Introduction
A large scale crisis, like what we are experiencing during the COVID-19 pandemic, carries with it both pain and promise. Each day, we are reminded that much of what we thought was in our control is not, what we thought was constant is in fact fluid, and what we thought was true contains an even deeper level of truth. There is a collective sense of loss as the realities we once knew, as well as the realities we dreamed of, change so rapidly.
As we apply these considerations to our work, BreastfeedLA would like to acknowledge that for pregnant and parenting individuals, this experience may be heightened. Preparing to shepherd a little life is a monumental shift under normal circumstances, and may seem astronomical now. However, we are also mindful that in every paradigm shift there is an opportunity for growth; there is a chance to discover new strength, new connection, and new purpose.
As we move through this experience, we want to remind you that we are here for all of it. We are here as your advocates, we are here as your partner in protecting, promoting, and supporting your health, the health of your baby, and the health of the community just as we have always been.
Like you, we have been watching the landscape of maternity care shift during this public health emergency. We have been heartbroken, we have been weary, but we will remain hopeful. Given the widespread panic and general sense of unease we know many of you are feeling, BreastfeedLA would like to offer you some of the principles that have grounded us in our approach to improving the experience of birthing and breast/chestfeeding persons in Los Angeles County.
Statement (updated 5/20/20)
BreastfeedLA unequivocally maintains that during the COVID-19 pandemic breast/chestfeeding should be encouraged as a vital public health intervention at a community level and supported for every parent/baby dyad interested and willing at an individual level. Practitioners, parents, and community partners should continue to be made aware the of the unparalleled immunological, nutritional, and psychosocial benefits of breast/chestfeeding and human milk for infants as well as the social-emotional benefits of breast/chestfeeding for the lactating person, particularly in states of emergency.
Additionally, BreastfeedLA recognizes the importance of:
Labor Support Persons – The opportunity for a safe and satisfying birth experience is a human right. Research shows that the continuous physical, emotional, and informational support of a labor support person during childbirth leads to better birth outcomes. As hospital Labor & Delivery visitation policies shift in response to COVID-19, BreastfeedLA supports the recommendations of the CDC and the World Health Organization in allowing at least one birthing partner to support the laboring person continuously throughout labor and birth. This companion should be whomever the birthing person deems appropriate.
Fathers/Intimate Partners – Beyond providing the physical, emotional, and informational support crucial to all birthing people, we want to highlight the experience and involvement of co-parents as essential, not optional, caregivers for infants and their families. Family units, whatever their makeup, are a critical aspect of the social, emotional, and physical development of children. Fathers, intimate partners, and co-parents are not replaceable by healthcare staff and should be permitted to accompany the birthing person for the entirety of the hospital stay.
Postpartum Support – BreastfeedLA would like to elevate the postpartum visitation policies of leading institutions that allow for one continuous support person to stay with the birthing person throughout the entire postpartum stay. This companion should be whomever the birthing person deems appropriate.
Healthcare Professionals – Preserving and protecting our skilled workforce, including but not limited to midwives, nurses, OB/GYNS, pediatricians, doulas, and lactation professionals cannot be overlooked as a basic tenet to ensuring a safe and satisfying birth experience. It is with the utmost gratitude that BreastfeedLA recognizes the importance of limiting exposure to hospital and care facility staff, many of whom are mothers, fathers, and caregivers themselves. We support the practice of extending universal precautions and the use of proper personal protective equipment to essential visitors, as well as widespread temperature checks and health screenings upon facility entrance.
Shared decision making model – No policy can address the multifaceted needs of every patient. Although we understand the importance of creating a container for behaviors in the healthcare system, we urge care facilities and practitioners to use these tools as defined recommendations in conversations with patients as decisions are made together. We warn against universal predetermined actions that would seek to limit the practice of skin-to-skin, establish routine separation of parents from their infants, and/or lead to the early cessation of breast/chestfeeding. Such blanket policies pose an increased risk of further bias and discrimination against marginalized communities. Now and always, our standard of care should be individualized care, driven by a belief in the inherent dignity of every person and the human right to health and happiness.
Continuation of Care – Learning new behaviors takes time and constant support. With nearly half of all newborn readmissions due to feeding difficulties, BreastfeedLA highly encourages active partnership between birthing facilities and community organizations offering outpatient lactation support and follow-up services. This safety net of support should be culturally responsive and easily accessible to families despite location or income level.
Mental Health – Depression and anxiety are the leading complications in childbirth, yet few birthing people get the care and support they truly need. Having a support person present during childbirth and in the immediate postpartum period, as well as access to trusted, well-trained and culturally responsive mental health providers will help to support the mental health of both parents and baby. Appropriate and consistent breast/chestfeeding support can also help to promote a positive infant feeding experience, which can have a positive effect on the mental well-being of both the parent and child. Also under consideration is the effect of maternal mental health on the development of positive infant-caregiver attachment as it relates to long-term family outcomes and future protection against abuse and neglect. BreastfeedLA endorses the screening of all birthing individuals during prenatal and postpartum care visits and partnerships with community organizations offering mental health services.
We hope that by sharing some of the tenets that guide our work, you are better able to raise your voice, well supported, to be heard and respected. For your patients, for your families, for yourselves. Perhaps that is one thing that hasn’t changed.
In partnership, as always,
The BreastfeedLA Team
Need Resources? Please visit https://www.breastfeedla.org/resources-map/
Questions or Concerns? Interested in advocating for policy change at your institution? Please contact Cindy Young (cyoung@breastfeedla.org), Hannah Halliwell (hhalliwell@breastfeedla.org) or Arissa Palmer (apalmer@breastfeedla.org).