Last update: April 11, 2020.

These days we are facing an exceptional situation and we know that this causes a lot of concern among families, since many of you have made us aware of your doubts and concerns. Therefore, at LactApp we have been reviewing the latest recommendations from international disease and breastfeeding experts to provide you with up-to-date information.

We have been able to confirm that the great majority of these organizations conclude, that when the mother suffers from the infection or if the mother has been breastfeeding for some time, the recommendation would be to continue breastfeeding, while maintaining the appropriate hygiene measures, such as:

• Maintain proper hand hygiene by washing your hands before touching the baby, breast pump or additional milk supply system.
• Avoid coughing and sneezing on the baby during any feeding activity.
• Consider wearing a mask, if available, during infant feeding or care.
• If a breast pump is used, clean it after each use and consider having a healthy family member feed the baby the expressed milk.
• If the baby is fed formula milk, instructions for making up bottle feeds by the manufacturer must be strictly followed.
• If the baby is fed expressed breast milk, it is crucial to maintain  disinfection of the container(s) used in the feeding process.

I’m pregnant, what if I catch it?

The limited data available to date indicate that it appears that pregnant women are not particularly susceptible to the complications of the disease.

With regard to vertical transmission (transmission from mother to child in pregnancy or during birth), the evidence published so far suggests that vertical transmission is likely, although the proportion of affected pregnancies and the consequences for the newborn have not been determined. Published case series in China suggest that there is no conclusive evidence and that amniotic fluid, cord blood, pharyngeal samples from newborns, placenta samples, vaginal fluid and milk samples from mothers infected with COVID-19 have so far given negative results for the virus. Articles published in late March 2020 describe that some newborns born to mothers with COVID-19 had certain anti-Sars-CoV-2 immunoglobulins in their blood at birth. These types of immunoglobulins do not cross the placental barrier and could mean that the baby has been in contact with the virus. Although the virus could not be isolated from the baby.

 If you have been in contact with someone who has the disease or suspect that you may have it, we advise you to contact your medical centre by phone so that they can explain the appropriate measures. (1)

I’m pregnant and have tested positive for COVID-19. When my baby is born, will I be able to have skin-to-skin and breastfeed?

As we have said before, we have very little information about the coronavirus. International medical organisations warn, that the case for a separation of mother and baby is not clear. Given the limited evidence of potential complications of the disease in newborns, it is therefore necessary to consider each case individually. Thus, in some cases separating mother and baby may be advisable.

According to the World Health Organization, a COVID-19 positive woman should be supported to breastfeed safely, hold her baby skin-to-skin, and share a room with her baby. Also, the Spanish Society of Neonatology (SENEO) in its document “Recommendations for the management of the newborn in relation to SARS-CoV-2 infection” states: “If adequate isolation between mother and child can be guaranteed, late cord clamping and skin-to-skin contact after birth could be considered. Although at present and in view of the lack of evidence of vertical transmission, we continue to recommend assessing the pros and cons of these measures in each case”. (2)

If I am already breastfeeding and become infected, can I still breastfeed?

It seems that the virus is not transmissible through breast milk. It is recommended to observe proper hygiene measures as we explained above.

So, can I still co-sleep with my baby?

The official recommendations do not give information on this point. Since there is little evidence, we know that various local protocols recommend not having continuous contact with the baby, but this is not reflected in the information provided by the World Health Organization.

Does the virus reach the milk?

As we have seen above, it seems that the virus is not found in breastmilk.

If we compare it to other similar viruses, we know that the contagion occurs by being in contact with the respiratory secretions (cough or sneeze) of infected individuals. For example, we know that the virus that causes Severe Acute Respiratory Syndrome (SARS) was not found in breastmilk.

Is the medication I take for COVID-19 compatible with breastfeeding?

In principle, the medication recommended for COVID-19 is compatible with breastfeeding. You can find all information about medication and compatibility with breastfeeding on the website: www.e-lactancia.org Currently, the following groups of medications are usually recommended:

Antimalarial: Chloroquine or Hydroxychloroquine

Antivirals:

• Remdesvir
• Lopinavir
• Beta Interferon
• Alpha Interferon

Antibiotic therapy: Most antibiotics are compatible with breastfeeding. If in doubt, please check on: www.e-lactancia.org.

Is there anything I can do to avoid getting infected?

The official recommendations insist on maintaining hygienic measures such as frequent hand washing, using disposable tissues to cover your mouth when you cough or sneeze (if you do not have them, use your sleeve or arm), avoiding crowded places and if the country where you live is not applying quarantine measures, avoiding travelling to places where there is an outbreak of the virus. Avoid contact with people suspected of having contracted the virus.

What do international authorities say regarding to COVID-19?

Here you will find links to the most relevant recommendations: 

WHO

“An exception can be made in the case of a nursing mother. Considering the benefits of breastfeeding and the limited role of breast milk in the transmission of other respiratory viruses, the mother can continue to breastfeed, although it is advised that she wears a mask when she is near the infant and that she washes her hands thoroughly before touching the infant.”

UNICEF

“[…] If a mother is very ill it is recommended that she expresses her milk and gives it to the baby using a clean cup and/or spoon, observing at all times the same measures to prevent infection.”

LA LECHE LEAGUE INTERNATIONAL

“If someone who is breastfeeding becomes ill, it is important not to interrupt direct breastfeeding. The baby has already been exposed to the virus by the mother and/or family and will benefit most from continued direct breastfeeding.”

CDC (Centers for Disease Control and Prevention)

Breastfeeding if you have COVID-19

• Breast milk provides protection against many illnesses and is the best source of nutrition for most infants.

• You, along with your family and healthcare providers, should decide whether and how to start or continue breastfeeding

• In limited studies, COVID-19 has not been detected in breast milk; however we do not know for sure whether mothers with COVID-19 can spread the virus via breast milk.

• If you are sick and choose to direct breastfeed:
  • Wear a facemask and wash your hands before each feeding.

• If the you are sick and choose to express breast milk:
  • Express breast milk to establish and maintain milk supply.
  • A dedicated breast pump should be provided.
  • Wash hands before touching any pump or bottle parts and before expressing breast milk.
  • Follow recommendations for proper pump cleaning after each use, cleaning all parts that come into contact with breast milk.
  • If possible, consider having someone who is well feed the expressed breast milk to the infant.

E-LACTANCIA.ORG (Breastfeeding Medical reference database)

” …] Since the symptoms, at least initially, are those of a common cold, it is very difficult and ineffective to isolate a mother with cold symptoms from her nursing baby in a timely manner. Considering the benefits of breastfeeding and the negligible role of breast milk in the transmission of other respiratory viruses, the mother can continue to breastfeed.”

BREASTFEEDING SPANISH ASSOCIATION (AELAMA) (Spanish version): 

“[Health authorities] recommend maintaining mother-child contact as well as breastfeeding in cases of infected mothers, while adopting the necessary measures to limit the risk of contagion.

PUBLIC HEALTH ENGLAND

If you are breastfeeding while infected

There is currently no evidence to suggest that the virus can be transmitted through breast milk. Infection can be spread to the baby in the same way as to anyone in close contact with you. The current evidence is that children with coronavirus (COVID-19) get much less severe symptoms than adults. The benefits of breastfeeding outweigh any potential risks of transmission of the virus through breast milk or by being in close contact; however, this will be an individual decision and can be discussed with your midwife, health visitor or GP by telephone.

If you or a family member are feeding with formula or expressed milk, you should sterilise the equipment carefully before each use. You should not share bottles or a breast pump with someone else.

You can find more information at the Royal College of Obstetricians and Gynaecologists website.

(1) Guidance for healthcare professionals on coronavirus (COVID-19) infection in pregnancy, published by the RCOG, Royal College of Midwives, Royal College of Paediatrics and Child Health, Public Health England and Health Protection Scotland. https://www.rcog.org.uk/globalassets/documents/guidelines/2020-04-09-coronavirus-covid-19-infection-in-pregnancy.pdf

(2) Sociedad Española de Neonatología. Recomendaciones para el manejo del recién nacido en relación con la infección por SARS-CoV-2. Versión    5.0 Fecha 16/03/2020. Consultado 07/04/2020 https://seneo.es/images/site/noticias/home/Recomendaciones_SENeo_SARS-CoV-2_Version4.1.pdf.

Other sources of information:

WHO EMRO

WHO EMRO flyer

WHO “Pregnancy, Childbirth, breastfeeding and COVID-19”