Wellbeing of Breastfeeding Women in Australia and New Zealand during the COVID-19 Pandemic: A Cross-Sectional Study

COVID-19 Public Health Restrictions and New Mothers' Mental Health: A Qualitative Scoping Review

Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers' perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers' self-perceived mental health during the pandemic (N = 55). Our synthesis found that new mothers' mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers' mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers' mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.

Using the principles of practice development to address challenges in recruitment and data collection when face-to-face methods are unavailable

BACKGROUND

Researchers conducting studies involving pregnant women often find recruitment challenging. The COVID-19 pandemic added further complexity to studies requiring face-to-face participation.

AIM

To demonstrate how to maintain the principles of practice development (PD) when a study must switch from face-to-face to remote methods of collecting data.

DISCUSSION

The number of participants in the authors' study increased when they moved from face-to-face to telephone engagement during the COVID-19 pandemic. They continued using PD principles when they changed method and the quality of the data they collected remained constant, even once lockdown restrictions were in place.

CONCLUSION

PD principles can offer ways for nurse researchers to engage, collaborate with and reflect with people for research projects, including when constraints compete with participation. They can also assist researchers in optimising and maintaining recruitment and data collection when face-to-face research methods are impossible.

IMPLICATIONS FOR PRACTICE

The telephone can be a valuable alternative medium for recruiting participants and collecting data when face-to-face methods are impossible to use. PD principles can be maintained and response rates and participation may even be greater when using it.

Feeding Practices of Stable Term and Late Preterm Neonates Born at a Tertiary Hospital in the Philippines during the COVID-19 Pandemic

Objective

We aimed to evaluate the impact of maternal COVID-19 infection and separation of the mother-baby dyad on feeding practices by determining modes of feeding upon discharge and following up at 2-3 days, 14 days, and 1 month post-discharge.

Methods

This was a prospective observational cohort study conducted at the Philippine General Hospital, a tertiary government COVID-19 referral center in Manila. Mothers who delivered between the months of July and August 2021, and whose COVID-19 status was known were followed up on their baby's mode of feeding at 2-3 days, 14 days, and 1 month post-discharge via phone call. For babies of COVID-19 positive mothers, presence of any symptoms (up to the 14-day time point only) as well as adherence to infection prevention and control practices were also identified.

Results

For all time points post-discharge, breastfeeding rates were higher in babies born to COVID-19-negative mothers and in those who were roomed in. However, the differences were not statistically significant. Of the 108 infants, 72.90% remained exclusively breastfed by 1 month of age, with 4.67% formula-fed and 22.43% on mixed feeding. Perception of insufficient milk supply was the most common reason for shifting to formula or mixed feeding. We found a significantly higher direct breastfeeding rate upon discharge in the roomed-in population compared to those admitted to the NICU. Risk factors affecting breastfeeding at 1 month of age was the presence of COVID-19 infection in the mother and mother-baby separation due to NICU admissionCOVID-19-positive mothers were 66.02% less likely (p=0.016, 95% CI 0.1411 to 0.8183) to still be breastfeeding at 1 month, and separation was not found to be a significant risk factor.

Conclusions

Feeding practices can be affected not only by COVID-19 infection in the mother and its attendant difficulties such as prolonged hospital stay and physical and social isolation, but also by limitations in the hospital environment that can have an impact on breastfeeding education, support, and opportunities for mother-child bonding.

The role of stress in perinatal depression and anxiety - A systematic review

Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.

PsyNBIOsis: Investigating the Association between Maternal Gestational Diabetes, Mental Health, Diet and Childhood Obesity Risk: Protocol for a Prospective, Longitudinal, Observational Study

BACKGROUND

Gestational diabetes mellitus (GDM) is associated with poorer maternal mental health (depression and anxiety). Maternal mental health and GDM are likely to influence diet, which in turn impacts the course of GDM. Maternal diet may also be directly or indirectly associated with changes in infant anthropometry. The aims of this study are to (1) examine the associations between maternal GDM, mental health and diet, and (2) evaluate the associations between these maternal factors, breastmilk composition and infant anthropometry.

METHODS

This prospective, observational, longitudinal cohort study compares a cohort of women with and without GDM. Maternal mental health and diet are assessed using validated questionnaires. Breastmilk composition is measured with the Human Milk Analyzer, and infant body composition is measured with air displacement plethysmography.

SIGNIFICANCE AND IMPACT

Once data have been collected, PsyNBIOsis will provide evidence for the associations between maternal mental health, GDM status and diet, and their impact on breastmilk composition and early infant growth. The results may inform the Developmental Origins of Health and Disease framework and provide data on which to build cost-effective interventions to prevent both the development of mental health issues in mothers and adverse growth patterns in infants.

The role of doulas in providing breastfeeding support during the COVID-19 pandemic

BACKGROUND

Doulas have been instrumental in providing breastfeeding support to nursing mothers before and during the COVID-19 pandemic, as they can significantly impact a mother's ability to initiate and maintain breastfeeding. However, the COVID-19 pandemic, subsequent lockdowns, and social isolation created challenges for nursing mothers to access doulas' services, usually provided in person. In this study, we examined the role of doulas in providing breastfeeding support during the COVID-19 pandemic, exploring adaptation to COVID-19 guidelines and the challenges doulas face in providing breastfeeding support during the pandemic.

METHODS

A systematic review was conducted following the PRISMA guidelines. Thirteen scientific databases and twenty peer-reviewed journals were searched for journal articles published in English between January 2020 and March 2022 using key search terms (e.g., Doula, Breastfeeding, COVID-19). Studies evaluating the role of doulas in providing breastfeeding support during COVID-19, and the impact of COVID-19 Guidelines on doula services, were included. Two reviewers independently performed the risk of bias assessment and data extraction. Summative content analysis was used to analyze the data.

RESULTS

The majority of studies were conducted in developed nations. This systematic review includes eight articles, four qualitative, one survey, two mixed-methods studies, and one prospective research study. Seven of the eight studies were conducted in the United States, and the eighth was conducted in multiple countries. These studies have three main themes: (1) virtual breastfeeding support provided by doulas during the pandemic; (2) remote social support provided by doulas to breastfeeding mothers during the pandemic; and (3) barriers to doula service delivery due to COVID-19 restrictions, primarily the exclusion of doulas as essential workers. The eight studies showed that doulas found innovative ways to serve the needs of birthing and nursing mothers during the difficulties brought on by the pandemic.

CONCLUSION

Doulas provided breastfeeding support during the COVID-19 pandemic by utilizing innovative service delivery methods while navigating changes in COVID-19 guidance. However, system-level integration of doulas' work and the acknowledgment of doulas as essential healthcare providers are needed to enhance doula service delivery capacity, especially during a pandemic, to help improve maternal health outcomes.

Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review

BACKGROUND

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status.

AIMS

This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures.

METHODS

Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains.

RESULTS

The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices.

CONCLUSIONS

Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.

The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis

BACKGROUND

This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women.

METHODS

All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 - July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed.

RESULTS

This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic.

DISCUSSION

It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times.

OTHER

The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.

Breastfeeding in the pandemic: A qualitative analysis of breastfeeding experiences among mothers from Canada and the United Kingdom

BACKGROUND

Previous research shows that the COVID-19 pandemic resulted in both barriers and facilitators to breastfeeding. However, little research has looked specifically at first-time mothers' experiences of breastfeeding during the pandemic or compared experiences of mothers living in different countries.

AIM

This research explores mothers' breastfeeding experiences to describe how the COVID-19 pandemic has affected breastfeeding journeys in Canada and the United Kingdom.

METHODS

Ten semi-structured online interviews were undertaken with first-time mothers who breastfed their baby at least once during the COVID-19 pandemic and are living in Canada or the United Kingdom. Interview transcripts were coded inductively using thematic analysis.

FINDINGS

One overarching theme (all on mother) and four sub-themes were identified: 1) accessing and advocating for health care, 2) social support, 3) becoming a mother in isolation, and 4) breastfeeding baby. Similar themes were constructed for both countries.

DISCUSSION

Mothers reported that diminished health care and social support created challenges in their breastfeeding journey. Many mothers reported receiving virtual breastfeeding support, which was largely experienced as unhelpful. Some mothers reported fewer distractions from visitors and more one-on-one time with their infant, which helped them to establish breastfeeding and a strong mother-infant bond.

CONCLUSION

In both Canada and the United Kingdom, new mothers need consistent, reliable health care and social support when breastfeeding. This study supports the need to protect breastfeeding support in the midst of a global emergency and beyond to ensure positive breastfeeding experiences for both mother and baby.

Effect of Training Program on Knowledge and Practice of Breast feeding Women During COVID-19

Aim

Evaluate the effect of the training program on knowledge and practice of breastfeeding women during coronavirus disease 2019 (COVID-19).

Methods

One-group pretest/post-test quasiexperimental research design was utilized to accomplish the aim of this study. The study was carried out at the primary health care units Ad Dar Al Baida 1, Ad Dar Al Baida 2, Al Aziziyah at Riyadh Province of Saudi Arabia. The study included a convenience sample of 100 breastfeeding women.

Tool

A structured interviewing questionnaire sheet was used for data collection that included three parts knowledge, reported practice, and demographic characteristics.

Results

More than one-quarter (30%) and (28%) of studied women had satisfactory knowledge-related causes, risk factor and signs, symptoms of COVID-19 at preintervention, while the majority 85% and 86% of them had satisfactory knowledge postintervention at p-value <.01**. In addition, less than one-fifth (17%) and (16%) of studied women had satisfactory knowledge about Breastfeeding guidelines during COVID-19 and care of breastfeeding women during COVID-19, compared with most of them (89%) and (92%) postintervention at p-value <.01**.

Conclusion

Based on our current study, it was concluded that the educational program effectively improves breastfeeding women's knowledge and practices. There was a highly statistically significant positive linear correlation between the breastfeeding women's knowledge and reported practices regarding COVID-19 infection before and after the implementation of the educational program at p < .0.

Either 'a blessing in disguise', or 'I couldn't get help,': Australian and Aotearoa NZ women's experiences of early infant feeding during COVID-19

BACKGROUND

To manage the COVID-19 pandemic, public health restrictions and a rapid pivot to telehealth occurred. Peripartum services were significantly affected by a strained infrastructure. Decreased face to face access to health services and support affected maternal experiences and confidence internationally, yet little was reported with the Australian and Aotearoa New Zealand context.

AIM

To explore the early parenting and infant feeding experiences of new mothers from Australia and Aotearoa New Zealand in the context of a pandemic.

METHODS

An interpretive qualitative approach and thematic analysis obtained an in-depth understanding of the experiences of 27 mothers who gave birth during the first wave of the COVID-19 pandemic in 2020.

FINDINGS

Australian and Aotearoa New Zealand women reported similar experiences, which varied contextually. Restrictions and requirements impacted favourably and unfavourably. Many women found the peace and space of social distancing an unexpected benefit and were proud of their achievements, whilst others shared feelings of isolation and distress. Some women felt they instinctively did what they needed to do. Experiences correlated with differing levels of self-efficacy.

DISCUSSION

While many women relished the freedom from social obligations when faced with feeding challenges, there was general dissatisfaction with the level of support available. Care was fragmented, and health care needs were unmet, impacting feeding and parenting decisions and mental health.

CONCLUSION

Access to timely and appropriate professional support is an important factor in establishing breastfeeding and developing parenting confidence, particularly in the context of a pandemic and should be a health policy priority.

Impact of the COVID-19 Pandemic on Breastfeeding Support Services and Women's Experiences of Breastfeeding: A Review

Objective

The aim of this systematic review was to explore the impact of the COVID-19 pandemic on breastfeeding support services and continuation rates.

Methods

Electronic searches were undertaken in seven databases: Academic Search Complete, Springer Nature Journals, CINAHL Medline, Health Source: Nursing/Academic Edition, Masterfile premier, and SocINDEX. Publications following the COVID-19 pandemic between January 2020 and March 2022 were searched for using the following keywords: impact or effect or influence and breastfeeding support and breastfeeding continuation and COVID-19 or coronavirus. Fifteen studies were included for investigation and extracted to identify seven themes related to breastfeeding support during COVID-19.

Results

Factors which impacted breastfeeding support during the COVID-19 pandemic included separation, lack of skin-to-skin contact, insufficient support, online breastfeeding support, the impact of the pandemic on breastfeeding rates and experiences, fears of the pandemic, and the need for additional support. The pandemic mostly influenced breastfeeding support negatively, with a small exception occurring where some mothers experienced lockdown as positive since it protected the mother-infant dyad from unwanted visitors. Virtual breastfeeding support was introduced in many contexts; however, practitioners and mothers reported that this could not replace the need for face-to-face support.

Conclusion

Breastfeeding is a lifesaving intervention, especially in the face of a disruption such as a pandemic. This work highlights the need for clear, consistent, and evidence-based information about risks, and for key practices to be maintained including not separating mothers and infants, promoting skin-to-skin contact, and ensuring availability of high-quality breastfeeding support.

Predictors and impact of women's breastfeeding self-efficacy and postnatal care in the context of a pandemic in Australia and Aotearoa New Zealand

OBJECTIVE

To investigate predictors of breastfeeding self-efficacy, postnatal care experiences, and there subsequent impact on breastfeeding outcomes in Australia and Aotearoa New Zealand in the context of the COVID-19 pandemic.

DESIGN

A cross-sectional online survey collected data between August and October 2020 with recruitment via social media. Quantitative data were analyzed using descriptive analyses, and linear and logistic regression analysis related to the Breastfeeding Self-Efficacy Scale-Short Form findings. Open text responses were analyzed using content analysis.

FINDINGS

There were 1001 complete responses. Visitor restrictions impacted the woman's early parenting experience in both positive and negative ways. One third of participants stated their postnatal needs were not met with 82 stating that they had no postnatal care at all. During the first six weeks postnatal, 48.1% felt not very or not at all confident caring for their baby. Despite 94.3% of participants initiating breastfeeding, only 70% were exclusively breastfeeding at six weeks. The mean self-efficacy score was 49.98 suggesting the need for additional help, with first time mothers having a statistically significant lower score.

DISCUSSION/CONCLUSION

Sub-optimal postnatal care and support negatively influence breastfeeding self-efficacy. Women desired additional help during the COVID-19 pandemic inclusive of support and education to meet their postnatal needs and exclusively breastfeed.

IMPLICATIONS FOR PRACTICE

Women require appropriate and timely postnatal care and support to promote confidence in caring for baby and achieve their breastfeeding goals. Preferably this care should be provided face-to-face.

The Effect of Knowledge Levels of Breastfeeding Mothers About the Disease on Their Levels of Anxiety During the COVID-19 Pandemic Process

Background:

The health impact of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) spans across all age groups including mothers and their newly born infants; and breastfeeding women during this pandemic deserves special attention due to its short and long-term health implications. When planning the current study, our hypothesis was that the anxiety of transmitting the COVID-19 disease to the baby through breastfeeding would increase among breastfeeding women and it would predominantly be state anxiety. The current study aims to investigate the relationship between the knowledge levels of breastfeeding mothers about COVID-19 and their anxiety levels.

Materials and Methods

This is a cross-sectional study and we aimed to reach all mothers with babies between 0 and 24 months of age who applied to the Healthy Child Care Policlinic of Ankara University Faculty of Medicine Hospital between July 1 and August 31, 2020 Questionnaires measuring the level of knowledge about COVID-19 disease and breast milk and questionnaires measuring anxiety levels were administered to mothers. The state-trait anxiety levels and knowledge levels of breastfeeding mothers about COVID-19 disease, as well as their knowledge levels about breast milk and sociodemographic characteristics were compared.

Results

A total of 145 breastfeeding mothers were included in the study. The trait anxiety was found to be either absent or mild in 89 (61.4%), moderate in 28 (19.3%), and advanced in 28 (19.3%) mothers. The state anxiety level, however, was found to be either absent or mild in 51 (35.2%), moderate in 42 (29%), and advanced in 52 (35.9%) mothers. When mothers' trait and state anxiety levels and their knowledge levels about breast milk, their knowledge levels about COVID-19 disease and their sociodemographic characteristics were compared, it was determined that mothers with 0–6 months old infants had lower state anxiety levels compared to mothers with older infants. However, the anxiety levels of mothers whose children were >12 months old were mostly moderate (p < 0.05). There was no statistically significant difference in terms of other variables (p < 0.05). A positive correlation was found between the child age and state anxiety level (p = 0.027).

Conclusion

Moderate and advanced level of state anxiety was found to be higher than level of trait anxiety parallel to our hypothesis. Among breastfeeding mothers, those with the lowest state anxiety scores were those who had babies between 0 and 6 months. It is important to support breastfeeding mothers in promoting breastfeeding, especially after 6 months of birth. Policymakers, obstetricians and especially the family physicians should be aware that adverse life events may put a higher burden on the emotional wellbeing of breastfeeding women especially after 6 months of birth of the babies. So, breastfeeding promotion, protection and support strategies should be reconsidered specially after 6 months.

A review of the disruption of breastfeeding supports in response to the COVID-19 pandemic in five Western countries and applications for clinical practice

Background

The COVID-19 pandemic has significantly altered how breastfeeding support is provided, resulting in mixed breastfeeding outcomes and experiences for mothers. The World Health Organization has consistently supported breastfeeding from the beginning of the pandemic. However, recommendations from obstetrical and gynaecological societies within individual countries have varied in their alignment with this guidance, resulting in inconsistent recommendations. It is unknown how breastfeeding guidelines, maternal breastfeeding experiences, and breastfeeding initiation and duration compared across five Western countries. The current study is comprised of two parts, each with a different objective. Part One objective: to review pandemic-related changes in professional society guidelines on breastfeeding support in Australia, New Zealand, Canada, the United Kingdom, and the United States; and Part Two objective: to conduct a narrative review to summarize the evidence of how the pandemic has changed breastfeeding initiation, duration, and mothers’ breastfeeding experiences during the pandemic in these five countries and provide recommendations for clinical lactation support.

Methods

We searched for indicators that are impactful on breastfeeding outcomes: skin-to-skin contact, rooming in, direct breastfeeding and breast washing, in the five countries mentioned above and compared these to the recommendations from the World Health Organization. Next, we conducted a narrative review of the literature from these five countries to explore how the pandemic altered breastfeeding outcomes and used this information to provide suggestions for clinical practice moving forward.

Results

Recommendations on the four practices above differed by country and were not always in alignment with the World Health Organization recommendations. Mother-infant separation after birth in the United States was associated with a lower prevalence of breastfeeding initiation and duration. While some mothers reported positive breastfeeding experiences during the pandemic, many mothers indicated negative experiences related to decreased social and professional support.

Conclusions

The pandemic can inform practice recommendations and can be viewed as an opportunity to permanently modify existing methods to support breastfeeding families. The use of virtual care increased during the pandemic and should continue with specific considerations for prioritizing in-person care. This will help to provide more timely and accessible support for breastfeeding mothers.

Breastfeeding in a COVID-19 world

PURPOSE OF REVIEW

The coronavirus disease 2019 (COVID-19) pandemic has changed the birthing and postnatal experience of women. This review highlights how policy changes have affected pregnant and breastfeeding women, the evidence for continued breastfeeding and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines, and how the pandemic's unexpected consequences have affected these women's wellbeing. Additionally, we postulate the future of lactation and perinatal support as the pandemic continues.

RECENT FINDINGS

Women who have given birth during the pandemic have had restricted access to postnatal care. Although pregnant and breastfeeding women who contract SARS-CoV-2 are more vulnerable to poor health outcomes than their nonpregnant counterparts, they are also at higher risk of mental health difficulties, with limited access to support. Continued breastfeeding may be protective to the infant, offering passive immunity against SARS-CoV-2, and vaccination against COVID-19 is safe and effective for pregnant and lactating women. Innovative and adaptable lactation care, including holistic perinatal, mental health, and social support services, both digital and in-person, will help mothers continue breastfeeding during future outbreaks.

SUMMARY

Continued breastfeeding and vaccination may confer protection to the infant against SARS-CoV-2 infection. New mothers should not be isolated in future pandemics. Prioritizing lactation and perinatal care, including in-person services, remains paramount to optimizing breastfeeding during COVID-19.

Breastfeeding Patterns and Stress Among Lactating Women in Pune During the COVID-19 Pandemic

Lactating mothers (n=126) residing in Pune, Maharashtra were interviewed to assess the prevalence of stress, rate of exclusive breastfeeding (EBF), and its association with different demographic factors. 75.4% mothers were found to be moderately stressed. Rate of EBF was 62.7%. Moderate stress and testing positive for COVID—19 were significantly negatively associated with EBF (P<0.001).

Effect of the Covid 19 pandemic on depression and mother-infant bonding in uninfected postpartum women in a rural region

Background

Postpartum depression and maternal-infant attachment scores were examined in uninfected women during the COVID 19 pandemic in Kutahya, a rural province in Turkey's North Aegean region.

Methods

This cohort study was conducted in the Kutahya Health Sciences University Hospital obstetrics unit between April 2021 and August 2021. 178 low-risk term pregnant women who gave birth were given the surveys Edinburgh Postpartum Depression Scale and Mother-to-Infant Bonding Scale (MIBQ) 6 weeks after birth. The Edinburgh Postpartum Depression Scale was used to determine postpartum depression and the Mother-to-Infant Bonding Scale was used to determine maternal attachment.

Results

In this study, the postpartum depression rate was calculated as 17.4%. When depressed and non-depressed patients were compared, education level, maternal age, BMI, MIBQ score, history of previous pregnancies, route of delivery, previous operation history, economic status, employment status and pregnancy follow-up information were found to be similar (p > 0.05). The ratings on the Mother-to-Infant Bonding Scale were found to be similar in depressed and non-depressed patients (p > 0.05). The odds of maternal depression for patients who received guests at home was 3.068 (95%CI [1.149–8.191]) times the odds of patients who did not receive guests at home.

Conclusions

Although a relationship has been found between accepting guests in the postpartum period and postpartum depression, it is necessary to investigate in further studies whether there is a causal relationship.

Born Under COVID-19 Pandemic Conditions: Infant Regulatory Problems and Maternal Mental Health at 7 Months Postpartum

Background

The SARS-COVID-19 pandemic and its associated disease control restrictions have in multiple ways affected families with young children, who may be especially vulnerable to mental health problems. Studies report an increase in perinatal parental distress as well as symptoms of anxiety or depression in children during the pandemic. Currently, little is known about the impact of the pandemic on infants and their development. Infant regulatory problems (RPs) have been identified as early indicators of child socio-emotional development, strongly associated with maternal mental health and the early parent–infant interaction. Our study investigates whether early parenthood under COVID-19 is associated with more maternal depressive symptoms and with a perception of their infants as having more RPs regarding crying/fussing, sleeping, or eating, compared to mothers assessed before the pandemic.

Methods

As part of a longitudinal study, 65 women who had given birth during the first nationwide disease control restrictions in Northern Germany, were surveyed at 7 months postpartum and compared to 97 women assessed before the pandemic. RPs and on maternal depressive symptoms were assessed by maternal report. Number of previous children, infant negative emotionality, and perceived social support were assessed as control variables.

Results

Compared to the control cohort, infants born during the COVID-19 pandemic and those of mothers with higher depressive symptoms were perceived as having more sleeping and crying, but not more eating problems. Regression-based analyses showed no additional moderating effect of parenthood under COVID-19 on the association of depressive symptoms with RPs. Infant negative emotionality was positively, and number of previous children was negatively associated with RPs.

Limitations

Due to the small sample size and cross-sectional assessment, the possibility for more complex multivariate analysis was limited. The use of parent-report questionnaires to assess infant RPs can support but not replace clinical diagnosis.

Conclusions

The pandemic conditions affecting everyday life may have a long-term influence on impaired infant self- and maternal co-regulation and on maternal mental health. This should be addressed in peripartum and pediatric care. Qualitative and longitudinal studies focusing on long-term parental and infant outcomes under ongoing pandemic conditions are encouraged.

Neonates and COVID-19: state of the art : Neonatal Sepsis series

The SARS-CoV-2 pandemic has had a significant impact worldwide, particularly in middle- and low-income countries. While this impact has been well-recognized in certain age groups, the effects, both direct and indirect, on the neonatal population remain largely unknown. There are placental changes associated, though the contributions to maternal and fetal illness have not been fully determined. The rate of premature delivery has increased and SARS-CoV-2 infection is proportionately higher in premature neonates, which appears to be related to premature delivery for maternal reasons rather than an increase in spontaneous preterm labor. There is much room for expansion, including long-term data on outcomes for affected babies. Though uncommon, there has been evidence of adverse events in neonates, including Multisystem Inflammatory Syndrome in Children, associated with COVID-19 (MIS-C). There are recommendations for reduction of viral transmission to neonates, though more research is required to determine the role of passive immunization of the fetus via maternal vaccination. There is now considerable evidence suggesting that the severe visitation restrictions implemented early in the pandemic have negatively impacted the care of the neonate and the experiences of both parents and healthcare professionals alike. Ongoing collaboration is required to determine the full impact, and guidelines for future management. IMPACT: Comprehensive review of current available evidence related to impact of the COVID-19 pandemic on neonates, effects on their health, impact on their quality of care and indirect influences on their clinical course, including comparisons with other age groups. Reference to current evidence for maternal experience of infection and how it impacts the fetus and then neonate. Outline of the need for ongoing research, including specific areas in which there are significant gaps in knowledge.

Longitudinal changes in wellbeing amongst breastfeeding women in Australia and New Zealand during the COVID-19 pandemic

The COVID-19 pandemic has impacted new mothers' wellbeing and breastfeeding experience. Women have experienced changes in birth and postnatal care and restricted access to their support network. It is unclear how these impacts may have changed over time with shifting rates of infection and policies restricting movement and access to services in Australia and New Zealand. This study investigated the longitudinal effect of the COVID-19 pandemic on breastfeeding and maternal wellbeing in Australia and New Zealand. Mothers (n = 246) completed an online survey every 4 weeks for 6 months that examined feeding methods, maternal mental wellbeing, worries, challenges, and positive experiences during the pandemic. Mothers maintained high full breastfeeding rates at 4 months (81%) which decreased to 37% at 6 months. Perceived low milk supply contributed to the earlier cessation of full breastfeeding. Poor infant sleep was associated with stress, perinatal anxiety, mental wellbeing, and breastfeeding status. Although mothers initially reported that lockdowns helped with family bonding and less pressure, prolonged lockdowns appeared to have adverse effects on access to social networks and extended family support.    Conclusion: The results highlight the changing dynamic of the pandemic and the need for adaptable perinatal services which allow mothers access to in-person services and their support network even in lockdowns. Similarly, access to continuous education and clinical care remains critical for women experiencing concerns about their milk supply, infant sleep, and their own wellbeing. What is Known: • The COVID-19 pandemic and lockdown restrictions have significantly affected perinatal mental health, disrupted maternal services, and subsequent breastfeeding. What is New: • In Australia and New Zealand, breastfeeding women experienced challenges to their mental wellbeing, sleep, and breastfeeding, which was likely exacerbated over time by the pandemic. Lockdowns, while initially beneficial for some families, became detrimental to maternal support and wellbeing.

Does COVID-19 Policy Affect Initiation and Duration of Exclusive Breastfeeding? A Single-center Retrospective Study

Purpose

It assessed the effect of a COVID-19 policy that involved maternal-neonatal separation on early initiation and duration of exclusive breastfeeding (EBF) at two weeks, three, and six months postpartum during the peak of the COVID-19 pandemic in 2020.

Patients and Methods

This retrospective study included consecutive mother-newborn dyads with deliveries between mid-March and the end of December 2020 who agreed to participate and were eligible according to the following criteria: full-term pregnancy, singleton birth, and healthy newborn. Participants were called at least twice during the study period to inquire about exclusive breastfeeding status at two weeks, three, and six months postpartum. Multivariate logistic regression analysis was carried out to identify associated factors with EBF.

Results

A total of 454 eligible mother-infant dyads were included. Mean maternal age (in years), gestational age (in weeks), birth weight (in kilograms), and 5-min Apgar score was, respectively, 32±5.4 years, 39±1.3 weeks, 3.1±0.42 kg, and 9.24±0.6. Most of the mothers (86.1%) had no known chronic diseases and had a normal spontaneous vaginal delivery (NSVD, 91.4%). Approximately 44.7% of the sample initiated breastfeeding either directly or with expressed breastmilk during their hospital stay. Prevalence of EBF during the first two weeks, three, and six months postpartum was, respectively, 30%, 19.8%, and 31.7%. EBF was associated with birth weight, hospital breastfeeding and EIBF at early postpartum period, while EBF at six months was associated with parity and method of delivery.

Conclusion

During the peak of the COVID-19 pandemic, the prevalence of breastfeeding initiation and EBF in the first six months postpartum were low among Saudi mothers. However, multicenter, prospective, cohort studies with adjustment for known confounding factors are required to explore the impact of infection control policies on breastfeeding. Meanwhile, these policies should support early and safe breastfeeding practices, especially with new and evolving information regarding the current pandemic.

Breastfeeding supportive practices in European hospitals during the COVID-19 pandemic

INTRODUCTION

During the first year of the COVID-19 pandemic, international recommendations and guidelines regarding breastfeeding-supportive hospital practices changed frequently. For example, some recommended separation of mothers and infants; others, feeding pumped milk instead of milk fed directly from the breast. Many recommendations were inconsistent or in direct conflict with each other. Guidance from UENPS (the Union of European Neonatal and Perinatal Societies) published in April 2020 recommended rooming in and direct breastfeeding where feasible, under strict measures of infection control, for women who were COVID-19 positive or under investigation for COVID-19.

KEY FINDINGS

Our study assessed data from respondents from 124 hospitals in 22 nations, with over 1000 births per year, who completed a survey on practices during the COVID-19 epidemic, as they related to the World Health Organization (WHO) Ten Steps to Successful Breastfeeding, considered to be the gold standard for breastfeeding support. The survey was conducted in the fall of 2020/winter of 2021. Overall 88% of responding hospitals had managed COVID positive mothers, and 7% had treated over 50 birthing women with confirmed COVID-19. The biggest change to hospital policy related to visitation policies, with 38% of hospitals disallowing all visitors for birthing women, and 19% shortening the postpartum stay. Eight hospitals (6%) recommended formula feeding instead of breastfeeding for women who tested positive for COVID-19 or were under investigation, whereas 73% continued to recommend direct, exclusive breastfeeding, but with some form of protection such as a mask or hand sanitizer for the mother or cleaning the breast before the feed. While 6% of hospitals discontinued rooming in, 31% strengthened their rooming in policy (keeping mothers and their babies together in the same room) to protect infants against possible exposure to the virus elsewhere in the hospital . Overall, 72% of hospitals used their country's national guidelines when making policy, 31% used WHO guidelines and 22% UENPS/SIN guidelines. Many European hospitals relied on more than one accredited source.

DISCUSSION

Our most concerning finding was that 6% of hospitals recommended formula feeding for COVID positive mothers, a measure that was later shown to be potentially harmful, as protection against the virus is transmitted through human milk. It is encouraging to note that a third of hospitals strengthened rooming in measures. Especially given the emergence of the highly transmissible Delta variant, the situation around postnatal care in maternity hospitals requires ongoing monitoring and may require proactive investment to regain pre-COVID era practices.

25 Years of Research in Human Lactation: From Discovery to Translation

Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.