Pregnant women who become infected with the new coronavirus or are exposed to the illness it causes face more distressing news: possible separation from their newborn for up to a week or more.
That’s the recommendation of the U.S. Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecology to stop the potential spread of the virus from mother to child.
The new guidelines state "facilities should consider temporarily separating the mother who has confirmed COVID-19 or is a PUI (person under investigation) from her baby until the mother’s transmission-based precautions are discontinued." Separation guidance varies from 72 hours to seven days and in some cases up to 14 days depending on time since symptoms and recovery.
It is not known if pregnant women are more likely to get sick from the virus or what if any risk infants face if their mom has COVID-19.
The CDC recommendation notes the health risks and benefits of separation should be discussed with the mother and she should be involved in decision-making.
Hospitals including Massachusetts General Hospital and Johns Hopkins are following the guidelines.
"Transmission of COVID-19 from mother to the newborn after birth, through infectious respiratory droplets, is a concern," Mass General said on its website. "To reduce the risk of this transmission, temporarily separating a mother who has suspected or confirmed COVID-19 from her baby may be recommended by the health care team."
Breastfeeding advocates and expectant moms, however, are concerned interrupting bonding between mother and newborn will have troubling consequences.
Jessica Powell, 34, is ready to welcome her baby girl in August but isn’t sure if she wants to go to the hospital for a traditional birth amid the pandemic. She’s considering a home birth or birthing center for her fourth child.
The preschool principal from Haymarket, Virginia says she couldn’t imagine being separated from her newborn.
“It would be heartbreaking,” she said. “You’re establishing your schedule in those first couple of weeks and bonding with the baby. So, I can’t imagine that aspect being taken away.”
While the coronavirus is not known to be transmitted in breast milk, it spreads from person to person through respiratory droplets.
“It comes down to assessment of risk versus benefits,” said Dr. Jeanne Sheffield, professor and Director of Obstetrics and Maternal-Fetal Medicine at Johns Hopkins. “Right now, we have come down to say that the risk of skin-to-skin breastfeeding COVID positive moms is high enough.”
Sheffield encourages nursing mothers with COVID-19 to use a designated pump and have a healthy family member feed the baby.
A lack of skin-to-skin contact worries Rebecca H. McCormick. The president of La Leche League USA, a nonprofit that advocates breastfeeding, said separation at birth could have long-lasting effects on both baby and mother.
Research on NICU babies show early separation can cause post-traumatic stress disorder in the baby, she said.
“The presence of the nursing parents is just as important as their milk,” McCormick said. “When a baby is able to attach to a caregiver, they have better mental health and emotional health long-term.”
McCormick also said women are less likely to breastfeed, or only partially breastfeed, long-term unless they do it in the first hours and days after birth. It has long been associated with reduced rates of disease such as breast cancer, ovarian cancer and type 2 diabetes, she said.
Breastfeeding already is more difficult in the current climate as lactation consultants are sent home, McCormick added. Many hospitals are only allowing fathers or significant others in the delivery rooms during birth.
“A lot of (pregnant women) are panicked,” she said.
At John Hopkins, Sheffield said the final decision is up to the mother. If she chooses to keep her baby with her and breastfeed skin-to-skin, health care workers will try prepare her, providing a mask and educating about hand-washing.
If a COVID-19 positive mother decides to separate from her baby while at the hospital, Sheffield stressed the importance of continued distancing at home.
Mom should wear a mask and be at least six feet away from baby until she’s recovered, conservatively about 14 days. Sheffield also recommended a healthy family member be on hand to provide a bonding experience for the child.
“Whatever we can do to get mom and baby together again we will do. But we have to do it in a safe environment because we have to protect the baby,” she said.