Explained: Should Covid positive mothers stay away from their newborns?

According to doctors, the risk of a baby contracting life-threatening infections is way higher if it is not provided breastmilk and kangaroo care. It is the mother's milk that gives a baby its immunity to fight every infection.

Neonatal experts say that is a myth that Covid positive mothers should not be kept with their newborns. In fact, it is only breastmilk that provides the baby with the required immunity to fight against Covid-19 as well as other infections. The Indian Express explains why newborns and their mothers should not be separated even during the pandemic.

What is kangaroo mother care?

Kangaroo mother care refers to a special kind of care that is given to the newborns, involving prolonged skin-to-skin contact of the baby with its parents, especially mother. Kangaroo mother care is highly recommended for babies who are born preterm (premature) or who are underweight (weighing less than 2 kilos) at birth.

It primarily includes resting the baby on the mother’s chest to provide warmth and motherly affection which helps the baby recover. It also includes the promotion of breastmilk feeding, to provide needed immunity to the child to fight against infections, including Covid-19, after birth. The World Health Organization (WHO) recommends kangaroo care for all babies weighing less than 2 kilos.

Why should newborns not be separated from their mothers even during Covid?

According to doctors, the risk of a baby contracting life-threatening infections is way higher if it is not provided breastmilk and kangaroo care. It is only mother’s milk that gives a baby its immunity to fight every infection, said experts.

A research report published on the WHO website reads, ‘A study published in the Lancet EclinicalMedicine highlights the critical importance of ensuring newborn babies have close contact with parents after birth, especially for those born too small (at low birthweight) or too soon (preterm).

However, in many countries, if Covid-19 infections are confirmed or suspected, newborn babies are being routinely separated from their mothers, putting them at higher risk of death and lifelong health complications.’

‘WHO advises that mothers should continue to share a room with their babies from birth and be able to breastfeed and practice skin-to-skin contact — even when Covid-19 infections are suspected or confirmed — and should be supported to ensure appropriate infection prevention practices,’ the report further says.

WHO adds that kangaroo mother care and breastfeeding are the most cost-effective ways of protecting small and sick newborns and a lot of lives could be saved if these two methods are continued for newborns even during Covid.

How grave is the risk of newborns getting infected with Covid from positive mothers?

According to neonatal experts, even if the mother tests Covid positive, the risk of infection being transferred to the baby is ‘extremely rare’. Doctors say that breastfeeding and kangaroo care should not be discontinued even if the mother is Covid positive because the risk of the baby contracting other life-threatening infections is way higher than Covid. Further, it is only the mother’s breast milk that can provide the child with nutrients and immunity boosters that help fight Covid and other infections.

Dr Kamaldeep Arora, associate professor, department of neonatology, Dayanand Medical College and Hospital (DMCH), Ludhiana, says that when a baby tests Covid positive immediately after birth to a Covid-positive mother, it is called ‘vertical transmission’ of infection in womb or ‘placental transmission’. However, such cases are ‘extremely rare’.

“In our hospital, more than a hundred deliveries of Covid positive mothers have taken place since the pandemic started last year. It is only during the second wave in 2021 that we came across four rare cases where babies tested Covid positive after birth (sample collected within 24 hours). In all other cases, babies were negative despite their mothers being positive. The four babies who tested positive after birth also recovered and tested Covid negative within few days because we did not stop their breastfeeding. If a mother cannot feed the baby in her lap, then breast milk has to be fed with a spoon. It is called Express Breast Milk,” said Dr Arora.

“Even if the mother is Covid positive, risk of transmission to the baby is rare, so they should not be separated at all. The mother should just follow Covid-appropriate behavior while handling the baby. We haven’t come across any case yet in which any newborn died of Covid,” he added.

“Not just mothers, but fathers too can give kangaroo care to newborns. Newborns have high resistance to Covid so separating mothers from newborns does not make any sense,” said Dr Arora.

Dr Kanya Mukhopadhyay, professor, neonatology, department of pediatrics, PGIMER Chandigarh, says that the chances of baby getting Covid is always way lesser than other conditions.

“Even if the mother is Covid positive, breastfeeding must be continued and she has to wear a mask, wash hands and follow Covid appropriate behavior. Mother’s milk has antibodies, which help a baby fight Covid and other infections. Kangaroo care is for premature babies and sometimes we face issues in providing KMC if mother is sent home and babies are still under observation. When Covid was at peak, we were even facing issues in arranging breastmilk for some babies as asymptomatic mothers were discharged. In developing countries, babies are even dying due to lack of breastfeeding.”

Dr Arun Kumar Baranwal, professor, pediatric emergency, PGIMER Chandigarh, too said that even if the mother is Covid positive, effort should be to keep the baby in touch with her most of the time. “If one does not breastfeed the baby, other unhygienic ways will be adopted for feeding which will lead to more health issues. Nothing can match breast milk for newborns.”

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Do families agree to keep babies with mothers if she is Covid positive?

Dr Arora says that a lot of counselling is always required to convince the families because many often believe the myth that their baby will also contract Covid if the mother is positive.

“The decision of newborns and Covid positive mothers living together or not is often left on the families. In some cases, mothers prefer living separately from their babies till they test negative, but separating mothers and newborns is not recommended. If the baby and mother are stable, she can easily breastfeed taking baby in her lap. Families agree after we counsel them. Breastfeeding has to continue, either directly or by expressing milk from mother’s breast and feeding it with spoon if the mother is in critical care, such as on ventilator.”

Which practices should be followed by Covid positive mothers while breastfeeding or pumping milk?

– Wash hands before and after touching the infant or feeding equipment
– Avoid using a pump shared by others
– Wear a mask or face covering during breastfeeding and pumping
– Clean pump parts after each use

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How Kangaroo mother care (KMC) can help in saving the lives of preterm and underweight babies?

Keeping babies and mothers together could save more than 125000 lives, says WHO. ‘Up to 125000 babies’ lives could be saved with full coverage of kangaroo mother care. For babies born preterm or at low birthweight, kangaroo mother care (early, prolonged skin-to-skin contact with a parent and exclusive breastfeeding) is particularly critical.

Among infants born preterm or at low birthweight, kangaroo mother care has been shown to reduce infant deaths by as much as 40%, hypothermia by more than 70%, and severe infections by 65%,’ says WHO, adding that ‘Covid-19 is severely affecting the quality of care given to small and sick newborns, resulting in unnecessary suffering and deaths.’

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