Early in the COVID-19 pandemic, a troubling trend emerged—as hospitals struggled to understand the new risk, birthing parents and their infants were routinely being separated. Parents were told not to breastfeed or chestfeed, or counseled to only feed expressed milk.
Babies were spending the first days of their lives unable to be in contact with their lactating parent.
Nearly a year later, that situation in many places still stands. Despite scientific evidence that infants kept together with their mother or other lactating parent are at no greater risk for SARS-CoV-2 infection than those cared for separately, routine separation is still happening.
Why is this the case? In her new webinar, available to ILCA members here, Dr. Cecília Tomori, PhD, MA., Director of Global Public Health and Community Health at the Johns Hopkins School of Nursing, draws on her dual training in anthropology and epidemiology to answer this critical question.
UNDERSTANDING THE BACKDROP
To understand why separating birthing parents and their infants was an automatic response from many guiding bodies and institutions, one has to understand an invisible historical backdrop, according to Tomori.
Healthcare policy does not take shape in a vacuum, nor is it ever simply the result of a neutral examination of hard scientific data. “It really is drawn from how we approach the evidence, and these things are social,” she says.
In this case, much of the world approached the evidence about COVID-19 and parent-baby separation from a single perspective: they assumed that separating parents and infants is a neutral, default act with no potential for harm.
Why? As Tomori explained, that attitude is the result of decades of industrial capitalism and colonialism that led to a medicalization of birth and parenting and to the view of parents and babies as completely separate.
Shored up by cultural beliefs about independence, by the mid-20th Century this added up to a loss of the previous understanding of birthing parents and their infants as a dyad—they were no longer seen as an interconnected unit that needed to stay together.
By the late 20th Century, parent-infant interdependence and breastfeeding had been “rediscovered,” but in a very medicalized version. And importantly, medical training in much of the world is still rooted in the previous paradigm.
It is this view of separation as the default, according to Tomori, that has led to damaging separation policies and practices during the pandemic. Keeping parents and babies together is seen only as a threat—in this case, as a potential source of SARS-CoV-2infection.
Tomori acknowledges that it can be hard to grasp how such large, unseen forces are at work when one of your clients is told they cannot keep their baby with them, or is urged to express milk instead of nursing. But she argues that it’s important to understand the assumptions behind the policies in order to evaluate what is truly happening.
When policies are made based on the belief that separation is benign and that proximity only represents a threat, the threat of very real, cumulative harm due to separation is ignored.
Keeping babies and their birthing parents together is the evolutionary and biological norm because human infants are comparatively immature and vulnerable. Unlike many other primates, they are unable to cling to their parent and unable to maintain their temperature. Proximity to their parent—and breastfeeding in particular—are unique adaptations that allow the parent to co-regulate the baby’s system. Separation prevents this. “Evidence for this is vast,” Tomori notes.
One other harm from separation is totally overlooked as well. Since breastfeeding is often seen only as nutrition, providers miss the fact that “breastfeeding is a major adaptation for protection from infectious disease,” Tomori says. “This is repeatedly overlooked … and that’s a really major oversight during a pandemic, when you’re looking at an emerging infectious disease.”
Another major oversight? Providers who advocate separation assume it will lessen the infant’s exposure—but in fact, the opposite may be true. Infants require extensive care, and if their parent is not able to do it, healthcare staff or another caregiver will need to do it instead. Each new contact the baby has can increase exposure. The baby may end up with more exposure and less immune protection from breastfeeding.
INEQUITIES EXACERBATE HARMS
The harms of separation are extensive and cumulative, according to Tomori—and they are also uneven. They do not affect all parents and babies equally.
Why? Because far from being a “great equalizer,” as some suggested early on, COVID-19 has instead revealed and worsened preexisting inequities between groups.
Who are the parent-baby pairs most likely to be harmed by separation? Those whose essential worker status forces them to attend jobs, those who are least able to follow recommendations to avoid exposure, those with underlying conditions due to historical inequities, those with less access to culturally competent, skilled birth and lactation support, and those for whom power dynamics make it more difficult to challenge medical advice.
“Separation has a disproportionate effect on the most vulnerable mothers and infants,” Tomori says.
What are your setting’s policies and practices around separation during COVID-19? For tips on how you can take action to support parent-infant togetherness, check out the first blog in this series here.
Ready to learn even more? ILCA members can access Tomori’s webinar at ILCA Learning: WEBINAR – Protecting Mother-infant Contact and Breastfeeding During the COVID-19 Pandemic.