1. Spatz, Diane L. PhD, RN-BC, FAAN

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The COVID-19 pandemic has strained the health care system. Through the course of this pandemic, care of childbearing and breastfeeding families has been deprioritized in the United States and globally. In the United States, data collected by the Centers for Disease Control and Prevention (CDC) found 17.9% of hospitals reported in-person lactation support decreased (Perrine et al., 2020). Most (72.9%) hospitals reported discharging mothers and newborns in less than 48 hours after birth (Perrine et al.). Among mothers with confirmed or suspected COVID-19, 14.0% of hospitals discouraged skin-to-skin contact and 6.5% of hospitals prohibited skin-to-skin contact (Perrine et al.). Even more worrisome is that 20.1% of hospitals discouraged direct breastfeeding but would allow it if it was the mother's choice and 12.7% did not encourage direct breastfeeding, but allowed for feeding of expressed milk if mothers were confirmed or suspected to have COVID-19 (Perrine et al.). Over one-third (37.8%) of hospitals discouraged rooming-in and 5.3% of hospitals prohibited rooming-in (Perrine et al.).


These practices are concerning because the hospital stay after giving birth is a critical window of opportunity to effectively establish lactation and breastfeeding. When newborns are separated from their mothers at birth and have a short length of stay, they will need enhanced postdischarge assistance. In interviews that we conducted with first-time mothers at the start of the pandemic, we found that mothers were not getting the help that they needed and it caused them significant stress (Spatz & Froh, 2021). At Children's Hospital of Philadelphia, we have an extensive network of pediatric primary care offices and have seen the strain placed on our health care team to try provide enhanced breastfeeding assistance and care in a very structured billable and time constrained environment. With the shift to more breastfeeding care needing to be provided in primary care sites, there needs to be nurses and other health care providers who are educated and knowledgeable in evidence-based lactation interventions.


On a positive note, 48.7% of hospitals provided virtual breastfeeding consultations (Perrine et al., 2020). The CDC had not collected data on this prior to the pandemic. Many community-based lactation organizations have been able to effectively convert their breastfeeding classes and support groups into virtual platforms. This is an encouraging outcome of the pandemic and one that I hope persists long-term. However, it is important to note that the however, it is important to note that while the virtual world may be helpful for education and support, it does not replace in-person care world maybe helpful for education and support, it does not replace in-person care. Many mothers need expert in-person technical support to establish breastfeeding. In our work with first-time mothers at the start of the pandemic, one mother described how she had to have her husband hold up her computer for the lactation consultant to look at her baby's latch (Spatz & Froh, 2021). She said she did not believe the visit was effective in helping her with the latch and firmly stated the need for in-person technical assistance (Spatz & Froh).


As nurses, we must continue to promote and protect the use of human milk and breastfeeding. We should continue access to online and virtual breastfeeding help but expand opportunities for in-person technical breastfeeding assistance in pediatric offices and in the community. The future health and wellbeing of our society are at stake.




Perrine C. G., Chiang K. V., Anstey E. H., Grossniklaus D. A., Boundy E. O., Sauber-Schatz E. K., Nelson J. M. (2020). Implementation of hospital practices supportive of breastfeeding in the context of COVID-19 - United States, July 15-August 20, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(47), 1767-1770.[Context Link]


Spatz D. L., Froh E. B. (2021). Birth and breastfeeding in the hospital setting during the COVID-19 pandemic. MCN. The American Journal of Maternal Child Nursing, 46(1), 30-35.[Context Link]