From HMN Partner KnoWEwell
Breastfeeding is considered a baby’s first vaccine, offering the best means of protecting infants from illness. Mothers begin making colostrum, the “first milk,” when a baby is born. The La Leche League (LLL) recommends skin-to-skin contact between mother and baby within the first hour of birth, to encourage the newborn’s breastfeeding instinct. However, the COVID-19 pandemic has raised questions about the safety of keeping mothers and newborns together, potentially interfering with the benefits of breastfeeding.
Health organizations worldwide recommend breastfeeding for many reasons, including its ability to shield against infectious diseases. The US Centers for Disease Control and Prevention (CDC) advises, “Breast milk provides protection against many illnesses,” while the World Health Organization (WHO) states that “breastfeeding [protects] against morbidity and death in the post-neonatal period and throughout infancy and childhood.”
Colostrum is rich in antibodies that protect against infection. This thick, first-stage milk introduces beneficial bacteria to the newborn’s undeveloped gastrointestinal tract, establishing the microbiome, and the immunoglobulins in it confer important immunity to the infant. Colostrum also contains bioactive components that are vital to neurological development.
The COVID-19 pandemic has caused public health officials to rethink all aspects of human interaction, including in maternity wards, due to concerns of widespread contagion. In the absence of early data, recommendations for mothers and newborns varied. The CDC’s original guidance called for separation and isolation of newborns and mothers if COVID-19 was suspected or confirmed in the mother, advising hospitals should “consider temporarily separating the mother from her infant” until the mother is no longer contagious.
Breastfeeding [protects] against morbidity and death in the post-neonatal period and throughout infancy and childhood.
Subsequently, the CDC revised its guidelines, encouraging medical professionals to assess “the risks and benefits of temporary separation” and share decision-making with their patients. Across the United States, and even from hospital to hospital within cities, policies varied widely on the advisability of separating newborns from mothers who may have been exposed to the COVID-19 virus. Dr. Melissa Bartick, MD, founder and co-chair of the Massachusetts Baby Friendly Hospital Collaborative, in a Q&A session with the Harvard Medical School, pointed out that initially, many health authorities did not take into account the fact that not breastfeeding has risks. “We know that breastfeeding is really the key public health strategy for infants in an emergency. And, this is an emergency,” she said.
Although separation may reduce the risk of transmitting COVID-19 from mother to newborn during the hospital stay, experts say there are other important considerations. Infants who are separated from their mothers have higher heart rates and respiratory rates and lower glucose levels than infants who have skin-to-skin contact with their mothers. Research has shown that separation increases stress activity in newborns by 176%. The Royal College of Obstetricians and Gynecologists states, “Routine precautionary separation of mother and a healthy baby should not be undertaken lightly, given the potential detrimental effects on feeding and bonding.”
Researchers note that isolation of newborns infected with COVID-19 could, in fact, worsen the disease course of the newborn. Separation is stressful on mothers and could consequently worsen the mother’s disease course as well. Separating mothers from newborn babies disrupts breastfeeding. Many babies struggle to begin or return to breastfeeding after a period of separation from the mother. Separation also decreases breastfeeding duration compared to non-separation.
According to the American Academy of Family Physicians, the risks of not breastfeeding are substantial and include a higher propensity for gastroenteritis, atopic dermatitis, severe lower respiratory infections, sudden infant death syndrome, type 1 diabetes, asthma, childhood leukemia, and later-life illness such as high blood pressure, obesity, and type 2 diabetes. A University of Amsterdam study of 960 children taking asthma medication showed that children who had been breastfed as infants had a 45% lower incidence of asthma attacks. Research shows that infants who are not breastfed are more than three times more likely to be hospitalized with pneumonia than those who are exclusively breastfed for more than four months. Studies also show that breastfed babies are less likely to develop childhood illnesses such as ear infections, food and airborne allergies, and leaky gut syndrome.
Breastfeeding is also associated with better mental health throughout childhood. Although formula is often supplemented with omega-3 fatty acids, breast milk is considered the gold standard due to its content of omega-3 fatty acids such as DHA and ARA. Dr. Vandana Bhide, MD, board-certified internist, and pediatrician notes that about one-third of breast milk is DHA which is critical for brain development. Studies have shown that babies who get DHA in the ratio found in breast milk during the first year of life have improved cognition. A review of 17 studies on breastfeeding and I.Q. showed breastfed infants achieved higher I.Q. scores than their non-breastfed counterparts. One study showed that even a single month of breastfeeding increases I.Q. scores at five years of age by three points. Another study suggests breastfeeding is associated with better I.Q. scores even 30 years later.
Research shows that infants who are not breastfed are more than three times more likely to be hospitalized with pneumonia.
Several small studies have examined breast milk samples of mothers with COVID-19 and none found the presence of the virus in breast milk. Globally there have been three published reports of the virus in breast milk. Although data are very limited on the risk of transmitting COVID-19 through breast milk, research on influenza and other types of coronaviruses may provide guidance. In a study of mothers immunized against influenza, breast milk contained high levels of protective influenza antibodies for as long as 6 months. The breast milk of one mother infected with a severe case of the SARS virus tested negative for the virus but antibodies were present 130 days after the onset of the infection in the mother. A recent study showed that 80% of new mothers who had previously tested positive for COVID-19 had antibodies for the virus in their breast milk.
As scientists learn more about COVID-19, recommendations are evolving. The WHO, CDC, and the American Academy of Pediatrics (AAP) now all agree that the benefits of breastfeeding outweigh any potential risks of transmitting COVID-19. The AAP states that mothers and infants who room-in together at the hospital appear to be at no greater risk of virus transmission if appropriate measures are followed. New mothers who are sick are now advised to take precautions such as wearing a mask, washing hands, and routinely cleaning surfaces. Dr. Lauren Hanley, MD, medical director of lactation at Massachusetts General Hospital says, “We are actually expediting discharge for our COVID-positive patients and families. We want to get people away from the health care setting and back into their safe, insulated home.” The Public Health Agency of Canada advises new mothers with suspected cases of COVID-19 to isolate themselves from everyone at home—except their baby—as much as possible.
“Even pre-COVID, the first two weeks after a discharge is an extremely vulnerable time for a breastfeeding dyad. They need support in so many places,” says Dr. Hanley. The COVID-19 pandemic has reduced the traditional multi-generational sources of support for new mothers; lockdowns and social distancing requirements have meant support from mothers, sisters, grandmothers, and friends may not be available to new mothers.
Douglas Wyatt, director of the Sovereign Health Initiative, has suggestions for mothers who want to breastfeed but are unable to. In his white paper, Colostrum & Infant Health: The Importance of Colostrum for Infants Who Are Not Breastfed, he states that one drawback of infant formula and pasteurized milk is that neither contains the immunoglobulins found in colostrum. He recommends liposomal bovine colostrum supplementation for optimal neurological and physical development and for overall health in childhood and beyond. Bovine colostrum, which passes immunity to the newborn through immunoglobulins, similar to human colostrum, has been shown to protect against a number of common childhood conditions. Antibodies in bovine colostrum protect against diarrheal disease, the second leading cause of infant death worldwide, which is especially important because antibiotics are ineffective against virus-caused diarrhea. Bovine colostrum may protect against respiratory illnesses due to its bioactive agents such as lactoferrin and proline-rich polypeptides. These agents may also protect against seasonal influenza and allergies in infants. Lysosome, which is known to prevent tooth decay, is found naturally in bovine colostrum. The growth factors in bovine colostrum are known to promote healing, growth, and gut integrity.
When choosing bovine colostrum, Mr. Wyatt stresses it is important to choose a supplement that uses liposomal delivery, which retains bioavailability of active components in order to gain the gastrointestinal and immune benefits. Look for a supplement that is soluble, has undergone rigorous quality control, and is GMP (Good Manufacturing Practices)-certified, is flash pasteurized and low-heat dried, and is sourced from the first-milking of pasture-raised cows.
Bovine colostrum, which passes immunity to the newborn . . . has been shown to protect against a number of common childhood conditions.
For mothers who prefer to give their babies human milk, the Human Milk Banking Association of North America (HMBANA) offers pasteurized donor milk at their member donor banks throughout the country. HMBANA states that as studies have shown the heat of pasteurization inactivates viruses that are genetically similar to COVID-19, there is no evidence human pasteurized donor milk poses a risk of transferring COVID-19 to babies.
Dr. Hanley says, “There are virtual support groups that are coming online every day,” helping families find support no matter where they may live. ZipMilk is a site that provides listings for breastfeeding resources sorted by ZIP Code, to find board-certified lactation consultants, breastfeeding counselors and educators, breastfeeding support groups, free community-based lactation resources, and more. These include programs for mothers who qualify for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to their infants and children up to age five who are found to be at nutritional risk. La Leche League offers support and encouragement about breastfeeding via their phone helpline and local groups. New mothers can now take comfort in the many resources available to them to give their newborns all the advantages of colostrum and breast milk.
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