There has not been much discussion here on Lactnet about the latest CDC
Guidelines, issued 10 Nov 2009, entitled "Interim Guidance: Considerations
Regarding 2009 H1N1 Influenza in Intrapartum and Postpartum Hospital
Settings by CDC"  The document itself is at <
http://www.cdc.gov/h1n1flu/guidance/obstetric.htm>.

The "bad" news is that CDC continues to recommend that H1N1 moms and their
BF'g babies be separated at birth.  The "good" news is that this statement
-- if you read it carefully, and compare it to the earlier statements, is
VERY strong in IBCLC- and BF-advocacy.

ILCA/USLCA are sponsoring a FREE WEBINAR open to all, entitled "Supporting
Breastfeeding During Flu Season:  Working with the CDC Guidelines in Your
Hospital."  It runs Tues 1 Dec 2009, 2-3:30 pm EST, and you can register by
going to the home page at ILCA, www.ilca.org, and clicking on the button
there.  Anyone may particpate in the webinar.  The focus of the conversation
will be on USA hospitals, as the Centers for Disease Control are a USA
federal agency.  But anyone can benefit from the overall discussion on this
topic.  The flu goes everywhere!

Now, some background, for those of you (like me) who were disappointed that
the CDC did not update their guideline to allow babies of H1N1 mothers to
remain with the mom in the first few days after birth.

(1)  PREVENTION is key.  If you are worried that a laboring mom is going to
come into the hospital, be "suspected" of H1N1, and thus become separated
from her newborn, then help her to PREVENT getting H1N1.  Public health
experts *overwhelmingly* recommend that pregnant women in all trimesters get
an H1N1 flu vaccination. Simple hand-washing is a critical component of
prevention.  IBCLCs can play a role in discussing prevention.

(2)  This new Guidance is only for H1N1 moms .... so other Guidance that
discusses "regular" flu is still valid.

(3)  The CDC only offers GUIDANCE -- on any health matter -- it does not
issue RULES or PROTOCOLS.  That is something that is left to individual
hospitals, health care providers or public health centers -- allowing
for the populations they serve, what health experts and equipment are
available, etc.  Indeed the intro to the new H1N1 Guidance says: "*A
cautious approach to the management of ill mothers and their newborns is
still recommended, but several options are provided based on hospital
configuration, staffing, and surge capacity."*
**
What that means is:  the CDC wants us all to go back to our OWN facilities,
and figure out the best policies and protocols to design and implement for
our OWN facilities and populations.

(4)  The CDC acknowledges that it is taking a VERY cautious approach.  That
is because they collect all the data from all the reports of H1N1 -- and we
know that pregnant mothers and young children MIGHT become very ill and even
die from this new flu strain.  They look at the entire population, and come
up with public health recommendations (a.k.a. guidance) to fit the entire
population.

This does not prevent individual doctors from assessing individual patients,
and deciding the best course of treatment/care plan for that dyad.  The
doctors have at their disposal this guidance, which they will weigh along
with the myriad of other factors that go into figuring out how to treat this
one patient, lying in the bed before them.

(5)  This new Guidance does NOT consider the newborn baby "infected" --
merely "exposed."  This means Dad or another family member can do LOTS of
skin-to-skin and newborn care.

(6)  A laboring mother suspected of H1N1 should be advised to BF!  The CDC
Guidance says: *"Because of the many benefits of breast milk, including
newborn protection against respiratory illnesses, encourage the mother to
provide her breast milk as an important method of protection for the infant*."

**
This provides IBCLCs an impetus to push for staff education on BF-support
and promotion.  If your administrators have been groaning every time you say
you want to do a BF in-service -- show them this CDC Guidance.

(7)  Separation does NOT mean Baby has to go down to the Nursery.  The
Guidance says:  *"The most appropriate option for the placement of the
mother and newborn should be considered based on hospital configuration and
existing infection control policies. One option is to co-locate the newborn
in the same room as mother within an isolette. If an isolette is not
feasible or available, the newborn can be placed in an open bassinet at a
distance of greater than 6 feet away, ideally separated by a plexiglass
barrier or curtain."*

This means mom can see her baby, at least, in the arms of a loving partner,
father or grandparent.  This whole scenario really stinks, I know, but I
would MUCH rather see my baby being snuggled by my partner in my room, than
down the hall gawd-knows-where, being not held?  held by a stranger?  crying
for me?

(8)  Getting the mother and baby back together and BF "like normal" are seen
as a critical priority.  Note this VERY strong language ... much stronger
than in the Jul 6 version of CDC Guidance:

*"The mother who plans to breastfeed should be fully supported as it is the
best way to protect the infant against 2009 H1N1 virus and other respiratory
pathogens. However, the mother who acquires 2009 H1N1 virus infection during
the intrapartum period may not develop passive antibodies to further protect
her newborn baby via breast milk until 2 weeks after infection. A lactation
consultant should be involved in the care of the mother and infant to assure
effective establishment of breastfeeding. Immediately following delivery,
the mother should be assisted and supported to express her milk/colostrum.
The mother’s milk should be fed to the newborn by a healthy caregiver until
criteria are met for close contact (see above). Unlike other body fluids and
secretions, human milk is not considered a body fluid to which standard,
droplet, or contact precaution recommendations apply and milk from an
infected mother is not considered infectious. Anti-viral medication use by
the mother is not a contraindication to breastfeeding."*

Once again, the IBCLC can use this to help her facility see the critical
need for the IBCLC expertise to develop facility-specific protocols, and
increase staff education, on BF support.

(9)  There are valid, well-supported and influential differences of opinion
out there!  The ILCA site links you to the AAP Statement, and the New South
Wales Australia protocol, which all say KEEP mom and baby together.  CDC is
but one very respected resource out there.  The Academy of Breastfeeding
Medicine has a statement that urges careful case-by-case analysis.

This means IBCLCs can show their administrators *all* of these statements,
and explain:  NO ONE knows The One Right Answer for H1N1.  Here are several
documents from health experts discussing several options.  Here are the pros
and cons of each.

-- 
Liz Brooks JD IBCLC FILCA (ILCA Secy 2005-2011)
Wyndmoor, PA, USA

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