Can you conceive while breastfeeding

Coronavirus / COVID-19 and breastfeeding: current international recommendations

Annex to several newsletters 2020 and 2021

Last update: May 18, 2021, first version of the article: 03/04/2020

Glossary:

SARS-CoV-2: the causative agent of the current pandemic (often simply referred to as "coronavirus", but strictly speaking a virus that, like other viruses before, comes from the coronavirus family)

COVID-19: the disease caused by infection with SARS-CoV2

BRIEF SUMMARY OF KEY POINTS:

- Infected mothers try to prevent transmission through hygiene measures in contact with the baby, but otherwise continue to breastfeed normally (no transmission through breast milk)

- Immediately after the birth, skin contact continues and breastfeeding begins as usual, with hygiene measures (mask, etc.)

- If the mother is too sick to care for the baby, breast milk can be expressed and given without restrictions

- Pregnant and breastfeeding women are currently not vaccinated on a regular basis, as sufficient studies are not yet available. However, after individual risk assessment, it is possible and the international specialist societies consider it very unlikely that the vaccination poses a risk to the infant.

- Initial data show that women with vaccination protection pass the antibodies on through their breast milk and thus indirectly protect the child

The global pandemic has also led to major changes in our everyday lives in German-speaking countries. As medical specialists, we also accompany pregnant or breastfeeding women who are sick with COVID-19 or who are considered to be the contact person for an infected person and are therefore classified as suspected cases.

In this article, which is updated regularly, we summarize the current status of the recommendations of internationally recognized bodies in German and list relevant sources that are available to you for more detailed information.

To protect the medical care staff, contact with suspected or definitely infected pregnant and breastfeeding women should take place in accordance with the current recommendations for the care of such patients (protective clothing, isolation room, etc.) - for more information, please contact the → Robert Koch Institute ( RKI) in Germany or at the US → Center for Disease Control (CDC).

In the meantime, it's no longer just a question of how Dealing with pregnant and breastfeeding women regarding potential COVID-19 disease or an infection, but has also existed since the beginning of 2021 Questions about vaccination for this particular group. We have therefore revised our website and divided it into two areas:

→ Infection / Disease: Summary of the current recommendations

→ Vaccination: summary of the current recommendations

Infection / Disease: Summary of Current Recommendations

We refer to the following sources in our summary below:

Breastfeeding women (after the first few days)

So far, only very few individual cases have been described worldwide in which components of the pathogen were found in breast milk. In all cases, it was not a question of pathogens that had the potential to multiply and infect another person, and transmission through breastfeeding is still considered unlikely. The transmission of SARS-CoV2 in direct interpersonal contact occurs primarily via droplets and aerosols.

On the other hand, a high number of antibodies was found in breast milk during / after infection of the mother, sometimes earlier and in higher concentrations than in serum. Therefore, continued breastfeeding is most likely an active protection against infection for the breastfed child.

A previously breastfeeding mother who is now suspected or confirmed to be infected with SARS-CoV2 should take measures to avoid transmission to her child without stopping breastfeeding. This includes:
• Thorough hand washing / disinfection before and after breastfeeding as well as before and after every contact with the child
• Wear a suitable face mask every time you come into contact with the child

It is possible to continue breastfeeding. If the mother does not feel that she is in a healthy position to do so, she can express breast milk and it can be fed by a healthy caregiver without restriction.
If the mother pumps milk, careful hand hygiene is to be observed; vessels and pump sets should be sterilized after each use.

Pregnant women and peripartum management

A basic distinction must be made as to whether the pregnant woman is a suspected case or an infection that has already been confirmed. If a mother-to-be, who has not yet been tested but is suspected, begins giving birth, it is urgently necessary to carry out a test and clarification as soon as possible. If an infection can be ruled out, this means an enormous relief of the situation for mother, child and also the caregivers.

Transmission from the infected pregnant woman to the unborn child in the womb is possibly possible but very unlikely. In principle, pregnant women do not seem to be affected by the infection more often than other parts of the population of a comparable age and state of health. There is evidence that pregnant people who are infected develop symptoms less often, but have an increased risk of severe disease, especially if other risk factors are present.

The mode of delivery should be determined individually, regardless of a SARS-CoV2 infection, based on obstetric indications and the woman's wishes. WHO and DGGG recommend performing a caesarean section only if it is medically necessary, e.g. due to the mother's state of health.

The international recommendations on a potential mother-child separation if the mother is definitely infected have come to a consensus in recent months: the child should be isolated with the mother and remain in the rooming-in, provided the mother's state of health allows it. Immediately after delivery, mothers should have full skin-to-skin contact with their child and begin breastfeeding, while carefully observing all necessary hygiene measures to minimize the risk of infection for the child. Mouth and nose protection should be worn whenever there is contact with the child and hand hygiene should be practiced.
The German-speaking professional societies recommend unrestricted skin-to-skin contact while avoiding the exchange of mucous membranes ("stroking yes, kissing no").

According to the current state of knowledge, newborns from infected mothers are no more health endangered than other children. If they are actually infected with SARS-CoV2, the course of the disease is mild in almost all cases.

Separation of mother and child does not seem to reduce the risk of transmission. If separation is necessary because of the mother's state of health, careful consideration should be given to where and by whom the newborn child can be cared for. A child born to a mother who tested positive is considered a contact person / suspected case.
At the moment, the recommendations include that in this case, until the end of the test to determine whether it is itself infected, healthy relatives or medical staff may also only be looked after in protective clothing. In the interest of the newborn, it is therefore important to carry out a quick test.

Since breast milk is not considered a likely carrier of the virus, if the mother breaks up, the mother can express her milk and the milk can be given to the baby without restriction. Special hygiene measures must be observed when pumping (see above).

Practical questions for health workers accompanying pregnant and breastfeeding women

Since the pandemic arrived in German-speaking countries, our lecturers and employees have often been asked for specific recommendations for practice. That is why we have published a separate article on this, which you can read in addition to the information above:

Vaccination: a summary of the current recommendations

We refer to the following sources in our summary below:

At the moment there are no extensive data on the vaccination of pregnant or breastfeeding women. The recommendations of the professional associations are therefore based on fundamental considerations about the mechanisms of action of the vaccines and on known data from previous experience with other vaccinations.

The international professional societies currently agree:

- For the time being, pregnant women should not be vaccinated regularly unless they are particularly endangered by previous illnesses or a high risk of exposure. In this case, an individual risk assessment must be carried out with the attending physician. On the basis of fundamental considerations, the risk of vaccination (both with mRNA vaccines and with vector-based vaccines) is estimated to be low.
In order to indirectly protect pregnant women, close contact persons and caring medical staff should be vaccinated.

- There is no indication of possible deviations from the rest of the population for breastfeeding women. Breastfeeding women (e.g. health workers) should therefore receive the vaccination at the normal time when it is normally intended for the person concerned.

© March, April, May, June, July and October 2020, January, February and April 2021, Anja Bier (IBCLC) for the newsletter of the European Institute for Breastfeeding and Lactation.
Collaboration: Gabriele Nindl, IBCLC and Gudrun von der Ohe, IBCLC and doctor

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