April 3, 2020
Informed Choice Maryland strongly endorses the World Health Organization (WHO) guidance on pregnancy and breastfeeding for Covid-19 infected mothers and babies. The evidence-based WHO recommendation encourages companions to be with the mothers during labor, and encourages healthcare providers to support mothers and babies in maintaining skin-to-skin contact and breastfeeding on demand while rooming together in hospital, birth center, and home settings, unless otherwise contraindicated by emergent conditions such as necessary NICU support. This is the policy we believe will produce the best outcomes. We endorse the WHO guidelines for mothers infected with Covid-19 to wash hands frequently and practice respiratory hygiene, including use of masks when possible, which are demonstrated to prevent person-to-person Covid-19 transmission.
We recognize that the available peer-reviewed evidence on mother-to-infant transmission is inconclusive; however there is to date no evidence that Covid-19 has been transmitted to any infant by contact with an infected mother after birth. (Some data suggest that mother-to-child transmission is possible in utero.) There is to date no evidence that Covid-19 can be transmitted from mothers to infants through breastmilk. However, there is strong evidence that breastmilk provides antibody protection against infectious pathogens, and supporting contact between mother and baby directly after birth is imperative in achieving the best possible outcomes for mothers and infants. In addition to increasing positive breastfeeding outcomes, skin-to-skin contact protects infants from infections and promotes rapid recovery from illness by regulating body temperature, increasing oxygen saturation, and regulating heart rate.
Current CDC guidance on Covid-19, which directly conflicts with the WHO guidelines, advises facilities to restrict any birth partner or family member from labor and delivery and to “consider temporarily” separating mothers and newborns when the mother is infected with Covid-19; we find that guidance to lack supporting evidence and consider it to be potentially detrimental to mothers and babies. The United States ranked 33rd out of 36 OCED countries for infant mortality in 2018, and is the first country to report infantile Covid-19 deaths.
Federal law protecting parental rights under the 14th Amendment guarantees that any restrictions on parental rights must be narrowly tailored to the precise public urgency; strict scrutiny applies. A universal policy of separating Covid-19 infected mothers and suspected infected mothers from their babies is unconstitutional because it interferes with parental rights to the care, custody, and control of their child regarding best practices to maintain the optimal health of their infant. Informed Choice Maryland strongly supports the evidence-based WHO guidance to promote the best possible outcomes for mothers and infants during the Covid-19 pandemic.