The COVID-19 Pandemic: The Role of Childbirth Educators in Promoting and Protecting Breastfeeding

Abstract

The healthcare system is being challenged in the United States and worldwide due to the pandemic of coronavirus disease 2019 (COVID-19). However, all through this pandemic, families will continue to birth children. Childbirth educators play a particularly important role in ensuring that families receive appropriate evidence-based information about human milk and breastfeeding as a lifesaving medical intervention. In the current COVID-19 crisis, breastfeeding and the provision of human milk remains recommended by national and international organizations.

The World Health Organization (WHO) states the following: considering the benefits of breastfeeding and the insignificant role of human milk in the transmission of other respiratory viruses, mothers should breastfeed while applying all necessary precautions (UNICEF, 2020). In research to date, the coronavirus disease 2019 (COVID-19) virus has not been detected in human milk (Centers for Disease Control and Prevention [CDC], 2020). The spread of COVID-19 and other respiratory viral disease is thought to occur mainly via respiratory droplets from an infected person who coughs or sneezes (CDC, 2020). There is no data as of now to demonstrate if a COVID-19 positive mother could transmit the virus through human milk (CDC, 2020).

Mothers presenting with flu like symptoms or confirmed or suspected COVID-19 should wear a mask when near the child including during breastfeeding, wash hands before and after contact with the child and disinfect all surfaces (WHO, 2020). If maternal infant separation occurs, the mother should start expressing milk immediately to establish and maintain milk supply (CDC, 2020). Prior to expressing, the mother should practice hand hygiene (CDC, 2020). After each pumping session, all parts that come into contact with human milk should be washed thoroughly. The breast pump should be appropriately disinfected per the manufacturer's instructions (CDC, 2020).

La Leche League International (LLLI) states that it is important not to interrupt direct breastfeeding if a mother or family member experiences illness from a virus (LLLI, 2020). In such as case, an infant would have already been exposed and the child will benefit most from continued direct breastfeeding (LLLI, 2020). Disruption of breastfeeding will increase the risk of the infant becoming ill due to the lack of immune support from direct breastfeeding (LLLI, 2020). Without losing the focus on childbirth preparation, educators can shift their focus to add more breastfeeding content (LLLI, 2020).

In light of this current pandemic, childbirth educators can play a crucial role in educating families about breastfeeding as a critical intervention to improve health and developmental outcomes and save the lives of our children globally. As a childbirth educator, I recommended a shift of the current practice paradigm. Currently, much of pregnancy is spent focused on preparing for birth, which is important but a very small segment in time compared to the recommended duration of breastfeeding. Without losing the focus on childbirth preparation, educators can shift their focus to add more breastfeeding content. For example, in my clinical practice, as soon as a family is 16 weeks pregnant, the family is learning about the physiology of milk production (Spatz, 2016).

During childbirth preparation, educators can provide appropriate anticipatory guidance and education to ensure the best start to lactation following birth. Interventional deliveries and an increase in intravenous fluids during labor and the birth process can impact breastfeeding outcomes post-giving birth (Spatz, 2018b). Childbirth educators play a key role in teaching families the importance of minimizing interventions during birth. Childbirth educators should empower the family to support the mother for the first 2 weeks after birth, so that she can optimize her personal milk making capacity (Spatz, 2016). There is a critical window to effectively establish lactation to ensure copious milk supply long term (Spatz, 2020). For the mother, her most important jobs are to eat, sleep, and make milk for her child. Childbirth educators can help mobilize the family to understand that they have important roles in supporting the lactating parent.

Childbirth educators also have the opportunity to change how families are taught about breastfeeding. It is not enough to teach families that breastfeeding is “good.” Childbirth educators should enhance their teaching to focus on the science of human milk as a medical intervention to improve health and developmental outcomes for the child both in the short and the long term. Families are exposed to significant infant formula company marketing, so many families believe that infant formulas contain magical ingredients for their child. As childbirth educators, let's change the paradigm to focus on the science of human milk and the specific ways in which the ingredients in human milk protect and develop the infant.

The first step of the Spatz 10 step model to promote and protect human milk and breastfeeding for vulnerable infants is informed decision making (Fugate, Hernandez, Ashmeade, Miladinovic, & Spatz, 2015; Spatz, 2004, 2018a). Childbirth educators should teach families about how components of human milk are unique and not present in infant formula (Spatz, 2016). In my clinical role, I have the opportunity to provide personalized prenatal lactation intervention to families. Families are absolutely fascinated to learn about stem cells, white blood cells, antibodies, lactoferrin, human milk oligosaccharides, and other ingredients and how the milk is specific and tailored for their child to ensure optimal health and developmental outcomes (Spatz, 2016).

In the current COVID-19 pandemic, there have been reports of infant formula shortages and stores price gouging the cost of infant formula. The Women Infant and Children's (WIC) supplemental food and nutrition program spends 25 times more money on vouchers for infant formula compared to the amount invested in breastfeeding support (Baum-gartel, Spatz, & American Academy of Nursing, 2013) and in this current pandemic in-person lactation support and intervention has been halted or suspended in many states. At-risk families may be less able to access evidence-based lactation support and care. Therefore, childbirth educators should use this pandemic as a way to increase visibility of the critical role of human milk and breastfeeding for all families at all times! Childbirth educators are in a unique position to better prepare families to have realistic expectations about breastfeeding and the effort needed to establish effective lactation. Childbirth educators are perfectly poised to change the prenatal care paradigm to improve human milk and breastfeeding education and preparation.

Biography

DIANE L. SPATZ is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing. She shares a joint appointment as a nurse scientist in lactation at Children's Hospital of Philadelphia.

DISCLOSURE

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.