Separating mothers with COVID-19 from their newborns may be unnecessary and cause long-term harm, researchers find
Melissa Bartick, MD, MS, FABM
Cambridge, Mass. – In the wake of declaring COVID-19 a pandemic in March 2020, the World Health Organization (WHO) published guidelines recommending that new mothers with suspected or confirmed COVID-19 continue breastfeeding, maintain skin-to-skin contact and remain in close proximity with their newborns — three recommended behaviors known to promote infants' developing immune systems and overall health as well as mothers' emotional wellbeing. However, at the beginning of the pandemic in the absence of any data on infants and COVID-19, the American Academy of Pediatrics (AAP) issued initial guidance advocating separating newborns from mothers with confirmed or suspected cases of COVID-19 in March 2020, a recommendation the AAP and Centers for Disease Control and Prevention (CDC) subsequently changed with emerging evidence.
A large international study led by breastfeeding expert Melissa Bartick, MD, MS, FABM, a hospitalist at Mount Auburn Hospital (MAH), provides new evidence that the benefits of keeping mothers and infants together likely outweigh the risks of infection to babies born to mothers with COVID-19. The COVID Mothers Study, one of the largest studies of its kind to date, is a retrospective cohort study of 357 cis-gender biological mothers in 31 countries, published in the journal Breastfeeding Medicine, evaluates the benefits of mother-baby contact versus separation with regard to viral transmission, clinically significant symptoms of COVID-19, and investigates whether breastfeeding might protect infants from infection.
"In the beginning of the pandemic, mothers were often routinely separated from their infants and given little choice, with the assumption that doing so would ultimately benefit the child as it was assumed that bonding and the establishment of breastfeeding could be dispensed with without consequences," said Bartick, who is also an Assistant Professor of Medicine at Harvard Medical School. "Our study is one of the few to examine mothers' experiences of separation, and the harm this practice can bring both to the success of breastfeeding and to mothers' emotional health, which is already at risk during the pandemic."
Contradicting earlier reports that separating infants from mothers with COVID-19 may be beneficial, Bartick and colleagues' analysis of anonymous survey responses from around the world revealed that newborns of mothers who had prolonged skin-to-contact at birth, roomed in within arms' reach, and directly breastfed actually saw a decrease in the risk of hospitalization for COVID-19 — though it was statistically non-significant — compared to newborns who were taken at birth, stayed in a separate room, or did not directly breastfeed, respectively.
Furthermore, the researchers found that infants taken from their mother at birth, who stayed in a separate room, or who did not directly breastfeed, were markedly less likely than their counterparts to be exclusively breastfed in the first three months of life — a practice well known to confer immune benefits and overall health benefits to infants and to promote emotional wellbeing in both infants and mothers. Almost a third of separated mothers were unable to breastfeed once reunified with their infants, despite trying.
"Overall, we were alarmed to see just how harmful infant separation and interruption of breastfeeding is for the mother and child," said Bartick. "We saw that nearly 60 percent of mothers who experienced separation reported feeling very distressed, with nearly 80 percent reporting at least moderate distress."
Bartick and colleagues also noted that undermining exclusive breastfeeding puts infants at risk of hospitalization for lower respiratory tract infections — which are not transmitted via breast milk, the authors note — and increased infant mortality, and that delayed breastfeeding initiation increases the risk of infant mortality. Therefore, policies to separate mothers and infants could potentially result in the unintended consequence of increased risk of infant respiratory infections — including COVID-19 and influenza — if exposed later during infancy.
"Our study provides more evidence that it is important to keep mothers and infants together, and that providers and families need our data on the risk of harm of separation when making decisions about separation," said Bartick, who published an article in Maternal & Child Nutrition, last month highlighting the importance of shared decision-making between health care providers and mothers of infants in the setting of COVID-19. "This should prompt medical authorities to question the underlying assumptions of risks and benefits behind any policy decisions that include forms of separations for mothers and infants."
In addition to Bartick, co-authors included Verónica Valdés, of the Department of Family Medicine, School of Medicine, Catholic University, Santiago Chile; Angela Giusti, of the National Center for Disease Prevention and Health Promotion, NIH, Rome Italy; Elise M. Chapin, of Baby Friendly Initiatives, Italian National Committee for UNICEF, Rome Italy; Nikhil B. Bhana, John Gaughan and Lori Feldman – Winter of Cooper Medical School, Rowan University, Camden New Jersey; Maria-Teresa Hernández-Aguilar, Unidad de Lactancia, Dr. Peset University Hospital, Valencia Spain; and Elysângela Dittz Duarte, of the Department of Maternal and Child Public Health, School of Nursing, Federal University of New Minas Gerais, Belo Horizonte, Brazil and Lucia Jenkins of Baby Café USA.
No funding was received for this article. The authors declare no financial conflicts of interest. Bartick serves in an unpaid position on the Board of the Academy of Breastfeeding Medicine. For a complete list of disclosures, please see the full text of the article: https://www.liebertpub.com/doi/10.1089/bfm.2020.0353
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