First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined
- PMID: 36741988
- PMCID: PMC9889271
- DOI: 10.3389/fnut.2022.1049610
First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined
Erratum in
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Corrigendum: First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined.Front Nutr. 2023 Mar 2;10:1166221. doi: 10.3389/fnut.2023.1166221. eCollection 2023. Front Nutr. 2023. PMID: 36937363 Free PMC article.
Abstract
Background: In March 2020, the World Health Organization (WHO) published clinical guidance for the care of newborns of mothers with COVID-19. Weighing the available evidence on SARS-CoV-2 infection against the well-established harms of maternal-infant separation, the WHO recommended maternal-infant proximity and breastfeeding even in the presence of maternal infection. Since then, the WHO's approach has been validated by further research. However, early in the pandemic there was poor global alignment with the WHO recommendations.
Methods: We assessed guidance documents collected in November and December 2020 from 101 countries and two regional agencies on the care of newborns of mothers with COVID-19 for alignment with the WHO recommendations. Recommendations considered were: (1) skin-to-skin contact; (2) early initiation of breastfeeding; (3) rooming-in; (4) direct breastfeeding; (5) provision of expressed breastmilk; (6) provision of donor human milk; (7) wet nursing; (8) provision of breastmilk substitutes; (9) relactation; (10) psychological support for separated mothers; and (11) psychological support for separated infants.
Results: In less than one-quarter of country guidance were the three key breastfeeding facilitation practices of skin-to-skin contact, rooming-in, and direct breastfeeding recommended. Donor human milk was recommended in under one-quarter of guidance. Psychological support for mothers separated from their infants was recommended in 38%. Few countries recommended relactation, wet nursing, or psychological support for infants separated from mothers. In three-quarters of country guidance, expressed breastmilk for infants unable to directly breastfeed was recommended. The WHO and the United Kingdom's Royal College of Obstetricians and Gynecologists were each cited by half of country guidance documents with the United States Centers for Disease Control and Prevention directly or indirectly cited by 40%.
Conclusion: Despite the WHO recommendations, many COVID-19 maternal and newborn care guidelines failed to recommend skin-to-skin contact, rooming-in, and breastfeeding as the standard of care. Irregular guidance updates and the discordant, but influential, guidance from the United States Centers for Disease Control may have been contributory. It appeared that once recommendations were made for separation or against breastfeeding they were difficult to reverse. In the absence of quality evidence on necessity, recommendations against breastfeeding should not be made in disease epidemics.
Keywords: COVID-19; breastfeeding; policy; psychosocial support systems; rooming-in care.
Copyright © 2023 Gribble, Cashin, Marinelli, Vu and Mathisen.
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
-
- World Health Organization. Clinical Management of Severe Acute Respiratory Infection (SARI) when COVID-19 Disease is Suspected: Interim Guidance, 13 March 2020. Geneva: World Health Organization; (2020). 10.15557/PiMR.2020.0003 - DOI
-
- World Health Organization. Clinical Management of COVID-19: Interim Guidance, 27 May 2020. Geneva: World Health Organization; (2020). 10.15557/PiMR.2020.0004 - DOI
-
- World Health Organization. COVID-19 Clinical Management: Living Guidance, 25 January 2021. Geneva: World Health Organization; (2021).
-
- World Health Organization. COVID-19 Clinical Management: Living Guidance, 23 November 2021. Geneva: World Health Organization; (2021).
-
- World Health Organization. Frequently Asked Questions: Breastfeeding and COVID-19 For Health Care Workers. Geneva: World Health Organization; (2020).
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