The first week in August is World Breastfeeding Awareness Week and the aim is to highlight the benefits that breastfeeding can have on the health and welfare of babies and their mothers. The NHS promotes breastfeeding and advises that any amount of breastfeeding is beneficial for both mother and baby.
During the coronavirus pandemic, mothers have been advised to continue breastfeeding their babies. Based on the Royal College of Paediatrics and Child Health’s (RCPCH) Research Evidence Summaries, there is currently no evidence that Covid-19 can be passed through breastmilk and that the benefits of breastfeeding outweigh any risk of potential transmission.
The caveat to this is that mothers with suspected or confirmed Covid-19 should ensure they follow good hygiene practices by washing their hands and not coughing or sneezing on their baby. Unless breastfeeding is not possible for medical reasons, the continuation of breastfeeding should be supported and encouraged.
In recent years, the NHS has encouraged mothers to harvest their very first milk, the colostrum. This is rich in nutrients and antibodies and can be collected during pregnancy and frozen in syringes for the baby following birth. Colostrum harvesting is often encouraged in the third trimester of pregnancy so that it is available for the baby should the mother choose not to breastfeed or be unable to breastfeed due to medical complications.
For mothers who decide to breastfeed, the NHS advises that breastfeeding exclusively for six months offers the most protection. This includes:
From six months onwards, breastfeeding can be combined with the introduction of solid food. The baby will continue to be protected from infection.
The NHS Start4Life information page confirms that mothers can benefit from breastfeeding. As well as bonding with their baby, breastfeeding can help reduce the size of the uterus more quickly, lower the risk of breast cancer, ovarian cancer, osteoporosis, diabetes and cardiovascular disease, and help burn calories.
Despite the well-recognised benefits of breastfeeding, a study conducted by The Lancet reveals that the UK has one of the lowest rates of breastfeeding in Europe. The 2010 Infant Feeding Survey found that, although more than eight of out ten UK mothers started breastfeeding, only a third (34%) of babies were still receiving breast milk at six months and, by 12 months, only 0.5% of UK babies were still being breastfed.
Lack of support and guidance may be one reason why the breastfeeding rate is so low in the UK. Unfortunately, breastfeeding is not always straightforward and physical difficulties can include problems with the baby's latch on to the nipple, painful chapped and bleeding nipples, and conditions such as mastitis. Breastfeeding can also be emotionally and physically exhausting with young babies often feeding on demand or cluster feeding for hours.
The 2010 Infant Survey reported that maternal concern about milk supply often resulted in advice to supplement with formula feeding. This then affects a mother’s milk production and is strongly associated with lactation failure and prematurely stopping breastfeeding.
The RCPCH has reviewed these findings and made recommendations that all paediatricians should be aware of breastfeeding guidelines and be able to provide support to mothers, including those with pre-term or poorly babies, to breastfeed.
Paediatricians should be trained to avoid undermining breastfeeding by inappropriate formula ‘top-ups’ and should try to ensure that systems and environments support breastfeeding, including keeping mothers and babies together. Paediatricians should also be aware of the local and national support available and be able to direct mothers to these services.
Local breastfeeding networks and charities offer specialist support to mothers alongside the guidance traditionally offered by midwives and health visitors. However, during the coronavirus pandemic, many of these services have been reduced or not able to operate at all due to restrictions and mothers have therefore been left with very limited support and guidance.
For breastfeeding mothers who wish to have the Covid-19 vaccine, the Royal College of Obstetricians and Gynaecologists confirms that vaccination is recommended for breastfeeding women. It confirms that ‘there is no plausible mechanism by which any vaccine ingredient could pass to your baby through breast milk. You should therefore not stop breastfeeding in order to be vaccinated against Covid-19.’
The vaccine does not pass through breast milk but antibodies do, so it has been suggested that breastfed babies could possibly have some protection from Covid-19 as they could benefit from their mother’s antibodies.
Sarah Hibberd, an associate in the clinical negligence team at Penningtons Manches Cooper, commented: “Despite the NHS’s promotion of the benefits of breastfeeding, the UK has some of the lowest rates in Europe. Accessing support can be difficult for mothers and has unfortunately been made even harder during the pandemic.
“There are many reasons why women may not breastfeed, either through personal choice, difficulties establishing breastfeeding or as a result of medical complications. Sometimes, women who have experienced traumatic births or undergone caesarean sections can struggle to establish breastfeeding and it is vital that there is specialist support available for these women. I am pleased to see the recommendations by RCPCH as hopefully this will help to create a better understanding of women’s needs and the level of support that is required.
“The standard of care a woman receives during her pregnancy, labour and in the post-natal period is of vital importance as it forms the foundation for the parenting journey. Providing good care to help women establish breastfeeding, as well as ongoing support to maintain it, should not be overlooked as difficulties in breastfeeding can have a significant effect on a mother’s physical and mental health.”