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. There is also evidence that mothers with Covid-19 pass their antibodies to their baby through breastmilk, thereby giving protection to their baby. 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 is important that we 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 (see N. Rollins, 2021). 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 fluid-resistant face mask
- 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.
See the NHS website for further information.
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. Should mothers and babies be separated during the Covid-19 outbreak?
No. There is good evidence that the baby is safer when mothers and babies remain together and practice skin-to-skin contact and rooming in during the day and night, whether or not the mother or her baby has suspected, probable or confirmed Covid-19.
9. 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.
10. 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. Therefore, supporting breastfeeding through this crisis and in particular on neonatal units remains very important. 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 may therefore be separated from her baby 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 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. This does not apply to the majority of mothers with a baby on the neonatal unit.
11. Can my organisation distribute infant formula to families who cannot access first stage infant milk?
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 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.
12. When should parents wear face masks?
When babies are being cared for on a postnatal ward 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.
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 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.
13. Can mothers receive a Covid-19 vaccine while breastfeeding?
Updated 1st March 2021
Evidence suggests that women who are breastfeeding can be offered a Covid-19 vaccine as part of the mass vaccination programme.
Planning a conversation
When planning a conversation with a mother about the use of the vaccine, it is important to consider her individual situation and how she feels about breastfeeding, how she feels about the vaccine and what her original plans regarding how long to breastfeed were. The following may be useful to explore:
- Breastfeeding has many short- and long-term benefits for mothers and babies and the longer they breastfeed the greater the advantages.
- Breastfeeding protects babies from infections, including respiratory infections.
- These vaccines are new and have not yet been tested on pregnant or breastfeeding women or babies. Evidence from other non-live vaccines indicates that there is no known risk associated with them being given to breastfeeding women. Further studies will be undertaken as soon as possible to confirm that the Covid-19 vaccines are also, as expected, low risk.
- Guidance for women who may have recently stopped breastfeeding and would like to get support on maximising breastmilk and re-lactation.
- For women in frontline roles, it may be possible to talk to their employer about their desire to continue breastfeeding and to discuss having the vaccine or alternative ways of working. Employers are required by law to protect the health and safety of breastfeeding mothers and their babies.
- For women with health issues that make them particularly vulnerable to Covid-19, a discussion around having the vaccine should take place related to starting or continuing breastfeeding, their level of risk and their current health.
- For women who do not fall into the current categories for priority vaccination, they should continue to do all they can to protect themselves from Covid-19 in line with government recommendations and continue breastfeeding as normal.
For more information see:
Useful links and references
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
- Bliss report: Locked Out: The Impact of COVID-19 on Neonatal Care
- Drug treatments for breastfeeding mothers with Covid 19
- GOV.UK Safer Medicines in Pregnancy and Breastfeeding Consortium
- GOV.UK COVID-19 vaccination: a guide for all women of childbearing age, pregnant or breastfeeding
- Hearts Milk Bank
- Journal of Neonatal Nursing: The implications of face masks for babies and families during the Covid-19 pandemic – A discussion paper
- Public Health England – Guidance for households
- NHS: Supporting pregnant women using maternity services during the coronavirus pandemic: Actions for NHS providers
- 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 FAQs: Breastfeeding and COVID-19 for health care workers
- WHO Infant and young child feeding
- WHO Q&A on Covid-19, pregnancy, childbirth and breastfeeding
- WHO video on Covid-19 and breastfeeding (available in Spanish, Portuguese, Thai, Nepali, Maithili, Bahasa and Japanese)