We wrote the following letter to the Royal College of Obstetricians and Gynaecologists. We were responding to their published guidance on Covid-19, infant feeding and the postnatal period.
Re: Guidance on COVID-19 and Infant Feeding
We are parents campaigning for compassion, autonomy and safety in infant feeding. We are writing regarding recently published RCOG guidelines and information on COVID-19 (such as this video and on this web page).
We would like to offer our perspective on how the sections on infant feeding and the postnatal period could be revised to promote a more compassionate stance. We believe such an approach would better facilitate parents making confident and informed infant feeding decisions that best meet the needs of their families during the pandemic.
The guidelines state that parents should have a discussion with their maternity team about the risks and benefits of breastfeeding. Unfortunately, in our experience of care before the pandemic, such communication is typically poor. As parents we were confidently told by our maternity care professionals that breastfeeding prevents infections, improves IQ, enhances mother-baby bonding, prevents obesity, cancer and many other illnesses, and might even create a more peaceful society. We weren’t told that exclusive breastfeeding increases the risk of excessive infant weight loss, neonatal jaundice, hypoglycaemia and mastitis, or how it might, in some cases, adversely impact our mental health.
As you are no doubt aware, recent guidelines from Baby Friendly UK state that if parents are considering stopping breastfeeding, healthcare staff should have a sensitive conversation with them about the value of continuing during the COVID-19 outbreak. We aren’t aware of any guidance that clarifies what the benefits of continuing to breastfeed during the pandemic might be. We are concerned about an increase in pressure to breastfeed and about communications implying breastfeeding may protect against COVID-19, in the absence of clear evidence that it does. Given this situation, we feel it would be very helpful if RCOG could produce accurate materials depicting the absolute risks and benefits of breastfeeding and formula. We feel this would support parents in making informed decisions.
Great effort is made in RCOG’s guidance to reassure mothers with COVID-19 about continuing breastfeeding and choosing to stay with their babies. However, no such reassurance is given to those who decide not to breastfeed, or who might temporarily arrange for an alternative caregiver to meet their baby’s needs while they recover. As we are sure you are aware, while most people with COVID-19 don’t become critically ill, many with so-called ‘mild’ symptoms feel very unwell. For a proportion of these people, the symptoms may be prolonged for weeks or even months. The continued emphasis on breastfeeding as the primary concern overlooks mothers’ needs to rest when unwell with COVID-19, on top of recovering from birth.
We feel the guidelines should emphasise the need for parents to look after themselves and attend to their own physical and psychological needs, while they face the dual challenges of a newborn baby and COVID-19. Social distancing, home-working and school closures have created new demands on family life and limited the social and practical support available. All this may impact on infant feeding experiences and decisions.
We would like to request that guidance is updated to:
- Describe the current data on infant feeding and COVID-19 in a user-friendly way, acknowledging uncertainty about any conclusions to be drawn
- Provide clear communication about the absolute benefits and risks of available options
- Recognise the effects of the pandemic on family life and the availability of social support, and how these may influence parents’ decisions about how to feed their babies
- Emphasise the importance of parents attending to their own physical and psychological needs, especially if they become unwell with COVID-19
- Offer reassurance to parents who want or need to formula feed during the pandemic, in the same manner that reassurance has been given to those who wish to breastfeed, to alleviate parental anxiety in these unprecedented and stressful times.
We hope that this feedback is helpful and are willing to engage constructively in providing parent-led input with any future revisions to the guidelines. We can make ourselves available for a conversation via video call if this would be helpful.
Dr Ruth Ann Harpur on behalf of Infant Feeding Alliance