BREASTFEEDING & COVID-19

Kellie Eason RN, RM, IBCLC

Kellie is a Nurse, Midwife and International Board Certified Lactation Consultant in private practice, with over 25 years experience.  
She has a special interest in providing personalised support for families with complex infant feeding issues as well as Gentle Sleep & Settling Solutions for Newborns to 3 Year Olds.   
Working collaboratively with holistic practitioners at Osteo 4 Kids & Adults in Preston, & Family Tree Health in Briar Hill, Melbourne, Kellie also supports families via in home & Skype/FaceTime Consultations.

FOR MOTHERS WHO ARE UNABLE TO BREASTFEED OR PROVIDE BREASTMILK TO THEIR BABIES
During pregnancy, mothers pass antibodies to her fetus through the placenta.
These proteins circulate in the infant’s blood for weeks to months after birth, neutralizing microbes or marking them for destruction by phagocytic immune cells that consume and break down bacteria, viruses and cellular debris.
This is the passive immunity that you provide your baby.

This article is intended as a health promotion measure and is NOT INTENDED to infer any guilt or shaming of mothers who are unable to breastfeed.  Please know that we health professionals are well aware that not all mothers can breastfeed and I want you to be reassured that if you have tried but couldn't, just know that the efforts you have made, do make a vital difference to the health and wellbeing of your children.

Also, how great is it that your body is capable of transferring immunity that lasts for weeks, even months for your baby?

BREASTFEEDING & COVID-19 THE FACTS TO DATE
The Royal College of Obstetricians & Gynaecologists have identified that there is no evidence that COVID-19 can be carried in breastmilk.  So it’s felt that the well-recognised benefits of breastfeeding outweigh any potential risks of transmission of COVID-19 through breastmilk.

The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.

A discussion about the risks and benefits of breastfeeding should take place between you and your family and your maternity team.

This guidance may change as knowledge evolves.

If you choose to breastfeed your baby, the following precautions are recommended:

•         Wash your hands before touching your baby, breast pump or bottles
•         Try and avoid coughing or sneezing on your baby while feeding at the breast;
•         Consider wearing a face mask while breastfeeding, if available
•         Follow recommendations for pump cleaning after each use
•         Consider asking someone who is well to feed expressed breast milk to your baby.

If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.

HOW BREASTMILK PROTECTS BABIES AGAINST INFECTIONS
The list below describes just 18 out of over 200 beneficial health components of breastmilk.
A description of each will help you understand how it is beneficial in protecting infants from infections and given the COVID-19 Pandemic, why it is ever so important for parents to be informed about this.

Enteromammary Pathway
When mothers are exposed to harmful viruses and bacteria within their immediate environment, their immune system  builds extra antibodies and immune factors which are then passed onto the baby through breastmilk.  

​This is one of the ways that breastfeeding provides natural immunisation for infants during viral and bacterial illnesses and why it is recommended to continue breastfeeding and providing breastmilk to infants during the COVID-19 Pandemic.

Secretory IgA, IgG, IgM, IgD and IgE

• Secretory IgA colonises in abundance within the gut and respiratory tract.
• These secretory immunoglobulins bind to harmful respiratory and gastrointestinal viruses, bacteria and parasites, inhibiting them from infecting the body
• Overgrow within the gut to out crowd harmful bacteria, preventing infection
• ​Prevent bacteria from binding to respiratory and intestinal mucosal surfaces
• Minimises inflammation and repairs damaged tissue

​Human Milk Oligosaccharides

• Prevent infection by Intercepting bacteria and forming complexes that the baby then excretes
• Adhere to bacteria and viruses, eliminating them from the body
• Envelopes and damages the cell membranes of the chicken pox virus

​Interferon
Strong antiviral activity

HAMLET (Human Alpha-Lactalbumin Made Lethal to Tumour Cells)

• Kills tumour cells, by scavenging and destroying them
• Currently in trial for cancer therapy featuring promising results

Lactoferrin

• Binds iron atoms within breastmilk to starve bacteria which rely on iron for survival
• Enhances iron absorption, delivering more oxygen and nutrients to maintain the immune system
• ​Disrupts carbohydrate consumption by staphylococcus aureus (pathogenic bacteria)

B12 Binding Protein
Starves pathogenic bacteria that relies on Vitamin B12 to thrive

Fibronectin

• Repairs inflamed and damaged tissue
• Activates the detection and elimination of harmful bacteria not already detected by immunoglobulins

Leukocytes

• White blood cells that protect the breast from infection
• Directly fight infection and activate further immune defense mechanisms
• Secrete enzymes to destroy bacterial cell walls
• Abundant in the infant gut, ingesting and destroying pathogenic gut bacteria
• Send out chemical messages to other parts of the immune system to mobilise and invade infection, furthering the infant's immune system
• Proliferate in the presence of e.coli which can cause necrotising enterocolitis, a fatal gut infection predominantly affecting premature infants

Probiotics

• Lactobacillus, Staphylococcus, Enterococcus, and Bifidobacterium are amongst many strains of probiotics within breastmilk
• ​Has been found on infant skin and within the gut to protect against infection
• Faciliate development of the immune system
• Creates a healthy gut microbiome
• Reduces likelihood of constipation
• Reduces eczema
• Reduced risk of fungal infections
• Faciliates absorption of vitamins and nutrients

Lysozyme
Disrupts bacterial proliferation by destroying their cell walls

Cortisol/epidermal growth factor/nerve growth factor/insulin-like growth factor and somatomedin C
Until approximately 4-6 months of age, the infant's gut lining is highly permeable and most vulnerable to absorbing infections pathogens.

These factors help to close up the leaky gut lining of the newborn, making it relatively impermeable to unwanted pathogens and other potentially harmful agents

LA LECHE LEAGUE INTERNATIONAL'S MEDIA RELEASE RE: COVID-19 AND BREASTFEEDING
Mothers who become infected with COVID-19 shortly before giving birth and then begin breastfeeding, and those who become infected while breastfeeding, will produce specific secretory IgA antibodies and many other critical immune factors in their milk to protect their nursing infants and enhance their infants’ own immune responses.

At this time, these immunologic factors will aid their infants’ bodies to respond more effectively to exposure and infection. Following good hygiene practices will also help reduce transfer of the virus.
If someone who is breastfeeding becomes ill, it is important not to interrupt direct breastfeeding. The baby has already been exposed to the virus by the mother and/or family and will benefit most from continued direct breastfeeding.  Any interruption of breastfeeding may actually increase the infant’s risk of becoming ill and even of becoming severely ill.

Disruption of breastfeeding may lead to several issues:

• significant emotional trauma for the nursing baby or toddler,
• a drop in milk supply due to the need to express milk,
• later breast refusal by the infant due to the introduction of bottles,
• a decrease in protective immune factors due to lack of direct breastfeeding and expressed milk not matching the infant’s needs at a particular time, and
• an increased risk of the infant becoming ill due to lack of immune support from direct breastfeeding.​

A FEW FACTS
1. DID YOU KNOW YOU CAN RELACTATE and RE-ESTABLISH YOUR BREASTFEEDING?
Did you know that if you commenced breastfeeding or expressing breastmilk, you can seek support from an IBCLC to restore your ability to breastfeed and lactate?

Not matter the amount of breastmilk a mother provides to her baby, she is still transferring these powerful immune factors to her baby which have been proven to reduce the risk of respiratory borne illnesses amongst infants.

A consultation is needed to assess:

• Asses and manage any medical conditions which affect breastmilk production
• Your breastfeeding and lactation history in order to provide you with an estimate as to how long and what your chances are of establishing either a complete or partial ability to breastfeed/lactate
• Your current feeding circumstances in order to give you the best chance of achieving your relactation/breastfeeding goals

As a general rule of thumb, the more recent you have ceased expressing or breastfeeding, the quicker and higher your chances are of re-establishing breastfeeding and lactation.

For example, if you stopped breastfeeding or expressing 2 weeks ago, it may take as little as 2 weeks, to re-establish breastfeeding and lactating.

2. IF YOU ARE THINKING OF STOPPING BREASTFEEDING OR EXPRESSING BREASTMILK
It is more certain now than ever, that now is not the time to stop as you are providing the best immune protection for your baby not only against COVID-19, but a host of other breastfeeding/breastmilk preventable illnesses such as Type 2 diabetes, Obesity and Leukaemia

There is no vaccine against COVID-19 and babies have immature immune systems and where possible, need to be boosted with protective breastmilk.

If you are struggling with breastfeeding or expressing breastmilk, please seek help (see information at bottom of this article)

3. BREASTMILK & BREASTFEEDING DOESN'T HAVE TO BE "ALL OR NOTHING" 
Whether an infant's diet is solely or partially based on breastfeeding and/or breastmilk, any amount of breastmilk has proven benefits to the health of all infants.  Obviously the greater the amount of breastfeeding or breastmilk a baby receives, the better the immune protection. 

All breastfeeding and all breastmilk feeding counts, no matter how much!

​4. DONATING BREASTMILK OR ACCESSING DONATED BREASTMILK

• There are many children who rely on donor breastmilk.
• Some have allergies or severe intolerances to infant formula
• ​Some are unable to access infant formula
• Some infants have leukaemia and depend on the availability of human breastmilk

If you have a breastmilk supply that exceeds the needs of your own infant's needs, please consider expressing and donating this breastmilk for children in need.

Discussing human breastmilk donation is an article in itself, so I will refer you to these sites for more information:

• ​EATS ON FEETS
• HUMAN MILK FOR HUMAN BABIES​

IF YOU NEED HELP
For us here at MILK...early parenting support, it is business as usual, with extra precautions within our clinic and for home visits due to the COVID-19 Pandemic.  

• We screen all patients at risk and offer them online bookings 
• We screen all patients on the day of appointment and may change the appointment to an online booking
• I am doing all that I can to protect myself and others from COVID-19 

Hygiene measures as to the WHO COVID-19 guidelines have been in effect such as:
1. Screening patients as above
2. Asking patients to wash their hands with our sanitiser
3. Sanitising all door handles, desks, bench tops and any equipment used after each patient
4. Asking parents to change their child's nappy in their car rather than at the clinic

Please Contact us, we offer:
1. Clinic based consultation at our Preston & Greensborough/Briar Hill in Victoria Australia (click here to book online)
2. Online consultations for those of you who feel more comfortable to stay at home (click here to book online)
3. In home consultation within the Northern Suburbs of Melbourne (click here to call us 0473 799 478)

To contact an IBCLC within Australia & NZ
Find a lactation consultant directory 

For 24 hour National Breastfeeding Support
Call 1800686268

SOURCES

1. www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/
2. www.lcanz.org
3. ​www.llli.org/coronavirus-resources/
4. kellymom.com/pregnancy/bf-prep/how_breastmilk_protects_newborns/
5. www.sciencefocus.com/news/compound-found-in-human-breast-milk-has-the-potential-to-fight-cancer/