New Haven Register (New Haven, CT)
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 Schindler-Ruwisch, 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 Marshall-Crim, 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 weighed to see how it was growing or how much milk it was getting.
“That’s hard to tell sometimes in telehealth,” LaPlant said.