In an earlier post, we discussed how COVID-19 can become so severe as to require that the patient be put on mechanical ventilation, which also means that doctors must also induce a coma. Along with being unconscious, such a patient would be in a prone (tummy/chest down) position with a lot of instrumentation connected to her. She would also be in what’s called a negative pressure isolation room, which keeps infectious particles, such as viruses, flowing only from the outside in, while room air is removed through special filters. All this would be in an intensive care unit (ICU) and getting to such a patient would require health workers to don (put on) personal protective equipment (PPE) with particular procedures before entering the room, and then to follow particular doffing procedures on the way out, to get the pieces of equipment off in the correct order. To help protect those who are caring for patients, whenever possible, there are people in the donning and doffing areas whose role is to watch over PPE donning and doffing, making sure that health workers follow the correct procedure. It’s quite a big deal to get people into and out of a room of a COVID-19 patient, so, as you might imagine, moving a newborn into and out of such an environment might compete with the process of preparing for a spacewalk.
Considering all of this, the prospect of a severely ill COVID-19 mother nursing might not sound realistic, but as we also discussed in previous posts, the majority of people with COVID-19, particularly those who are young to middle age women, do not become severely ill. If you have no medical conditions, if you don’t smoke, and if you become infected with the SARS-CoV2 virus (the virus that causes COVID-19) near the end of your pregnancy, or after giving birth, most likely, you will suffer no more than symptoms ranging from those of a common cold to those of a mild to moderate flu. If you suffer a moderate case of COVID-19, then you may suffer some amount of breathing difficulty as well, so there are a range of reasons that might need hospitalization.
Particularly if you are in a non-ICU hospital setting, there is nothing about COVID-19 that would interfere with your ability to produce milk, but if you have COVID-19 then you are extremely contagious. The same is true of a woman who suffers from symptoms suggesting that she might possibly have COVID-19; until the answer is known, she is considered to be a person under investigation (PUI). Considering such scenarios, numerous unknowns concerning the SARS-CoV2 virus, and experience with two other human coronaviruses (SARS-CoV1 and MERS-CoV), the US Centers for Disease Control and Prevention (CDC) has issued certain recommendations. These include that infants who may possibly have COVID-19 should be isolated from other infants and also that new mothers who are hospitalized for COVID-19 and their doctors should decide on a case-by-case basis as to whether to they and their newborns should be separated. According to the CDC website, the decision should be made based on the following:
- The clinical condition of the mother and of the infant
- SARS-CoV-2 testing results of mother and infant. If both are negative or both are positive, there is no need to separate them.
- Desire to feed at the breast
- Capabilities of the facility (to keep the mother and infant separate)
- The ability to maintain separation upon discharge
- Other risks and benefits of temporary separation of a mother with known or suspected COVID-19 and her infant
After the above CDC recommendations were published, a handful of obstetric medical experts were interviewed for an article appearing on Medscape (the physician-oriented arm of the outlet WebMD). In the article, the experts were quoted suggesting that the recommendation even to consider separating mothers and newborns is not evidence-based.
However, the CDC also has issued precautions that should be used by mothers who are COVID-19 positive (or are PUIs) and who choose to remain with their infants. These precautions are as follows:
- Use physical barriers, such as curtains, between you and the newborn and stay at least 2 meters (6 feet) apart
- If you feed at the breast, use a face mask and clean your hands before each feeding
- If you are not breastfeeding and no other healthy adult can care for the newborn, if you have COVID-19, or are a PUI, put on a face mask and clean your hands before each feeding and before other close contact with the infant
Additionally, you should follow CDC recommendations on HOW to wash your hands, making sure that you spend time soaping and scrubbing your fingers in particular.