COVID-19 pandemic pushes breastfeeding services online
Kathryn Phillips gave birth to her son in 2019, spending the first few months bonding with other new moms in a breastfeeding support group in Guilford.
But when her baby was six months old, the pandemic hit, closing a large part of the state down and moving her group, along with many other aspects of life, online.
“It’s much harder to be social on Zoom,” said Phillips, an associate professor at Fairfield University. “You’re just there in your little box.”
It’s one of the ways the pandemic affected breastfeeding and access to lactation services in Connecticut, something Phillips and her co-author and Fairfield University colleague, Jennifer SchindlerRuwisch, highlight in a new study.
The study, touted as one of the first of its kind in the country, surveyed dozens of lactation specialists in the state, including Women, Infants and Children groups, about what they experienced. It concluded that while there were benefits including more convenience, the switch to telemedicine exacerbated existing barriers to breastfeeding and presented a number of challenges.
A decrease
“What we saw across the board was a significant decrease in lactation visit frequency,” said SchindlerRuwisch who is also a member of the Connecticut Breastfeeding Coalition.
She said most women had four or five lactation visits prior to the pandemic and now only had one. There were also more referrals for formula because the initial touch point wasn’t there.
Helen Wilde LaPlant, program manager for the Hispanic Health Council’s Breastfeeding Heritage and Pride, said they lost all of their in-person contact at the start of the pandemic. They’re still unable to do home visits but staff can be at the participating hospitals’ clinics again.
“Unfortunately there was a slight dip in caseload and overall participation,” she said, adding recruitment is much more effective when it can be done in person at the clinics.
The pandemic also caused a decrease in the number of women who wanted to breastfeed.
Dr. Mary MarshallCrim, an OB-GYN with Hartford HealthCare, said her hospital had a lot of success with switching to telehealth, but they still saw a dip of about several percentage points in intent rates, going from about 90 percent or more prior to the pandemic to the low to mid 80s now.
She said people were especially scared at the beginning of the pandemic about spreading COVID and there was confusing information from the different organizations that offer the health recommendations.
“People aren’t sure what they should do,” she said, adding research now shows if the mother is vaccinated then antibodies will be delivered to the baby through the milk.
Another challenge was that people were being discharged as soon as possible in the beginning, with vaginal births leaving after 24 hours and Cesarean births leaving after 48 hours, compared to the usual 48 hours and 96 hours, respectively, before the pandemic. MarshallCrim said they weren’t always able to identify there was a need for lactation specialists with women leaving earlier.
Instead, they would send the mothers home with items and then specialists followed up on a Zoom call. Marshall-Crim said they had 120 telehealth calls in the first month alone, which has remained fairly steady until things started opening up again and mothers were more comfortable about masking up and going out again.
Challenges
Schindler-Ruwisch said the study’s survey responses claimed telehealth was not as effective as in-person would have been but was better than nothing. About 70 percent of the responders were using only telehealth, with most connecting with the mother on whatever technology
she had.
“It was really an informal process,” she said, adding some could only speak over the phone and had no visual at all.
Missing the in-person element was highlighted as the biggest challenge, especially
since a lot of the help is offered based on what the lactation specialist sees.
“You’re missing out on the whole body language to see if they need encouragement or if they understand,” said SchindlerRuwisch.
The virtual element made it harder for the specialist to reposition the baby or see how the baby was latching or if its tongue was tied. It also meant the baby couldn’t be
Schindler-Ruwisch said the study’s survey responses claimed telehealth was not as effective as in-person would have been, but was better than nothing. About 70 percent of the responders were using only telehealth, with most connecting with the mother on whatever technology she had.
weighed to see how it was growing or how much milk it was getting.
“That’s hard to tell sometimes in telehealth,” LaPlant said.
Providers had to get creative in offering instruction remotely. For those at Hartford Hospital, that included dolls and cloth breasts, Marshall-Crim said.
There were also logistical challenges, including figuring out how to hold the phone to conference with the specialist while breastfeeding.
Access to technology was another challenge though some places loaned out phones to those who needed it so they could use the services.
In other cases, translation services were also harder to get remotely, emphasizing the language barrier, SchindlerRuwisch said. She added insurance didn’t necessarily cover the virtual programs, preventing people from using it because they couldn’t afford it.
Even when it was in person, people were wearing masks and the specialist couldn’t demonstrate how the baby should latch, Phillips said. Experts also said the pandemic created a feeling of isolation.
Phillips said support is an important part, with women more likely to continue breastfeeding if it’s there.
“It’s always good to have that network of other moms and specialists,” she said.
Benefits
But while the remote elements present challenges, experts say there are also positives, including reaching people outside of their direct service areas and adding a convenience of sorts for the mothers.
Especially at the beginning, mothers didn’t want to bring their baby outside and risk them catching COVID, so this allowed them to see specialists from home.
“For the most part, people really wanted it,” Marshall-Crim said, adding it removed the transportation obstacles and helped mothers who were having a hard time physically recovering.
She said the hospital provided cell phones to people who might not have access otherwise and ensured the hospital translation services were available, so she didn’t see those barriers highlighted in the study.
The additional services were so popular that she had to hire three more fulltime staff and three per diem staffers to meet the demand, as well as cover for others who were out due to COVID.
Shannon Chaiklin, assistant area online coordinator for La Leche League of Connecticut, said the organization saw its reach expand during the pandemic.
Before the pandemic, La Leche League of Connecticut was offering 18 in-person meetings and one private Facebook meeting a month, as well as providing email and phone support, she said.
She currently oversees groups in Shelton, Orange and Milford. Other groups are held throughout the state, including Fairfield, Greenwich, Stamford, Ridgefield, Wilton, Hamden, Madison, New Haven, North Haven and Westport.
“Once the pandemic began, all in-person support was quickly put on hold and a small group of leaders jumped into crisis mode offering increased support through the Facebook group,” Chaiklin said.
Since then, the organization offers six to seven virtual meetings a month at different times throughout the week, split between Zoom and the private Facebook group. There is also more interaction in the Facebook group and a new Spanish speaking Zoom meeting.
“Our increased virtual presence, without question, has been incredibly valuable to both leaders and parents,” she said.
Chaiklin said the group has expanded its online reach beyond Connecticut with parents from all over the world coming to them for information and peer-to-peer support.
For now, most experts are looking to virtual as a way to expand their offerings but not a total solution.
“I hope we never have to give up Zoom in terms of the breastfeeding world,” Marshall-Crim said. “I think it’s been so positively received.”