Nurses Talk About Delivering, Feeding, And Caring For Babies Following The AAP Guidelines When A Mother Is infected With The COVID-19 Virus

 

We know everyone’s anxiety level is very high right now because of the uncertainly of delivering your baby during the COVID-19 pandemic. Our goal is to provide real-life experiences of nurses who are taking care of people in labor and postpartum so that parents can have an idea of what to expect when delivering their babies.

The most recent guidelines released by the AAP, CDC, and ACOG apply to babies in the U.S.A.

Since these guidelines are different from the WHO guidelines and parents have been receiving mixed messages and are asking for clarification. We want to clarify the recommendations for parents so they can be fully informed of their choices. Generally speaking, parents who live in developed countries such as the USA have access to breast pumps, clean water, masks, cleaning supplies, and formula. The science-based recommendations are based on these choices.

WHO COVID-19 Guidelines

 

AAP Guidelines: Rooming-in for mothers and well newborns: While difficult, temporary separation minimizes the risk of postnatal infant infection from maternal respiratory secretions. If possible, admit the infant to an area separate from unaffected infants, and wear gowns, gloves, eye protection goggles and standard procedural masks for newborn care.

If the center cannot place the infant in a separate area — or the mother chooses rooming-in despite recommendations — ensure the infant is at least 6 feet from the mother. A curtain or an isolette can help facilitate separation.

AAP Key Points: 

• Current evidence is consistent with low rates of peripartum transmission and is
inconclusive about in utero transmission of SARS-CoV-2 from mothers with COVID-19 to their newborns.
• Neonates can acquire SARS-CoV-2 after birth. Their immature immune system leaves newborns vulnerable to other serious respiratory viral infections, raising concern that SARS-CoV-2 may cause severe disease among neonates.
• Airborne, Droplet, and Contact Precautions should be utilized when attending deliveries from women with COVID-19 due to the increased likelihood of maternal virus aerosols .and the potential need to administer newborn resuscitation to infants with COVID-19 infection that can generate virus aerosol
• When the physical environment allows, newborns should be separated at birth from mothers with COVID-19. Families who choose to have their infants room in with the mother should be educated on the potential risk to the newborn of developing COVID-19.
• SARS-CoV-2 has not been detected in breast milk to date. Mothers with COVID-19 can express breast milk to be fed to their infants by uninfected caregivers until specific maternal criteria are met.
• Infants born to mothers with COVID-19 should be tested for SARS-CoV-2 at 24 hours
and, if still in the birth facility, at 48 hours after birth. Centers with limited resources for testing may make individual risk/benefit decisions regarding testing.
• A newborn who has a documented SARS-CoV-2 infection (or who remains at risk for postnatal acquisition of COVID-19 due to inability to test the infant) requires frequent outpatient follow-up via telephone, telemedicine, or in-person assessments through 14 days after discharge.
• After hospital discharge, a mother with COVID-19 is advised to maintain a distance of at least 6 feet from the newborn, and when in closer proximity use a mask and hand-hygiene for newborn care until (a) she is afebrile for 72 hours without use of antipyretics, and (b) at least 7 days have passed since symptoms first appeared.
• A mother with COVID-19 whose newborn requires ongoing hospital care should
maintain separation until (a) she is afebrile for 72 hours without use of antipyretics, and(b) her respiratory symptoms are improved, and (c) negative results are obtained from at least two consecutive SARS-CoV-2 nasopharyngeal swab tests collected ≥24 hours apart.

 

Nurse Amanda talks about how she took care of a laboring mother who was COVID-19 positive: 

“I am pleased to report that the care given to laboring patients with COVID-19 is not much different, except that everyone (including the mother’s support person) is masked with an N95 mask and protected with gowns, goggles, face shields, and gloves; this is to protect ourselves, other patients on the unit, and the baby after birth. This mother was experiencing significant shortness of breath, fatigue, and body aches from COVID-19. After her vaginal birth, the baby was placed in an isolette in the delivery room to stabilize, and parents were able to see their baby the entire time.  The baby was then taken to a private special care room in our nursery area, fed donor milk, and bathed. The baby remained there with 1:1 nursing care and was monitored and assessed every three hours. The parents had access to a 24/7 video camera to see their baby, and a tablet was used for constant communication. It was very reassuring to the parents to see that their baby was being well cared for, which reduced their separation anxiety.

The mother desired to breastfeed, and her colostrum was hand expressed by the nurse after cleansing her breasts using sterile technique. It was delivered to her baby in a sealed plastic bag.  Since this mother wasn’t producing enough colostrum, the baby was supplemented with donor milk.  

The family was discharged home at 36 hours with specific instructions about taking the baby’s temperature every 8 hours, keeping the baby six feet away from the mother, how to pump according to the CDC guidelines and having the father take care of the baby. They were followed daily by a public health nurse and their pediatrician.”

Nurse Katie SAYS: 

“In our hospital, every mother who is COVID-19 positive will have their own specific needs according to her unique circumstances. We practice according to the AAP/CDC guidelines for the best outcome, while supporting the mother’s wishes. The COVID-19 positive mother I took care of had mild symptoms, and she wanted to breastfeed. We discussed how to directly breastfeed while protecting her baby. After her baby was born, she wanted the baby placed on a warm blanket that was placed on her chest to protect her from droplets on her skin while pushing. She wore an N95 mask and also wanted to wear gloves while breastfeeding.  After the baby was fed, she was bathed and kept in the mother’s room; however, she was placed on the other side of the room with her father caring for her. “

Nurse Monica says:

“If an asymptomatic mother comes in, she is allowed one support person. We keep the support person in the room and provide them with meals. The entire staff wears surgical masks during the entire shift. If those patients/support persons leave the room, they must wear masks. If they leave the hospital, they won’t be readmitted. We are discharging mothers who had vaginal births at 24 hours and c-sections at 36–48 hours, as long as they have good follow-up care scheduled for the baby. For COVID-19 positive or PUIs [persons under investigation who may be positive], unfortunately, no support person is allowed. We are wearing full PPE with N95s with all contact. We keep the IV pump outside the door and communicate mostly through telephone. Epidurals are given early. Mother and baby are separated at birth. We encourage pumping. Neonatologists determine when babies will be discharged. The mother goes to the COVID floor if she needs medical management after delivery. “

Nurse Miranda says:

“I took care of a COVID-19 positive mother who was readmitted  2 days after her delivery because she required intensive respiratory support. She was able to pump to manage her engorgement and she dumped her milk.  She did not want to take any chances with contamination during collection and storage while in the hospital environment. Her intention was to protect her milk supply while she recovered so that she could breastfeed her baby. Her partner was at home caring for their baby.”

ACOG Breastfeeding and formula feeding— It is unknown whether the virus can be transmitted through breast milk. The only report of testing found no virus in the maternal milk of six patients [48]. However, droplet transmission could occur through close contact during breastfeeding. A potential benefit of breast milk is that it may be a passive source of antibody protection for the infant.

In mothers with confirmed COVID-19 or symptomatic mothers with suspected COVID-19, to minimize direct contact, ideally, the infant is fed expressed breast milk by another caregiver until the mother has recovered or has been proven uninfected, provided that the other caregiver is healthy and follows hygiene precautions. In such cases, the mother should use strict handwashing before pumping and wear a mask during pumping. The CDC has issued guidance about cleaning breast pumps and parts. If possible, the pumping equipment should be thoroughly cleaned by a healthy person.

If feeding by a healthy caregiver is not possible, mothers with confirmed COVID-19 or symptomatic mothers with suspected COVID-19 should take precautions to prevent transmission to the infant during breastfeeding (including assiduous hand hygiene and use of a face mask) [47,49,50].

Women who choose not to breastfeed must take similar precautions to prevent transmission through close contact when feeding the infant formula.

Every day new information is published, and we will keep all of the resources updated and available to keep parents informed. Please remember you have the final say about the way you want to feed your baby and will receive the appropriate support. If you are infected you will be making antibodies that will be in your breastmilk, but we don’t know how long it will take for the full passive antibody response to take effect. In the meantime, it’s imperative that you follow the guidelines described above when breastfeeding your baby.

 

Resources:

Guidelines for Pregnant and Breastfeeding Mothers During the Coronavirus Pandemic

Will Breast Milk Protect My Baby From Getting Sick? Passive Immunity 101

AAP management of infants born to COVID-19 mothers

Up to date Coronavirus disease 2019 (COVID-19): Pregnancy Issues

https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf?fbclid=IwAR1ms0J9bN42r0heQJvu1uCPwUzUOhPQ6U4T40Vs2xdTh-bZB81cBU8jjk8 Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/ijgo.13146?fbclid=IwAR0nIVUfZ_HAMWQZUlCjjqQinnAJuaLNRldNub7yyW9FLGsfcMZbnBMR36c  Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection

WHO Q&A on COVID-19, pregnancy, childbirth and breastfeeding

https://www.nature.com/articles/s41591-020-0843-2?fbclid=IwAR14RqyqrRtEeZgQCYNT8IM3bNGQ6j0uF9y_EkBbBium5Jt_QWhKYehMD2w   Brief CommunicationRespiratory virus shedding in exhaled breath and efficacy of face masks

https://jamanetwork.com/journals/jama/fullarticle/2763854?utm_source=facebook&fbclid=IwAR2KTOPf4HvYGvl_-ie2MDNrcnEnW5ga7Y01wjzpKZfrP4fWJGxMqRzlkAw    Antibodies in Infants Born to Mothers With COVID-19 Pneumonia

https://www.nejm.org/doi/full/10.1056/NEJMc2007605?query=TOC&fbclid=IwAR0omwQoUwDNQBZO8cXa8BZU0dmy-M_NPFaqtLHSjroEo28KMGUVXbY8FkE   Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis

https://www.aappublications.org/news/2020/04/02/infantcovidguidance040220?fbclid=IwAR00V2zvgO4h6HCIzuLV0BCfgVh_-hKyuohD6wO5ZQzCFOPaOrw6XduWH4Q Care of the COVID mother/baby that follows AAP guidelines, including recommending separation of mother and baby.

Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis

 

 

 

 

 

 

 

 

 

 

 

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Hospital Drops Baby-Friendly Program After Doctor’s Baby Was Harmed

Written by an anesthesiologist and Intensivist physician

“The biggest achievement of my life as a physician was stopping my hospital’s Baby-Friendly program after my child was harmed.”

It was September 20th, and we were headed to the hospital for my induction.  I was nervous, as any first-time mother would be. I was worried that I was doing the wrong thing, even though I knew the literature, and my physicians supported my decision for an elective induction at 40 weeks. I was already dilated to 4 cm and my baby had dropped way back at 33 weeks.  We all thought it would take just a hint of Pitocin, but I labored for 24 hours until my son was born. I was later told that he was born with a compound hand (up by his head), causing the prolonged pushing time and his distress with each contraction.

While pregnant, I had decided to attempt breastfeeding, even though I had had a breast reduction in 2003. I tried to read as much as I could, but honestly, I didn’t have any idea how much information one needed to do something that everyone swore was “best” and “natural.”  My baby was born at 4:14 a.m. I thought this would be ideal, because I would have the support and help as I learned how to be a mother, knowing more staff were available during the day.  As the first day melted into the first night, nursing became more and more painful, and he needed to feed almost continuously. When he wasn’t feeding, he was either rooting or screaming.   Continue reading

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Will Breast Milk Protect My Baby From Getting Sick? Passive Immunity 101

Written by Jody Segrave-Daly MS, RN, IBCLC

As a veteran neonatal nurse and lactation consultant, I am often asked by parents to explain how the antibodies found in breastmilk work to protect their babies. Published research on immunology is extremely technical and difficult to understand, and unfortunately, the information that is readily available (especially on social media) contains a lot of false and conflicting information. So I’m here to share evidence-based information about this very important topic in a way that is easier for most parents to understand.

How does the immune system work?

Our immune system is very complex, but generally speaking, it is responsible for fighting off both germs that enter our bodies from our environment, and also for protecting us from diseases like cancer that occur within our bodies. I will be focusing on how the immune system fights off germs, which it does by producing antibodies.

What is an antibody and what does it do?

An antibody is a protein that is produced by the body’s immune system when it detects the surfaces of foreign and potentially harmful substances, also known as pathogens. Examples of pathogens are bacteria, fungi, and viruses, which are all microorganisms. The antibody response is specific; it will seek out and neutralize the microorganism and stop the invasion. There are five classes of antibodies: IgM, IgG, IgA, IgD, and IgE.

There are two ways babies acquire and develop immunity:
  • The first way is through passive immunity (temporary)
  • The second way is through active or acquired immunity (lifelong) 

Note: Antibody types and where they are acquired from are denoted by color throughout the blog.

Continue reading

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Baby-Friendly USA Acknowledges Their Mistakes; Are They Going To Make Real Changes In The New Year Or Are They Providing Lip Service To Mothers?

Dear BFUSA,

Thank you for your long-overdue public acknowledgment endorsing what the Fed Is Best Foundation has been fiercely advocating for over the past 3 years. 

According to your recent blog post you now agree with us that:

1. Delayed onset of copious milk production is common. 

BFUSA: “Delayed lactogenesis is actually increasingly common because the risk factors for it are potentially increasing,” Dr. Rosen-Carole says. “When a baby is born into that situation, the goal is to closely monitor what the baby is doing, instead of giving a bottle right away. “If the baby is hungry and they’re not getting enough milk out of the mother’s breast, then they need to be supplemented,” she says. 

FIBF: We have been passionately educating parents about safe breastfeeding since the beginning of our advocacy over 3 years ago with the current scientific studies that have confirmed over and over again that delayed onset of milk production and low milk supply are common.  We question why it took you so long to acknowledge this deadly and 100% preventable consequence of insufficient breastfeeding? Does this mean you will ban the belly bead stomach models that do not reflect the current science?

Will you please apologize to the thousands of mothers who bravely told their stories of accidental starvation?  You have previously tried to discredit their stories, called them “‘anxiety-provoking,” and characterized our foundation as BFHI detractors— simply because we offer a social media platform for mothers to be heard by you. Have you ever heard a mother break down and scream in horror when she learned her baby was starving to death because she followed your breastfeeding education and protocol?  We have—over and over again, and it is the most haunting sound. It’s what drives us to fiercely advocate for safe breastfeeding because no other health organization is doing so.

BFUSA: Dr. Bobbi Philipp agrees. “If you see signs that the mother’s milk is insufficient, you need to feed the baby,” she says. “And if the mother is really committed to breastfeeding, you’ve got to bridge the gap in a way that you support her, feed the baby, and don’t undermine the breastfeeding. It’s that simple.”

FIBF: Now that you are acknowledging delayed onset of milk is common, something that we have been passionately writing and speaking about for years, we expect that you will stop calling us “fibbers.” Name-calling is what a child having a temper tantrum does, not what a professional organization should do; the appropriate response to being called out and held accountably, is to take responsibility and revise your guidelines based on current research and patient feedback. Continue reading

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Dear Parents, Did You Know Just 2 Teaspoons Of Supplementation Can Protect Your Baby And Your Breastfeeding Journey?*

Written by: The Fed Is Best Foundation IBCLC Team

There have now been six studies showing that in some infants, a little bit of supplementation with two teaspoons (10 mL) of formula or donor breast milk after nursing had no effect on long-term breastfeeding. One study showed it prevented hospital readmissions in all of the supplemented newborns. Another showed it actually helped breastfeeding! 

Why aren’t medical and lactation professionals recommending this intervention?

Many medical and lactation professionals believe that a tiny amount of formula will contaminate the baby’s gut, causing lifelong health problems. They refuse to admit that formula supplementation can be helpful, and they have baseless concerns that temporary formula supplementation will become routine for all babies.  According to Baby-Friendly USA, “donor [breast] milk takes the fight out of this.” What they mean is that the few babies who are born in a hospital with donor milk can be fully fed, while the vast majority of babies who are born in hospitals without donor milk just have to tolerate hunger and thirst so as to avoid a few teaspoons of formula.  

Did you know two teaspoons of formula or donor milk has seven calories?  

Continue reading

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Baby-Friendly: Failure and the Art of Misdirection

By Alex Fischer, PhD Candidate, Brooke Orosz, PhD, Jody Segrave-Daly, RN, IBCLC and Christie Del Castillo-Hegyi, M.D.

Any good magician will tell you that the secret to their trade is misdirection—making the audience look one way while doing something the other way. And even knowing this, most of us are still baffled by a magician’s tricks. So it’s no wonder that Baby-Friendly USA (BFUSA) has tried to employ that same tactic in their statement titled “Fact vs FIB: The Impact of Baby-Friendly on Breastfeeding Initiation Rates.”  In this statement written by an anonymous author representing BFUSA, they attempt to dispute the findings of a recent study published in Journal of Pediatrics, “Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications” by Bass et al. This study examines the impact of statewide breastfeeding initiation rates as well as the impact of BFHI facilities on continued breastfeeding after hospital discharge (exclusive or combination). The Fed is Best Foundation read this study and agreed: “Baby-Friendly does not work.” These five words are the instigators of the entire statement by BFUSA and its misrepresentation of a very robust scientific study.  Continue reading

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U.S. Study Shows Baby-Friendly Hospital Initiative Does Not Work

by Christie del Castillo-Hegyi, M.D.

On October 14, 2019, the Journal of Pediatrics published astonishing findings regarding the effects of the Baby-Friendly hospital certification on sustained breastfeeding rates as defined by the 2020 Healthy People Goals of: 

  1. any breastfeeding at 6 and 12 months
  2. exclusive breastfeeding at 3 and 6 months. 

They did so by measuring the relationship between statewide breastfeeding initiation rates data and the above breastfeeding rates. They then measured the contribution of Baby-Friendly hospital designation on these same breastfeeding outcomes.

According to the study authors, the increase in hospital designation in the Baby-Friendly Hospital Initiative (BFHI) began in 2011 when the U.S. Surgeon General issued a call to action for maternity care practices throughout the U.S. to support breastfeeding. The Centers for Disease Control (CDC) became involved in promoting the BFHI policies in hospitals and health facilities, as breastfeeding was thought to be associated with lower rates of childhood obesity. The assumption was that by increasing breastfeeding rates through the BFHI, there would be a concomitant decline in childhood obesity. Upon initiation of this program, the CDC initiated surveillance of state-specific data on breastfeeding outcomes after discharge including BFHI designation rates. This data is made available to the public through the CDC Breastfeeding Report Card, which provides annual reports from 2007 through 2014 and biennial reports from 2014.

As expected, they found that states with higher breastfeeding initiation rates had higher rates of these sustained breastfeeding outcomes. You cannot have high breastfeeding rates unless mothers are given education and successfully initiate breastfeeding. However, when they measured the effects of Baby-Friendly certification, this is what they found.

“Baby-Friendly designation did not demonstrate a significant association with any post-discharge breastfeeding outcome (Figures 1, B and 2, B). There was no association between Baby-Friendly designation and breastfeeding initiation rates.” Continue reading

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National Women’s Health Advocate Describes How A Baby-Friendly Hospital Starved Her Baby

Sarah Christopherson is a mother and the Policy Advocacy Director at the National Women’s Health Network, a non-profit advocacy organization in Washington, D.C. She talks about her breastfeeding experiences and her recent experience in a Baby-Friendly hospital where her child became severely dehydrated and lost 15% of her birth weight while in the hospital. She discusses how policies can negatively affect patient health and how systemic change is needed to support positive patient health outcomes and prevent patient coercion.

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Two Physicians Describe How Their Baby-Friendly Hospital Put Their Newborn in Danger

John and Kristen are both surgical residents who recently had their first child. This is their story.

By John and Kristen Waters

Let me start by saying we are one of the lucky ones. Our first-born was born at term on July 25th, 2019 at 9:43 p.m., a healthy 7 lb, and 10oz. My wife – a general surgery resident – was planning on beginning to breastfeed right after birth. My wife had undergone a bilateral breast reduction about 15 years ago, so issues with breastfeeding were on our radar. Immediately after birth, we were taken from the delivery room to the postpartum unit, where at 2 a.m. my wife and I were given a pile of paperwork and instructions on breastfeeding practices. All the while both of us were seeing double from the long day and night of laboring and delivery.

Over the course of the next 12-24 hours, our baby attempted to latch and breastfeed, continuing to have issues with falling asleep while on the breast. We spoke with a lactation consultant and multiple nurses who stated that things were going fine and that everything was normal. Over this time the rate of wet diapers continued to decrease and our baby did not have a bowel movement.

As we got into our second night of life, our child began to cry hysterically.

Continue reading

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We Were Awarded A Malpractice Financial Settlement Because My Baby Suffered From Starvation In A BFHI Hospital

By A Mother from the Fed is Best Community who wishes to remain anonymous

This is my baby girl in NICU. She developed a high fever, jaundice, and dehydration with a 10.1% weight loss 56 hours after birth while exclusively breastfeeding in a ‘Baby-Friendly’ hospital.

During our stay, the hospital pediatrician saw my baby twice a day but he failed to inform us she had a 7.2% weight loss in the 30th hour of life. Hence, we were not given the information to decide if we should supplement with formula.

According to a review published in the Journal Of Family Practice in June 2018, “exclusive breastfeeding at discharge from the hospital is likely the single greatest risk factor for hospital readmission in newborns. Term infants who are exclusively breastfed are more likely to be hospitalized compared to formula-fed or mixed-fed infants, due to hyperbilirubinemia, dehydration, hypernatremia, and weight loss.” They estimated that for every 71 infants that are exclusively breastfed, one is hospitalized for serious feeding complications.

She was always furiously latching and my nipples were cracked and bleeding from constant nursing. She became very sleepy and now I know she was lethargic. Naively, I continued to breastfeed as instructed, and we told everything was fine until she developed a high fever just before discharging. They suspected bacterial infection and my poor baby endured a spinal tap, blood tests, IV glucose, and prophylactic IV antibiotics while waiting for results to come back. There was a very concerned NICU nurse that told me it’s time someone questions the strict exclusive breastfeeding practices of the BFHI. She was the one that told me to look at the weight loss when I was shocked and confused wondering how on earth my little girl caught a bacterial infection. Continue reading

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