The ongoing Covid-19 pandemic has resulted in many pregnant mothers being afflicted by the contagious virus.
In an interview with the Sunday Observer, Consultant neo pathologist attached to the Neonatal unit, De Soyza Maternity Ward and Senior lecturer Neonatal Unit, University of Colombo Dr. Nishani Lucas discusses the immense benefits of breastfeeding and skin to skin contact by Covid affected mothers while emphasising the point that there was no evidence that Covid positive mothers could transmit the virus to through breastfeeding, to date.
Excerpts.
Q. We are now amidst a fast spreading Covid- epidemic. With many pregnant women being afflicted by the virus several questions and concerns have arisen with regard to breast feeding by mothers suspected or confirmed Covid- 19 positive. Should such mothers should be allowed to breast feed their babies? If so what evidence is there to back up your answer?
A. Breastfeeding is recommended for all babies as breast milk gives the best nutrition and best protection. Babies of Covid positive mothers are no exception. Babies of Covid positive mothers should be breastfed.
As per WHO, UNICEF and CDC there is no evidence that Covid-19 is transmitted through breast milk. In fact, Covid positive mothers transfer antibodies that will protect the baby against Covid-19 indicating that breastfeeding is beneficial and protective against the baby developing Covid-19.
Q. Regarding your reference to the production of antibodies by our immune system against every foreign substance we are exposed to. Tell us how the pregnant mother transfers these antibodies in her immune system while to her unborn baby before delivery and thereafter once the baby is born?
A. Breast milk transfers maternal antibodies to the baby. The immune system in our body makes antibodies against every foreign substance that we are exposed to. All antibodies that the mother has made until the time of delivery will be transmitted to her baby though the placenta.
After birth, maternal antibodies are transferred to the baby through breast milk. We make antibodies against all microorganisms and allergens that we are exposed to.
This is how we fight infection and recover from illness. It is one of our body’s main defences. When a mother gets infected with Covid, she develops antibodies against Covid , which will help her to overcome the disease.
These antibodies will be transferred to the baby through the placenta if she is still pregnant or through breast milk when she breastfeeds
Q. Can a Covid mother have skin to skin contact with her baby?
A. Yes, skin to skin contact is recommended by the WHO.
Q. What are the benefits?
A. Skin to skin care is very beneficial to babies. It includes keeping them warmer, better establishment in breastfeeding, colonization( is there a simpler way to replace this word) of the baby with friendly bacteria which help to fight disease, shorter hospital stay, better bonding, and lesser chance of morbidity and mortality.
Q. Can Covid reduce the mother’s milk supply?
A. Covid does not reduce milk supply. However, separation and anxiety may reduce the milk supply. Therefore, we need to ensure that babies are not separated from their mothers unless either of them require intensive care.
Q. What are the precautions that should be put in place to protect the baby when the mother holds her new born baby to breast feed? Will basic precautions like wearing face masks, gloves, Covi shield etc be enough?
A. A mother should wear a mask and wash her hands before handling the baby. (WHO recommendations)
Q. Is there a special way she should hold the baby to minimise transmission risks?
A. There is no special way for the mother to hold the baby. Mother can hold the baby in any way she pleases provided she wears a mask and washes her hands. Distancing between the mother and baby is not recommended (WHO). Distancing is likely to result in harm due to poor establishment of breastfeeding due to mothers fearing that they will infect their babies by going near them in addition to the fact that there is no evidence that it reduces Covid transmission.
Q. As soon as the baby is born, is it safe for a mother with covid-19 to cuddle her baby?
A. Yes, a mother can cuddle her baby soon after birth. As I mentioned earlier, skin to skin care immediately after birth is recommended by the WHO.
The baby should be placed in between the mother’s breast for immediate skin to skin care similar to babies of non- Covid mothers due to the benefits of skin to skin care which too were mentioned earlier.
Q. What happens to a mother who is unable to feed her baby because she is too ill due to Covid-19? Can her milk be expressed and given to the baby? Who will perform this task and what precautions does that person have to take?
A. If the mother is too sick too directly breastfeed her baby, her milk should be expressed and given to the baby.
Expression of the milk will be taught to the mother and she will be encouraged to express the milk after washing her hands. The health care staff (nurses / midwives / doctors) caring for her should express the milk if mother is too sick and teach her to express when she is stable enough. All health care staff caring for a Covid patient should wear the full PPE as per national heath guidelines.
Q. Alternatively, can the baby be bottle fed if the mother is to sick?
A. Bottle feeding is harmful and is not recommended due to its many harms.
Bottle feeding can cause diarrhoea due to poor hygiene, milk aspiration due to fast flow and suck confusion, due to difference of the bottle nipple to the human nipple, reducing the suckling from the mother and thereby reducing breast milk production.
Q. There are several myths with regard to breast feeding by Covid positive mothers. What are the most common among Sri Lankan mothers?
A. I guess the most common would be that the baby is more likely to get Covid from the mother if the baby is breastfed, due to the close contact that occurs during breastfeeding.
Q. Has the Ministry of Health and world authorities like WHO and UNICEF drawn up any Covid guidelines for lactating mothers? What are they?
A. Yes, there are guidelines from WHO, UNICEF and from the Ministry of Health which recommend uninterrupted skin to skin care and breastfeeding as mentioned above.
Q. Can Covid affect the foetus of an unborn baby? Is there a possibility of preventing it?
A. Yes, it can. Covid during pregnancy has been associated with preterm births as well as reducing the oxygen supply to the baby in some instances.
Q. Is testing for all pregnant women for Covid and other infections diseases a routine procedure for in ward patients ?
A. The latest Health Ministry guideline on Covid testing dated 9.6.21 indicates testing those with symptoms, those from high-risk areas, those in quarantine, those undergoing operative procedures or need admission to an ICU. In addition, each hospital may have institutional guidelines requiring testing of all admissions. Those who test positive will be sent to the Covid positive section of the hospital where they will be monitored and treated if required.
Q. Is testing voluntary? If the mother refuses what happens?
A. I have not experienced anyone refusing to date. Refusal to test will require the patient to be regarded as Covid positive and admitted to the Covid positive section as it will endanger other patients and staff, if such a patient is allowed in the non-Covid area.
Q. Treatment- will these mothers continue to be treated even while they are nursing their babies ?
A. Covid positive mothers will be admitted to the Covid positive ward/s with their babies without separation where uninterrupted health care will be continued.
Q. Can some of the medications given her affect the baby?
A. Medications given as part of Covid management to not affect the baby.
Q. Most Covid affected mothers experience many emotional and psychological problems apart from their physical pain. What are they and how do they affect their health?
A. A mother being Covid positive would mean that the rest of her family are likely in quarantine, which will lead to a feeling of social isolation.
Also, she would be required to stay in the hospital for 10 days, as per national health guidelines. Being away from her home and family is likely to cause emotional problems.
Q. Have you counsellors specially trained to help them?
A. We don’t have specially trained counsellors, but the health care staff caring for them do their best to make these mothers feel at home during their stay at the hospital.
Q. For how long should a Covid positive mother breastfeed her baby? Should she follow UNICEF’s recommendation of feeding a new born baby exclusively on breast milk for the six months period ? Is it possible for her to do this despite her having tested Covid positive?
A. Yes, she can and should. Covid does not affect the ability to breastfeed.
Breastfeeding should not be denied to babies born to Covid positive mothers.
Q. As you mentioned at the beginning of our interview, breast milk is the best milk a baby can have. Jog our memory with regard to why it is regarded as superior to any other milk ?
A. Breast milk increases the IQ. It improves immunity with a lowering risk of respiratory infections (72%), diarrhoea (64 percent), necrotizing enterocolitis (58 percent), ear infections (50%) and sudden death (38 percent) during the first two years of life.
It also reduces the risk of asthma by nine percent and promotes jaw development and reduces malocclusion (68 percent). Breastmilk reduces the risk leukemia. Breastmilk improves adult health through the early programming by altering the baby’s genetics (epigenetics) and microbiological flora (microbiome) resulting in a reduction of obesity, diabetes, heart disease, hypertension, hypercholesterolemia, inflammatory bowel disease, multiple sclerosis etc. (Lancet 2016, UNICEF 2012)
Q. Does the Ministry of Health have any plans in the near future to facilitate breast feeding for Covid affected mothers?
A. The Ministry of Health had clear guidelines to facilitate breastfeeding from April 2020 which has been in effect since.
Q. What are the gaps you see in the present system with regard to delivering optimal care to covid affected mothers and their new born babies?
A. Covid and non-Covid areas which give the same care to both Covid and non -Covid patients was challenging. Decreasing number of health care staff with increasing workload, due to being affected with Covid-19 or pregnancy is an ongoing challenge.
Q. Your message to all Covid affected pregnant women and new mothers?
A. Get the vaccine if you are at high risk. Protect yourself and your family by wearing masks, washing hands and social distancing. Attend antenatal clinics and do not delay seeking health care. Covid or not we will look after you.