If you haven’t taken or finished the COVID-19: Best Practices for Lactation Consultants, Perinatal Educators and Doulas, please know that this blog and the ones that follow are ADDENDUMS and SUPPLEMENTS to the course. They will refer to the essential information in that program.
As we developed a communication plan for our students, we have a weekly briefing newsletter (which you are welcome to sign up for, even if you’ve yet to take the course), and these supplements. We decided to post some of these publicly. If you’re new to WisdomWay Institute, we hope this information may be of benefit to you.
But please don’t stop there to learn what you need to know in order to keep your communities healthy. We must work together to mitigate the spread of coronavirus and meet the needs for reproductive health services. For the sake of time and the urgency to get out new information, you will see places where we refer to the course.
In my last blog post “COVID-19: Are you prepared to serve your clients”, I posed the question about COVID-19: “Are you prepared to serve your clients?”. At that time it was early days of the global pandemic with just 1200 confirmed cases of COVID-19 and a dozen reported deaths. Now with more than 10.3 million confirmed infections and 500,000+ deaths worldwide, the coronavirus has taken root; transforming the nuances of our daily life and routines into a whirlwind of waiting, wondering, and constantly adapting.
Let’s revisit where we’re at some 20 weeks later…
What do we currently know about COVID-19, Pregnant Persons, and Infants?
The CDC continues to report that there is no current data that indicates pregnant people are affected by the coronavirus any differently than non-pregnant persons. However; we do know that there is a greater risk for pregnant people if only because of other respiratory viruses, such as asthma, chronic obstructive pulmonary disease (COPD), bronchitis, and cystic fibrosis, that increase the risk of COVID-19. Overall main recommendations advise that the main steps for reducing your risk of getting sick when pregnant are properly washing your hands, practicing social distancing, and wearing protective facemasks in public spaces.
Among the most significant of the new findings:
- COVID-19 presents as a coagulation disorder and seems to impact the circulatory and cardiovascular system and is not just a respiratory infection.
- Rashes & swelling, as well as an inability to taste or smell, have been added to the list of symptoms associated with COVID-19.
- More than 100 children have been hospitalized for what has been described as a ‘Kawasaki-like’ illness. The inflammation that occurs can lead to an increased risk of cardiac arrest, cardiac damage, and stroke.
And much is still unknown about infant-related risks and birth parent-to-child transmission, specifically after birth and when the adult may be infected. We know that transmission during pregnancy is unlikely; however a few newborns have tested positive for COVID-19 (globally), but it’s still unknown at what point these babies may have been infected: before, during, or after birth. What we do know is that face masks or shields are not recommended for infants, although that’s more because of the increased risk of SIDS rather than any data regarding babies wearing masks.
What to Watch:
Recent WHO statements have reported that asymptomatic carriers have a low or “rare” occurrence of being the source of spread. Some epidemiologists are asking for more support for this statement. Check out that conversation here.
What about Lactation and Breast/Chest Feeding?
Position statements have landed more solidly on the side of nursing and preventing separation unless the medical stability of the parent indicates it since our early lessons were published. Using face coverings, hand-washing, and allowing other caregivers to manage infant care other than feeding, is recommended but avoiding nursing at the breast when a parent is infected has softened.
ILCA and USLCA have issued joint statements, advising that parents and infants remain together whenever possible, and reinforcing the practices to prevent parent to infant transmission. As have the AAFP. ACOG encourages shared decision-making around this issue. Transmission of COVID-19 from breast/chest feeding parent-to-child through milk is determined to be highly unlikely. Experts suggest that for reducing the risk of transmission from a birth parent who has the coronavirus via breast/chest feeding includes wearing a face mask or covering, and washing your hands before and after each feeding.
When expressing milk, recommendations include using a dedicated pump (and washing appropriately after use), wearing a face mask or cloth during expression, and washing hands before you touch any part of the pump, bottle, etc. For caregivers or birthworkers supporting lactation with families where contact or close proximity is needed, it’s important to communicate the above preventative measures clearly, in addition to using gloves when providing hands-on support with latch or positioning, and washing your hands (before and after).
When we talked about family preparation in March, we mentioned how in our practice we provide resources for families to prepare when anticipating a few scenarios, such as when traveling, attending childbirth classes in protected settings, and expectations for interacting with the health care system expectations. The last month and a half have shown us a wide range of additional scenarios to help our families be prepared for:
- Giving birth in a health care setting where there are visitor, labor, and birth plan limitations, specifically low-intervention births when possible and minimizing time spent in the hospital;
- Supporting at-home labor, including best practices for doulas, midwives and other birth supporting people with a limited personal contact; and
- In-home postpartum care, such as preparing the home environment, creating a support system for breast/chest feeding, and considerations for visitations from family and friends.
At Wisdomway and Birthways, we continue to offer suggestions to our families and doulas about best practices with our expanding knowledge of the virus, recommendations for prevention, and changing local restrictions.
Doulas, Lactation Consultants and Perinatal Educators: Reimaging Practice and Care
As states teeter back and forth between phases of reopening, many of us have experienced a re-entry into daily life in some capacity. As infectious disease specialists continue studying the impacts on various demographics, health care professionals continue offering guidance on prevention practices for infected persons and virus treatment/vaccine trials.
As doulas, perinatal educators, and LCs in private practice we continue to build our toolbox of best practices from state/national guidelines and explore the multitude of ways that others in our profession are successfully supporting families virtually, and from a distance. What continues to remain most important in our work of caring for families is following the proper precautions.
- Understand exclusion criteria and how to make decisions about staying home when you could put others at risk
- How to talk to your clients about creating a safe work environment and partnering to keep everyone safe
- What you need to know about face coverings, PPE and when and how to use appropriate measures
- What to expect when you attend your clients in labor
- Get updated practices that guide you from your commute to client homes, and home again
During this difficult and distressing time one thing that’s been incredibly inspiring to see the ways in which local and national doulas, midwives, and perinatal educators are supporting and caring for families, and with the most creative and innovative practices! In our biweekly-hosted community conversation for doulas, lactation consultants, and perinatal educators (2nd Tuesday of the month, 4-5 pm CST) we continue to discuss how to elevate our virtual caregiving skills to help ensure that the pregnant people we’re working with have a strong support system during and after pregnancy. We also talk about any updates of best practices for caregiver support during the pandemic and will continue to do so as local restrictions lessen.
Guidelines and Future Learning
We’ve re-issued our Best Practice COVID Guidelines with updates and clarification on when and how to use PPE and an easy to use exclude from duty checklist and a list of questions to ask your client. Sign up now to get a copy to guide you with Lactation Consultations, Postpartum Care, & Labor Support.
Regardless of current state restrictions, risks of exposure, and health care system capacities, my previous statement stands: babies continue being born, and we continue supporting them. We encourage you to continue building that toolbox of skills and knowledge so that we can do what we do best: support, care for, and educate families through their pregnancy and parenting journey.
Looking to expand your toolbox?
Our COVID-19: Best Practices for Lactation Consultants, Doulas & Perinatal Educators has been updated to include the most relevant guidelines for caring for families at this time and preventing the spread of the virus when providing in-person care. Sign up today and get access to the online, self-paced course.
We also welcome you to join us for our biweekly Community Conversations: WisdomWay Doulas. Register here today