ABSTRACT

Objective:

to identify how the COVID-19 pandemic has influenced postpartum women in breastfeeding.

Method:

a scoping review, with a search in seven databases. Studies available in full, in English, Portuguese or Spanish, published from December/2019-April/2021 were included. The analysis was carried out by categorizing common themes.

Results:

25 studies were included, grouped into five categories, presenting the influence of the pandemic: in the routine of breastfeeding care, evidencing preventive measures against COVID-19; in breastfeeding rates, highlighting changes in dietary practices; in the support network for breastfeeding, indicating a lack of service care; in the postpartum women’s emotions, with predominance of concern and stress; in the use of technology to support breastfeeding, with teleservice facilitating care.

Conclusion:

the COVID-19 pandemic has influenced new forms of care, in the offer and duration of breastfeeding, in emotional health and in the support network fragility. It is expected to contribute so that health professionals provide care with greater assertiveness in the face of this new situation.

DESCRIPTORS
Postpartum Period; Breast Feeding; COVID-19; Review

RESUMEN

Objetivo:

identificar cómo la pandemia de COVID-19 ha influido en las puérperas en la lactancia.

Método:

scoping review, con búsqueda en siete bases de datos. Se incluyeron estudios disponibles en su totalidad, en inglés, portugués o español, publicados entre diciembre/2019 y abril/2021. El análisis se llevó a cabo mediante la categorización de temas comunes.

Resultados:

se incluyeron 25 estudios, agrupados en cinco categorías, que presentan la influencia de la pandemia: en la rutina de cuidados de la lactancia materna, evidenciando medidas preventivas contra la COVID-19; en las tasas de lactancia materna, destacando los cambios en las prácticas dietéticas; en la red de apoyo a la lactancia materna, indicando falta de asistencia en el servicio; en las emociones de las puérperas, con predominio de preocupación y estrés; en el uso de tecnología para apoyar la lactancia materna, con teleservicio facilitando la asistencia.

Conclusión:

la pandemia de COVID-19 influyó en las nuevas formas de asistencia, en la oferta y duración de la lactancia materna, en la salud emocional y en la fragilidad de la red de apoyo. Se espera contribuir para que los profesionales de la salud brinden asistencia con mayor asertividad ante esta nueva situación.

DESCRIPTORES
Periodo Posparto; Lactancia Materna; COVID-19; Revisión

RESUMO

Objetivo:

identificar como a pandemia de COVID-19 tem influenciado as puérperas no aleitamento materno.

Método:

scoping review, com busca em sete bases de dados. Incluíram-se estudos disponíveis na íntegra, em inglês, português ou espanhol, publicados de dezembro/2019-abril/2021. A análise deu-se por categorização de temas comuns.

Resultados:

incluíram-se 25 estudos, agrupados em cinco categorias, apresentando a influência da pandemia: na rotina de cuidados ao aleitamento materno, evidenciando medidas preventivas contra COVID-19; nas taxas do aleitamento materno, destacando mudanças nas práticas alimentares; na rede de apoio para o aleitamento materno, apontando falta de assistência de serviços; nas emoções das puérpera, predominando preocupação e estresse; no uso da tecnologia para apoio ao aleitamento materno, com teleatendimento facilitando a assistência.

Conclusão:

a pandemia de COVID-19 influenciou novas formas de assistência, na oferta e no tempo de amamentação, na saúde emocional e na fragilidade da rede de apoio. Espera-se contribuir para que profissionais da saúde proporcionem assistência com maior assertividade diante dessa nova situação.

DESCRITORES
Período Pós-Parto; Aleitamento Materno; COVID-19; Revisão

INTRODUCTION

The Coronavirus Disease 2019 (COVID-19) pandemic, declared on March 11, 2020, by the World Health Organization (WHO), caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, late 2019, spreading across all continents, infecting and victimizing millions of people(¹1. DiLorenzo MA, O’Connor SK, Ezekwesili C, Sampath S, Zhao M, Yarrington C, et al. COVID-19 guidelines for pregnant women and new mothers: A systematic evidence review. Int J Gynaecol Obstet. 2021;153(3):373-82. DOI: https://doi.org/10.1002/ijgo.13668
https://doi.org/10.1002/ijgo.13668... ,²2. Brasil. Ministério da Saúde. Nota Informativa Nº 13/2020 – SE/GAB/SE/MS. Manual de Recomendações para a Assistência à Gestante e Puérpera frente à Pandemia de COVID-19 [Internet]. Brasília; 2020 [cited 2021 Jan 07]. Available from: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2020/09/Manual-de-Recomenda-es-para-Gestante-1.pdf
https://portaldeboaspraticas.iff.fiocruz... ), with 235,175,106 confirmed cases worldwide as of October 5, 2021(³3. World Health Organization. WHO Coronavirus (COVID-19) Dashboard [Internet]. Geneva: WHO; 2021 [cited 2021 July 26]. Available from: https://covid19.who.int/
https://covid19.who.int/... ).

The first case reported in Brazil was on February 26, 2020, and as of July 17, 2021, 19,342,448 confirmed cases of COVID-19 have been recorded in the country(⁴4. Brasil. Ministério da Saúde. 72 – Boletim epidemiológico especial: Doença pelo Coronavírus COVID-19 [Internet]. Brasília; 2021 [cited July 26]. Available from: https://www.gov.br/saude/pt-br/media/pdf/2021/julho/23/boletim_epidemiologico_covid_72_final23jul21-c-1.pdf
https://www.gov.br/saude/pt-br/media/pdf... ). Among pregnant women and postpartum women, 544 deaths were reported in 2020, and as of May 26, 2021, 911 deaths have been recorded(⁵5. Fiocruz. Ministério da Saúde. Boletim observatório Covid-19 [Internet]. Rio de Janeiro: Fundação Oswaldo Cruz; 2021 [cited 2021 July 16]. Available from: https://agencia.fiocruz.br/sites/agencia.fiocruz.br/files/u34/boletim_covid_2021-semanas_20-21-red.pdf
https://agencia.fiocruz.br/sites/agencia... ). Postpartum women present clinical manifestations similar to those of the general population and, for the Ministry of Health (MoH), women up to the 14^th postpartum day are considered a risk group for COVID-19(²2. Brasil. Ministério da Saúde. Nota Informativa Nº 13/2020 – SE/GAB/SE/MS. Manual de Recomendações para a Assistência à Gestante e Puérpera frente à Pandemia de COVID-19 [Internet]. Brasília; 2020 [cited 2021 Jan 07]. Available from: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2020/09/Manual-de-Recomenda-es-para-Gestante-1.pdf
https://portaldeboaspraticas.iff.fiocruz... ).

Considering the recommended social isolation, behavioral changes and uncertainties occurred, such as women experiencing their labor without a companion and postpartum women, being separated from their children after birth. The possibility of the virus being transmitted through breast milk was also a cause for concern for postpartum women, sometimes being told that breastfeeding was not safe(⁶6. Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Matern Child Nutr. 2020;17(1):e13088. DOI: https://doi.org/10.1111/mcn.13088
https://doi.org/10.1111/mcn.13088... ).

A review identified SARS-CoV-2 ribonucleic acid (RNA) genetic material in breast milk(⁷7. Caparros-Gonzalez RA, Pérez-Morente MA, Hueso-Montoro C, Álvarez-Serrano MA, de la Torre-Luque A. Congenital, Intrapartum and Postnatal Maternal-Fetal-Neonatal SARS-CoV-2 Infections: A Narrative Review. Nutrients. 2020;12(11):3570. DOI: https://doi.org/10.3390/nu12113570
https://doi.org/10.3390/nu12113570... ); however, the evidence is still not clear about the potential for transmission of this virus by this route. Therefore, WHO and institutions such as the MoH(²2. Brasil. Ministério da Saúde. Nota Informativa Nº 13/2020 – SE/GAB/SE/MS. Manual de Recomendações para a Assistência à Gestante e Puérpera frente à Pandemia de COVID-19 [Internet]. Brasília; 2020 [cited 2021 Jan 07]. Available from: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2020/09/Manual-de-Recomenda-es-para-Gestante-1.pdf
https://portaldeboaspraticas.iff.fiocruz... ), a Brazilian Federation of Gynecology and Obstetrics Associations(⁸8. Federação Brasileira das Associações de Ginecologia e Obstetrícia. Infecção pelo Coronavírus SARS-CoV-2 em obstetrícia. Enfrentando o desconhecido! [Internet]. São Paulo: FEBRASGO; 2020 [cited 2022 Jan 21]. Available from: https://www.febrasgo.org.br/pt/noticias/item/948-infeccao-pelo-coronavirus-sars-cov-2-em-obstetricia-enfrentando-o-desconhecido?highlight=WyJhbGVpdGFtZW50byJd
https://www.febrasgo.org.br/pt/noticias/... ,⁹9. Federação Brasileira das Associações de Ginecologia e Obstetrícia. Nótula complementar sobre COVID-19 e Aleitamento Materno [Internet]. São Paulo: FEBRASGO; 2020 [cited 2022 Jan 21]. Available from: https://www.febrasgo.org.br/pt/noticias/item/949-notula-complementar-sobre-covid-19-e-aleitamento-materno?highlight=WyJhbGVpdGFtZW50byJd
https://www.febrasgo.org.br/pt/noticias/... ), the Brazilian Society of Pediatrics(¹⁰10. Sociedade Brasileira de Pediatria. O Aleitamento Materno nos Tempos de COVID-19! [Internet]. SBP; 2020 [cited 2022 Jan 21]. Available from: https://www.sbp.com.br/fileadmin/user_upload/22393c-Nota_de_Alerta_sobe_Aleitam_Materno_nos_Tempos_COVID-19.pdf
https://www.sbp.com.br/fileadmin/user_up... ) and the American Academy of Pediatrics recommend continuing breastfeeding, as the practice reduces the risk of infants having severe respiratory symptoms(¹¹11. World Health Organization. Breastfeeding and COVID-19 [Internet]. WHO; 2020 [cited 2021 Jan 13]. Available from: https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19
https://www.who.int/news-room/commentari... ,¹²12. Almeida M, Shrestha AD, Stojanac D, Miller LJ. The impact of the COVID-19 pandemic on women’s mental health. Arch Womens Ment Health. 2020;23(6):741-8. DOI: https://doi.org/10.1007/s00737-020-01092-2
https://doi.org/10.1007/s00737-020-01092... ). Moreover, antibodies to SARS-CoV-2 were found in breast milk, suggesting protection against infection with the virus(¹³13. Mitoulas LR, Schärer-Hernández NG, Liabat S. Breastfeeding, Human Milk and COVID-19—What Does the Evidence Say? Front Pediatr. 2020;8:613339. DOI: https://doi.org/10.3389/fped.2020.613339
https://doi.org/10.3389/fped.2020.613339... ). Breastfeeding protects women from many diseases, presents fewer symptoms related to emotional problems, reinforces the bond between the mother-child dyad, generating a decrease in the demand for medical care by lactating women(¹⁴14. Del Ciampo LA, Del Ciampo IRL. Breastfeeding and the Benefits of Lactation for Women’s Health. Rev Bras Ginecol Obstet. 2018;40(6):354-9. DOI: https://doi.org/10.1055/s-0038-1657766
https://doi.org/10.1055/s-0038-1657766... ).

Due to the pandemic, in order to reduce the displacement of patients, in order to reduce exposure to SARS-CoV-2, there was a reorganization in health care aimed at this population, with some consultations carried out by video call, when possible, or by phone(²2. Brasil. Ministério da Saúde. Nota Informativa Nº 13/2020 – SE/GAB/SE/MS. Manual de Recomendações para a Assistência à Gestante e Puérpera frente à Pandemia de COVID-19 [Internet]. Brasília; 2020 [cited 2021 Jan 07]. Available from: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2020/09/Manual-de-Recomenda-es-para-Gestante-1.pdf
https://portaldeboaspraticas.iff.fiocruz... ,⁶6. Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Matern Child Nutr. 2020;17(1):e13088. DOI: https://doi.org/10.1111/mcn.13088
https://doi.org/10.1111/mcn.13088... ,¹⁵15. Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study. Appetite. 2021;156:104985. DOI: https://doi.org/10.1016/j.appet.2020.104985
https://doi.org/10.1016/j.appet.2020.104... ). In the UK, postpartum women who gave birth during the lockdown due to COVID-19 had more frequent contact with a healthcare professional than those who gave birth before this period. Of the 1,049 postpartum women who gave birth before the lockdown, 57% (n = 601) reported reduced support for infant feeding in this period(¹⁵15. Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study. Appetite. 2021;156:104985. DOI: https://doi.org/10.1016/j.appet.2020.104985
https://doi.org/10.1016/j.appet.2020.104... ). Regarding breastfeeding, some postpartum women chose not to breastfeed, however, for most mothers, breastfeeding practice remained. There were numerous behavioral changes in the routine of postpartum women(¹⁶16. Ahlers-Schmidt CR, Hervey AM, Neil T, Kuhlmann S, Kuhlmann Z. Concerns of women regarding pregnancy and childbirth during the COVID-19 pandemic. Patient Educ Couns. 2020;103(12):2578-82. DOI: https://doi.org/10.1016/j.pec.2020.09.031
https://doi.org/10.1016/j.pec.2020.09.03... ).

Faced with the problem of breastfeeding in times of a pandemic and the importance for health that this practice represents, both for children and for postpartum women, this study aimed to identify how the COVID-19 pandemic has influenced postpartum women in breastfeeding.

METHOD

Design of Study

This is a scoping review, based on the method proposed by the Joanna Briggs Institute (JBI). A scoping review aims to map concepts that underpin an area of research, report the types of evidence available, regardless of methodological quality, and identify existing gaps in the research field(¹⁷17. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editores. JBI Manual for Evidence Synthesis. JBI; 2020. DOI: https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12... ). Thus, the steps proposed by the JBI were followed, which included: the research objective and question definition; inclusion criteria development; data search approach description, selection, and extraction and presentation of evidence; search; selection; extraction; evidence analysis; results presentation; and synthesis of evidence(¹⁷17. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editores. JBI Manual for Evidence Synthesis. JBI; 2020. DOI: https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12... ).

The guiding question was elaborated from the Population, Concept and Context (PCC) strategy, being defined: P - postpartum women; C - breastfeeding during the COVID-19 pandemic; C – without delimitation of scenarios. In view of this, the guiding question was formulated: how has the COVID-19 pandemic influenced postpartum women in breastfeeding?

An initial search was carried out in the Virtual Health Library (VHL) and PubMed/MEDLINE databases to analyze the terms used to describe the articles relevant to the study. Then, a search was carried out in the VHL, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed/MEDLINE, Scientific Electronic Library Online (SciELO), Scopus and Web of Science databases. The search strategy in Chart 1 was developed with the help of a librarian at Universidade Federal do Paraná (UFPR), according to the Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH), and the same search strategy was used in the databases that composed the study.

Selection Criteria

Studies including postpartum women and/or puerperium, which simultaneously investigate breastfeeding and the COVID-19 pandemic, available in full in English, Portuguese or Spanish, available institutionally, primary studies, review articles, experience reports, research reports, comments and opinion articles, having been published from December 2019, the time of onset of the first cases of unidentified pneumonia that started in Wuhan, China and was confirmed to be COVID-19, to April 2021, being the period of completion of the research, were included. Editorials, letters, videos, websites, news, pre-prints, abstracts and protocols were excluded.

Data Collection

Data collection took place from April to June 2021. Initially, the articles found were incorporated into the EndNote software, a reference manager that helps researchers in the operationalization of the selection of primary studies(¹⁸18. Mendes KDS, Silveira RC de CP, Galvão CM. Use of the bibliographic reference manager in the selection of primary studies in integrative reviews. Texto & Contexto Enfermagem. 2019;28:e20170204. DOI: https://doi.org/10.1590/1980-265X-TCE-2017-0204
https://doi.org/10.1590/1980-265X-TCE-20... ). After removing the duplicates in EndNote, studies were entered into the Rayyan software, an application developed to speed up the initial screening of titles and abstracts of studies in systematic reviews(¹⁹19. Ouzzani, M, Hammady, H, Fedorowicz, Z, Elmagarmid A. Rayyan – a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. DOI: https://doi.org/10.1186/s13643-016-0384-4
https://doi.org/10.1186/s13643-016-0384-... ), in which the removal of duplicates that were not detected by EndNote occurred. These removed duplicates were considered only once, and not removed in their entirety.

Titles and abstracts were reviewed by a reviewer on Rayyan. In cases of doubt, the articles remained for the next phase, which involved reading in full by two reviewers independently. At this stage, the results were discussed in a consensus meeting, and conflicting studies (n = 5) were resolved by reading the entirety blindly by a third reviewer to define the insertion or exclusion of studies. To present the selection process of scoping review studies, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) was used, as recommended by the JBI(¹⁷17. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editores. JBI Manual for Evidence Synthesis. JBI; 2020. DOI: https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12... ).

To extract the data from the selected studies, an instrument made available by the JBI was used(¹⁷17. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editores. JBI Manual for Evidence Synthesis. JBI; 2020. DOI: https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12... ). The selected information was authorship, year of publication, title, journal, volume, edition, pages, country, language, context, participants (age and number), objective(s), methodology/methods, main results, and conclusions.

Data Analysis and Treatment

Data analysis took place through the categorization of studies, bringing together themes in common, involving data coding, with the selection of registration units (RU), corresponding to clippings of significant and representative textual content for analysis, thus originating the themes. After that, RU are enumerated and, then, data classification and aggregation in the form of categories, consisting of the grouping of common themes(²⁰20. Bardin L. Análise de conteúdo. 1ª ed. São Paulo: Edições 70; 2016.).

RESULTS

The search resulted in 297 studies. After removing the duplicates, reading the title and abstract and reading in full, the final sample consisted of 25 studies, as shown in Figure 1.

Of the included studies (Table 1), there was a predominance of English (n = 22.88%), followed by Spanish (n = 2.8%) and Portuguese (n = 1.4%). The United States of America was the country with the highest number of publications (n = 9, 36%), followed by Spain, Italy (n = 3, 12%), Brazil (n = 2, 8%), China, Vietnam, Belgium, India, Nepal, Iran and Austria (n = 1.4%), in addition to a study in the SIBEN Network of Latin America and Equatorial Guinea (n = 1.4%). Articles published in 2020 predominated (n = 15, 60%), with 10 (40%) in 2021.

Of the 25 studies, 4 (16%) were characterized as cross-sectional studies, 2 (8%), as retrospective studies, 1 (4%), as ambispective and prospective, 6 (24%), as experience/case reports, 5 (20%), as review articles, 2 (8%), as comments, 1 (4%), as research report, short communication, case-control study and descriptive study. Of 21 studies, 16 (76%) were in hospitals, 4 (19%) in the community and 1 (5%) in primary care. Postpartum women (n = 11, 44%), pregnant women and postpartum women (n = 4, 16%), hospital institution professionals (n = 4, 16%), mothers (n = 2, 8%), pregnant women and breastfeeding women, breastfeeding women, pregnant women and NB of mothers tested for COVID-19 (n = 1, 4%) participated in the study.

From the categorical analysis, common themes emerged that answer the research question, organized into five categories: Influence of the pandemic on breastfeeding care routine; Influence of the pandemic on breastfeeding rates; Influence of the pandemic on the support network for breastfeeding practice; Influence of the pandemic on postpartum women’s emotions; Influence of the pandemic on the use of technology to support breastfeeding.

Influence of the Pandemic on Breastfeeding Care Routine

Studies have pointed out preventive measures adopted against COVID-19(²²22. Paz MMS da, Almeida M de O, Cabral NO, Assis TJCF de, Mendes CKTT. Barriers imposed in the relationship between puerperal mothers and newborns in the pandemic scenario of COVID-19. Revista Brasileira de Saúde Materno Infantil. 2021;21 Supl 1:229-32. DOI: https://doi.org/10.1590/1806-9304202100S100012
https://doi.org/10.1590/1806-9304202100S... ,²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ,²⁵25. Tran HT, Huynh LT, Le CHM, Nguyen VD, Nguyen PTT, Hoang DT, et al. Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied. Acta Paediatr. 2021;110(7):1991-4. DOI: https://doi.org/10.1111/apa.15837
https://doi.org/10.1111/apa.15837... –³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.–⁴⁵45. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-21. DOI: https://doi.org/10.1111/1471-0528.16278
https://doi.org/10.1111/1471-0528.16278... ). They highlighted the recommendation to use a mask when breastfeeding(²²22. Paz MMS da, Almeida M de O, Cabral NO, Assis TJCF de, Mendes CKTT. Barriers imposed in the relationship between puerperal mothers and newborns in the pandemic scenario of COVID-19. Revista Brasileira de Saúde Materno Infantil. 2021;21 Supl 1:229-32. DOI: https://doi.org/10.1590/1806-9304202100S100012
https://doi.org/10.1590/1806-9304202100S... ,²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ,²⁵25. Tran HT, Huynh LT, Le CHM, Nguyen VD, Nguyen PTT, Hoang DT, et al. Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied. Acta Paediatr. 2021;110(7):1991-4. DOI: https://doi.org/10.1111/apa.15837
https://doi.org/10.1111/apa.15837... ,²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ,³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁵45. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-21. DOI: https://doi.org/10.1111/1471-0528.16278
https://doi.org/10.1111/1471-0528.16278... ), hand hygiene before touching the infant(²²22. Paz MMS da, Almeida M de O, Cabral NO, Assis TJCF de, Mendes CKTT. Barriers imposed in the relationship between puerperal mothers and newborns in the pandemic scenario of COVID-19. Revista Brasileira de Saúde Materno Infantil. 2021;21 Supl 1:229-32. DOI: https://doi.org/10.1590/1806-9304202100S100012
https://doi.org/10.1590/1806-9304202100S... ,²⁵25. Tran HT, Huynh LT, Le CHM, Nguyen VD, Nguyen PTT, Hoang DT, et al. Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied. Acta Paediatr. 2021;110(7):1991-4. DOI: https://doi.org/10.1111/apa.15837
https://doi.org/10.1111/apa.15837... ,²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ,³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ) and when handling the breast pump(²²22. Paz MMS da, Almeida M de O, Cabral NO, Assis TJCF de, Mendes CKTT. Barriers imposed in the relationship between puerperal mothers and newborns in the pandemic scenario of COVID-19. Revista Brasileira de Saúde Materno Infantil. 2021;21 Supl 1:229-32. DOI: https://doi.org/10.1590/1806-9304202100S100012
https://doi.org/10.1590/1806-9304202100S... ,²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ) and the adoption of tests for COVID-19 at hospital admission(²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ,²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ).

Regarding the change in the hospital routine, maintenance of rooming-in with a distance of at least 1 meter between the crib and the mother’s bed was mentioned(²²22. Paz MMS da, Almeida M de O, Cabral NO, Assis TJCF de, Mendes CKTT. Barriers imposed in the relationship between puerperal mothers and newborns in the pandemic scenario of COVID-19. Revista Brasileira de Saúde Materno Infantil. 2021;21 Supl 1:229-32. DOI: https://doi.org/10.1590/1806-9304202100S100012
https://doi.org/10.1590/1806-9304202100S... ,²⁵25. Tran HT, Huynh LT, Le CHM, Nguyen VD, Nguyen PTT, Hoang DT, et al. Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied. Acta Paediatr. 2021;110(7):1991-4. DOI: https://doi.org/10.1111/apa.15837
https://doi.org/10.1111/apa.15837... ,²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ,²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... ,³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ). Cases were highlighted in which rooming-in was not allowed or was discouraged(²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ,²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... –³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ). Concern about exposure to the virus, together with the prevention measures adopted, such as the dyad separation, can harm breastfeeding(³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,³⁹39. Tomori C, Gribble K, Palmquist AEL, Ververs MT, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. Matern Child Nutr. 2020;16(4):e13033. DOI: https://doi.org/10.1111/mcn.13033
https://doi.org/10.1111/mcn.13033... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ).

It was observed that breastfeeding was maintained and supported with a discussion between the mother and the health team about the risks and benefits(²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁵45. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-21. DOI: https://doi.org/10.1111/1471-0528.16278
https://doi.org/10.1111/1471-0528.16278... ). However, it was described that breastfeeding was not possible, due to the dyad being separated(³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ).

Regarding the presence of a companion, the permission of follow-up during the postpartum period(²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ), the non- permission(⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ) and the non-receipt of visits during hospitalization were described(³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ). Regarding the visits of parents to hospitalized infants, it was recorded that the mother was authorized to visit her child after 16 days of hospitalization(³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ) and that visits were not allowed(⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ).

The COVID-19 pandemic influenced lactation care and hospitals started to offer virtual breastfeeding consultations(²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ). Breastfeeding classes were canceled, as postpartum women sought friends instead of health professionals(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ).

Fragility of information related to COVID-19, pregnancy and puerperium was observed(²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.–³⁹39. Tomori C, Gribble K, Palmquist AEL, Ververs MT, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. Matern Child Nutr. 2020;16(4):e13033. DOI: https://doi.org/10.1111/mcn.13033
https://doi.org/10.1111/mcn.13033... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ,⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ), negatively affecting childbirth, puerperium and breastfeeding management in women positive for COVID-19(²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... ), mental health(³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.), humanized care(⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ) and the challenge of making a decision regarding breastfeeding due to lack of information(³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ).

On the other hand, the knowledge about COVID-19, demonstrated by postpartum women(³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ), helped them keep their children protected from the SARS-CoV-2 virus(³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... ), and the benefits of breastfeeding encouraged the maintenance of this practice(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ). A study showed that the non-performance of breastfeeding, due to the dyad separation, can bring negative outcomes to postpartum women, such as increased risk of postpartum hemorrhage, maternal anemia, spaced births, increased risk of breast cancer, among others, in addition to damage to infants’ health(³⁹39. Tomori C, Gribble K, Palmquist AEL, Ververs MT, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. Matern Child Nutr. 2020;16(4):e13033. DOI: https://doi.org/10.1111/mcn.13033
https://doi.org/10.1111/mcn.13033... ). Finally, it was highlighted that rooming-in and breastfeeding practice allowed postpartum women to learn about safe prevention measures against COVID-19 and breastfeeding or milk extraction, reducing the risks of transmission of the virus(³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ).

Influence of the Pandemic on Breastfeeding Rates

In this category, the use of formula feeding was described(²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ), due to NB being in the NICU during isolation(²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ) or parents being quarantined(⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ). It was found that mothers positive for COVID-19 had higher rates of formula feeding, 56.8% (n = 71), followed by pumped breast milk, 36% (n = 45)(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ) and 63% (n = 49) opted for the formula, compared to 24% (n = 19), who maintained breastfeeding, and 13% (n = 10), pumped breast milk(⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ).

Breastfeeding was performed during postpartum hospitalization of mothers with COVID-19(²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ) during NB’s hospitalization in the NICU(²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ) and until postpartum women was asymptomatic, thus being able to establish breastfeeding(³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ). Breastfeeding during postpartum hospitalization was reported(²⁵25. Tran HT, Huynh LT, Le CHM, Nguyen VD, Nguyen PTT, Hoang DT, et al. Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied. Acta Paediatr. 2021;110(7):1991-4. DOI: https://doi.org/10.1111/apa.15837
https://doi.org/10.1111/apa.15837... –²⁷27. Zanardo V, Tortora D, Guerrini P, Garani G, Severino L, Soldera G, et al. Infant feeding initiation practices in the context of COVID-19 lockdown. Early Hum Dev. 2021;152:105286. DOI: https://doi.org/10.1016/j.earlhumdev.2020.105286
https://doi.org/10.1016/j.earlhumdev.202... ,³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ,³⁴34. Mejía Jiménez I, Salvador López R, García Rosas E, Rodriguez de la Torre I, Montes García J, Cruz Conty M, et al. Umbilical cord clamping and skin-to-skin contact in deliveries from women positive for SARS-CoV-2: a prospective observational study. BJOG. 2020;128(5):908-15. DOI: https://doi.org/10.1111/1471-0528.16597
https://doi.org/10.1111/1471-0528.16597... ,⁴⁵45. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-21. DOI: https://doi.org/10.1111/1471-0528.16278
https://doi.org/10.1111/1471-0528.16278... ). In Italy(²⁷27. Zanardo V, Tortora D, Guerrini P, Garani G, Severino L, Soldera G, et al. Infant feeding initiation practices in the context of COVID-19 lockdown. Early Hum Dev. 2021;152:105286. DOI: https://doi.org/10.1016/j.earlhumdev.2020.105286
https://doi.org/10.1016/j.earlhumdev.202... ), the rate of exclusive breastfeeding was lower (n = 107, 70.39%) in postpartum women who gave birth during the COVID-19 pandemic, compared to postpartum women who gave birth in 2019 (n = 123, 86.39%). It was observed that, of 1,343 hospitals, the rate of exclusive breastfeeding decreased in 12.2% of them(²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ).

In one study, 94% (n = 31) of NB who were with their mothers were breastfed in the first hour of life(³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ). The breastfeeding rate in a group that had DCC was higher compared to the early cord clamping group (77.3% vs. 50.2%)(³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ). A study(⁴⁵45. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-21. DOI: https://doi.org/10.1111/1471-0528.16278
https://doi.org/10.1111/1471-0528.16278... ) pointed out that 26.2% (n = 11) of postpartum women with COVID-19 breastfed in the postpartum period.

Exclusive breastfeeding, breast milk and expressed breast milk(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ) were reported. A study observed that, of 97% in breastfeeding, 53% of infants were exclusively breastfed at home(²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ). It was identified that 55% of mothers provided breast milk exclusively during meetings of the breastfeeding support group, in addition to the increase in the breastfeeding rate from 43% in 2017 to 55% in 2020(²¹21. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, et al. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021;16(2):156-64. DOI: https://doi.org/10.1089/bfm.2020.0323
https://doi.org/10.1089/bfm.2020.0323... ).

There was a record of lower rates of exclusive breastfeeding of mothers who breastfed during the pandemic, adopting more complementary feeding practices, as well as switching from formula milk to breastfeeding due to lack of formula, cost, fear of contamination of the formula or because they believe that milk was the best option to protect their children Mothers mentioned a positive impact of the pandemic on breastfeeding(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ).

Infant feeding plans were also mentioned, with a one-year feeding plan combining breast milk on the breast and pumped(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ). It was pointed out that the infant’s diet did not change due to the pandemic and that 97% of mothers did not consider stopping offering breast milk, as well as women with previous breastfeeding experience reported that SARS-CoV-2 had no influence on how they dealt with breastfeeding(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ).

The protection that breast milk can offer against SARS-CoV-2 was also mentioned, demonstrating that, of four samples, three tested positive for IgM or IgG against SARS-CoV-2(²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ). It is noteworthy that decreased breastfeeding could limit protection against the virus(³⁹39. Tomori C, Gribble K, Palmquist AEL, Ververs MT, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. Matern Child Nutr. 2020;16(4):e13033. DOI: https://doi.org/10.1111/mcn.13033
https://doi.org/10.1111/mcn.13033... ).

Studies have mentioned an increase in the frequency of breastfeeding(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ), demonstrating growth compared to before the pandemic, one of the reasons being at home longer due to the lockdown and the desire to offer protection against the virus through breast milk, considering extending the time of breastfeeding due to the coronavirus(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ). Increased maternity leave duration was reported as a positive influence on the journey to breastfeed, as well as the fear of lack of formula milk, being an incentive to continue breastfeeding(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ).

Moreover, decreased frequency(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ) has been described. Postpartum women mentioned that the decline or interruption of breastfeeding was due to the consequences of the lockdown, such as working from home alongside other childcare responsibilities, an increased workload or a reduction in milk production due to coronavirus concerns(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ).

There was a record about the refusal of postpartum women (n = 3, 23.1%) to breastfeed, even wishing to do so, after knowing the positive result for COVID-19(²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... ) and that, at some point, there was interruption of breastfeeding(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ) and change of feeding to milk in formula(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ).

Influence of the Pandemic on the Support Network for Breastfeeding Practice

Themes related to this category correspond to the support received by postpartum women both from health professionals and from support groups, family, friends and co-workers(²¹21. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, et al. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021;16(2):156-64. DOI: https://doi.org/10.1089/bfm.2020.0323
https://doi.org/10.1089/bfm.2020.0323... ,²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ,³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ,³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ). The support network involving family and friends(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ) and co-workers(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ) was cited. The care of health professionals included care and guidance in breast- feeding care and consultation on lactation(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ). In a hospital, videoconferencing was observed with families who could not go to visits(³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ). The positive influence of a breastfeeding support group was reported(²¹21. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, et al. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021;16(2):156-64. DOI: https://doi.org/10.1089/bfm.2020.0323
https://doi.org/10.1089/bfm.2020.0323... ), but there was a cancellation of support groups due to the pandemic(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ).

The lack of care by health services was observed(²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ,³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ). There was a reduction in access to face-to-face lactation support(²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ). Postpartum women reported dissatisfaction with the care they received, in addition to lactation support reduction in the hospital environment(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ). They felt the impact on medical advice, reported that they received less professional care compared to before the pandemic. Mothers who breastfed for less than 6 weeks reported that the pandemic affected their care and less than 10% of postpartum women reported having received more professional care(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ).

Lack of family support was reported during postpartum women’s hospitalization with COVID-19(³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.). There was a report of the desire to have received more support from daycare centers and the family that, due to the pandemic, could not be close(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ). Of 39% of postpartum women who reported having received less social support during breastfeeding, 87% reported having family and friends(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ).

Influence of the Pandemic on Postpartum Women’s Emotions

The studies gathered in this category presented the feelings expressed by postpartum women. Concerns due to the pandemic were described(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ), attributed to the return to work due to new policies that make it difficult to remove breast milk at work, related to the maintenance of lactation(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ) with regard to both manual milking of breast milk and extraction by extracting pumps, for not being able to perform maternal functions because it is far from their hospitalized children, with judgments due to the disease(³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.), with the financial burden to buy infant formula and its availability in stores, as well as if stress would affect the supply of milk(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ) and with the transmission of the virus through breastfeeding(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ).

A study identified that 23.03% (n = 35) of postpartum women who gave birth during the COVID-19 pandemic had the Edinburgh Postnatal Depression Scale (EPDs) score for risk of depressive symptoms >12, compared to 11.56% (n = 17) of postpartum women who gave birth in 2019, as well as presenting higher scores on the anhedonia and depression subscale. It was also observed that postpartum women who were exclusively breastfed had significantly lower scores in these subscales than those who established complementary practices and artificial feeding(²⁷27. Zanardo V, Tortora D, Guerrini P, Garani G, Severino L, Soldera G, et al. Infant feeding initiation practices in the context of COVID-19 lockdown. Early Hum Dev. 2021;152:105286. DOI: https://doi.org/10.1016/j.earlhumdev.2020.105286
https://doi.org/10.1016/j.earlhumdev.202... ).

Appetite loss and interest in daily activities were reported during hospitalization(³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.) and depressive symptoms in postpartum women breastfeeding(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ). From another perspective, postpartum women in exclusive breastfeeding had lower EPDS scores, compared to other feeding methods(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ).

Stress(²⁴24. Mayopoulos GA, Ein-Dor T, Dishy GA, Nandru R, Chan SJ, Hanley LE, et al. COVID-19 is associated with traumatic childbirth and subsequent mother-infant bonding problems. J Affect Disord. 2021;282:122-5. DOI: https://doi.org/10.1016/j.jad.2020.12.101
https://doi.org/10.1016/j.jad.2020.12.10... ,³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ) was related to the breastfeeding trajectory due to lack of support and how the pandemic could influence postpartum women and their son(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ), also due to unfulfilled maternal duties(³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.). Frustration(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ) was described as a disappointment with the social distancing measures, for having planned the participation of her family and friends in her birth, and, due to the pandemic, only her husband could be present(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ). Stress was also related to expectations of an unmet maternity and the feeling of missed opportunity to breastfeed their children(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ).

Fear was reported by the possibility of infection from hospitalization or breastfeeding(³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.) and the diagnosis and consequences that this can cause(³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ). There were reports of anxiety due to concerns(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ), fear(³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.), feelings of isolation(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.), guilt(³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ), sadness for not receiving visits from family and friends during hospitalization(³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ) and for not participating in support groups due to social distancing(⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ).

The challenges described were related to decision-making regarding breastfeeding with limited information about COVID-19(³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ) and the fact that if the pandemic had occurred in the first experience of postpartum women, the challenges would have been greater(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ). Another aspect pointed out was that the mother-child bond may end up being impacted by preventive measures adopted to combat COVID-19, in addition to the fear and anxiety by mothers that may end up affecting the construction of this bond(²²22. Paz MMS da, Almeida M de O, Cabral NO, Assis TJCF de, Mendes CKTT. Barriers imposed in the relationship between puerperal mothers and newborns in the pandemic scenario of COVID-19. Revista Brasileira de Saúde Materno Infantil. 2021;21 Supl 1:229-32. DOI: https://doi.org/10.1590/1806-9304202100S100012
https://doi.org/10.1590/1806-9304202100S... ). It was also reported the gratifying moment of postpartum women to have contact with their child after being unable to visit them for days, thus being able to start maternal care(³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ).

Influence of the Pandemic on the Use of Technology to Support Breastfeeding

Here are included studies that reported the experiences of postpartum women with the use of technology(²¹21. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, et al. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021;16(2):156-64. DOI: https://doi.org/10.1089/bfm.2020.0323
https://doi.org/10.1089/bfm.2020.0323... ,³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ,³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... ,³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ). The sources of information described were the online environment(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ), such as social networks(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... ), television and radio(³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... ). Regarding online consultations, after hospital discharge, there was 100% compliance with televisits(³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ) and postpartum care facilitated through telehealth, including lactation visits(⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ). However, there was difficulty and concern in obtaining good care related to breastfeeding through telehealth(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ).

The use of video calls in a hospital was mentioned, being carried out by professionals between postpartum women and NB, who were hospitalized in another unit, making it possible to send photos and updates about the infant until postpartum women could visit them. Virtual visits helped the mother to express her milk to send to her child(³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ). Also noteworthy is the increase in the frequency of meetings of a breastfeeding support group after the beginning of the pandemic, in the online format. Social media was a good alternative to involve participants, considering continuing with the virtual option of meetings, since, in this format, it is possible for mothers who have difficulty attending in person to participate(²¹21. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, et al. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021;16(2):156-64. DOI: https://doi.org/10.1089/bfm.2020.0323
https://doi.org/10.1089/bfm.2020.0323... ).

DISCUSSION

Changes in breastfeeding practices demonstrated(²²22. Paz MMS da, Almeida M de O, Cabral NO, Assis TJCF de, Mendes CKTT. Barriers imposed in the relationship between puerperal mothers and newborns in the pandemic scenario of COVID-19. Revista Brasileira de Saúde Materno Infantil. 2021;21 Supl 1:229-32. DOI: https://doi.org/10.1590/1806-9304202100S100012
https://doi.org/10.1590/1806-9304202100S... ,²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ,²⁵25. Tran HT, Huynh LT, Le CHM, Nguyen VD, Nguyen PTT, Hoang DT, et al. Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied. Acta Paediatr. 2021;110(7):1991-4. DOI: https://doi.org/10.1111/apa.15837
https://doi.org/10.1111/apa.15837... ,²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ,³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁵45. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-21. DOI: https://doi.org/10.1111/1471-0528.16278
https://doi.org/10.1111/1471-0528.16278... ) are in line with the recommendations of WHO(⁴⁶46. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected [Internet]. WHO; 2020 [cited 2021 July 13]. Available from: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf
https://www.who.int/docs/default-source/... ), Centers for Disease Control and Prevention (CDC)(⁴⁷47. Centers for Disease Control and Prevention. Care for Breastfeeding People [Internet]. COVID-19; 2021 [cited 2021 July 13]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/care-for-breastfeeding-women.html
https://www.cdc.gov/coronavirus/2019-nco... ) and MoH(⁴⁸48. Brasil. Ministério da Saúde. Nota técnica Nº 7/2020-DAPES/SAPS/MS [Internet]. Brasília; 2020 [cited 21 July 13]. Available from: http://www.saude.sp.gov.br/resources/instituto-de-saude/homepage/pdfs/sei_ms-0014033399-notatecnicaaleitamentoecovid.pdf
http://www.saude.sp.gov.br/resources/ins... ), in order to prevent transmission of the virus to the infant. The maintenance of rooming-in(²²22. Paz MMS da, Almeida M de O, Cabral NO, Assis TJCF de, Mendes CKTT. Barriers imposed in the relationship between puerperal mothers and newborns in the pandemic scenario of COVID-19. Revista Brasileira de Saúde Materno Infantil. 2021;21 Supl 1:229-32. DOI: https://doi.org/10.1590/1806-9304202100S100012
https://doi.org/10.1590/1806-9304202100S... ,²⁵25. Tran HT, Huynh LT, Le CHM, Nguyen VD, Nguyen PTT, Hoang DT, et al. Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied. Acta Paediatr. 2021;110(7):1991-4. DOI: https://doi.org/10.1111/apa.15837
https://doi.org/10.1111/apa.15837... ,²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ,²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... ,³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ) and breastfeeding(²⁸28. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44(7):151320. DOI: https://doi.org/10.1016/j.semperi.2020.151320
https://doi.org/10.1016/j.semperi.2020.1... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁵45. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-21. DOI: https://doi.org/10.1111/1471-0528.16278
https://doi.org/10.1111/1471-0528.16278... ) corroborate the WHO recommendations(¹¹11. World Health Organization. Breastfeeding and COVID-19 [Internet]. WHO; 2020 [cited 2021 Jan 13]. Available from: https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19
https://www.who.int/news-room/commentari... ). The dyad must remain together, and breastfeeding must continue, regardless of suspicion or confirmation of COVID-19.

The CDC(⁴⁹49. Centers for Disease Control and Prevention. Breastfeeding and Caring for Newborns [Internet]. COVID-19; 2021 [cited 2021 July 13]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html
https://www.cdc.gov/coronavirus/2019-nco... ) advises that the decision for rooming-in be made in consensus between the mother and the team, after knowing the risks and benefits, since this practice helps in the development of mother-infant bond and in breastfeeding. As mentioned in a study(⁵⁰50. Popofsky S, Noor A, Leavens-Maurer J, Quintos-Alagheband ML, Mock A, Vinci A, et al Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at Birth. J Pediatr. 2020;226:64-70. DOI: https://doi.org/10.1016/j.jpeds.2020.08.004
https://doi.org/10.1016/j.jpeds.2020.08.... ), only 12% of postpartum women who were separated from their children during hospitalization in the COVID-19 pandemic breastfed at home, compared to 27.8% of mothers who were not separated, demonstrating that separation has a negative impact on breastfeeding, such as observed in the findings(²⁷27. Zanardo V, Tortora D, Guerrini P, Garani G, Severino L, Soldera G, et al. Infant feeding initiation practices in the context of COVID-19 lockdown. Early Hum Dev. 2021;152:105286. DOI: https://doi.org/10.1016/j.earlhumdev.2020.105286
https://doi.org/10.1016/j.earlhumdev.202... ,³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,³⁹39. Tomori C, Gribble K, Palmquist AEL, Ververs MT, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. Matern Child Nutr. 2020;16(4):e13033. DOI: https://doi.org/10.1111/mcn.13033
https://doi.org/10.1111/mcn.13033... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... –⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ).

WHO recommends the presence of a companion during labor and childbirth(⁵¹51. World Health Organization. WHO recommendations Intrapartum care for a positive childbirth experience [Internet]. WHO; 2018 [cited 2021 July 25]. Available from: http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf;jsessionid=EAF86236F2A8E00D4EFB98BF409FDF7D?sequence=1
http://apps.who.int/iris/bitstream/handl... ). In Brazil, mothers are entitled to a companion of choice during labor, childbirth and immediate postpartum, regulated by law(⁵²52. Brasil. Lei nº 11.108, de 7 de abril de 2005. Altera a Lei nº 8.080, de 19 de setembro de 1990, para garantir às parturientes o direito à presença de acompanhante durante o trabalho de parto, parto e pós-parto imediato, no âmbito do Sistema Único de Saúde – SUS [Internet]. Brasília; 2005 [cited 2021 July 24]. Available from: http://www.planalto.gov.br/ccivil_03/_ato2004-2006/2005/lei/l11108.htm
http://www.planalto.gov.br/ccivil_03/_at... ), however, in two studies in this review, postpartum women did not have this permission(⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... ,⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ). The presence of a companion, in addition to conveying security to postpartum women, was associated with good care practices, such as breastfeeding in the first hour of life, choosing the childbirth position, not being tied up, submission to non-pharmacological maneuvers and analgesia for pain relief(⁵³53. Tomasi YT, Saraiva S dos S, Boing AC, Delziovo CR, Wagner KJP, Boing AF. From prenatal care to childbirth: a cross-sectional study on the influence of a companion on good obstetric practices in the Brazilian National Health System in Santa Catarina State, 2019. Epidemiol Serv Saude. 2021;30(1):e2020383. DOI: https://doi.org/10.1590/S1679-49742021000100014
https://doi.org/10.1590/S1679-4974202100... ), highlighting the importance of companions in this process.

The impact of COVID-19-related misinformation(³⁰30. Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, et al. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40(7):987-96. DOI: https://doi.org/10.1038/s41372-020-0695-0
https://doi.org/10.1038/s41372-020-0695-... ,³⁶36. Adhikari SP, Pariyar J, Sapkota K, Gurung TK, Adhikari SR. Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study. Kathmandu Univ Med J (KUMJ). 2020;18(2):10-4. DOI: https://doi.org/10.3126/kumj.v18i2.32938
https://doi.org/10.3126/kumj.v18i2.32938... –³⁹39. Tomori C, Gribble K, Palmquist AEL, Ververs MT, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. Matern Child Nutr. 2020;16(4):e13033. DOI: https://doi.org/10.1111/mcn.13033
https://doi.org/10.1111/mcn.13033... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ,⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ) on postpartum women who stopped breastfeeding is observed, in which they were more likely to be told by health professionals or family and friends that breastfeeding would not be safe or that they could not do so if they had symptoms of the disease(⁶6. Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Matern Child Nutr. 2020;17(1):e13088. DOI: https://doi.org/10.1111/mcn.13088
https://doi.org/10.1111/mcn.13088... ). It is possible to see the importance of transmitting updated information about COVID-19, as evidence about the virus that causes this disease changes rapidly. In this way, health professionals must guide and make decisions, in a shared way, with the family, respecting parents’ will(¹1. DiLorenzo MA, O’Connor SK, Ezekwesili C, Sampath S, Zhao M, Yarrington C, et al. COVID-19 guidelines for pregnant women and new mothers: A systematic evidence review. Int J Gynaecol Obstet. 2021;153(3):373-82. DOI: https://doi.org/10.1002/ijgo.13668
https://doi.org/10.1002/ijgo.13668... ). In this sense, a scientifically based strategy to support breastfeeding women was observed by lactation consultants, in which real-time online meetings were promoted with professionals from various health areas, in order to resolve doubts from families and so that postpartum women remain encouraged to continue breastfeeding, reinforcing for postpartum women the importance of consulting information about COVID-19 and breastfeeding from safe and reliable sources(⁵⁴54. Lima ACMACC, Chaves AFL, Oliveira MG de, Lima SAFCC, Machado MMT, Oriá MOB. Breastfeeding consultancy during the COVID-19 pandemic: experience report. Escola Anna Nery. 2020;24(Spe):e20200350. DOI: https://doi.org/10.1590/2177-9465-EAN-2020-0350
https://doi.org/10.1590/2177-9465-EAN-20... ).

Regarding formula feeding, a study found data similar to the findings(²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ,⁴²42. Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, et al. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med. 2020;13(3):307-11. DOI: https://doi.org/10.3233/NPM-200478
https://doi.org/10.3233/NPM-200478... –⁴⁴44. Sola A, Rodríguez S, Cardett M, Dávila C. COVID-19 perinatal en América Latina. Rev Panam Salud Publica. 2020;44:e47. DOI: https://doi.org/10.26633/RPSP.2020.47
https://doi.org/10.26633/RPSP.2020.47... ), demonstrating that this type of feeding predominated in the group of mother-infant dyads who were separated during hospitalization, being 81.6% compared to 27.8% of dyads that were not separated. Breastfeeding rate was lower among separated dyads (0%) compared to non-separated dyads (22%)(⁵⁰50. Popofsky S, Noor A, Leavens-Maurer J, Quintos-Alagheband ML, Mock A, Vinci A, et al Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at Birth. J Pediatr. 2020;226:64-70. DOI: https://doi.org/10.1016/j.jpeds.2020.08.004
https://doi.org/10.1016/j.jpeds.2020.08.... ). The results found on exclusive breastfeeding(²¹21. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, et al. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021;16(2):156-64. DOI: https://doi.org/10.1089/bfm.2020.0323
https://doi.org/10.1089/bfm.2020.0323... ,²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ,²⁷27. Zanardo V, Tortora D, Guerrini P, Garani G, Severino L, Soldera G, et al. Infant feeding initiation practices in the context of COVID-19 lockdown. Early Hum Dev. 2021;152:105286. DOI: https://doi.org/10.1016/j.earlhumdev.2020.105286
https://doi.org/10.1016/j.earlhumdev.202... ,³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ) are corroborated by studies, in which 58.6% of participants breastfed exclusively at home during the pandemic(⁶6. Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Matern Child Nutr. 2020;17(1):e13088. DOI: https://doi.org/10.1111/mcn.13088
https://doi.org/10.1111/mcn.13088... ), in which 40% of 316 mothers who gave birth during social isolation were exclusively breastfed at home(¹⁵15. Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study. Appetite. 2021;156:104985. DOI: https://doi.org/10.1016/j.appet.2020.104985
https://doi.org/10.1016/j.appet.2020.104... ), and who identified that, at discharge, 69.4% of infants were exclusively breastfed, compared to 97.7% of infants in 2018(⁵⁵55. Latorre G, Martinelli D, Guida P, Masi E, De Benedictis R, Maggio L. Impact of COVID-19 pandemic lockdown on exclusive breastfeeding in non-infected mothers. Int Breastfeed J. 2021;16(1):36. DOI: https://doi.org/10.1186/s13006-021-00382-4
https://doi.org/10.1186/s13006-021-00382... ).

It was observed in the findings of this review that most meal plans were not negatively influenced by the pandemic(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ). In the literature, 219 (14.2%) parents reported changes in diet due to the pandemic, with 95% weaning later than planned(⁵⁶56. Palmquist AE, Fox C, Chung S, Tomori C, Quinn EA. Infant Feeding during the COVID-19 Pandemic in the U.S. – 90th Annual Meeting of the American Association of Physical Anthropologists. Am J Phys Anthropol. 2021;174 Suppl 71:81. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajpa.24262
https://onlinelibrary.wiley.com/doi/epdf... ). However, in one study, 35.3% of mothers changed their meal plans due to COVID-19, considering the separation and, consequently, the difficulty of latching on to the breast as reasons(⁵⁰50. Popofsky S, Noor A, Leavens-Maurer J, Quintos-Alagheband ML, Mock A, Vinci A, et al Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at Birth. J Pediatr. 2020;226:64-70. DOI: https://doi.org/10.1016/j.jpeds.2020.08.004
https://doi.org/10.1016/j.jpeds.2020.08.... ). Mothers who gave birth during the lockdown reported that feeding plans changed due to lack of breastfeeding support (6.6%), mainly in face-to-face care, with practical problems, such as latching on to the breast, which resulted in the withdrawal of breast milk and introduction of formula or interruption of breastfeeding(¹⁵15. Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study. Appetite. 2021;156:104985. DOI: https://doi.org/10.1016/j.appet.2020.104985
https://doi.org/10.1016/j.appet.2020.104... ).

There is a record of the presence of IgM or IgG antibodies against SARS-CoV-2 in breast milk(²³23. Gao X, Wang S, Zeng W, Chen S, Wu J, Lin X, et al. Clinical and immunologic features among COVID-19-affected mother-infant pairs: antibodies to SARS-CoV-2 detected in breast milk. New Microbes New Infect. 2020;37:100752. DOI: https://doi.org/10.1016/j.nmni.2020.100752
https://doi.org/10.1016/j.nmni.2020.1007... ). In the review, there were two evidences of the presence of IgG antibodies against the same virus in breast milk, but no IgM antibodies were identified(⁷7. Caparros-Gonzalez RA, Pérez-Morente MA, Hueso-Montoro C, Álvarez-Serrano MA, de la Torre-Luque A. Congenital, Intrapartum and Postnatal Maternal-Fetal-Neonatal SARS-CoV-2 Infections: A Narrative Review. Nutrients. 2020;12(11):3570. DOI: https://doi.org/10.3390/nu12113570
https://doi.org/10.3390/nu12113570... ). These findings indicate possible protection for infants against SARS-CoV-2, and reduced breastfeeding could limit protection against the virus(³⁹39. Tomori C, Gribble K, Palmquist AEL, Ververs MT, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. Matern Child Nutr. 2020;16(4):e13033. DOI: https://doi.org/10.1111/mcn.13033
https://doi.org/10.1111/mcn.13033... ).

The increase in the frequency of breastfeeding(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ) is in accordance with data obtained in the UK and USA, in which one of the reasons for this increase among postpartum women was being at home longer during the pandemic(¹⁵15. Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study. Appetite. 2021;156:104985. DOI: https://doi.org/10.1016/j.appet.2020.104985
https://doi.org/10.1016/j.appet.2020.104... ,⁵⁶56. Palmquist AE, Fox C, Chung S, Tomori C, Quinn EA. Infant Feeding during the COVID-19 Pandemic in the U.S. – 90th Annual Meeting of the American Association of Physical Anthropologists. Am J Phys Anthropol. 2021;174 Suppl 71:81. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajpa.24262
https://onlinelibrary.wiley.com/doi/epdf... ). Despite this, there have been reports of decline, interruption or discontinuation of breastfeeding(²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... ,³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ). These results are consistent with another finding, in which insufficient professional support, latching difficulty, tiredness, insufficient milk and pain were attributed to stopping breastfeeding in the UK in the current pandemic(⁶6. Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Matern Child Nutr. 2020;17(1):e13088. DOI: https://doi.org/10.1111/mcn.13088
https://doi.org/10.1111/mcn.13088... ).

Still in the same study, 67% of participants reported feeling less support for breastfeeding during the lockdown(⁶6. Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Matern Child Nutr. 2020;17(1):e13088. DOI: https://doi.org/10.1111/mcn.13088
https://doi.org/10.1111/mcn.13088... ), another finding similar to this review(²⁹29. Vila-Candel R, Mena-Tudela D, Gómez-Seguí A, Asensio-Tomás N, Cervera-Gasch A, Herraiz-Solerd Y. Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community. Enferm Clin. 2021;31(3):184-8. DOI: https://doi.org/10.1016/j.enfcli.2021.01.006
https://doi.org/10.1016/j.enfcli.2021.01... ,³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ). It was noted, in a study carried out before the current pandemic, that adequate support for breastfeeding plays a fundamental role in the perceived success of breastfeeding, in which the absence of breastfeeding difficulties and receiving support in the event of difficulties was associated with a lower risk of non-exclusive breastfeeding(⁵⁷57. Gianni ML, Bettinelli ME, Manfra P, Sorrentino G, Bezze E, Plevani L, et al. Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation. Nutrients. 2019;11(10):2266. DOI: https://doi.org/10.3390/nu11102266
https://doi.org/10.3390/nu11102266... ). Women who sought professional help due to breastfeeding difficulties were more likely to discontinue exclusive breastfeeding(⁵⁸58. Moraes BA, Strada JKR, Gasparin VA, Espirito-Santo LC do, Gouveia HG, Gonçalves AC. Breastfeeding in the first six months of life for babies seen by Lactation Consulting. Rev Lat Am Enfermagem. 2021;29:e3412. DOI: https://doi.org/10.1590/1518-8345.3538.3412
https://doi.org/10.1590/1518-8345.3538.3... ). Also, some postpartum women, during the COVID-19 pandemic, stopped breastfeeding earlier than they wanted due to lack of support in the hospital and at home(⁵⁹59. Rice K, Williams S. Women’s postpartum experiences in Canada during the COVID-19 pandemic: a qualitative study. CMAJ Open. 2021;9(2):E556-62. DOI: https://doi.org/10.9778/cmajo.20210008
https://doi.org/10.9778/cmajo.20210008... ).

As for the support network(³²32. Ceulemans M, Verbakel JY, Calsteren KV, Eerdekens A, Allegaert K, Foulon V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int J Environ Res Public Health. 2020;17(18):6766. DOI: https://doi.org/10.3390/ijerph17186766
https://doi.org/10.3390/ijerph17186766... ,³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.), there is a study that recorded that support for infant feeding has decreased since the lockdown in 57% of women who gave birth before the lockdown, as well as support for day care has decreased for 69% of participants(¹⁵15. Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study. Appetite. 2021;156:104985. DOI: https://doi.org/10.1016/j.appet.2020.104985
https://doi.org/10.1016/j.appet.2020.104... ). Furthermore, the lack of social and emotional support in the pandemic has negatively impacted the breastfeeding experience among postpartum women in the UK(⁶6. Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Matern Child Nutr. 2020;17(1):e13088. DOI: https://doi.org/10.1111/mcn.13088
https://doi.org/10.1111/mcn.13088... ), reinforcing the importance of social support for breastfeeding women, observed in the positive influence of the support group on breastfeeding(²¹21. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, et al. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021;16(2):156-64. DOI: https://doi.org/10.1089/bfm.2020.0323
https://doi.org/10.1089/bfm.2020.0323... ). Social support has strong protection against postpartum depression (PPD), and having an adequate support network is critical to reducing PPD symptoms(⁶⁰60. Pao C, Guintivano J, Santos H, Meltzer-Brody S. Postpartum depression and social support in a racially and ethnically diverse population of women. Arch Womens Ment Health. 2018;22(1):105-14. DOI: https://doi.org/10.1007/s00737-018-0882-6
https://doi.org/10.1007/s00737-018-0882-... ).

Regarding the influence on emotions(²⁷27. Zanardo V, Tortora D, Guerrini P, Garani G, Severino L, Soldera G, et al. Infant feeding initiation practices in the context of COVID-19 lockdown. Early Hum Dev. 2021;152:105286. DOI: https://doi.org/10.1016/j.earlhumdev.2020.105286
https://doi.org/10.1016/j.earlhumdev.202... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ), psychophysiological factors such as stress and sleep can affect milk production(⁶¹61. Bryant J, Thistle J. Anatomy, Colostrum [Internet]. 2021 [cited 2022 Jan 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513256/
https://www.ncbi.nlm.nih.gov/books/NBK51... ). In a survey in Belgium, of 5,866 women, 2,421 of whom were pregnant and 3,445 breastfeeding women, almost half of the sample had depressive or anxious symptoms. The data obtained was considerably higher than the estimates obtained before the COVID-19 pandemic(⁶²62. Ceulemans M, Hompes T, Foulon V. Mental health status of pregnant and breastfeeding women during the COVID-19 pandemic: A call for action. Int J Gynaecol Obstet. 2020;151(1):146-7. DOI: https://doi.org/10.1002/ijgo.13295
https://doi.org/10.1002/ijgo.13295... ). Another study carried out before the pandemic identified an association between maternal satisfaction with breastfeeding and PPD symptoms, in which there was a higher prevalence of satisfaction with breastfeeding among postpartum women without PPD symptoms(⁶³63. Avilla JC de, Giugliani C, Bizon AMBL, Martins ACM, Senna AFK de, Giugliani ERJ. Association between maternal satisfaction with breastfeeding and postpartum depression symptoms. PloS One. 2020;15(11):e0242333. DOI: https://doi.org/10.1371/journal.pone.0242333
https://doi.org/10.1371/journal.pone.024... ).

Social isolation, decreased social support, financial problems are related to an increased risk of developing anxiety and mood disorders(⁶⁴64. Goyal D, Selix NW. Impact of COVID-19 on Maternal Mental Health. MCN Am J Matern Child Nurs. 2021;46(2):103-9. DOI: https://doi.org/10.1097/NMC.0000000000000692
https://doi.org/10.1097/NMC.000000000000... ), this fact was evidenced in our findings(³³33. Snyder K, Worlton G. Social Support During COVID-19: Perspectives of Breastfeeding Mothers. Breastfeed Med. 2021;16(1):39-45. DOI: https://doi.org/10.1089/bfm.2020.0200
https://doi.org/10.1089/bfm.2020.0200... ,³⁵35. Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, et al. Why I Can’t Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care. 2020;26 Suppl 1:S150-2.,³⁷37. Calil VMLT, Krebs VLJ, Carvalho WB de. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Med Bras (1992). 2020;66(4):541-6. DOI: https://doi.org/10.1590/1806-9282.66.4.541
https://doi.org/10.1590/1806-9282.66.4.5... ,³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ,⁴¹41. Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G; board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd. 2020;80(8):813-9. DOI: https://doi.org/10.1055/a-1207-0702
https://doi.org/10.1055/a-1207-0702... ,⁴³43. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Ávila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11(3):34. DOI: https://doi.org/10.3390/bs11030034
https://doi.org/10.3390/bs11030034... ). Concern and guilt were identified, evidenced in a study in the USA, due to the limited supply of breast milk, as a result of increased stress for postpartum women due to the pandemic(⁶⁵65. Shuman CJ, Morgan ME, Chiangong J, Pareddy N, Veliz P, Peahl AF, et al. “Mourning the Experience of What Should Have Been”: Experiences of Peripartum Women During the COVID-19 Pandemic. Matern Child Health J. 2022;26(1):102-9. DOI: https://doi.org/10.1007/s10995-021-03344-8
https://doi.org/10.1007/s10995-021-03344... ). Changes arising from the pandemic, such as social distancing, can negatively affect postpartum women’s experiences and emotional state, increasing their risk of developing mental health problems(¹²12. Almeida M, Shrestha AD, Stojanac D, Miller LJ. The impact of the COVID-19 pandemic on women’s mental health. Arch Womens Ment Health. 2020;23(6):741-8. DOI: https://doi.org/10.1007/s00737-020-01092-2
https://doi.org/10.1007/s00737-020-01092... ,¹⁵15. Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study. Appetite. 2021;156:104985. DOI: https://doi.org/10.1016/j.appet.2020.104985
https://doi.org/10.1016/j.appet.2020.104... ).

As seen in studies carried out during the pandemic, in Serbia, 14.8% of postpartum women demonstrated a risk for non-psychotic postpartum anxiety and mood disorders, related to social distancing, emotional problems and lack of social support(⁶⁶66. Stojanov J, Stankovic M, Zikic O, Stankovic M, Stojanov A. The risk for nonpsychotic postpartum mood and anxiety disorders during the COVID-19 pandemic. Int J Psychiatry Med. 2021;56(4):228-39. DOI: https://doi.org/10.1177/0091217420981533
https://doi.org/10.1177/0091217420981533... ). Research carried out in five European countries with 9,041 women, of which 5,134 are breastfeeding women, identified depressive symptoms in 13% of breastfeeding women and rates of moderate to severe generalized anxiety symptoms in 10% of breastfeeding women(⁶⁷67. Ceulemans M, Foulon V, Ngo E, Panchaud A, Winterfeld U, Pomar L, et al. Mental health status of pregnant and breastfeeding women during the COVID-19 pandemic—A multinational cross-sectional study. Acta Obstet Gynecol Scand. 2021;100(7):1219-29. DOI: https://doi.org/10.1111/aogs.14092
https://doi.org/10.1111/aogs.14092... ).

In addition to the negative effects of not breastfeeding on women’s health described in one of the studies(³⁹39. Tomori C, Gribble K, Palmquist AEL, Ververs MT, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. Matern Child Nutr. 2020;16(4):e13033. DOI: https://doi.org/10.1111/mcn.13033
https://doi.org/10.1111/mcn.13033... ), breastfeeding mothers have lower levels of anxiety, negative mood, stress, as well as prolonged sleep patterns and better chances of a secure mother-child bond(⁶⁸68. Krol KM, Grossmann T. Psychological effects of breastfeeding on children and mothers. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018;61(8):977-85. DOI: https://doi.org/10.1007/s00103-018-2769-0
https://doi.org/10.1007/s00103-018-2769-... ). The literature also shows that the link between the dyad and, consequently, breastfeeding, can be impacted by social distancing measures due to the COVID-19 pandemic, such as the mother-child separation(⁶⁹69. Tscherning C, Sizun J, Kuhn P. Promoting attachment between parents and neonates despite the COVID-19 pandemic. Acta Paediatr. 2020;109(10):1937-43. DOI: https://doi.org/10.1111/apa.15455
https://doi.org/10.1111/apa.15455... ).

The use of technology, such as online care, has become essential nowadays in order to limit exposure to SARS-CoV-2, thus being able to guarantee continuous access to health care(⁶⁴64. Goyal D, Selix NW. Impact of COVID-19 on Maternal Mental Health. MCN Am J Matern Child Nurs. 2021;46(2):103-9. DOI: https://doi.org/10.1097/NMC.0000000000000692
https://doi.org/10.1097/NMC.000000000000... ). Additionally, remote care enables the promotion of breastfeeding and facilitates access to health services in distant locations(⁷⁰70. Santos LF dos, Borges RF, Azambuja DA de. Telehealth and Breastfeeding: An Integrative Review. Telemed J E Health. 2020;26(7)837-46. DOI: https://doi.org/10.1089/tmj.2019.0073
https://doi.org/10.1089/tmj.2019.0073... ). This is also in line with tech-related observations(²¹21. Ware JL, Love D, Ladipo J, Paddy K, Starr M, Gilliam J, et al. African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeed Med. 2021;16(2):156-64. DOI: https://doi.org/10.1089/bfm.2020.0323
https://doi.org/10.1089/bfm.2020.0323... ,²⁶26. Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, et al. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020. Morbidity and Mortality Weekly Report [Internet]. 2020 [cited 2021 June 30];69(47);1767-70. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947a3-H.pdf
https://www.cdc.gov/mmwr/volumes/69/wr/p... ,³¹31. Patil UP, Maru S, Krishnan P, Carroll-Bennett R, Sanchez J, Noble L, et al. Newborns of COVID-19 mothers: short-term outcomes of aúdeating and breastfeeding from the pandemic’s epicenter. J Perinatol. 2020;40(10):1455-8. DOI: https://doi.org/10.1038/s41372-020-0765-3
https://doi.org/10.1038/s41372-020-0765-... ,³⁸38. Farhadi R, Mehrpisheh S, Philip RK. Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation. Cureus. 2021;13(3):e13699. DOI: https://doi.org/10.7759/cureus.13699
https://doi.org/10.7759/cureus.13699... ,⁴⁰40. Spatz DL, Froh EB. Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic. MCN Am J Matern Child Nurs. 2021;46(1):30-5. DOI: https://doi.org/10.1097/NMC.0000000000000672
https://doi.org/10.1097/NMC.000000000000... ). However, telelactation requires planning and participation from both professionals and parents so that the service is adequate(⁷¹71. Singh AP, Kumar VHS, Panda S. Supporting Breastfeeding in 2021 and Beyond—Lessons from the Pandemic. Pediatr Rep. 2021;13(2):289-301. DOI: https://doi.org/10.3390/pediatric13020037
https://doi.org/10.3390/pediatric1302003... ).

Before the COVID-19 pandemic, telelactation was practiced, with good acceptance of videoconferencing for lactation consultations among postpartum women(⁷²72. Habibi MF, Springer CM, Spence ML, Hansen-Petrik MB, Kavanagh KF. Use of Videoconferencing for Lactation Consultation: An Online Cross-Sectional Survey of Mothers’ Acceptance in the United States. J Hum Lact. 2017;34(2):313-21. DOI: https://doi.org/10.1177/0890334417711385
https://doi.org/10.1177/0890334417711385... ). Breastfeeding consultants, in which 73% of the care was provided online in the current pandemic, reported that breastfeeding women were notably satisfied with the service provided, mainly because they had a reduced support network, enabling breastfeeding promotion and breastfeeding women’s mental health(⁵⁴54. Lima ACMACC, Chaves AFL, Oliveira MG de, Lima SAFCC, Machado MMT, Oriá MOB. Breastfeeding consultancy during the COVID-19 pandemic: experience report. Escola Anna Nery. 2020;24(Spe):e20200350. DOI: https://doi.org/10.1590/2177-9465-EAN-2020-0350
https://doi.org/10.1590/2177-9465-EAN-20... ).

The limitations for this scoping review consist of not having published a prospective protocol, not performing manual searches in the main journals or other information sources, and the restriction to Spanish, English and Portuguese.

CONCLUSION

The articles analyzed in this study pointed out that the influence of the COVID-19 pandemic on breastfeeding practice can be very heterogeneous, since for some postpartum women, it can be said that the pandemic had a positive influence, allowing more time for breastfeeding, while for others, the opposite was demonstrated, interrupting breastfeeding due to greater burden or less social support. It was understood that safe information, social support, emotional health and new ways of caring for lactation are factors to be considered in breastfeeding care. Thus, the support network of postpartum women during the COVID-19 pandemic has become an important issue for future research.

This review also pointed out that telehealth can be a good alternative for support in this period, allowing the transmission of safe guidelines, and can also identify other problems not related to breastfeeding. It is hoped that this study will bring new knowledge to postpartum women and society in general and to health professionals, in order to contribute to care with greater assertiveness in the face of this new situation, promoting care that meets the new needs in relation to breastfeeding.

ASSOCIATE EDITOR

Ivone Evangelista Cabral

REFERENCES

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