Newsletter #46: Breastfeeding Crucial During COVID-19

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.

Parents would naturally be concerned about breastfeeding their newborns in the midst of COVID-19 [Stock Photo]

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.

Empty shelves at supermarkets threw people into a frenzy, including parents who wanted to obtain formula milk for their babies. [Stock Photo]

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.

Unless either a mother or her baby is ill right after birth, it is recommended that mothers and babies are together to establish breastfeeding through efforts such as skin-to-skin and initiating the first latch. [Stock Photo]

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.

Breastfeeding remains the best form of protection for babies against COVID-19. Breastfeeding should begin right from the moment baby is born. [Stock Photo]
  • 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.

Breastfeeding remains a crucial aspect of infant and young children feeding in emergencies (IYCF-E) and should be part of nationwide policies in the event of a pandemic or national emergency. [Stock Photo]

Newsletter #45: How Has Covid-19 Affected Mothers?

By BMSG Editorial Team

The presence of Covid-19 in our lives has been hugely unexpected. For mothers, it brings about multiple reasons to cause anxiety and worry. Over the past months, we have read many stories in the news about how mothers have been affected by Covid-19. From mothers who could not send their milk home to their babies living overseas back home, to new mothers who face isolation and lack of family support with a newborn in hand – the challenges seem endless.

The fear is real and the struggle is even more. We highlight other struggles that mothers have faced based on a survey that we conducted in early 2020 as well as from our interactions with mothers who have reached out to us via our social media platforms.

Fear of Being Separated from Baby if Mum Gets Infected

From the very beginning, what is probably on every mother’s mind is what happens when she or her baby gets infected with the virus. For some mothers, the worry of being separated especially when baby is breastfeeding is a terrifying thought. Applie Wan, a mother of two, had a wake-up call when a member of her family had become infected early this year. The breastfeeding counsellor, who has a young baby and toddler, was concerned about having enough breastmilk for her baby in the event that she has to be warded or isolated from the family. 

Separating from a breastfeeding baby, especially if baby is very young, can be stressful for mothers. [Stock Photo]

“There is a constant worry about whether I will be separated from my three-month-old baby if ever I was to contract the virus, and whether I am still able to breastfeed her because of that,” said Applie. She also started to pump extra breastmilk if she had to be separated from her child suddenly. “I’m also motivated to have a bit of oversupply to provide my toddler with breastmilk, too, to try and boost her immunity,” she added.

It is understood that one parent is able to accompany a child who gets infected with the virus. However, not much information is available on the arrangement when a breastfeeding mum is the one who catches the virus. According to KK Women’s and Children’s Hospital, in a letter responding to BMSG’s queries on the matter above, each hospital adopts individual protocols to suit the needs of patients best. It is still not clear if a lactating mother is allowed to have her nursing baby with her if she is to be under isolation or warded at the hospital, especially since no visitors are allowed to see patients who contract the illness.

Challenges for Mums who want Urgent Lactation Care

For some mothers, receiving urgent lactation services from lactation consultants has proven to be challenging. 

Two mothers whom we interviewed had faced difficulties in trying to receive care for mastitis. One mother, Marissa Lee (not her real name) who developed mastitis when her two week-old son had been warded at a hospital for high fever, was turned down from the same hospital when she presented herself at the A&E department.

“It was disappointing to be turned away when I was already having a high fever and pain in my breast. Because I was not a mother who had given birth at that hospital, I was not able to receive emergency lactation care right away. I was, in fact, redirected to a nearby hospital, which did not have any lactation service,” she said.

After being discharged when her fever subsided, Marissa decided to go to another hospital when her fever returned on the same day. Thankfully, it offered her outpatient lactation service through a lactation consultant and helped her resolve her mastitis. Unfortunately, due to having a long separation from her son and coupled with the complications of mastitis, the mother eventually had to resort to exclusively pumping as her baby had developed a preference for bottle feeding. She has not had her issue completely resolved and has had to depend on breastfeeding support groups and advice from fellow mums to resolve her recurring milk duct. “It has been such a long and emotional rollercoaster ride,” she said.

Mothers who need professional lactation care may find themselves having to wait till CB ends before securing an appointment due to social distancing measures. [Stock Photo]

For another mother Shena Ng (not her real name), Circuit Breaker (CB) measures had made it impossible for her to reach lactation consultants and a paediatric dentist when she sensed something was amiss with her newborn’s latch. As CB measures were already put into place by then, she was disappointed to discover that lactation consultants were no longer allowed to conduct home visits. “I desperately wanted to seek expert advice regarding my daughter’s latching. Breastfeeding has been painful and unbearable,” she said. 

While Shena attempted to return to the hospital she birthed at to set an appointment with a lactation consultant, she was gently turned away as they had discovered that her baby was taking the bottle, possibly due to hospitals wanting to prevent seemingly unnecessary visits. “The lactation consultant had been really helpful and contacting me via phone calls. She said the hospital has been very strict about setting appointments for lactation care. I’m still trying to latch my baby on and off, but I really want to see a paediatric dentist or anyone who can tell me what is going on with my baby,” she said.

A Challenging Time to Give Birth

In the same survey, four pregnant mothers shared their concerns about precautions in the hospital, particularly in the delivery suites.

With limitations on visitors at the hospitals, pregnant mothers are anxious to know if their partners will be allowed to enter the delivery suite during labour. Wen Xiu, a pregnant mother of two, shared her real worries: “I am most worried that my husband will not be allowed in the delivery suite.”

Some expecting mothers are anxious about giving birth during the Covid-19 season while some are worried about having their partner around during labour. [Stock Photo]

According to Shaheeraa Khan, a doula and EXCO member of Doulas of Singapore, such anxieties are valid. “Having a support person to be there with the laboring mother is essential for her needs. Thankfully, all hospitals in Singapore do allow husbands or an immediate family member  into the delivery suite,” said Shaheera. All accompanying partners or family members must also not have been issued a SHN or be under quarantine orders. They must also comply with safety measures imposed by the hospital.

Unfortunately, for mothers who desire to have a doula with them during labour, doula services have been suspended across all hospitals except for Thomson Medical Centre.  

This has not dampened the spirit of doulas and clients alike; many doulas continue to provide prenatal support virtually or on mobile to parents. “Doulas can still be part of your birth team. Prenatally,  the doula will work with both parents to prepare them for their birth; go through comfort measures, types of pain relief and address any other concerns which the parents may have to guide them to have (a) positive birth.”  

According to Shaheera, from the 37th week onwards (although this may vary from doula to doula), the doula will still be on standby remotely to answer any questions which the parents may have.  During labor, she will support the labouring mother closely via phone. “We will help in answering any questions the couple has, encourage the mother and advising the father on what to do and ensuring that everything is going well while not physically being there. She will guide the father on what to say or what not to say and how to offer comfort measures. She is also there to offer encouragement,  advice and really holding the space virtually to encourage the mother to have a pleasant birthing experience,” said Shaheeraa.

Mothers who give birth in the season of Covid-19 have had to adapt and recalibrate their expectations of the postpartum period. [Stock Photo]

Babies Not Allowed in Other Hospital Wards

For mothers who are hospitalised for other medical reasons, such as an illness, having baby be with mother has proven to be impossible. We spoke to Emma Bell, who recently gave birth to her second baby, on her harrowing experience when she had to be hospitalised for post-birth complications. Emma had to be hospitalised when she developed a fever due to a womb infection. As she was a breastfeeding mother, she expected to be able to have baby with her at the hospital so that she could latch baby on demand.

She was warded at two hospitals, the first being just before CB was implemented. “They allowed baby in during visiting hours (at the first hospital) but not at night, so I pumped at night,” said Emma, whose husband brought baby to the hospital daily so that she could nurse her.

However, when she decided to transfer to another hospital, CB had just been implemented on the same day. Unlike at the first hospital, this time, baby could not join her at all. “They did not allow (my) baby in at all. My husband brought her in the first day but the nurses insisted that she leave and couldn’t come back so I didn’t see her again until I was home. I pumped the whole time I was there,” said Emma, who decided to go home after six days at the hospital so that she can rejoin her baby.

For a new mother, being totally separated from baby is extremely distressing. While Emma is now back home with her baby, she has not fully recovered and is facing the struggles of managing a newborn while trying to recuperate.

Extended Confinement

The confinement period can also be taxing on mothers during this CB period. An earlier article by TODAY Online interviewed many new mothers who had to struggle and make do with a lack of family support especially for those whose parents or family were not living in the same household.

Mothers who are recuperating for postpartum may feel frustrated and stifled when their freedom is restricted because of CB measures. Not being able to visit postpartum care professionals can also affect their emotional health. [Stock Photos]

For another mother we interviewed, the start of the CB coincided with the end of her confinement period. Having looked forward to being able to leave the house to get some fresh air and spend time with her husband and baby outdoors, she has had to deal with isolation and negative emotions of being confined at home instead.

“I took awhile to decide to visit the psychological services available at the hospital I gave birth at. I managed to book my initial appointment and had been looking to see a psychologist for some issues that I am currently facing,” she said. However, with the new CB measures in place, such services have not been able to be carried out and she has had to halt her visits. 

Many care services for mothers and babies have had to cease due to CB measures. Some mothers have voiced their disappointment at these because they see them as crucial for their and their babies’ well-being. [Stock Photo]

No Access to Other Services: Antenatal Classes, Masseuse, Confinement Nannies & Alternative Therapies

Mothers also reported that many things that they had planned for their pregnancy and postpartum during their pregnancies were now out of the question. 

One mother who had been looking forward to antenatal classes at the hospital she is due to give birth at has been sorely disappointed that these classes have been cancelled. A few mothers also lamented that postpartum masseuse services were regrettably unavailable since home visits are not allowed. As reported earlier this month, confinement nannies were also difficult to obtain as a lot of them hail from Malaysia; with the extended lockdown in Malaysia, and subsequently Singapore, mothers have had no choice but to grin and bear it during confinement.

Some mothers also mentioned their disappointment at the closure of alternative medicine and therapies such as osteopathy and chiropractic clinics.  

Mothers need to seek support as it is even more crucial during this period. Focus on connecting in other ways even though physical interactions are impossible. Confide in your partner, a trusted confidante or connect with other mothers in support groups and make new friends. [Stock Photo]

Seek Whatever Support is Available

With the extension of another month of CB, things may look bleak for mothers. However, we would like to offer some tips that can help you achieve some self-care and to constantly remain connected to services that would be of benefit to you:

  1. Take advantage of virtual support – consultations, support groups, helplines

    It may be easy to slip into an abyss of helplessness, but looking out for online platforms to connect with professionals and other mothers are imperative for your mental health at this point.

    Here are a list of helplines and online consults that may be useful for mothers:
  • General Support Hotlines:
    • National Care Hotline (24 hour) – 6202-6868 – emotional support for anyone who is in need
    • Samaritans of Singapore (SOS) – 1800-221 4444 / Email befriending:
    • HEAR4U (set up by CARE Singapore for Singaporeans to have a space to seek advice and express their concerns arising from the current COVID-19 situation) – WhatsApp 6978 2728
Be assured that this period is not permanent and it will back to business as usual, with our family and friends, before you know it. [Stock Photo]
  1. Know that CB is temporary; you are doing your part by staying at home
    • Speak to your partner or trusted family member about your struggles
    • Have regular virtual meetups with other friends, mummy confidantes, and family members to find solidarity and support
    • Avoid being alone for long periods of time; seek human connection at least once a day
  2. Prioritise your health and well-being
    • Have complete meals and eat nourishing foods
    • Stay away from self-destructive thoughts – focus on positive affirmations (e.g. I am a good mother, I am enough, I can do this no matter how long it takes)
    • Find a hobby or do something that you like for at least an hour every day

We know that with pregnancy or with a baby in tow can be isolating and frustrating, but taking stock of your feelings and taking the proper steps to remain calm and in control can help you manage these challenging times.

If you need help, seek them early and inform your spouse or family members.

We are all in this together! We support you mummies, and we have your backs!