, childbirth, and breastfeeding journeys. I know how tough this period is, but I also know you’re doing a great job. I know you’re being brave, and I know you’re the perfect mama for your baby.

Research is still being done, and doctors are learning more and more every day about COVID-19 and how it affects pregnant and breastfeeding mothers and their infants. While there is some disagreement, the general consensus is that moms and babies should be evaluated on a case-by-case basis, and families should be supported in the decisions they make regarding bonding and breastfeeding. 

Even though the information can feel confusing since it’s constantly evolving, I know you'll do what is best for your family unit. If you would like additional support from the Kindred Bravely community, join our Facebook group, KindredMamas, and follow us on Facebook, Instagram, and Pinterest.