Providing Care for Breastfeeding Dyads During COVID-19 Outbreak
by Anne Eglash MD, IBCLC, FABM
Healthcare systems are scrambling to change their operational processes, to care for their patients in a safe, organized fashion. It is critical to diagnose and treat individuals with COVID-19 during a time of limited testing capacity, but also to keep high priority patients with other health issues safe from those with respiratory illness.
This is a critical time to not expose pregnant and breastfeeding families to the COVID-19 virus, and at the same time, optimize support for breastfeeding in order to reduce maternal/child morbidity and mortality. Breastfeeding problems are often urgent issues, so cannot be put on hold. The challenge is providing direct or indirect care to breastfeeding families, particularly in health care systems, without exposing them to those with respiratory illnesses.
The Centers for Disease Control has guidance for healthcare providers on shifting their healthcare delivery modes of delivery, although there are no specific recommendations on the care of breastfeeding dyads who need breastfeeding support from a lactation consultant or breastfeeding medicine specialist.
Ideas based on advice from the CDC include:
- Use Telehealth or simply telephone calls for breastfeeding dyads who don’t need hands-on intervention such as a breast exam or weight check.
- Consider keeping anyone with respiratory symptoms out of the office, so that breastfeeding dyads coming to the office are not at risk of acquiring illness.
- Space out visits so that families do not come into contact with each other in the office.
- Home visits
- Physicians and other breastfeeding medicine care providers or consultants/counselors who are ill should NOT come into contact with breastfeeding families (or anyone else for that matter!)
See the Answer
Purpose of this Document
This interim guidance outlines goals and strategies for all U.S. healthcare facilities to prepare for and respond to community spread of coronavirus disease-2019 (COVID-19). Although it is not possible to predict the future course of the outbreak, planning for a scenario in which many persons become ill and seek care at the same time is an important part of preparedness and can improve outcomes if an outbreak occurs. Therefore, preserving healthcare system functioning is paramount. It is critical for healthcare facilities to continue to provide care for all patients, irrespective of COVID-19 infection status, at the appropriate level (e.g., home-based care, outpatient, urgent care, emergency room, or hospitalization). Facilities may need to respond to a surge in patients requiring care. Concentrated efforts will be required to mobilize all aspects of healthcare to reduce transmission of disease, direct people to the right level of care, and decrease the burden on the healthcare system.
Here is what is happening in my healthcare world- We are not allowing any patients with respiratory infections into our primary care offices, not only to protect healthcare workers, but also to prevent spread to other high priority patients who are most vulnerable to morbidity and mortality from COVID-19. Patients with respiratory symptoms are being triaged by phone and sent to specific medical locations for care if needed.
We are also not seeing patients who have non-urgent health problems that can wait a few months and, for many, we are providing telephone consultation. High priority patients are scheduled in the office, such as injuries, newborns, abdominal pain, and of course breastfeeding medicine patients. A large %, if not the majority, of breastfeeding problems are urgent. Mothers have the risk of breastfeeding complications, such as abscesses, engorgement, depression, and infants run the risk of early weaning, leading to increased risk of respiratory illness if breastfeeding problems are not addressed on a timely basis. Therefore, I am seeing breastfeeding dyads in the office, and calling those who don’t need hands-on exam or intervention.
We absolutely need to keep up our momentum of caring for breastfeeding dyads, and not delay care while we are overwhelmed with COVID-19.
M J Kiely, RN, IBCLC
In our Pasadena, CA community hospital, we are:
1) Working to provide FU phone calls on day 5 of life for all families
2) Contacting the MD offices to see if patients are making it to their FU appointments
3) Cancelled all group parenting classes and the weekly BF support group
4) Providing updated handout with highlighted resource phone numbers to call for support, including our postpartum unit 24/7, and CDC information on how to take care of their stress/mental health during a crisis like this.
5) Working with Customized Communications (our patient education booklet vendor) on their offer to provide for free their online prenatal classes and videos linked to our hospital site.
6) Educating staff on the most up-to-date CDC info regarding pregnancy, newborns, and BF information
7) Focusing on mental health considerations since the stress and isolation due to COVID-19 and reduction of traditional support systems during this time may really impact families, encouraging all people contacting our families to ask how they are doing emotionally and stress-wise, providing praise for their good parenting, encouraging them to continue to call for support, providing FU phone support when able, encouraging them to video chat with their personal support team for help.
Christine L
These are great ideas!
The hospital i work for is discharging moms and babies home sooner and there is less follow-up. Classes and support groups are not happening. People are scrambling right now. It does seem like finding more ways to reach moms online will be a good outcome of all of this.
Concerned IBCLC from NJ
It is a free for all at my hospital. They are not limiting visitors beyond the two per patient policy they rarely enforce. I was told that they are working on a plan but wouldn’t say what the plan will entail.
Sarah, IBCLC from Fort Wayne IN
We have cancelled our mom to mom group, but are offering weight checks for those moms and babies who are at risk. Visitation in hospital is restricted to 1 person per patient. We are strictly enforcing this at the entry points to the hospital. We have screening questions that are being asked prior to any outpatient lactation visit and we are limiting the consultation to mom and baby only. We have cancelled all in person childbirth/breastfeeding classes. We are looking into options for online classes. We are also looking into follow up phone calls on all moms post delivery to support their emotions and breastfeeding journeys.
Amy Clark
Thank you for this, but how are NONE of these correct answers?
I would think A, B & E are reasonably correct practice.
Anne Eglash
Sorry for the confusion. The list above the question is just a list of ideas. There are no ‘options’ to choose from for the actual question. We just want people to share their ideas for what they are doing to cope the the Corona Chaos as they try to help breastfeeding families
Amy
Thank you! That makes more sense. By the way, will you be cancelling your trip to Northern CA? I was looking forward to the conference… 🙁
Anne Eglash
Hi, the conference in Placer County is cancelled, and I would not be able to travel anyway!
SLW
We have already started instituting all of these steps. Our network is on lock-down, essentially. Our biggest issue is PCPs to see the babies because offices are closed and in-person lactation support.
Mary Enger
I am an independent lactation consultant; RN,BSN,IBCLC.
I am continuing to do home visits. I am wearing a mask even though I am symptom free, as a measure of protection for myself and my clients. Of course I am washing hands. I am only coming closer than 6 feet when needed to do the breastfeeding work.
I facilitate a breastfeeding support group which we are now running via Zoom. This allows for discussion and connection between moms and with me.
These are ways that keep timely and appropriate care coming to nursing dyads, and also keep moms in touch with each other and me. Isolation can be very compromising, so we are trying to be creative to keep connections flowing.
Martin Lalinec Michaud
What about post partum care for BF dyads. At my hospital, they will prevent skin to skin for anyone with a possibility of covid-19 (risk factors + URI),
The baby should be at a distance of at least 6 ft when not breastfeeding.
Any thought about that. It seems a bit drastic. I have not read that babies were particularly at risk for Covid-19, nor that these kind of measures were effective.
IBCLC in KC
I work in a pediatric primary care clinic that is part of a large pediatric hospital system. All pediatric ill visits are being triaged and either seen via telehealth, urgent care or ED as appropriate. In clinic we are only seeing newborns, weight checks, and well child checks from 2 months through 15 months. We have one IBCLC in clinic to help with feedings and complex problems. We have other IBCLCs working from home making follow up phone calls and answering calls to our helpline. Only one family member or support person is allowed to come with mom and baby to the visit and everyone is screened for symptoms and exposures. If an IBCLC is sick or has an exposure, they work from home and are not allowed to work in clinic. The stress our families are feeling right now is palpable. They need our support more than ever in a safe and responsible way. Although it’s not necessarily accessible to the lower income moms and babies I see, several of our local private practice IBCLCs are offering telehealth visits. One of the largest birth hospitals in the area is also starting virtual breastfeeding support groups this coming week.
Paula Hart/MOMS Lactation Resource Center
In my private consulting business we were seeing a slight uptick in questions/referrals just before all the news of Covid-19 broke. Now we are back to ground zero – no one is contacting us.
So in an effort to be proactive but safe we are trying to have a place in online discussion groups posting the current information, private messages to women who have recently been seen by the two of us, and studying the information about breastfeeding and Covid-19 as it comes out. Thanks to you Anne at IABLE for helping keep all of us up to date on ever-changing information. Or the lack thereof as it may be as it relates to breastfeeding and infection with this virus. It’s too new to have much information, or studies.
Shua Vang
I work on a postpartum unit here in Madison, Wisconsin as a RN and CLC. Currently our weekly breastfeeding support group is cancelled. We have a separate unit specifically for PUI and Covid-19. Birth Suites staff will do the labor and delivery part on their unit. The postpartum staff will care for the patient on the designated unit. Baby will be cared by a another staff in a separate room and will go out to feed when mother is in proper ppe. If the mother chose to keep the baby in her room, then only one nurse will care for mother and baby. The baby will be 6 ft away from the mother in the room if baby is not breastfeeding. The LC will connect with the patient via telephone or video conference. The LC will visit the patient in the event there is a need for that level of assistance. The main RN should be able to assist with the basics like breastfeeding or pumping assistance. When visiting patient on the convid unit, the LC will change to into hospital scrubs first before she puts on hospital ppe. She will then change back into her own scrubs before coming back to the regular unit. Our Warm Line is available for breastfeeding support over the phone.