Providing Care for Breastfeeding Dyads During COVID-19 Outbreak
by Anne Eglash MD, IBCLC, FABM
Healthcare systems are scrambling to change their operational processes, to care for their patients in a safe, organized fashion. It is critical to diagnose and treat individuals with COVID-19 during a time of limited testing capacity, but also to keep high priority patients with other health issues safe from those with respiratory illness.
This is a critical time to not expose pregnant and breastfeeding families to the COVID-19 virus, and at the same time, optimize support for breastfeeding in order to reduce maternal/child morbidity and mortality. Breastfeeding problems are often urgent issues, so cannot be put on hold. The challenge is providing direct or indirect care to breastfeeding families, particularly in health care systems, without exposing them to those with respiratory illnesses.
The Centers for Disease Control has guidance for healthcare providers on shifting their healthcare delivery modes of delivery, although there are no specific recommendations on the care of breastfeeding dyads who need breastfeeding support from a lactation consultant or breastfeeding medicine specialist.
Ideas based on advice from the CDC include:
- Use Telehealth or simply telephone calls for breastfeeding dyads who don’t need hands-on intervention such as a breast exam or weight check.
- Consider keeping anyone with respiratory symptoms out of the office, so that breastfeeding dyads coming to the office are not at risk of acquiring illness.
- Space out visits so that families do not come into contact with each other in the office.
- Home visits
- Physicians and other breastfeeding medicine care providers or consultants/counselors who are ill should NOT come into contact with breastfeeding families (or anyone else for that matter!)
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Purpose of this Document
This interim guidance outlines goals and strategies for all U.S. healthcare facilities to prepare for and respond to community spread of coronavirus disease-2019 (COVID-19). Although it is not possible to predict the future course of the outbreak, planning for a scenario in which many persons become ill and seek care at the same time is an important part of preparedness and can improve outcomes if an outbreak occurs. Therefore, preserving healthcare system functioning is paramount. It is critical for healthcare facilities to continue to provide care for all patients, irrespective of COVID-19 infection status, at the appropriate level (e.g., home-based care, outpatient, urgent care, emergency room, or hospitalization). Facilities may need to respond to a surge in patients requiring care. Concentrated efforts will be required to mobilize all aspects of healthcare to reduce transmission of disease, direct people to the right level of care, and decrease the burden on the healthcare system.
Here is what is happening in my healthcare world- We are not allowing any patients with respiratory infections into our primary care offices, not only to protect healthcare workers, but also to prevent spread to other high priority patients who are most vulnerable to morbidity and mortality from COVID-19. Patients with respiratory symptoms are being triaged by phone and sent to specific medical locations for care if needed.
We are also not seeing patients who have non-urgent health problems that can wait a few months and, for many, we are providing telephone consultation. High priority patients are scheduled in the office, such as injuries, newborns, abdominal pain, and of course breastfeeding medicine patients. A large %, if not the majority, of breastfeeding problems are urgent. Mothers have the risk of breastfeeding complications, such as abscesses, engorgement, depression, and infants run the risk of early weaning, leading to increased risk of respiratory illness if breastfeeding problems are not addressed on a timely basis. Therefore, I am seeing breastfeeding dyads in the office, and calling those who don’t need hands-on exam or intervention.
We absolutely need to keep up our momentum of caring for breastfeeding dyads, and not delay care while we are overwhelmed with COVID-19.