By BMSG Editorial Committee
Since it appeared in late 2019, we have been continuously learning about the SARS-CoV-2 virus and COVID-19. We don’t yet know of its full impact on the world. Understandably, parents have particular concerns for their young children including wanting to know if breastfeeding is safe during this pandemic.
Why Breastfeeding Should Continue During COVID-19
It is imperative to understand that breastfeeding is not just for nutrition and nourishment; it also plays a huge role in the developing immunity of a child. It has been shown that the level of SARS-CoV-2 virus particles present in the breastmilk of mothers who test positive for COVID-19 is insignificant, and that COVID-19 does not pass through breastmilk.
When the human body encounters a virus, the immune system works to produce antibodies to part or all of it. Generally these antibodies, specific to particular viruses and pathogens, are present in breastmilk. There are some preliminary findings which suggest that breastmilk actually provides babies with protection against COVID-19.
When a mother is infected with COVID-19, it is recommended that simple hygiene measures such as hand-washing and mask-wearing should be taken when breastfeeding. Breastmilk is still the best food (in the presence of COVID-19 or not) for babies – including for those who require donated breastmilk.
Breastmilk Contributes to Food Security
The COVID-19 pandemic has also had massive economic repercussions. Rates of unemployment have increased exponentially due to disrupted economies. In a highly commodified world, this naturally translates to limited resources, including food.
Formula milk, which has become a very common milk substitute for babies in developed countries, is expensive and is also vulnerable to supply disruptions. In times of crisis, it may become an even more costly commodity and may run off the shelves due to panic buying. The World Health Organization (WHO) is now encouraging mothers to consider relactating or delay weaning off the breasts, to continue providing immunity to their breastfeeding children.
Improving Management of COVID-19 for Postpartum and Breastfeeding Mothers in Singapore
WHO guidelines on management of COVID-19 encourage breastfeeding and advise against the separation of mother and child.
As the only Singaporean charity that supports breastfeeding mothers via various counselling channels, BMSG encourages mothers to continue breastfeeding and for family members to give their strong support. A previous article outlined the worries of our mothers during the initial Circuit Breaker period and we want to offer recommendations for mothers to continue breastfeeding even if they are infected with COVID-19 at the time of their pregnancies or when giving birth.
- Infected Mothers Should Continue Rooming-In with Newborns After Giving Birth
Most hospitals which are Baby-friendly Hospital Initiative (BFHI) certified have policies where mothers and babies are able to room-in together after birth, unless there is a medically indicated reason for it. It also allows mothers and their newborns to have unrestricted skin-to-skin time after delivery, a recommendation by the WHO that helps to facilitate breastfeeding. Hearteningly, this guidance has been instituted at the various maternity hospitals in part or in totality since 2013.
While there have been no reports of infected mothers giving birth as of yet in Singapore, there was a mother in Australia who was infected with COVID-19 and was allowed to room in together with her baby until discharge. The baby did not contract COVID-19 and was breastfed by the mother from Day 1. India has also reported that 100 babies born to mothers who had contracted COVID-19 before they went into labour had shown negative results for COVID-19, with the exception of two babies. These babies were also quick to bounce back, showing negative results after subsequent tests were done just a few days later. These mothers and their babies were also allowed to room-in together and the mothers had breastfed their infants.
If you come down with COVID-19, you can insist on rooming-in with the baby as long as you and all visitors practise good hygiene. The precious hours and days right after the birth are when babies receive the goodness of colostrum which can be considered their very first immunisation. Every single drop is filled with antibodies and immune factors that serve to develop the child’s fighting capacity against the very pathogens that we seek to protect them from.
- Babies of Mums with COVID-19 May Not be Allowed in Quarantine Facilities
In relation to the above point, BMSG has contacted the Ministry of Health (MOH), and from our communication there seems to be no clear guidelines as to whether or not breastfeeding mothers can be housed with their babies should they be infected with COVID-19.
If you find yourself in this situation, advocate strongly for your baby to be allowed in the facility with you to protect your breastfeeding relationship. Breastmilk is one of the best ways to protect babies from the infection, which is why it is crucial to ensure that the breastfeeding relationship continues.
If it is not possible for you to be with your child (e.g. warded in ICU), you can still continue to pump milk. As always, practise good hygiene while pumping, such as washing hands before pumping and storing milk, sterilising all pump parts before pumping and making sure that milk is stored according to the recommended milk storage guidelines.
- Lack of Postpartum & Breastfeeding Resources for Mothers at Home
Many mothers struggle with breastfeeding in the few days after birth, particularly after discharge from hospital. Breastfeeding challenges typically arise around days 2 to 4 when breast engorgement, difficulty in latching, and the overall struggle of caring for a newborn can impede mothers’ efforts to breastfeed.
The Circuit Breaker that started in early April 2020 affected mothers and infants at their most vulnerable period. Mothers who required a Lactation Consultant (LC) to assist with breastfeeding were not able to have one visit them and yet may not have been well enough to visit one at the hospital. Families who were expecting confinement nannies from Malaysia to help care for newborns had to cope on their own. Other postpartum care services such as postnatal massages were similarly nonexistent for isolated new mothers, and more so with no visits from extended family members for support. This posed a huge challenge and strain, physically, emotionally, mentally.
We know that the first two to four weeks are when both mothers and babies learn how to latch well and we often refer to this as the “golden period”. When mothers receive adequate support during this time, they tend to have a better breastfeeding journey. By the time a mother is able to access help, she may have already given up on breastfeeding.
Breastfeeding feeds not just a baby, but the whole nation. If we aim for a healthier generation, we need to be able to support our breastfeeding dyads.
How Should Singapore Move Forward?
It is clear that Singapore needs to create or adapt our own national guidelines to safeguard our vulnerable young children in the event of a future crisis – be it another pandemic, a natural disaster, or others.
Australia updated its IYCF-E guidelines this year after the catastrophic Australian bushfires in 2019. Dr Karleen Gribble, a breastfeeding advocate, produced detailed recommendations for families with young babies to plan for evacuation. We also looked for inspiration from Safely Fed Canada, an organisation that offers very clear advice to parents on how to facilitate breastfeeding and sustainable infant feeding during times of crises.
We urge Singapore to create ICYF-E policies that will help policymakers and our nation be more prepared on safe infant feeding during national crises, which include and promote breastfeeding at home and in institutions, and which guide parents and carers in detail on safe formula preparation and feeding. The availability of formula milk for babies is at the mercy of supply chains and carries with it increased risk of infections and contamination, especially in emergencies. Ample preparedness will safeguard the health and security of our children.
We also urge that Singapore create a national breastfeeding committee to encourage, facilitate and protect breastfeeding at a national level, for all times. When breastfeeding becomes part of our national policies, and our culture as a society, we will be providing our babies their primal rights, maintaining food security and improving overall health for our children now and in the future.