According to the Health Ministry's directives, pregnant and lactating women are not going to get the COVID-19 vaccine at the moment. The same directive also exempts newborns from vaccination. Therefore, it is an incredibly stressful time for any household welcoming a new child, with no extra help from extended families, and no vaccine in sight for the nursing mother and the new baby.
However, medical health experts suggest that cocooning of newborns and their mothers, managing new mothers' mental health, especially postpartum depression which has been aggravated by the pandemic and continuing to breastfeed, can help both new mothers and newborns in coping with the pandemic, even if they do not get vaccination right away.
Dr Tushar Parikh, Consultant Neonatologist & Paediatrician, Motherhood Hospital in Pune, pointed out that since clinical trials have not been done on nursing mothers, they have been exempted from the vaccination process for the time being, for their safety and to avoid any side effects.
"As far as COVID-19 is concerned, I feel that we are taking a cautious stance because we do not know what kind of effect it would have on pregnant as well as lactating mothers. We do not understand what side-effect profile will be there in the mothers themselves, and how it might impact their babies. Lactating mothers also undergo hormonal changes during the postpartum period. So, it is better to wait for clinical trials, "he said.
"However, to protect the newborn baby and the mother, what every household need to adopt is the cocoon strategy. In cocoon strategy, those who come in regular contact of the mother and the baby needs to be immunized. If everyone in the house is vaccinated, then it is as good as getting the young child vaccinated," pointed out Parikh.
Medical experts believe while hand hygiene and masks are a necessity for any new mother, during this crisis, it is also of utmost importance to understand that the child should not go without breastmilk.
"Breastmilk has tremendous nutritional value; it has been known to have a protective effect against all pathogens and immunity wise it is the most important thing for the baby, so even if a mother is COVID-19 positive she should continue to breastfeed. WHO and governmental recommendations also say that" pointed out Dr Shacchee Baweja, Paediatrician, Lactation Consultant (IBCLC) BLKSSH and President ALPI (Association of Lactation Professionals India).
"Breastmilk doesn't contain the coronavirus. In fact, if a baby is premature and he or she needs to be shifted to the NICU, mothers should express their milk and send," explained Baweja.
The Boon of Breastfeeding
Apart from its general nutritional value, several studies have claimed that it has COVID-19 antibodies. According to the preliminary findings from recent research led by a University of Massachusetts Amherst breast cancer researcher and a University of Massachusetts Medical School obstetrician-gynaecologist, antibodies for COVID-19 were found in colostrum (early breastmilk) of 14 of 15 women, who were COVID-19 positive before giving birth. However, whether those antibodies can be transferred to the baby is unclear.
Reshma Dhillon Pai, President of The Mumbai Obstetric & Gynecological society and a consultant at Jaslok and Lilavati Hospital, Mumbai told News18.com that it had been observed previously that expecting mothers who take vaccines against certain diseases can transfer the antibodies against those diseases to their newborns. Therefore, it cannot be ruled out that same can also happen in COVID-19 antibodies.
"Since newborns cannot be given the three-in-one vaccine (for tetanus-diphtheria, and whooping cough) till they are six weeks old, to ensure that they don't get any of the diseases, expecting mothers are given the three-in-one vaccine, at the time of their pregnancy so that their antibodies protect their babies. Therefore, in the first one and a half months (6 weeks), when the baby has no protection against these diseases, they are covered by the mother's antibodies," said Pai.
"So, there is a possibility that we may have the same situation in COVID-19, where the mother's antibodies are transferred to the child, but we do not know for sure. It is too early to say because we are still at a phase, in which we are not a hundred per cent sure of efficacy, safety and side effects of the vaccines. It is only after we know that can we do large scale clinical trials on lactating women to figure out how it works," she added.
Milk Bank Precautions
If for some reason mother's milk is unavailable, and the child is vulnerable and has low weight, then the child should be given donor mother's milk which is available free of cost in milk banks, pointed out Ruchika Chugh Sachdeva, Vice President, Nutrition, Vitamin Angels.
Sachdeva added that although so far there is little to no evidence to believe that covid 19 can be transferred from breastmilk if a child is being given donor mother's milk it is better to ensure that it is pasteurized.
In a paper published in Journal of Medico-Legal and Ethics Association, titled Guidance for use of Human Milk in India in the context of COVID-19 pandemic, authors Dr Jayashree Mondkar, Dr Ketan Bhardava, Ruchika Chugh Sachdeva et al., it is suggested that greater vigilance must be exercised in donor screening procedures.
Sachdeva, who is one of the authors of the paper told News18.com, "In addition to routine donor screening criteria for milk banking, the donor screening history and examination findings should be modified to include a detailed history regarding the risk of being a suspected or probable case of COVID-19 and the details should be documented. Mothers are not eligible to donate milk if nasopharyngeal swab tests positive for SARS CoV-2."
The paper recommends that all other asymptomatic potential donor mothers be checked for no ILI history (Influenza-like illness with symptoms like fever, cough, sore throat) in the last two weeks before donation. It also suggests that donor mothers should not have any close contact history with a laboratory-confirmed or probable case of COVID-19 in the previous 14 days. They should not have worked in or visited any healthcare facility without appropriate personal protective equipment where a case of COVID- 19 infection has been confirmed.
Mothers' Mental Health Guardrails
Natasha Mehta, Sr. Counselling psychologist, said that it is critical to increasing awareness of the impact of social (physical) isolation on postpartum women's mental health. "Experiencing depression and anxiety during the postpartum period can have detrimental effects on the mental and physical health of both mother and baby that can persist for years, affect mother-infant bonding, and cause developmental delays in infants," pointed out Mehta.
"The most important thing that a mother can do during this period is not to neglect herself. Keeping a routine is of paramount importance. Taking a shower every day, eating healthy foods and regular meals, drinking plenty of water, and getting a good night's sleep is necessary," said Mehta.
Priyanka Verma, Clinical Psychologist, pointed out that things have been worse for mothers who gave birth for the second time or are part of a nuclear family.
"Especially for those mothers, who were not giving birth for the first time, an obvious comparison has crept in. Previously, when they gave birth, there was a lot of jubilation and celebration. This time around, due to the pandemic, the experience has been that of loneliness, and isolation. Such feelings have aggravated postpartum depression in many cases," pointed out, Verma.
Verma explained that there is a common misconception that becoming a mother is a joyous process, but in reality, it isn't at all for many women. For them, motherhood comes as a bit of a shock, even though they were preparing for a while. Having family around that time is essential for getting accustomed to the new child. And, what helps most is to have a helpful partner.
"I think they also need to take time away from the baby, even though many think it isn't proper to do so. They need to find a semblance of routine they had before the child was born. One or two hours away from the child is very important and therefore, you need a very supportive partner at this point," she said.
"Also, we need to address male postpartum depression because just like a woman is adjusting to the significant change in her life, a man too, who becomes a new father has to adjust to it. As a consequence, during the pandemic, we have seen nuclear families suffer the most," concluded Verma.