National / International Guidance

Society for Maternal-Fetal Medicine (SMFM) has developed resources to support the work of OB care providers and their patients during the global pandemic. Their Board of Directors, Publications Committee, and volunteer leaders have developed a number of resources to guide MFM practice, all available at the link below.

During the COVID-19 pandemic, breastfeeding and the use of pasteurized donor human milk (PDHM) are more important than ever for maternal and infant health. USBC-affiliated Pasteurized Donor Human Milk (PDHM) constellation issued a statement on pasteurized donor human milk & COVID-19. The statement addresses the importance of donor milk for breastfeeding protection, donor milk access, and health equity, and action steps for promoting equitable access.

As World Breastfeeding Week 2020 commences, CDC shares an updated version of their guidance on the Evaluation and Management Considerations for Neonates At Risk for COVID-19. The updated guidance highlights:

• The importance of maternal autonomy in the medical decision-making process
• Latest evidence about the routes of SARS-CoV-2 transmission to neonates
• Recent guidance on infection prevention and control

​The American Academy of Pediatrics (AAP) released updated guidance for the care of newborns to mothers with COVID-19, finding that evidence now suggests that babies are at low risk of becoming infected when they remain in-room with the mother after birth if infection control practices are used. This marks a change from the initial AAP guidance, which recommended the temporary separation of newborn infants from infected mothers.

Experts based the cautious approach on the limited amount of information available in April, when the initial guidance was first written. The early research came from China, where the universal protocol was to immediately separate all newborn infants from infected mothers and isolate them for 14 days.

The new interim guidance, provided in an FAQ format, can be found at the link below.

In light of recent evidence of COVID-19 reactive antibodies in breast milk, the World Health Organization (WHO) has updated their guidance and taken a stronger stance in favor of breastfeeding and skin to skin care.

Anna Lavizzari, Claus Klingenberg, Jochen Profit, John A. F. Zupancic, Alexis S. Davis, Fabio Mosca, Eleanor J. Molloy, & Charles C. Roehr, International comparison of guidelines for managing neonates at the early phase of the SARS-CoV-2 pandemic. Pediatric Research. June 2020. doi:10.1038/s41390-020-0976-5

This recent pediatric research article reviews the range of different and sometimes conflicting COVID-19 guidelines from a range of agencies.​ The article presents a detailed review of ad hoc guidelines and highlights similarities and differences. The authors provide a broad overview of currently applied recommendations highlighting the need for international context-relevant coordination.

HMBANA has produced a detailed infographic with evidence-based information around the handling of human milk in the hospital setting. Please click below for more information.

This interim guidance is intended for healthcare providers who care for breastfeeding women and infants who receive breast milk feeds in the context of coronavirus disease 2019 (COVID-19). It is based on what is currently known about SARS-CoV-2, the virus that causes COVID-19, and provides breastfeeding guidance for mothers.

These FAQs complement the WHO interim guidance: Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. It provides some key updates and clarification on the skin to skin, washing the breasts, and what to do when masks are unavailable.

This Practice Advisory has been developed to aid clinicians in providing care during the rapidly evolving COVID-19 pandemic. ACOG has developed COVID-19 FAQs for Obstetrician–Gynecologists to supplement this Practice Advisory and provide additional information for clinicians on the front lines of the COVID-19 pandemic.

The American Academy of Family Physicians (AAFP) has issued a statement emphasizing the protective nature of breastmilk against many diseases and encouraging it as a “reasonable choice” for asymptomatic and symptomatic COVID-positive parents.

In this article, Dr. Spatz discusses why health care providers should use this current pandemic as an opportunity to educate the public about the importance of human milk and breastfeeding as lifesaving medical interventions.

In this commentary on maternity service practices and breastfeeding, Alison Stuebe, MD, evaluates the benefits and risks of temporary separation. The article enumerates additional considerations for promoting the health and well-being of mothers and babies in the months following birth.

Centers for Disease Control and Prevention (CDC). “Considerations for Inpatient Obstetric Healthcare Settings.” April 6, .2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html

These infection prevention and control considerations are for healthcare facilities providing obstetric care for pregnant patients with confirmed coronavirus disease (COVID-19) or pregnant persons under investigation (PUI) in inpatient obstetric healthcare settings including obstetrical triage, labor, and delivery, recovery, and inpatient postpartum settings.

Davanzo, R., Moro, G., Sandri, F., Agosti, M., Moretti, C., & Mosca, F. (2020). Breastfeeding and Coronavirus Disease‐2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Maternal & Child Nutrition.

This paper details the implications and importance of maintaining breastfeeding practices during the pandemic. It explores the potential effect of COVID-19 on neonatal outcome, the appropriate management of the mother‐newborn dyad, and finally the compatibility of maternal COVID‐19 infection with breastfeeding. This paper is premised on guidelines that were created on behalf of the Italian Society of Neonatology (SIN) and endorsed by the Union of European Neonatal and Perinatal Societies (UENPS).​

International Society for Research in Human Milk and Lactation (ISRHML) researchers have established a consensus protocol for collecting human milk for SARS-CoV-2 / COVID-19 research. These guidelines will be updated as the evidence and protocols evolve.

This interim guidance document is intended for clinicians taking care of hospitalized adult and pediatric patients with a severe acute respiratory infection (SARI) when a nCoV infection is suspected. It was created to strengthen the clinical management of these patients and provide up-to-date guidance.

*Click here to download image*

The World Health Organization (WHO) East Mediterranean Regional Office (EMRO) provides recommendations to mothers, healthcare workers, and psychosocial support believers.

Academy of Breastfeeding Medicine. Statement on Coronavirus 2019 (COVID-19). https://www.bfmed.org/abm-statement-coronavirus

The ABM statement discusses COVID-19 transmission and processes for ensuring the safety of breastfeeding moms and babies while at home and in the hospital.