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5 tips to breastfeed safely when you have COVID-19

How to keep you and your baby as safe as possible.
With a few simple tips, it is possible to keep breastfeeding while you have COVID-19.
With a few simple tips, it is possible to keep breastfeeding while you have COVID-19.Getty Images

If you're one of the millions of people in the U.S. who's had COVID-19 recently, you know the virus can have both health and logistical implications for your life. And, if you're someone who's trying to breastfeed or pump milk while COVID-positive, it can be complex and frustrating to navigate that process.

Experts say that you can safely continue breastfeeding or expressing milk while you have COVID-19. But you should take some specific precautions to make sure the process is as safe as possible for your baby.

Can COVID-19 spread via breastmilk?

Breastfeeding is not considered a risk for transmitting COVID-19.

"It's super important for patients to know that breastfeeding is very safe, even if you have been diagnosed with COVID," Dr. Joanne Stone, chair of the OBGYN Department at Mount Sinai, told TODAY.

Some studies have found small amounts of the virus in breastmilk, but any potential transmission is far more likely to be due to close contact with the baby rather than contamination of the milk, Dr. Karin Nielsen, professor of pediatrics in the division of infectious diseases at UCLA Children’s Hospital, told TODAY.

"We don't have a ton of data, but we don't think that COVID is probably spread through breast milk," Dr. Jourdie Triebwasser, maternal-fetal medicine specialist at the University of Michigan School of Medicine, told TODAY.

She pointed to a recent meta-analysis that found SARS-CoV-2 in breastmilk samples from 12 out of 183 women who recently tested positive for the virus. Of the 12 infants in that study that may have been exposed to the virus via breastmilk, six eventually tested positive.

"Even if those babies test positive, it is likely the close contact (that led to their infections) and not just consuming the viral load (in the breastmilk)," said Triebwasser, who is also the medical director of the birth center at Von Voigtlander Women’s Hospital.

In fact, breastfeeding after a COVID-19 infection may help pass along protective antibodies to the coronavirus, the American Academy of Pediatrics says. So, having a mild COVID-19 infection isn't a reason to skip out on breastfeeding, Nielsen said.

How to safely breastfeed or express milk when you have COVID-19:

Breastfeeding or expressing breastmilk when you have COVID-19 can be a daunting task. But experts told TODAY that there are some simple steps you can take to make the process much safer.

  • Wear a mask. Because COVID-19 is spread via respiratory and aerosolized droplets, wearing a mask when in close contact with your baby will drastically reduce the chances that you'll spread the infection to them. But, no, you do not need to mask your baby, Stone said.
  • Practice proper hand hygiene. Masking and hand hygiene are "the two most important things that you could do," Triebwasser said. Be sure to wash your hands before holding the baby and after you touch your face or mask, she explained.
  • Keep everything clean. It's not just about your hands; if you're pumping, make sure to wash your equipment "very meticulously," Stone said, "so that you're not transmitting any kind of particles on the surfaces of bottles or nipples or pumps."
  • Take advantage of caregiving help if you can. "If you have help around, of course, take advantage of that," Stone said. She also recommended trying to keep the baby distanced if possible "during the period that you're still infectious."
  • Monitor your baby for signs of COVID-19. With these precautions, breastfeeding is generally quite safe. But it's still a good idea to keep an eye out for any potential signs of COVID-19 in your baby. Those symptoms might include a fever, coughing, sneezing and diarrhea, Nielsen said. The baby might also be especially cranky. But really "any time there's a fever in an infant, it always requires attention, especially if it's a newborn," she said. 

Of course, if your COVID-19 symptoms become severe and you need to be hospitalized, things may change. "If the mother can't breastfeed directly, she could still express the breast milk and give it to the baby," Nielsen said. "But if the mother is having respiratory distress or needs oxygen, then it becomes very, very complex."

Your care team may be able to help you pump to keep up milk production, Nielsen explained. But "generally, at that point, breastfeeding would be very difficult.”

Get vaccinated before or during pregnancy

One of the most beneficial things you can do for your health and the health of your baby is to get vaccinated against COVID-19 before you become pregnant or during pregnancy.

"We know for sure that pregnancy itself is a risk factor for getting more severe disease," Stone said. Pregnant people are more likely to require hospitalization and ventilation due to COVID-19, the Centers for Disease Control and Prevention explain. Studies so far have found that vaccination is generally safe during pregnancy, that protective antibodies can pass to the baby via the placenta and that antibodies gained during pregnancy through vaccination are longer-lasting than those acquired through infection.

And in a new study, published in the CDC's Morbidity and Mortality Weekly Report, researchers found that babies born to mothers who received two doses of an mRNA vaccine in pregnancy were about 61% less likely to be hospitalized due to COVID-19. Of the 43 hospitalized infants included in the study, 88% of them (38 babies) had unvaccinated mothers.

"On top of the benefit of protecting themselves, they're actually going to protect their babies, which is fascinating and amazing," Dr. Natasha Halasa, professor in the division of pediatric infectious diseases at Vanderbilt University and an author on the new study, told TODAY.

The study also found that the mothers who got vaccinated later in pregnancy actually passed along even more protection than those who were vaccinated earlier in their pregnancies, but Halasa cautioned against making too much of those findings right now because the sample sizes are so small.

And pregnant people are at such a high risk for severe COVID-19 symptoms that they really shouldn't delay vaccination in the hopes of passing on more benefits to their baby, the experts said. But, if someone has been hesitant about getting vaccinated while pregnant, knowing there are extra benefits to the baby "might be the thing that helps them decide," Triebwasser added.

And, while you shouldn't delay your initial vaccine series, Triebwasser said that experts may decide it's OK to wait on your booster to get the most benefit for you and your baby, similar to the current approach with the Tdap vaccine. "We would certainly have someone get boosted during pregnancy," she said, "but we may learn over time that that might be the vaccine that could be timed a little bit differently."

For now, Halasa said it's too early to know if that's a better strategy, but that the idea "would be worth studying, for sure."

CORRECTION (February 25, 2022, 10:40 a.m.): An earlier version of this article misspelled Dr. Triebwasser’s first name. It is Jourdie, not Jordie.

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