The Massachusetts Department of Public Health (DPH) felt that the CDC breastfeeding guidelines regarding H1N1 were excessively restrictive and issued the following recommendations to all Massachusetts birthing hospitals. I sit on the Perinatal Advisory Committee to the DPH and we were asked what recommendations we thought would provide the greatest amount of safety while preserving early breastfeeding.
Marsha Walker, RN, IBCLC
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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