Resources for skilled lactation providers on COVID-19

Supporting lactation is important to human health at all times, but especially during times of emergency. As skilled lactation providers around the globe support families during the COVID-19 epidemic, ILCA is working to provide resources, guidelines, and communication tools. Please watch here for additional resources as they become available.

NOTE: Guidance for families and for those providing lactation support during COVID-19 is evolving. We at ILCA will do our best to keep this information as updated as possible. The information posted here may not reflect the latest news and practice guidance.  Have updates or regional guidelines to share? Please email media@ilca.org with details.

UPDATES:

23 March 20 to include Q&A from WHO

19 March 20 to include updates from SOGC and RCOG, our statement, and changes to the IBLCE exam schedule

18 March 20 to include tools from Lactation Education Resources

16 March 20 to include milk banking resources and virtual consult resource.

14 March 20 to include new WHO guidance: Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected

ILCA RESOURCES

ILCA Statement on Breastfeeding and Lactation Support During the COVID-19 Pandemic

“All international world health guidelines agree: Breastfeeding should continue and be supported during the COVID-19 epidemic, with appropriate precautions.”

(released 18 March 20)

Resources for Lactation Supporters Providing Infant and Young Child Feeding Advice During COVID-19

The COVID-19 pandemic has resulted in Declarations of Emergency in many countries and local municipalities around the world. Skilled lactation providers are being called upon to provide evidence- and policy-based advice on the feeding of infants and young children during this emergency. The following, based on international recommendations, can help guide your recommendations.

(released 24 March 20)

Social media frame for telehealth providers

Add this frame to your social media profile to let people know that you are a lactation consultant that provides telehealth.

INTERNATIONAL RESOURCES

World Health Organization (WHO) interim guidance on clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected:

“Infants born to mothers with suspected, probable, or confirmed COVID-19 should be fed according to standard infant feeding guidelines, while applying necessary precautions for IPC.”

“As with all confirmed or suspected COVID-19 cases, symptomatic mothers who are breastfeeding or practising skin-to-skin contact or kangaroo mother care should practise respiratory hygiene, including during feeding (for example, use of a medical mask when near a child if the mother has respiratory symptoms), perform hand hygiene before and after contact with the child, and routinely clean and disinfect surfaces with which the symptomatic mother has been in contact.”

“Breastfeeding counselling, basic psychosocial support, and practical feeding support should be provided to all pregnant women and mothers with infants and young children, whether they or their infants and young children have suspected or confirmed COVID-19.”

“In situations when severe illness in a mother with COVID-19 or other complications prevents her from caring for her infant or prevents her from continuing direct breastfeeding, mothers should be encouraged and supported to express milk, and safely provide breastmilk to the infant, while applying appropriate IPC measures.”

“Mothers and infants should be enabled to remain together and practise skin-to-skin contact, kangaroo mother care and to remain together and to practise rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”

“Parents and caregivers who may need to be separated from their children, and children who may need to be separated from their primary caregivers, should have access to appropriately trained health or non-health workers for mental health and psychosocial support.”

Download the document “Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected” here.
(interim guidance dated 13 March; accessed 14 March 20)

World Health Organization (WHO) guidance on breastfeeding with suspected COVID-19 with mild symptoms

“Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can [sic] continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document.”

Download the document “Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts” in Chinese, English, French and Spanish here. (interim guidance dated 4 February; accessed 12 March 20)

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

“Can women with COVID-19 breastfeed?
Yes. Women with COVID-19 can breastfeed if they wish to do so. They should:
Practice respiratory hygiene during feeding, wearing a mask where available;
Wash hands before and after touching the baby;
Routinely clean and disinfect surfaces they have touched.”

Find the Q&A here.

(Q&A dated 18 March 20; accessed 23 March 20)

UNICEF guidance for parents

Is it safe for a mother to breastfeed if she is infected with coronavirus?

All mothers in affected and at-risk areas who have symptoms of fever, cough or difficulty breathing, should seek medical care early, and follow instructions from a health care provider. Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions. For symptomatic mothers well enough to breastfeed, this includes wearing a mask when near a child (including during feeding), washing hands before and after contact with the child (including feeding), and cleaning/disinfecting contaminated surfaces – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children. If a mother is too ill, she should be encouraged to express milk and give it to the child via a clean cup and/or spoon – all while following the same infection prevention methods.”

Find UNICEF’s page on Coronavirus disease (COVID-19): What parents should know: How to protect yourself and your children here.

(accessed 12 March 20)


United Nations Population Fund (UNFPA) statement on pregnancy (includes information on lactating families)

Breastfeeding women should not be separated from their newborns, as there is no evidence to show that respiratory viruses can be transmitted through breast milk, according to UNICEF. The mother can continue breastfeeding, as long as the necessary precautions below are applied:

  • Symptomatic mothers well enough to breastfeed should wear a mask when near a child (including during feeding), wash hands before and after contact with the child (including feeding), and clean/disinfect contaminated surfaces.
  •  If a mother is too ill to breastfeed, she should be encouraged to express milk that can be given to the child via a clean cup and/or spoon – while wearing a mask, washing hands before and after contact with the child, and cleaning/disinfecting contaminated surfaces.

Provision of mental health and psychosocial support for affected individuals, families, communities and health workers is a critical part of the response.

Find the statement here

And the related press release here

(statement dated 5 March 2020; accessed 12 March 20)

REGIONAL RESOURCES

Alphabetical by Country of Origin

Canada

Public Health Agency of Canada (PHAC) Case Management in the Home and Co-Living Settings (self-isolation)

“For breastfeeding mothers: considering the benefits of breastfeeding and the insignificant role of breast milk in transmission of other respiratory viruses, breastfeeding can continue. If the breastfeeding mother is a case, she should wear a surgical/procedure mask when near the baby, practice respiratory etiquette, and perform hand hygiene before and after close contact with the baby.”

Find the interim guidance here in English and here in French.

(guidance issued 3 March 20; accessed 12 March 20)

British Columbia Centre for Disease Control (BCCDC) Interim Guidance: Public Health Management of cases and contacts associated with novel coronavirus (COVID-19) in the community

“For breastfeeding mothers: considering the benefits of breastfeeding and the insignificant role of breast milk in transmission of other respiratory viruses, breastfeeding can continue. If the breastfeeding mother is a case, she should wear a surgical/procedure mask when near the baby, practice respiratory etiquette, and perform hand hygiene before and after close contact with the baby.”

Access the interim guidance here.
(guidance issued 10 March 20; accessed 13 March 20)

Updated SOGC Committee Opinion – COVID-19 in Pregnancy

  • “Management in the post-partum period should be guided by a patient-centred discussion about the available evidence and its limitations.
  • We do not recommend universal isolation of the infant from either confirmed of suspected infection in the mother. However, depending on a family’s values and availability of resources they may choose to separate infant from mother until isolation precautions for the mother can be formally discontinued.
  • Women should practice good handwashing before and use of a mask while engaging in infant care.
  • Women who choose to breastfeed should be allowed to do so after appropriate handwashing and while wearing a mask. It is possible that the mother can transmit antibodies to the infant through breastmilk; however, there is limited evidence of this transmission and the potential benefits are unclear.”

Find the statement here. 

(dated 13 March 20; accessed 19 March 20)

Italy

L’epidemiologia per la sanità pubblica – Istituto Superiore di Sanità (Italian National Institute of Health) COVID-19: pregnancy, delivery and breastfeeding

“The clinical, organizational and logistical management of mothers and infants represents a challenge for health services already overloaded with emergency management. Moreover, different institutions and authors seem to apply the precautionary principle differently, in light of the same limited evidence. Whenever possible, it is essential to preserve the physiology of childbirth, the mother-child relationship and breastfeeding that, even in uncertainty, guarantee a protective potential for the newborn, widely documented in the literature, including previous SARS or MERS epidemics.

In this state of uncertainty, providing convincing and undisputable recommendations for SARS-COV-2 positive mothers and/or for those with Covid-19 clinical symptoms is challenging. Therefore, a multidisciplinary case-by-case assessment is desirable and recommended. Notably, the best care approach can be reached by taking into account the maternal exposure time to the coronavirus, the gestational age, the ongoing treatment, the individual immune response situation and all the variables that can influence the clinical condition.”

Find the information here.

(dated 5 March 20; accessed 13 March 20)

United Kingdom

Royal College of Obstetricians and Gynecologists (RCOG) National guidance on managing coronavirus infection in pregnancy

  • “Pregnant women do not appear to be more susceptible to the consequences of coronavirus than the general population and there is no evidence that the virus can pass to a baby during pregnancy
  • As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour are being advised to attend an obstetric unit for birth but their birth plan should be followed as closely as possible
  • At the moment there is no evidence that the virus can be carried in breastmilk, so it is felt the benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk. ”

Access the national guidance here.

(dated 9 March 20; accessed 13 March 20)

Royal College of Obstetricians and Gynecologists (RCOG) Coronavirus (COVID-19) Infection in Pregnancy: Information for Health Care Professionals

“It is reassuring that in six Chinese cases tested, breastmilk was negative for COVID-19; however, given the small number of cases, this evidence should be interpreted with caution. The main risk for infants of breastfeeding is the close contact with the mother, who is likely to share infective airborne droplets. In the light of the current evidence, we advise that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk. The risks and benefits of breastfeeding, including the risk of holding the baby in close proximity to the mother, should be discussed with her. This guidance may change as knowledge evolves. For women wishing to breastfeed, precautions should be taken to limit viral spread to the baby:

• Hand washing before touching the baby, breast pump or bottles;
• Try and avoid coughing or sneezing on your baby while feeding at the breast
• Consider wearing a face mask while breastfeeding, if available
• Follow recommendations for pump cleaning after each use;
• Consider asking someone who is well to feed expressed milk to the baby

For women bottle feeding with formula or expressed milk, strict adherence to sterilisation guidelines is recommended. Where mothers are expressing breastmilk in hospital, a dedicated breast pump should be used.

Access the information here.

(Version 1: Published/Revised Monday 18 March 20; accessed 19 March 20)

United States

United States Centers for Disease Control (CDC) Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19

“Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers. A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.”

Access the information here.

(Published/revised Wednesday 10 February 20; accessed 13 March 20)

United States Centers for Disease Control (CDC) Interim Considerations for Infection Prevention and Control of 2019 Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings

“During temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply. If possible, a dedicated breast pump should be provided. Prior to expressing breast milk, mothers should practice hand hygiene. After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer’s instructions. This expressed breast milk should be fed to the newborn by a healthy caregiver. If a mother and newborn do room-in and the mother wishes to feed at the breast, she should put on a facemask and practice hand hygiene before each feeding.”

Access the information here.

(Published/revised Tuesday 18 February 20; accessed 13 March 20)

Academy for Breastfeeding Medicine (ABM) Statement on Coronavirus 2019 (COVID-19)

“Breast milk provides protection against many illnesses. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. CDC has no specific guidance for breastfeeding during infection with similar viruses like SARS-CoV or Middle Eastern Respiratory Syndrome (MERS-CoV) also both Corona viruses. In a similar situation to COVID-19, the CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant. Given low rates of transmission of respiratory viruses through breast milk, the World Health Organization states that mothers with COVID-19 can breastfeed.”

The complete statement also includes guidance for both home and hospital.

“…In Hospital:
The choice to breastfeed is the mother’s and families. If the mother is well and has only been exposed or is a PUI with mild symptoms, breastfeeding is a very reasonable choice and diminishing the risk of exposing the infant to maternal respiratory secretions with use of a mask, gown and careful handwashing is relatively easy. If the mother has COVD-19, there may be more worry, but it is still reasonable to choose to breastfeed and provide expressed milk for her infant. Limiting the infant’s exposure via respiratory secretions may require more careful adherence to the recommendations depending on the mother’s illness. …”

Access the statement here.

(Published/revised Tuesday 10 March 20; accessed 13 March 20)

Academy for Breastfeeding Medicine (ABM) Breastfeeding and Respiratory Antivirals: Coronavirus and Influenza – Breastfeeding Medicine

“The short answer to questions regarding drug therapy for COVID-19 is that currently there is no antiviral agent proven to be effective against this new infection. However, one investigational drug so far, remdesivir, appears promising to treat COVID-19, and it is in phase 3 clinical trials in patients. Dr. Anderson notes: “Nothing is known about the passage of remdesivir into breastmilk.””

Access the information here.

(Published/revised Thursday 27 February 20; accessed 13 March 20)

Academy for Breastfeeding Medicine (ABM) News Release: Coronavirus Treatment and Risk to Breastfeeding Women — Mary Ann Leibert Inc. Publishers

Arthur I. Eidelman, MD, Editor-in-Chief of Breastfeeding Medicine, states: “Given the reality that mothers infected with coronavirus have probably already colonized their nursing infant, continued breastfeeding has the potential of transmitting protective maternal antibodies to the infant via the breast milk. Thus, breastfeeding should be continued with the mother carefully practicing handwashing and wearing a mask while nursing, to minimize additional viral exposure to the infant.”

Access the press release here.

(Published/revised Tuesday 4 March 20; accessed 13 March 20)

American Society of Obstetricians and Gynecologists (ACOG) Practice Advisory: Novel Coronavirus 2019 (COVID-19)

“The CDC has developed Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation for COVID-19. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and health care practitioners. Currently, the primary concern is not whether the virus can be transmitted through breastmilk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding. A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while breastfeeding. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant. In limited case series reported to date, no evidence of virus has been found in the breast milk of women infected with COVID-19; however, it is not yet known if COVID-19 can be transmitted through breast milk (ie, infectious virus in the breast milk).”

Access the practice advisory here.

(Published/revised Tuesday 10 March 20; accessed 13 March 20)

MILK BANKING RESOURCES

Alphabetical by country of origin

Human Milk Banking of North America (HMBANA)

Find HMBANA’s statement here.

(guidance issued 6 March 20, accessed 16 March 20)

European Milk Bank Association (EMBA)

Find EMBA’s statement here.

(dated 25 February 20; accessed 13 March 20)

VIRTUAL PRACTICE RESOURCES

Blog post: Virtual Consult Best Practices For Lactation Consultants

(Updated March 2020 With COVID-19 Guidelines) by Annie Frisbie, IBCLC

“While most clinicians can agree that nothing can replace an in-person lactation consult with a family in need of help feeding their baby, virtual consults are becoming more and more popular as a way to make services more accessible. In order to meet your ethical obligations and stay within your scope of practice as an IBCLC or other lactation credential, you’ll want to keep some key factors in mind.”

Access the blog post on paperlesslactation.com here.

(resource updated March 20; accessed 16 March 20)

Infographics on telehealth for lactation consultants, lactation care in the community setting, and telehealth decision algorithm

From Lactation Education Resources

(Resource shared 18 March 20; accessed 19 March 20)

SOCIAL MEDIA AND COMMUNICATIONS RESOURCES

Find infographics to share on lactation and human milk and COVID-19 here.

ILCA will continue to share these and other resources on our social media sites.

The World Health Organization has created a series of graphics that can be shared:

UPDATES FROM THE INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS

The International Board of Lactation Consultant Examiners (IBLCE) has made changes to:

– the late March/early April 2020 exam date
– the deadline to apply for the September 2020
– customer support delivery

For updates, please visit their website here.

Thank you to Safely Fed Canada, the US-based National Perinatal Association and others for compiling and sharing evidence-based information. Share updates and/or your region’s guidelines at media@ilca.org.