In the early days of the COVID-19 pandemic, one issue quickly rose to the surface for birthing families and their providers. Considering the new risks, could parents and their infants safely remain together?
It was a scary time for birthing parents and those who support them, as stories of painful separation abounded from areas around the globe.
Nearly a year later, data has shown that babies who stay with their parent are at no greater risk for COVID-19 infection than those who are separated. However, separation of birthing parents and their babies remains common practice in many settings. The implications are significant, and dire—particularly for the success of breastfeeding or chestfeeding. As a lactation professional, what can you do to help ensure contact for your clients and their babies?
In her new webinar, Dr. Cecília Tomori, PhD, MA., Director of Global Public Health and Community Health at the Johns Hopkins School of Nursing, discusses the latest developments, as well as what you can do to help. (Find the free webinar here; CERP-eligible for ILCA members here).
THE CURRENT CLIMATE
Months into the pandemic, researchers have gathered a lot of data. Unknowns remain, but there is growing agreement on significant points. First, infants and children are “underrepresented in reported and confirmed cases,” according to Tomori, suggesting they contract COVID-19 less frequently than older individuals.
Second, they are likely to have a milder clinical course if they do get sick. Exceptions exist, and there is the potential for severe cases, including the risk of Multisystem Inflammatory Syndrome, a rare but serious condition. However, “We have very good data now, from many months and thousands of papers,” Tomori says, “to support the fact that overall, we are definitely seeing lower severity among infants and children.”
Additionally, data has shown that separating infants from their parents in the hospital doesn’t reduce the likelihood of COVID-19 infection.
So with better data, is all well now? Not quite, according to Tomori.
Following nearly a year of mixed messages and policy reversals, birthing parents are still routinely being separated from their infants, and there is insufficient support for parent-baby contact and for breastfeeding in many areas.
Guidance varies across settings, and some settings are still recommending no breastfeeding or the feeding of expressed milk only.
Separation policies remain common, although they have taken different forms in different areas. In both the United States and the United Kingdom, anecdotal reports of hospitals routinely separating birthing parents and infants are still common, according to Tomori—even when the official policy supports keeping parents and babies together.
WHAT CAN YOU DO?
In the face of confusing and changing policies and practices, how can you advocate for the parents and babies in your care and help ensure they remain together? Tomori has several suggestions.
Reference high quality resources. As you work to keep up with emerging evidence, stick with proven sources. “Rely on experts who have thought about the issues carefully and thoroughly and are capable of integrating multiple sources of evidence,” she says. “When in doubt, go back to the WHO.” Whatever you do, don’t reference the day’s headlines. “Don’t follow whatever news release you may see—that may not be linked to any research at all, or to poor quality research,” she cautions. You can find up-to-resources at the ILCA website here.
Navigate the guidance. Carefully examine the policies and practices in your own setting. Compare to the WHO guidance, and look for differences and discrepancies. “Think through what the [practice or policy] actually does,” Tomori says. “Map out potential exposures. Map out the trade-offs.”
Challenge problems. If a policy or practice in your setting is out of line with best recommendations, speak up.
Keep parents’ and infants’ rights at the center. Look for opportunities to advocate for these rights in your setting.
Collaborate and communicate. “Don’t go it alone,” Tomori says. Look for others to work alongside you who share your commitment to parents and babies.
Evaluate for inequities. Importantly, any time you are evaluating guidance, policy, or practices, do so with an eye toward inequities. Look for places where your setting’s policies impact different families differently, and question the invisible beliefs and values behind the advice. “Ask, ‘What are the built-in assumptions that are not obvious?’” Tomori advises. “This should be a primary consideration. It will tell you a great deal about what is really happening.”
HOW DID WE GET HERE?
Early in the pandemic, the World Health Organization (WHO) issued guidance urging health care providers to keep birthing parents and their infants together, according to Tomori.
Unlike many country-level and professional bodies, WHO integrates knowledge of past pandemics with a focus on maternal-child health as well as expertise in feeding infants in emergencies and infectious disease control. The result was quick early guidance that centered the rights of the birthing parent, regardless of COVID-19 status.
WHO also stressed labor support, skin-to-skin care, and direct breastfeeding, with the parent wearing a mask and practicing hand hygiene.
However, things got much more complicated after that. National and professional bodies began to weigh in with conflicting recommendations.
Statements by various experts and advising bodies around the world recommended separating parents and babies, and even in areas where official guidance recommended keeping dyads together, individual institutions frequently opted for separate care.
Then in February 2020, the Centers for Disease Control (CDC) in the United States advised healthcare providers to consider separating mothers and babies. The CDC’s statement advocated shared decision making, with risks and benefits discussed between families and providers—but this did not routinely occur, according to Tomori. Instead, birthing parents were frequently separated from their newborns with no discussion of their options or of the risks of separation.
The CDC’s stance affected practices around the world, as many countries followed its advice.
With the support of lactation professionals and other parent-baby advocates, including ILCA, in April 2020, the CDC issued new guidance that re-emphasized the benefits of contact and the importance of breastfeeding.
In August 2020, revised CDC recommendations further re-centered contact, saying the risk of infection from parent to baby was low.
These final recommendations still stand, and in November 2020, new resources issued for the public by the CDC additionally acknowledged that breastmilk is not a likely cause of COVID-19 infection.
A BIGGER PICTURE
Larger questions remain: Why were policies and practices of separating parents and newborns so quick to emerge? And why have they been so hard to dispel? An anthropologist by training, Tomori has very clear answers for these questions—and the answers have big implications for caring for families. To learn more, read the upcoming blog “Anthropology Meets Public Policy: Understanding Parent-Baby Separation in the Pandemic.”
ILCA members can access Tomori’s CERP-eligible webinar at ILCA Learning: WEBINAR – Protecting Mother-infant Contact and Breastfeeding During the COVID-19 Pandemic. Non-members can access for free (not CERP eligible) here.
It would be helpful for your readers to all be on the same page. To do that – when you are asking us to “do” something, to “Reference high quality resources. As you work to keep up with emerging evidence, stick with proven sources” – is to provide us with solid evidence based links to articles or research.
Simply share with us what YOU are looking at so we can all then share with PIC’s and nursing supervisors of the hospitals in our individual areas – that are still separating + mothers from their babies.
Granted, your request is aimed at nurses “Carefully examine the policies and practices in your own setting” , but some of us are in private practice.
Regarding the nurses……Recognize that they are busy and would REALLY appreciate help in locating good evidence-based sites to save them a little time.
Thank you for reaching out! Great idea to add in a link here. We will do that now! ILCA has been compiling resources for providers around the globe, which you can find here: https://ilca.org/covid-19/
If you (or anyone else) is aware of other resources that should be added here, please let us know at firstname.lastname@example.org.
I’d like to make a suggestion on something to actually “do”.
As we all know, the AAP remains “in bed” with formula companies. While their “Motto” states:
The mission of the AAP is to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. To accomplish this mission, the AAP shall support the professional needs of its members.
AAP’s continued, persistent relationship with formula companies – in spite of the WHO Code – and not meeting the “needs” of their members by prioritizing the importance of and lack of training in breastfeeding and breastfeeding support along with skeptical, half hearted ‘support’ for Baby-Friendly Designation, renders their motto rather limp.
I’v tried to contact the AAP NUMEROUS times asking them to explain their ongoing relationship with formula companies (knowing it is all about MONEY). At first they would answer that my query was being forwarded to someone. Or that I would be contacted within so many days, etc., etc., etc. Until they just stopped replying entirely. Of course no one ever contacted me.
So what can ILCA “do”??
Join with other large breastfeeding organizations to get an answer. USBC, Breastfeeding USA, USLCA, LLL, WIC etc. There is power in numbers. What do we “do”?
Pursue the AAP asking why they are not following the WHO Code? Why don’t they fully support Baby-Friendly or at least adherence to the 10 steps (with ACCOUNTABILITY)? Why aren’t they leading the charge for ALL medical schools to make human lactation mandatory and, in obstetric and pediatric specialties, breastfeeding support along with NICU care of the breastfed infant.
After all, it’s been FOURTY (40) years since the WHO Code and TWENTY-EIGHT (28) years since WHO/UNICEF launched Baby-Friendly in India. How long should it take health care professionals to implement evidence based practices???
excellent lecture of Cecilia Tomori.