Should Infants Be Separated from Mothers with COVID-19?

The COVID-19 pandemic has affected every facet of life, beginning with the first hours and days after birth. In an effort to “bend the curve,” some have argued that the prudent course is to isolate infants from mothers with suspected or confirmed COVID-19 in order to reduce the risk of transmission from mother to baby.

Data are limited, and recommendations for the first days after birth differ. The World Health Organization (WHO) recommends that infants and mothers with suspected or confirmed COVID-19 “should be enabled to remain together and practice skin-to-skin contact, kangaroo care and to remain together and to practice rooming in throughout the day and night.” Breastfeeding is strongly recommended, given its known lifelong importance for maternal and child health. Mothers are encouraged to wash their hands, wear a mask if they have a cough, and routinely disinfect surfaces that they have touched.

The United States Centers for Disease Control and Prevention (CDC) advises that facilities “consider temporarily separating the mother from her infant” until the mother is no longer considered contagious. During separation, the CDC recommends that women express breast milk, to be fed to the newborn by a healthy caregiver. If rooming in is preferred by the mother or unavoidable due to facility limitations, steps to reduce risk are described. The CDC further suggests that “the risks and benefits of temporary separation should be discussed by the healthcare team,” but does not elaborate.

New data are emerging daily, and by the time this commentary is published, the landscape may have changed dramatically. But as of late March 2020, what might be the benefits and risks of temporary separation?

The benefit of separation is that it minimizes the risk of transmission of SARS-CoV-2 from mother to infant during the hospital stay. However, if the goal is the health and well-being of mother and child in the months following birth, there are additional considerations.

In the United States, technology and clinical science have long been “normal,” whereas skin-to-skin contact and rooming in defy the reductionism of Western medicine. In contrast, officials at the WHO remember the lessons of the human immunodeficiency virus epidemic, where recommendations to substitute formula for breastfeeding had devastating consequences in low-income countries. At the time of writing, we have no evidence to show that early separation improves outcomes. As we navigate the COVID-19 pandemic, I am hopeful that we can center mothers and babies and remember to first do no harm.

Alison Stuebe.Breastfeeding Medicine.ahead of print

Online Ahead of Print:April 7, 2020