Guidance for health professionals
FAQs - updated as new evidence emerges
1. What do midwives/health visitors need to discuss with pregnant mothers during the Covid-19 outbreak?
This can be an anxious time for pregnant mothers who may be worried about the wellbeing of their baby, themselves and their family. Therefore, mothers may appreciate someone to talk to who will listen to their concerns. All mothers should have the opportunity for an antenatal discussion about the value of breastmilk (particularly during the Covid-19 outbreak), getting breastfeeding off to the best start (see also meeting baby for the first time) and the importance of skin-to-skin contact. In addition, it is important to discuss with the mother how she can get to know her baby through closeness, comfort and connection and by taking the time to talk, sing and respond to baby’s movements. This can also reduce stress and will be good for the baby’s development.
2. Can women with Covid-19 breastfeed?
Yes. There is a wealth of evidence that breastfeeding reduces the risk of babies developing infectious diseases. There are numerous live constituents in human milk, including immunoglobulins, antiviral factors, cytokines and leucocytes that help to destroy harmful pathogens and boost the baby’s immune system. There is currently no evidence that Covid-19 can be passed to the baby through breastfeeding. Considering the protection that human milk and breastfeeding offers the baby and the minimal role it plays in the transmission of other respiratory viruses, it seems sensible to do all we can to continue to promote, protect and support breastfeeding. To facilitate breastfeeding, mothers and babies should be enabled to stay together as much as possible, to have skin-to-skin contact, to feed their baby responsively and to have access to ongoing support when this is needed. See question 4 below.
3. Can parents touch and hold their newborn baby if they have Covid-19?
Yes, touch, comfort and communication are vital for the baby’s wellbeing and development. Good hygiene habits are important and will keep the risks to baby as low as possible (see question 4 below). It is also useful to refer to the practical information provided by the UK governments and the World Health Organization (WHO).
4. What practical information do parents need if they have Covid-19 and are caring for their baby?
If parents/carers are infected, take precautions to limit the spread of Covid-19 to the baby by:
- Washing hands thoroughly before and after contact with the baby
- Routinely cleaning and disinfecting any surfaces touched
- Cleaning any infant feeding equipment, including breast pumps, thoroughly before and after use
- Practicing respiratory hygiene, including during feeding, for example by avoiding coughing or sneezing on the baby and by wearing a face mask or suitable alternative if available
- If a breastfeeding mother is feeling unwell, continuing breastfeeding rather than expressing may be easier and less stressful during this time. Alternatively, she may prefer for someone who is well to feed expressed breastmilk to the baby.
- If a baby is being bottle fed with formula or expressed milk, wash equipment in hot, soapy water and sterilise carefully before each use
- If the mother is too unwell to breastfeed or express breastmilk, she may be supported to once well enough. Consider using donor milk if available and applicable.
5. What can a mother do if she has Covid-19 but is too unwell to breastfeed?
This mother should be supported to safely provide her baby with breastmilk in a way that is possible, available and acceptable to her. Consider breastmilk expression by hand/pump and give via a suitable alternative method (see responsive and paced bottle feeding). Maximising breastmilk is important during this time. When the mother is feeling better, encourage skin-to-skin contact and return to full breastfeeding where possible.
6. If a mother has stopped breastfeeding and wishes to re-lactate, can this be done?
Yes. Re-lactation is generally possible and worth trying even if a return to full breastfeeding is not always achievable. Help can be found on the Unicef UK Baby Friendly guide to maximising breastmilk and supporting re-lactation.
7. Is it safe to use donor breastmilk during the Covid-19 outbreak?
Donor breastmilk that has been through a screening and pasteurisation process from a UK breastmilk bank can be used. Mother’s own milk should always be the first choice as this is responsive to her and her baby’s environment. Speak to your local breastmilk bank to ensure that screening and pasteurisation processes comply with the National Institute of Clinical Excellence [CG93] and the European Milk Banking Association Covid-19 guidelines. See also UKAMB and Hearts Milk Bank.
8. Is sharing breastmilk safe during the Covid-19 outbreak?
Informal breastmilk sharing is not recommended. Although the virus has not been detected in breastmilk, it can stay on the surface of containers and can also be passed via close contact with a person who may not be aware they have any symptoms.
9. Should mothers and babies be separated during the Covid-19 outbreak?
Whether or not the mother or her baby has suspected, probable or confirmed Covid-19, she should be enabled to remain with her baby, practice skin-to-skin contact and room-in throughout the day and night, especially after birth and during the establishment of breastfeeding. See WHO guidance.
10. Can mothers still express breastmilk for a baby on the neonatal unit?
Yes. Breastmilk is essential for sick and preterm babies as it significantly reduces the risk of serious complications both in the short and long term. Mother’s own milk should always be the first choice as this is responsive to her and her baby’s environment (particularly important during Covid-19). Mother should be supported to express as soon as possible after birth (ideally within 2 hours) and thereafter at least 8-10 times in 24 hours, including at night.
11. Can mothers who have suspected or confirmed Covid-19 still provide expressed breastmilk for their baby on the neonatal unit?
The importance of breastmilk and breastfeeding for all babies during the crisis has been confirmed by WHO and PHE. Therefore, supporting breastfeeding through this crisis and in particular on neonatal units remains very important. However, because the number of Covid-19 positive mothers with a baby on the neonatal unit has been very small thus far, there is very little evidence to guide practice. We recognise that this is a very difficult situation. Neonatal units can be very short of space, with numerous people caring for babies in close proximity to each other. A mother with suspected or confirmed Covid-19 will be contagious during her illness, meaning that the risk to babies, parents and staff is significant within the neonatal environment. She will therefore be asked to stay at home during her illness. A sensible approach to protect breastfeeding while ensuring safety seems to be to support the mother to maintain her milk supply through expressing, with her milk given to her baby if at all possible. If that is not possible, donor milk would be the second choice. It is also likely that the mother will have some stores of her own milk that can be used if her baby has been on the unit for a while. This situation is a reminder of the importance of supporting early and effective expressing to build up the milk supply. Once the mother is no longer contagious, it is very important that she be reunited with her baby and supported to express, breastfeed and continue building their relationship.
It is worth noting that these recommendations apply only to mothers who are suspected or confirmed Covid-19 positive, at present this applies to a very small number of mothers. It does not apply to the majority of mothers with a baby on the neonatal unit.
12. Can my organisation distribute infant formula to families who cannot access first stage infant milk?
During the coronavirus (Covid-19) outbreak there has been concern that parents cannot always access infant formula in the shops because of low stocks. There is also concern that families who are self-isolating may struggle to obtain infant formula and that the financial situation of some families is deteriorating rapidly, with the benefits system taking time to catch up. Some health services have considered obtaining supplies of infant formula and distributing this to families in need. Article 6.6 and 6.7 of the International Code of Marketing of Breastmilk Substitutes cover this and state that supplying infant formula is acceptable providing that the supplies are continued as long as the infants concerned need them. This means that services cannot simply supply one or two tins of formula and then leave the family without any further access to formula. Supplies must continue until the family are able to access formula in the normal way, e.g. once their benefits arrive and/or the stocks in shops improve and/or they come out of isolation – only then is it acceptable to cease provision. Normal care and safeguarding considerations still apply. Obviously, there should be no free samples from the manufacturers and nothing that could be interpreted as a sales inducement. Infant formula must be supplied only for babies that are already being formula fed.
13. When should parents wear face masks?
Early attachment between the mother (and/or other parent) and baby is critically important for the baby’s wellbeing and development. It is important to support new mothers to keep their babies close to them so that they can respond instinctively through gazing, stroking and talking. Infant cues such as smiling, crying or other facial expressions are powerful motivators of maternal behaviour, helping the mother to communicate and form attachments with her baby. In response, the baby learns to recognise his mother’s face, posture, tone of voice and to form a secure attachment. The baby’s brain grows rapidly from birth and at one year will have developed 70 per cent of its ‘wiring’ for the future and 90 per cent by age three. The development of positive neural pathways is significantly impacted by early parent-infant relationships.
With this in mind and based on the latest review of the evidence (Renfrew et al, 2020), we recommend that parents who are asymptomatic are not required to wear a mask when interacting with their baby. If a mother/parent has suspected or confirmed coronavirus, she/he should wear a mask when handling the baby, but enabled to remove it and interact visually with the baby at a safe distance.
When babies are being cared for on a neonatal unit, parents can be asked to wear a mask when entering and moving around the unit. However, providing that they are asymptomatic, steps should be taken to enable them to interact with their babies without wearing a mask.
Useful links and references
A range of Baby Friendly resources on infant feeding and supporting close and loving relationships can be found at: Unicef UK Baby Friendly Initiative.
Telephone support for parents: National Breastfeeding Helpline 0300 100 0212 from 9:30am to 9:30pm, 7 days a week. Live online support via web chat. Information on infant formula can be found at: First Steps Nutrition Trust.
You can also find more information at:
- BAPM Perinatal Covid-19 Resources
- BAPM Human milk and SARS-CoV-2 – A summary of knowledge to date
- BAPM / BLISS Family Integrated Care for Covid-19 – Frequently Asked Questions
- Hearts Milk Bank
- Public Health England – Guidance for households
- RCM Advisory Group Optimising mother-baby contact and infant feeding in a pandemic
- Royal College of Obstetricians and Gynaecologists
- Royal College of Paediatric and Child Health
- Unicef Infant & Young Child Feeding in the Context of Covid-19
- WHO Clinical management of severe acute respiratory infection when Covid-19 is suspected
- WHO Q&A on Covid-19, pregnancy, childbirth and breastfeeding
- WHO FAQs: Breastfeeding and COVID-19 for health care workers