Study affirms that mothers with COVID-19 should not be separated from newborns
Temporarily separating mothers with confirmed or suspected COVID-19 from their newborns and disrupting skin-to-skin care, rooming-in and direct breastfeeding was “associated with harm and may be unnecessary,” according to researchers.
The findings are from the COVID Mothers Study.
When less was known about COVID-19, the AAP recommended that mothers with suspected or confirmed COVID-19 be temporarily separated from their infants. Since then, AAP rescinded its recommendation.
“When we launched the study, infants were routinely being separated from infected mothers without evidence that it would benefit them,” Melissa Bartick, MD, MS, FABM, a hospitalist at Mount Auburn Hospital and coauthor of the COVID Mothers Study, told Healio Primary Care. “We needed to answer the urgent question about whether this was necessary and if it caused any harm.”
Bartick and colleagues performed a retrospective cohort study of 357 mothers who had confirmed or suspected SARS-CoV-2 infection. The study participants were part of an anonymous, worldwide, online survey conducted between May 4 and Sept. 30, 2020. Most responses came from the United States, Europe and Latin America. There were no “eligible responses” from women in China, Japan or India.
Among mothers who had SARS-CoV-2 infection within 3 days of birth, 7.4% of their newborns had tested positive, according to the researchers.
Bartick and colleagues reported a nonsignificant decrease in risk for hospitalization among newborns who roomed-in, directly breastfed or experienced uninterrupted skin-to-skin care (P > 0.2 for all). Newborns who did not directly breastfeed, experience skin-to-skin care or room-in within arms’ reach were significantly less likely to be exclusively breastfed in the first 3 months, after the researchers adjusted for maternal symptoms (P 0.02 for each).
In addition, after adjusting for maternal symptoms, the researchers did not find “a statistically significant protective effect of exclusive breastfeeding” in the first 3 months of life on the combined outcome of contracting SARS-CoV-2 infection or getting symptomatic disease among infants aged less than 1 month. Also, among 129 women with confirmed or suspected infection, 27.9% reported separation from their newborn “due to COVID-19.” Among this group of women, 58% said they felt “very upset or distressed” because of the separation, 78% reported feeling at least “moderate distress” and 29% said despite trying, they were unable to breastfeed their child after being reunited. These mothers and newborns were separated an average of 6 to 7 days.
“We expected moms who did not receive [skin-to-skin care, rooming-in and direct breastfeeding] would be less likely to exclusively breastfeed, but the degree to which thiswas true was remarkable,” Bartick said. “The nonsignificant trend in the decrease in hospitalization for infants who received these practices was also surprising.”
Bartick also said a physician’s decision to keep mother and newborn from engaging in skin-to-skin care, rooming-in and direct breastfeeding should only be done “after a very careful consideration of risks to mother and child when there is a new pathogen.”
“Breastfeeding is not dispensable in a pandemic,” she added. “On the contrary, it is vital that it be preserved.”
Perspective
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As with every part of life since the onset of the COVID-19 pandemic, the standard practices of a woman’s labor, delivery and postpartum experience have had to change over the last year. Without any data to inform their decisions, obstetricians and pediatricians across the world have had to decide how restrictive to be in their recommendations for contact between a mother and baby in the setting of a known, or suspected, COVID-19 infection. For many, this meant completely isolating an infected mother from her brand-new infant. As one might imagine, this breaking of the mother-baby dyad has grave implications for the emotional well-being of the mother as well as the early development of her baby, especially regarding infant breastfeeding.
This study by Bartick and colleagues is beneficial as a contribution to our understanding of COVID-19 transmission, specifically in the obstetric and pediatric communities. Similar to a few studies that have come before it, the investigators here find that it is likely not necessary to separate mothers from their babies.
In addition, Bartick and colleagues found that direct contact and continued breastfeeding between mother and baby is likely safe and beneficial, even in the setting of maternal infection with COVID-19. Among the positive implications of this finding is the associated decrease in maternal stress and increase in continued breastfeeding that comes from allowing proximity between mother and infant. This study has some limitations in its design and its findings should be interpreted in that context, but as a part of a larger body of evidence, this study helps arm providers with evidence to make educated recommendations to their postpartum patients while navigating the uncertainty of life during the COVID-19 pandemic.
Assistant professor, department of obstetrics and gynecology, Virginia Commonwealth University
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