Expert tips to breastfeed safely during the pandemic

For newborns, the most important source of nutrition is breast milk, which helps to protect them against diseases. The World Health Organisation (WHO) has recommended that mothers continue breastfeeding their babies during COVID-19 infection and after the vaccination. In fact, several studies have shown that breastfeeding may help build passive immunity as it contains antibodies that target the virus.

This Breastfeeding Awareness Month, we speak with Dr. Vidya Kaushal Jadhav, Paediatrician & International Board Certified Lactation Consultant (IBCLC), Mumbai on the importance of breastfeeding during the pandemic and how new mothers can protect themselves and their babies while feeding.

Dr Vidya Jadhav,  Paediatrician & International Board Certified Lactation Consultant, IBCLC
Dr Vidya Jadhav, Paediatrician & International Board Certified Lactation Consultant, IBCLC

Considering the pandemic and the health implications brought by it, how important is breastfeeding for new borns, currently?

Breastfeeding and skin-to-skin contact and early, exclusive breastfeeding helps babies to thrive and provides lifelong health benefits.

Breastmilk provides antibodies that give babies a healthy start in life and protect them against many infections. Breastfeeding significantly reduces the risk of illnesses in newborns and young infants, provides life-long health benefits for children, and improves the health of mothers as well.

Thus, breastfeeding forms an important pillar for protecting newborns from the ongoing pandemic. Further, there is overwhelming evidence in support of breastfeeding even in the current pandemic situation, as the transmission of COVID-19 virus through breastfeeding or by giving breast milk has not been detected.

Many mothers who have recovered from COVID-19 or are COVID-19 positive worry about breastfeeding their babies for fear of passing on the infection. Is this worry valid and what can be done to encourage breastfeeding?

To date, active COVID-19 virus has not been detected in the breastmilk of any mother with COVID-19, so it is unlikely that COVID-19 can be transmitted through breast milk. While researchers are continuing to test breast milk from mothers with confirmed and suspected COVID-19, the numerous benefits of breastfeeding substantially outweigh the potential risks of illness associated with the virus.

Hence, mothers who are COVID-19 positive should be encouraged and supported to continue breastfeeding following universal hygiene precautions. For mothers who have recovered from COVID-19, it is more important and beneficial to breastfeed as they can transfer the protective antibodies formed against the COVID-19 virus, to their breastfeeding baby and further enhance the immunity of the baby against the infection.

How can infected mothers safely breastfeed their babies?

Breastfeeding boosts the baby's immune system, and antibodies from the mother are passed to the baby through breastmilk, and thus help the baby fight infections. Hence, breastfeeding in mothers with COVID-19 infection should be continued with appropriate universal hygiene precautions:

● Wash hands frequently with soap and water or use alcohol-based (60 per cent or more) 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 after touching them.

● Mother’s breast only needs to be washed if she happens to cough on it just before breastfeeding or breast milk expression. Otherwise, the breast does not need to be washed before every feeding.

● Washing of breastmilk pumps, milk storage containers and feeding utensils after every use, as usual, is equally essential.

If the mother is feeling too sick to breastfeed, she can try and express breastmilk and feed the baby with a clean cup or spoon. Expressing breast milk is also important to sustain milk production so that the mother can breastfeed her child again, once she feels well enough to do so. Also, donor human milk can be considered if available in a nearby area.

There is no fixed time interval to wait after a confirmed or suspected COVID-19 infection. It is important to continue nourishing the baby with breastmilk, even when the baby is sick due to COVID-19 or another illness.

The mother can also consult a Lactation Consultant or healthcare professional about the options available for feeding the baby.

What are your tips and advice to make breastfeeding safer and more comfortable for new mothers?

Here are some tips that new mothers can follow to make breastfeeding more comfortable and safe:

  • Antenatal breastfeeding education and counselling to pregnant women and their families enable mothers to initiate and continue breastfeeding with utmost confidence, thus, improving the breastfeeding success rate and prolonging the duration of breastfeeding.

  • Engage in skin-to-skin contact within 5 minutes after delivery if both mother and baby are medically stable. Placing the newborn close to the mother in skin-to-skin contact enables the early initiation of breastfeeding. Timing is everything and it is recommended to initiate breastfeeding within the first hour after delivery with the support of trained nursing staff or a family member.

  • Rooming-in, that is keeping the baby with the mother in the same room 24/7, is essential for the mother to recognise the baby's feeding cues and successfully breastfeed the baby.

  • Breastfeeding baby on early feeding cues or on-demand and at least 8-10 times in 24 hours, day and night. Night feedings are equally important to improve and maintain the breast milk supply.

  • Breastfeeding is a pleasant experience for both mother and baby, and so painful breastfeeding should raise an alarm to seek timely medical advice to prevent early stoppage of breastfeeding. Mothers should try breastfeeding in different positions and choose the most comfortable one and also learn to latch the baby correctly to the breasts for the proper and complete transfer of milk from the breast to baby.

  • Even though breastfeeding is a natural process, it is a skill that can be learned by both the mother and the baby and improves with practice and proper support.

  • Few mothers may encounter lactation challenges in the early days, but knowing about common lactation related problems like sore nipples, engorgement, mastitis, breast abscess, insufficient breast milk supply, what to expect and when to seek lactation support, can help overcome them and continue breastfeeding successfully.

  • Continue exclusive breastfeeding up to the completion of six months of age of the baby. Breastmilk is complete nutrition for the baby, the foremilk is more watery to satisfy the baby’s thirst even in summers and the hindmilk is rich in calories to fulfil the baby's hunger and for adequate weight gain. Thus, it is important to completely feed the baby at one breast at each feeding session and complete emptying of breast per feeding session also ensures maintenance of adequate breast milk supply.

  • When a baby completes 6 months of age, introduce safe and healthy complementary foods with continued breastfeeding up to 2 years of age and beyond.

  • By following the above tips with proper universal hygiene precautions for the current pandemic situation, new mothers can enjoy a safer and comfortable breastfeeding experience.

In many countries, infant formula companies are cashing in on the pandemic to discourage breastfeeding - what can be done to counter this?

The COVID-19 pandemic has highlighted the need for stronger laws and rules to protect families from false claims about the safety of breast milk substitutes or aggressive marketing practices.

Organisations working for the promotion, protection and support of breastfeeding should encourage women to continue to breastfeed during the COVID-19 pandemic by creating awareness regarding the benefits of breastfeeding and breast milk, which outweighs the risk of infection and make the community aware of the harmful effects of infant formula milk use when not medically indicated.

In India, the Infant Milk Substitutes (IMS) Act, (related to the International Code of Marketing of Breast Milk Substitutes) governs the regulations on the marketing of breast milk substitutes. This has helped curb the promotion and use of breast milk substitutes to a larger extent.

WHO and UNICEF have also called on governments to urgently strengthen legislation on the Code during the COVID-19 pandemic. Governments and civil society organisations should also not seek or accept donations of breast-milk substitutes in emergency situations like the current pandemic and support, promote and protect breastfeeding.