Breastfeeding During the Covid-19 Pandemic

As part of World Breastfeeding Week, #WBW2020 and #GreenFeeding, we’re emphasising the importance of mothers having easy access to good quality breastfeeding support, if and when they need it. This is partly provided by skilled people and partly by evidence-based written information. 

This short leaflet for new parents gives tips about breastfeeding during the pandemic and also lists reliable sources of information and support. The aim is to help empower families who may be much more isolated than families generally were before the Covid-19 pandemic and have limited access to face to face help from health professionals and local breastfeeding support groups.  

A slightly shortened two-page landscape version of the leaflet can be downloaded from here.

How do I manage as a new mother breastfeeding during the Covid-19 pandemic? 

How can I best protect my baby? 

Breastfeeding is one of the most important ways you can protect your baby. Your body makes antibodies in your milk which help your baby fight infections. Breastfeeding also helps babies develop a good long term immune system, and also help to protect mothers from breast cancer, heart disease, obesity and diabetes. 

No evidence has been found that coronavirus is passed through breastmilk. Mothers make specific antibodies to any infections they are exposed to, and these pass into their milk. This means that a mother with Covid-19 can help protect her baby against all kinds of pathogens by breastfeeding, and may even provide specific antibodies to the novel coronavirus. 

Covid-19 precautions 

However a baby is fed, they could be exposed to Covid-19 if their carer coughs or sneezes over them so the parent/carer might prefer to wear a face covering when in close contact and needs to wash their hands regularly. RCOG (the Royal College of Obstetricians and Gynaecologists) provides more details under Advice for women with suspected or confirmed coronavirus infection who have recently given birth.

Fewer visits to GP or hospital 

Exclusive breastfeeding for 6 months, then continuing to breastfeed alongside other foods, helps babies to be as healthy as possible and lowers their chance of needing to see a GP or have a hospital stay, e.g. for ear or chest infections. 

Food security 

Breastfeeding means parents do not have to worry about formula supplies or even shop for formula. 

How do I know my baby is getting enough? 

Babies are normally weighed at birth, 5 days & 10-14 days (when the health visitor usually takes over from the midwife).  With the pandemic, there may be few opportunities to have your baby weighed or see your midwife or health visitor face-to-face.  

However, your baby’s behaviour and nappy contents can help you know if your baby is getting enough milk.  

The first 6 days are a time of change.  From mid-pregnancy breasts produce a thick, usually yellow, type of milk called colostrum. A few days after birth, colostrum transition to more mature milk. The breasts usually feel very full at this time. The poos change too: 

  • thick black meconium for the first couple of days after birth 
  • green around Day 3 to 4  
  • At least two yellow poos each day, by Day 5 to 6  

A baby who is getting enough shows this pattern, takes themselves off the breast and generally settles after feeds. For photos of nappy contents see this NCT information

From 6 days to around 6 weeks, milk intake is probably fine if: 

  • your baby is usually contented after feeds 
  • has at least 6 heavy wet nappies/ day 
  • has 2 poos each at least the size of a £2 coin per day 

After 6 weeks, some babies poo less often but the overall amount is about the same. 

In the first two weeks, if your baby hasn’t pooed for 24 hours, contact your midwife and a breastfeeding helpline or local supporter for help.  

How do I know breastfeeding is going well? 

It’s going well if your baby is getting enough and you are finding breastfeeding comfortable. 

Start4Life provides very useful information about how breastfeeding helps the health of babies and mothers and how to help your baby latch on well. 

However, if your baby often falls asleep during feeds and wakes up again hungry after a few minutes, feeds are regularly longer than an hour, or it is uncomfortable or painful for you, the most likely reason is that your baby isn’t latched well enough to feed effectively. 

How can I increase my milk supply? 

If your baby is producing less wee and poo than expected, or you are topping up with formula,  

  • can you breastfeed more often – another feed or two in 24 hours? 
  • are you offering both breasts at every feed? you could switch back and forth during a feed 
  • breast compression can increase milk flow 
  • can you contact a helpline or breastfeeding supporter for more suggestions?

Remember – if you feel your baby is feeding very often, they are trying to get enough milk, and also helping to increase your milk supply. 

And if breastfeeding isn’t going well? 

To latch well the baby needs to gape wide, have the nipple in the upper part of their mouth, and chin pressed against the breast. Snuggle your baby close, head free, nose level with your nipple. This detailed information from La Leche League shows different positions you could try, and ways of helping your baby latch better.

If feeding is painful, or you are breastfeeding very frequently but your baby isn’t getting enough milk, get skilled help! You can also express your milk and offer your baby expressed milk until your baby starts feeding better and your nipples have healed. The Breastfeeding Network has information about expressing and storing breastmilk.  Your midwife or health visitor can help you learn to use a cup or bottle safely. 

Where can I get skilled help? 

You can contact the local midwifery team or health visiting service using the phone numbers you’ve been given. Often there is an Infant Feeding Coordinator or team who can provide more specialised support. They may also put you in contact with a volunteer breastfeeding counsellor or peer supporter. There are several charities continuing to offer free skilled breastfeeding support (see below). Your GP is the appropriate contact for medical situations – such as mastitis that isn’t improving after 24-48 hours – alongside breastfeeding support. 

Partners and family support 

Her partner can be a huge support to a mother who is breastfeeding and one possible silver lining of the pandemic is that many are at home and able to give more support.

UK breastfeeding helplines  

National Breastfeeding Helpline 9.30am – 9.30 pm 0300 100 021 
La Leche League GB (LLLGB) (web chat and email also available) 0345 120 2918 
La Leche League Northern Ireland 028 95 818118 
NCT Helpline 8am – 12 midnight 0300 330 0700 
Breastfeeding Helpline for Bengali/Sylheti speakers 0300 456 2421 
Breastfeeding Helpline for Tamil/Telugu/Hindi speakers 0300 330 5469 
Drugs in Breastmilk Information – Breastfeeding Network (BfN) https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/ 
Email: drug-information@breastfeedingnetwork.org.uk 

Virtual Support by Video 

LLLGB has daily free local online support groups   https://www.laleche.org.uk/find-lll-support-group/ 
NCT  – details of free local Zoom support groups available via the helpline: 0300 330 0700 
IBCLCs (International Board-Certified Lactation Consultants) – these may work for the NHS, voluntarily or provide a paid-for service.  To find an IBCLC see the LCGB website.  https://www.lcgb.org/find-an-ibclc/ 

Reliable sources of information 

World Health Organisation

 LLL

BfN

NCT

ABM

The Baby Buddy app from Best Beginnings provides more personalised information. https://www.nhs.uk/apps-library/baby-buddy/ 

Specific concerns 

Further information and self-help suggestions for common concerns listed below are described on several websites, such as the Institute of Health Visiting Parent tips, NCT’s information on breasts after birth and the NHS website.  

My breasts are hard and painful 

In the early days, this could be engorgement. Frequent feeding helps. La Leche League provides detailed information.  

I have a small tender area in one (or both) breasts 

This could be a blocked duct. Gentle massage over the area while feeding often helps.    

I feel fluey and have a hot, hard, red area on my breast 

This is likely to be mastitis. Removing milk, by feeding baby or by expressing, is the most helpful action, along with other self-help measures described here. La Leche League provides detailed information. 

I think my baby has tongue-tie 

A tongue-tie only needs to be divided if it is significantly affecting feeding. If breastfeeding is affected, the first step is to check the baby is as well-latched as possible. For families who may have to wait for treatment during COVID19, this is a very useful and detailed article by Sarah Oakley, IBCLC. 

My baby takes a lot when I bottle feed 

“I’m giving some top-ups for the moment because my baby lost too much weight but he takes a lot quickly and then is uncomfortable with wind.” Having the bottle level rather than tilted and giving the baby pauses helps the baby cope with the flow from a bottle and it can be easier to tell when the baby has had just enough. This is called ‘responsive bottle feeding‘.  

My mother-in-law keeps wanting to give my baby formula 

ABM (the Association of Breastfeeding Mothers) has a leaflet for grandparents to help them understand what is now known about breastfeeding.  

I stopped breastfeeding but now I want to restart 

This can be done but needs commitment as it takes a while to build up the milk supply again. You may find it easier if you have someone providing you with ongoing skilled support with relactation.  

Our message to you 

We hope the above information, and support options if you need them, can help towards you enjoying breastfeeding and continuing for as long as you and your baby want to.    

Authors: The WBTi UK Steering Group – Helen Gray, Clare Meynell, Alison Spiro, Patricia Wise; design by Carol Smyth

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