What does a pregnant breast milk scientist do in a pandemic?
By: Toni Harman
Tags: Covid 19, Covid 19 Crisis, Lactation, Breastfeeding, Research

On pregnancy

Being 28 weeks pregnant herself, Dr Smilowitz recognises that she is part of a vulnerable population:

“What’s known about COVID-19 and pregnancy is that there is not any data to suggest that pregnant women are at greater risk of contracting SARS-CoV-2 than non-pregnant individuals. We know that in the pregnant state, we have physical changes; cardiac output is greater, lung capacity is lower and immune changes. Women who are pregnant are more at risk of developing respiratory tract infections. They just need to make sure that they take the guidelines seriously in protecting themselves from infection.”

SARS-CoV-2 and mother-baby transmission

I asked Dr Smilowitz what is known so far about the possibility of vertical transmission of SARS-CoV-2 between mother and baby.

“There have been a few studies published on the transmission of SARS-CoV-2 from mother to baby and they found that overall, there is no virus present in her vaginal secretions, cord blood, placenta or breast milk. This is great news for now. More research is needed to really understand if that is true for a large population, but the fact that we see it consistently in these few publications is really reassuring for mothers who want to breastfeed.”

About skin-to-skin

According to Dr Smilowitz, skin-to-skin contact is really important for many reasons.

“This is a really important question. I think there is a lot of confusion and fear out there about how close a mother should be with her baby. If a mother is suspected of being COVID-19 positive, or is positive for the virus, she should still consider, if she is well enough, to do skin-to-skin.” “Of course where are medical conditions that prevent early skin-to-skin contact, say mother is haemorrhaging, or the baby needs resuscitation then obviously we need to save lives, so address those immediate needs, but skin-to-skin should occur as early as possible. Skin-to-skin initiates bonding, the love hormone oxytocin is increasing and that is wonderful and good and fuzzy, but beyond that, skin-to-skin regulates baby’s heartbeat, regulates her blood sugar, lowers stress cortisol in both baby and mother, even father when he has skin-to-skin contact with baby. It increases breastfeeding success. So the goal is to have skin-to-skin contact as early as possible, as soon as possible after delivery”

About Colostrum

The first milk produced by the mother is colostrum, or as Dr Smilowitz calls it “phenomenal liquid gold.”

“Colostrum is this incredible substance. It’s choc-full of immune factors, these bioactives and delivers a package of protection. It’s abundant in immunoglobulins that coat and neutralise pathogens. It’s got active white blood cells, stem cells, hormones, growth factors that support the development and maturation of the intestinal epithelium. It’s not voluminous. Per feed in the first 24 hours we are talking about 2–10ml, which may max to 30ml in a 24 hour period. Babies are not really consuming a large volume of liquid, but this concentration of protection. It only lasts for the first 3 days of life, so it’s really critical that babies get colostrum as soon as possible after they are born.”

Recommendations for parents

Dr Smilowitz suggests that even if the mother is infected with the coronavirus, she can still breastfeed provided the mum follows guidelines and takes hygiene precautions.

“If moms want to breastfeed and they are positive for COVID-19, or suspect they have COVID-19, they just need to follow some guidelines. One — they need to wear a mask. Two — they need to wash their hands and to make sure their hands are always clean before they touch their baby or breastfeed their baby. Three — to maintain that surfaces around them are disinfected. There are specific guidelines from the World Health Organization (WHO) about how to do everything safely. Moms should not be afraid. We see in the minimal research out there so far that COVID-19 is not found in breast milk. It’s transmitted through respiratory droplets.”

Take-home message

Dr Smilowitz offers a simple but powerful take-home message, something for all those preparing to give birth and planning to breastfeed in a global pandemic.

“My message to mom- to-be is don’t forget you are having a baby. You are bringing life into this world and it’s going to get better. COVID-19 is just a chapter in our lives. Take the precautions like you are normally. Connect with your baby, breastfeed your baby, love your baby. Take care of yourself and your baby and don’t forget you are having a baby. Celebrate that.”

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Useful resources recommended by Dr Jennifer Smilowitz:

https://www.breastfeeding.asn.au/bf-info/early-days/let-down-reflex

https://www.liebertpub.com/doi/10.1089/bfm.2020.29153.ams

The full special COVID-19 interview with Dr Jennifer Smilowitz is included within our Breast Milk and the Infant Microbiome course — approved for 17 HOURS CPD / CE and 17 L-CERPs and featuring 7 professors and lactation scientists.

The full video interview includes transcripts, descriptions of the current (few) research papers on the vertical transmission of SARS-CoV-2 and Dr Smilowitz’s evidence-based recommendations for pregnant and expectant parents.

Link to full course: >>>> https://microbirth.teachable.com/p/breastmilk1