During the Coronavirus pandemic, supporting needs of childbearing families and the role of human milk as a lifesaving medical intervention should not be forgotten. International organizations have recommended early, exclusive breastfeeding and skin-to-skin contact during COVID-19 including women who are positive for the virus (United Nations Children's Fund [UNICEF], 2020; World Health Organization [WHO], 2020). Per UNICEF, considering the benefits of breastfeeding and the insignificant role of human milk in the transmission of other respiratory viruses, mothers can breastfeed while applying all necessary precautions. In the small number of studies conducted to date, COVID-19 has not been detected in human milk (Centers for Disease Control and Prevention [CDC], 2020).
The American Academy of Pediatrics (AAP, 2020) has been the only organization to recommend separation of mothers and infants at birth. This is concerning as we know that there is a critical window of opportunity to establish lactation and ensure that a mother has a copious milk supply. In their revised statement, they acknowledge importance of establishment of milk supply and that families should be informed that human milk is safe and important for their child.
Both the CDC (2020) and UNICEF (2020) state that the symptomatic mother who is well enough to breastfeed can put her child to breast while applying all necessary precautions, including wearing a mask while near the child and breastfeeding, washing hands before and after contact with the child, and disinfecting all surfaces. If the mother who has COVID-19 is too unwell to breastfeed, she should express milk and the milk can be fed by a healthy caregiver. If the mother is expressing milk, it is important that all pumping equipment is washed well with hot soapy water, rinsed well, and dried. Each day equipment should be sanitized (CDC). Appropriate hand hygiene is necessary both before and after pumping, as well as when handling expressed milk (CDC).
If the infant is not breastfeeding effectively, or the hospital has chosen to separate the COVID-19-positive mother from her infant, it is essential that the mother begins to pump early and often with hospital-grade pump technology every 2 to 3 hours for eight or more expression sessions in a 24-hour period (Spatz et al., 2015). Time is of the essence to come to full volume and develop a copious milk supply. These mothers should not be sent home with only a personal use pump. Insurance companies, in general, only provide personal use pumps and do not cover the cost of hospital-grade pump rentals; however, personal use pumps are not ideal for establishment of lactation. Without mothers having access to appropriate pump technology and with early separation of the maternal infant dyad in cases of COVID-19, healthcare providers are setting families up to not be able to meet their personal breastfeeding goals. This will require pediatric care providers to increase the time spent at the first appointment to assess and document maternal milk supply, infant's ability to effectively breastfeed at the breast, and the mother's access to appropriate pump technology.
If healthcare providers don't establish a sense of urgency during the first week, the family is not going to be a long-term breastfeeding family. Evidence-based lactation care and support with appropriate technology must be prioritized so infants have access to the lifesaving power of human milk. Nurses play an essential role in supporting the breastfeeding family, especially during times of crisis.
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