COVID-19 has caused more than 500,000 deaths worldwide as this new pandemic sweeps across the globe (1).
This has caused the global community to consider many new questions and changes, and one population, in particular, is facing many unknowns: newborns. Newborns are a very vulnerable population, with brand new immune systems, and giving them each their best start to life is the priority of every parent. This article takes a look at the risk of newborn transmission through C-section and vaginal deliveries, as well as the risk of transmission through breastfeeding.
As of June 2020, multiple studies are being released assessing the infection risk of COVID-19 based on newborn delivery route vaginally and C-section). There is little evidence of vertical transmission to newborns regardless of the route of delivery (2). China and the US have done studies with more than 100 actively infected COVID-19 mothers and their newborns. The process entailed swabbing the newborn at 12 hours and 72 hours after delivery. The double swab’s purpose was to make sure there was no false-negative and allow a longer incubation period. The results were negative for transmission through vaginal or C-section delivery for each test. Another study was done in Italy with 42 women, 24 of whom gave birth vaginally, in which they observed two early neonatal cases of COVID-19. However, one case was concluded to be due to cross-contamination (physical/droplet contact), and the other case cause is unknown, which is under investigation (3).
There have been other small studies done on the transmission risk between infected mothers and a preterm neonatal. The Italian Journal of Pediatrics posted a study of 24 infected women who gave birth prematurely between 26 and 39 weeks. All 24 babies were tested at birth, 14 hours, four days, and seven days after delivery. The results were negative for COVID-19 between all 24 neonatal babies (4). In conclusion, the route of delivery by an infected mother should be elevated case by case. Still, it should not be solely considered based on her infection and concern about transmitting it to the baby.
Besides looking at the risk of transmission via the delivery route, we should also consider the strenuous process a mother endures during any type of delivery. COVID-19 affects primarily the respiratory system, which is largely involved in childbirth. Some doctors are concerned that an actively infected mother would not have the lung strength to deliver vaginally. Some believe a C-section would be less stressful on the lungs during the child birthing process. Thus, more countries are encouraging C-section deliveries. One study showed that 90% of infected mothers choose, for different reasons, to have a C-section. However, there are other studies showing 57% of infected COVID-19 mothers choose to move forward with vaginal deliveries (3). There was zero infection transmission to the newborn in both studies, and the mother’s lung strength was still moderate after either type of delivery. There are many factors to consider as to which delivery route is best, such as prior birth history, newborn weight, weeks of gestations, and complications during pregnancy. These studies demonstrate that although an actively infected mother has impaired lung function, there is no difference in performance in delivery. Thus, being infected should not influence the mother’s choice on the specific route of delivery.
Furthermore, there has been a concern if COVID-19 could be transmitted during breastfeeding with an infected mother. The Japan Society of Obstetrics and Gynecology looked at multiple different studies concluding that Covid-19 is not believed to be a vehicle in human milk. COVID-19 has been traced to spread through droplet formation and other fluids such as bronchoalveolar lavage specimens, blood, and saliva, though not through breastfeeding (5). As of late April, more than 100 women infected with COVID-19 chose to breastfeed, according to the aforementioned study. Testing of the maternal breast milk and nasopharyngeal swabs of the newborn were performed at birth and one week later. All newborns tested negative for the virus before breastfeeding, and one week after (5). This is just one case study indicating breast milk does not carry the virus. There has been adequate research revealing that the flu, another respiratory droplet disease, also cannot be passed between mother and newborn during breastfeeding (6). While this study shows that breastfeeding does not transmit the virus, mothers still need to take precautions regarding their newborns and viral transmission.
Since COVID-19 is primarily transmitted in droplet form, there is still a concern for spreading the virus through physical contact with the newborn. The Center for Disease Control (CDC) advises mothers to be temporarily separated from her infant until the mother is considered no longer infectious. This means that the newborn cannot remain in the same room. Instead, breast milk should be pumped to make sure the infant still gets its much-needed nutrient and immunity from the mother. This milk should not be fed by the mother, as to avoid physical contact, but by either a family member or another healthy caregiver (4). It is advised for the mother to isolate herself from the baby until symptoms of a fever dissipate ( without using fever-reducing medication like acetaminophen or ibuprofen for 72 hours), or when other symptoms such as: diarrhea, cough, shortness of breath, and fatigue improve, or when at least ten days have passed since symptoms started (6). The World Health Organization (WHO) recommends that suspected positive Covid-19 mothers: “Should be enabled to remain together and practice skin-to-skin contact, kangaroo care and to remain together and to practice rooming-in throughout the day and night.” Breastfeeding is strongly recommended by physical contact between the mother and her infant, though WHO advises that the mother wear a mask during breastfeeding and frequently perform handwashing. Additionally, surfaces or items that have been touched by the infected mother need to be disinfected. The WHO recognizes the importance of mother-to-infant bonding and has not found studies of passing the infection to the newborn, as long as the mother takes the recommended precautions. Most studies have exhibited health care providers following the WHO recommendations worldwide. However, each pregnancy is uniquely different, and infant care decisions should be discussed with the individual’s doctor (7, 8).
This article took a look at the risk of COVID-19 transmission through vaginal and C-section deliveries, as well as breastfeeding. In conclusion, there is very minimal evidence that either vaginal or C-section deliveries can lead to a newborn infection. As of this article, there was no evidence found to indicate there was a possible risk or confirmed infected cases via either delivery method. Similarly, COVID-19 has not been found to be transmitted through breast milk and is not a concern that should be taken into consideration. Breastfeeding should be encouraged with the newborn immediately following birth. As always, this article provides the most up-to-date information on the current recommendation; though this is an ever-evolving field, thus more research and studies are continuously being released.
1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University [Internet]. Johns Hopkins University & Medicine. 2020. Available from: https://coronavirus.jhu.edu/map.html
2. Lowe B, Bopp B. COVID‐19 vaginal delivery – A case report. Aust N Z J Obstet Gynaecol. 2020 Jun;60(3):465–6.
3. Ryan GA, Purandare NC, McAuliffe FM, Hod M, Purandare CN. Clinical update on COVID ‐19 in pregnancy: A review article. J Obstet Gynaecol Res. 2020 Jun 4;jog.14321.
4. The Study Group of Neonatal Infectious Diseases of The Italian Society of Neonatology (SIN), De Rose DU, Piersigilli F, Ronchetti MP, Santisi A, Bersani I, et al. Novel Coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr. 2020 Dec;46(1):56.
5. Martins-Filho PR, Santos VS, Santos HP. To breastfeed or not to breastfeed? Lack of evidence on the presence of SARS-CoV-2 in breastmilk of pregnant women with COVID-19. Revista Panamericana de Salud Pública. 2020 Apr 27;44:1.
6. Awelewa T. Breastfeeding During the COVID-19 Pandemic [Internet]. 2020. Available from: https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Breastfeeding-During-COVID-19.aspx
7. Stuebe A. Should Infants Be Separated from Mothers with COVID-19? First, Do No Harm. Breastfeeding Medicine. 2020 May 1;15(5):351–2.
8. Coronavirus Disease (COVID-19) and Breastfeeding [Internet]. Center for Disease Control. 2020. Available from: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html