The Massachusetts Department of Public Health (DPH) felt that the CDC  
guidelines for mothers with flu-like symptoms was overly cautious and  
feared a negative impact on breastfeeding. I sit on the Perinatal  
Advisory Committee to DPH and we were asked what changes could safely be  
made to assure that breastfeeding could proceed while at the same time  
taking proper precautions. Below is what the DPH has issued to all of  
the hospitals in Massachusetts. You may wish to bring this to the  
attention of your hospital administrators.

Marsha Walker, RN, IBCLC
Weston, MA

The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health


Fall 2009 Clinical Advisory for New Mothers
with Influenza Like Illness who are Hospitalized

September 29, 2009

The Massachusetts Department of Public Health (MDPH) is providing  
updated guidance for otherwise healthy, hospitalized new mothers who are  
symptomatic with influenza-like illness.

The current Centers for Disease Control (CDC) guidance for pregnant  
women, Considerations Regarding Novel H1N1 Flu Virus in Obstetric  
Settings, issued July 6, 2009, (available at  
http://www.cdc.gov/h1n1flu/guidance/obstetric.htm) recommends placing a  
mother with influenza-like illness in isolation, separate from her  
infant, for a minimum of 48 hours after her delivery until her fever has  
fully resolved, she can control coughs and secretions and she has  
received 48 hours of antiviral medication. To accommodate this  
separation, CDC recommends that these mothers express their milk instead  
of breastfeeding. MDPH believes that this complete separation is an  
overly conservative approach and may have unintended, adverse effects.  
Ultimate breastfeeding success may be decreased by solely pumping,  
without infant contact, in the immediate postpartum period. New mothers  
may have difficulty expressing sufficient colostrum or milk to reassure  
themselves and health care providers that the infant is receiving  
adequate nutrition and hydration. This may make it difficult to avoid  
giving the baby formula, which may compromise ultimate breastfeeding  
success. From both the clinical and public health points of view, it is  
important to balance the desire to limit influenza virus transmission  
with supporting breastfeeding and the well established protection  
against infectious diseases afforded to breastfed infants. Further, for  
both nursing and non-nursing mothers, this proposed separation from  
their infant can interfere with the important task of mother-infant  
bonding.

With these issues in mind, the MDPH recommends that new mothers with  
influenza like illness, who are otherwise healthy, be cohorted with  
their baby and take the following precautions to prevent transmission of  
influenza viruses to their baby:
 Wear a face mask at all times when feeding or caring for their baby.
 Thoroughly wash their hands before handling their infant.
 Put on a new hospital gown each time before nursing or holding their  
infant.
 Ensure that sick friends and family members do not visit the infant.
 Get vaccinated for both seasonal and H1N1 (swine) flu.

In order to decrease the likelihood of developing influenza during their  
pregnancy or after delivery, all pregnant women should be strongly  
encouraged to be vaccinated against both seasonal and H1N1 (swine) flu  
during their pregnancy. In addition to protecting them, this will also  
help protect their infants, for whom vaccination is not recommended.

Additional Information and Resources
For the most up-to-date information concerning H1N1 (swine) flu and  
seasonal influenza, please check the MDPH flu web site at www.mass.gov/  
flu

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