Breastfeeding During a Pandemic

Cathy Walker, MA, RNC, IBCLC

In pre-pandemic times, having a baby is a tumultuous experience. There are many ups and downs. There is sheer exhaustion and unimaginable joy all happening at the same time. We are not meant to parent in a bubble. Breastfeeding requires support from society, family, friends, professionals and the work environment.  ““It takes a village to raise a child” is an African proverb that means that an entire community of people must interact with children for those children to experience and grow in a safe and healthy environment.” (Wikipedia, 2021) In pre-pandemic times, I see this as a struggle for many families in modern US culture. Often family does not live close by and paid leave from work is very limited. Parents have to make a concentrated effort to reach out to friends, support groups, family and medical professionals for the support they need. Some parents may just feel tired and overwhelmed and this effort is a struggle or impossible.
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Enter the Pandemic of 2020. Pregnant parents sometimes have to attend their prenatal appointment by themselves. No partner to share in the joy of milestones. No partner to support them if uncertain news or difficult news is delivered. Tablets and phones replace that in person presence. There was a brief time in some NYC city hospitals where partners were not allowed to be in the delivery rooms with their partner. This was reversed quickly but not before many people went through this amazing, difficult, scary, wonderful, momentous time in their lives essentially alone. Parents are together in the delivery rooms again and staying together in the rooms after birth.

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Some new families stay the normal course of 2-4 days in the hospital after delivery. Some are being discharged earlier than usual. (Kuehn, 2021) That extra 24hr in the hospital allows parents to practice the latch, and take in more education on feeding and expectations over the next few weeks. Packing in 48hr of education into 24hr is hard for the staff and parents. And in the early hours after birth, a lot of information is not retained. Parents are still recovering, have adrenaline coursing through their body and are physically exhausted. 

Now parents are at home with more limited resources and access to support. Many doctors allow both parents to attend early checks for their baby. But others only allow one parent. The ability of family to travel and stay with new parents can be limited due to covid restrictrictions, their own health concerns and fear of spreading this illness. That friend who normally would drop by with coffee and a boost of cheerleading and advice from their experience can’t come over. Most support groups are now being conducted online. These are so helpful and taking advantage of all online support, connection and help is critical. But human beings miss that in- person connection. There is no doubt that this is harder. 

IBCLC’s (International Board Certified Lactation Consultant’s) have now pivoted to offering virtual consults. There are some who still provide Home Consultations. There are many issues and concerns that can be addressed virtually in Lactation. I have been amazed at what can be accomplished. But there are certain aspects that need an in-person evaluation. 

Early on in the Pandemic, people were encouraged to stay home and not see their MD unless it was urgent, putting off well checks and follow ups for medical conditions. This has resulted in more morbidity or illness. (Rosenbaum, L., 2020) The medical profession has learned, yet again, that prevention is best. With each situation being considered individually, it is being recommended now that skipping certain check ups will be more detrimental to health overall. This is certainly true for Lactation. A virtual or in-person check up at the earliest sign of issues/concerns will help prevent further problems. Usually the earlier one reaches out, the easier it is to resolve the situation. 

Some extremely positive effects have developed from this health crisis that are specific to Breastfeeding. Many hospitals are limiting visitors and keeping the babies in the rooms with parents a lot more than usual. This chance to bond, learn the babies hunger cues, feed more often on demand and have uninterrupted time to learn from nurses, doctors and lactation consultants has resulted in better breastfeeding outcomes anecdotally for many. For those utilizing the full time allotted to adjust in the hospital and ask questions and get feedback, this rooming-in without visitor interruption has a positive impact on lactation. Anecdotally it has been noted that some have experienced an earlier onset of Lactogenesis II (transitioning to mature milk with higher milk volumes). This makes sense as the babies are nursing more times in 24hr in these circumstances. Having that dedicated time to take in the teaching and ask questions is really invaluable. I have several roles in lactation. I have a private practice and I work in a hospital as a nurse and a lactation consultant. I can tell you that I don't look forward to the return of visitors. It limits our chance to provide our services. Maybe a compromise of a short window of visitation each day would be great! Those grandparents need their cuddles!!

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So what can a parent do during this Covid-19 Health Crisis? 

1.Take advantage of every single support you can! And you may have to reach out more than usual to get access to what you need. (Which is not fair). Ask friends for help with research to find extra support if needed.  Take that off your plate.
2. Schedule Zoom calls with friends to vent about all the challenges and get those tidbits of wisdom.
3. Connect with a parent support group or breastfeeding support group that meets weekly online. 
4. Take a breastfeeding class prenatally.
5. Connect prenatally with an IBCLC for a virtual visit as another option. Also just having their contact information as a backup for later is very helpful and stress reducing. 
6. Reach out to an IBCLC early if you encounter difficulties. You can always start with virtual support and move to in-person if needed.
7. Make plans before birth for in-person support with family or hired help. Planning ahead will allow everyone involved to quarantine, get tested and be as safe as possible. 
8. Acknowledge and take in that this is Hard and you can do it with your village!

References:
Kuehn, B., (2021, January 12) Covid-19 Precautions Hamper Breastfeeding Support. JAMA Network. https://jamanetwork.com/journals/jama/fullarticle/2774844

Rosenbaum, L., (2020, June 11) The Untold Toll-The Pandemic’s Effect on Patients without Covid-19. The New England Journal Of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMms2009984

Wikipedia, (2021, January 12) It Takes A Village. Wikipedia. https://en.wikipedia.org/wiki/It_takes_a_village

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