COVID-19 and Breastfeeding: What Parents Need to Know

Note: We use the term “breastfeeding” to encompass all forms of lactation, including direct breastfeeding, chestfeeding, and providing expressed human milk in a bottle.

This year, World Breastfeeding Week feels different, overshadowed by so many other things that demand center stage. As Medical Director for Lactation Services, I have heard concerns from staff and parents about COVID-19 and breastfeeding.

At the beginning of the pandemic, many hospitals disagreed about keeping of COVID-positive mothers and their newborns together. Some hospitals recommended distancing within the room and the use of masks during breastfeeding, some kept mom and baby apart, and some hospitals discouraged breastfeeding, altogether.

Across the nation there was no consistency in practice; no one knew the right answer. Thankfully, we have learned a lot over the last four months.

Infectious disease experts believe that the virus that causes COVID-19 is spread through respiratory droplets, like the seasonal flu. Studies of mothers who delivered while sick with the flu showed that rooming with their infant did not increase the likelihood of the infant becoming infected¹. A recent study from hospitals in New York City found that 96% of infants who were born to mothers with COVID-19 and breastfed did not become infected in the first seven days after birth. More hospitals are now encouraging moms and babies to stay together in the immediate postpartum period.

For moms and babies who are not able to stay together, either because of maternal illness, infant admission to intensive care, or mother’s preference, the question becomes, “Can Mom provide milk safely?” Many doctors were afraid the milk itself could contain the virus and cause infection in the infant. We now have several studies who have concluded that human milk from COVID-positive mothers does not have living virus in it that would cause infection. These studies looked at human milk that was expressed with electric pumps and with hand expression.

Moms who are pumping at work are encouraged to follow the same procedures as before to prevent contamination – follow good hand hygiene by washing hands before pumping and wash pump parts when finished. Mothers should ask their doctor to write a note to specify the amount of time and resources she needs to pump safely at work. 

HMBANA (Human Milk Bank Association of North America) has published recommendations regarding handling of bottles with expressed milk provided by mothers with COVID. HMBANA does not recommend using any chemical disinfectants on the outside of milk bottles. Some hospitals will still use a disinfectant that is safe for food surfaces to wipe down the outside of bottles from COVID-positive mothers of infants who are hospitalized. This is to ensure the virus is not spread to bottles of other infants since all bottles are stored in the same refrigerator/freezer in the hospital.  This is not necessary for milk stored in your home.

There is still not much evidence about SARS-CoV-2 in human milk yet, but the research showing the benefits of breastfeeding and human milk are plentiful and well-documented. More hospitals across the nation are establishing guidelines to support breastfeeding and milk expression safely by emphasizing the importance of proper hand and breast hygiene, mask-wearing and proper cleaning of breast pump equipment. 

As parents, we make the best decisions for our children with the information we have at the time. For those mothers (and medical staff) who have been struggling, surviving, guessing, worrying, and rising above with the rest of us – I extend my utmost respect and kudos. This year’s World Breastfeeding Week should feel extra special to you, not overshadowed. Regardless of where you are in your breastfeeding journey and how you got there, you are a light beacon shining out to the rest of us. Thank you for your perseverance and your understanding as we grow and learn together.

1. Cantey, Joseph B., et al. "Prevention of mother-to-infant transmission of influenza during the postpartum period." American journal of perinatology 30.03 (2013): 233-240.