The year 2020 has seen us facing unprecedented multiple crises and emergencies:

• COVID19
• The Climate Emergency
• A crisis propelling equity, racial and social justice to the forefront through #BlackLivesMatter

The global theme of World Breastfeeding Week 2020, #WBW2020 and #GreenFeeding, “Support breastfeeding for a healthier planet,” is a focus on the Climate Emergency, and the impact of infant feeding on our environment and the planet.

When the novel coronavirus hit it reminded us that we are all linked, one people on one planet.

Breastfeeding and COVID-19

Some of those people were breastfeeding mothers and babies. At first, medical protocols for isolating COVID+ patients dictated that some mothers and babies were separated. Slowly the evidence accumulated that breastmilk itself did not appear to transmit the virus, and in fact antibodies to COVID19 began to be found in mothers’ milk. Now there are even research projects investigating whether the antibodies to COVID-19 in breastmilk could be used to protect others!

In the UK, the Royal Colleges who work with mothers and babies, led by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) quickly began to produce joint guidance, updated weekly. This was hosted on the RCOG website and became a global point of reference.

The web page includes

• Coronavirus (COVID19) infection and pregnancy: this clinical guidance contains their influential recommendations on keeping mothers and babies together in hospital after birth, whether or not the mother is COVID+, and their recommendation that staff support the mother to breastfeed or express her milk for her baby, unless the mother is too ill. These recommendations have influenced health policy around the world, keeping many mothers and babies together worldwide.

• A useful Q&A page of information for women and their families, written in plain language.

• Guidance for antenatal and postnatal services during the evolving coronavirus (COVID19) pandemic. This includes some information on the management of breastfeeding in the community, including the following : “Remote support by third-sector organisations will be invaluable to provide support for breastfeeding, mental health and early parenting advice.”

Unicef UK Baby Friendly Initiative has also been producing and regularly updating a suite of statements and resources, mainly for staff. https://www.unicef.org.uk/babyfriendly/COVID-19/

The World Health Organisation has produced a steady stream of updates and resources emphasising the importance of breastfeeding during the COVID crisis. This includes:

clinical guidance, for when coronavirus infection is suspected

a new scientific brief on breastfeeding and Covid-19

FAQs on breastfeeding and COVID-19 for health workers

infographics, and

a media briefing on the 12 June at which the Director-General stated:

“WHO has also carefully investigated the risks of women transmitting COVID-19 to their babies during breastfeeding.

We know that children are at relatively low-risk of COVID-19, but are at high risk of numerous other diseases and conditions that breastfeeding prevents.

Based on the available evidence, WHO’s advice is that the benefits of breastfeeding outweigh any potential risks of transmission of COVID-19.

Mothers with suspected or confirmed COVID-19 should be encouraged to initiate and continue breastfeeding and not be separated from their infants, unless the mother is too unwell.

WHO has detailed information in our clinical guidance about how to breastfeed safely.”

You can watch the media briefing here.

We recommend that mothers with suspected or confirmed COVID-19 should be encouraged to initiate and continue breastfeeding. From the available evidence, mothers should be counselled that the benefits of breast-feeding substantially outweigh the potential risks of transmission.

In the UK, breastfeeding services suffered as midwifery and health visiting staffing levels were reduced by illness and self isolation, some staff were redeployed to labour ward or public health, childrens’ centres and breastfeeding support groups were closed. Families were discharged with their new baby to go home to a changed world, isolated in their home. Most health professional contacts were now virtual, and there were few opportunities to have baby weighed or seen in person, so parents were left on their own to figure out if their baby was doing well.

In areas like Brighton, with a strong, integrated commissioned NHS breastfeeding support programme, with a well embedded, large trained peer support programme and where there is a specialist NHS IBCLC clinic for complex problems, all the NHS support simply moved online. Once the technical side of this was worked out, breastfeeding support was still there for those who needed it.

In other areas, that depended on health visitors alone to deliver all the breastfeeding support, where there was no peer support commissioned and no specialist clinic staff, once the childrens’ centres were closed and many health visitors redeployed to other public health roles during the COVID-19 crisis, there might be one infant feeding lead health visitor left in the whole community.

Across the country, breastfeeding organisations and breastfeeding supporters sprang into action. Calls to the National Breastfeeding Helpline rose significantly, and trained volunteers turned out in droves. NCT moved their antenatal classes online, La Leche League local groups and NCT breastfeeding support groups moved onto Zoom, and IBCLCs set up remote consultations. A new app was trialled through the NHSX TechForce19 competition, Peppy Baby, in collaboration with Lactation Consultants of Great Britain and NCT, providing free access to online support groups and even video consultations for specialist breastfeeding help and mental health support. Suddenly there was online breastfeeding support available somewhere, every day of the week.

This had some advantages: mothers could join a Zoom meeting with their baby, still in bed. No one had to travel to get help. But some families had complex situations that did need face to face support, and it could be a challenge to find a specialist who could provide face to face support, or a tongue tie clinic that was still open.

Some families were able “nest” in isolation, with both parents home and no visitors, and flourished. Others struggled without face to face contact, without weight checks for baby, or struggled with their mental health. It will be hard to unpick the outcomes, as in many areas the usual health visitor checks were no longer taking place in person, so there are many gaps in the data. For instance, in some areas, no-one collected breastfeeding rates at 6-8 weeks, so it will be difficult to see the impact of COVID-19 on breastfeeding there.

It is vital that we all call on our local authorities, our CCGs and our Local Maternity Systems to rebuild a stronger network of skilled breastfeeding support as we come out of this first COVID-19 crisis – we must be more prepared for the next one.

Author: Helen Gray