PETALING JAYA: Women who gave birth since the start of the Covid-19 have faced many difficulties breastfeeding their babies.
With Covid-19 restrictions affecting the income of many households, some women were forced to choose between spending more time at home nursing their babies or going out to work to support their families.
Others who delivered while infected with Covid-19 were not confident about breastfeeding for fear of infecting their babies.
As the initial movement control order restricted people to their homes, many new mothers found it hard to get adequate information and support about breastfeeding.
These difficulties illustrate how the pandemic has affected breastfeeding in Malaysia, said the Health Ministry’s nutrition division director Zalma Abdul Razak.
“Many families’ source of income was affected by the pandemic, which led to a disruption in the mother's emotions and decision to continue breastfeeding.
“There are mothers who also had to go out to work to help increase the family's income,” she said in an interview with The Star in conjunction with the World Breastfeeding Week from Aug 1-7.
She added that the mother’s emotions were also affected by the birth management protocols during the Covid-19 pandemic, which limited direct contact with their new-borns for mothers who were confirmed or suspected of having been infected with Covid-19.
“Mothers indirectly feel less confident to start or maintain breastfeeding due to the limited support and care system for mothers during and after delivery,” she said.
The Health Ministry, in its Guidelines for the Implementation of Baby-Friendly (Rakan Bayi) Hospital Practices during the Covid-19 Pandemic, stated that mothers with confirmed or suspected Covid-19 are allowed to room-in with safe spacing between feedings.
However, mothers need to adopt hygiene measures and minimise contact with the baby.
“If the mother cannot carry out all the hygiene measures and the condition of the ward is crowded and not conducive to safe confinement and breastfeeding, the mother and baby will be kept away from each other,” said the guidelines, with the implementation subject to the current policy code and instructions from the hospital director.
Zalma said mothers who lacked knowledge about the importance of breastfeeding would opt for alternatives.
“Mothers may also lack the skills to breastfeed, especially in relation to technique and position, which can lead the mother to feeling uncomfortable or experiencing pain while breastfeeding.
“Babies will be fussy or cry when they are not getting enough milk and this may cause the mother to think that she does not have enough milk for her child,” she said.
Nursing mothers need more support
Zalma said mothers who do not receive adequate support from their husband or partner, family, employer, and the community will often stop breastfeeding before the recommended duration is over.
“Such support is especially important to ensure that the child is given breast milk even when the mother is not with her.
“Inflexible working hours can make it difficult for mothers to express milk,” she said, adding that mothers also need suitable care centres and nursing-friendly workplace facilities.
She encouraged the government to produce policies that support breastfeeding, while employers can ease a mother’s breastfeeding journey by giving them adequate time and flexibility at work.
Babies weaned off earlier due to the pandemic
Fertility specialist and gynaecologist Dr Agilan Arjunan said several studies conducted in Western countries showed many mothers choosing to end breastfeeding earlier than usual during the Covid-19 pandemic.
“This is due to many uncertainties with Covid -19 infection, such as the severity of the infection, mother-to-baby transmission risk, effectiveness of vaccination and uncertainty on whether vaccines harm the new-born baby.
“New mothers tend to have shortened the breastfeeding duration due to difficulty getting family and social support during the pandemic,” he said.
Other challenges that contributed to the decline in exclusive breastfeeding, Dr Agilan said, were fear and anxiety during the pandemic and difficulty in getting support from healthcare facilities such as government health clinics.
“During the pandemic, especially during the initial stages when we lacked knowledge about the infection, many deliveries were done via caesarean section.
“This further caused difficulty to initiate breastfeeding, especially when there is no further support available for first-time mothers,” he said.
The Health Ministry now advises that indications for a caesarean section for Covid-19 positive mothers should be determined by obstetric indications rather than the diagnosis of Covid-19.
Support from early stage crucial
Dr Agilan said a mother’s breastfeeding journey starts even before delivery, where antenatal sessions can help educate both parents on the importance and benefits of breastfeeding.
“The involvement of the future father is also crucial as he is the pillar of support,” he said.
He added that hospitals should provide baby-friendly and father-friendly settings to initiate early breastfeeding and encouragement for all women during delivery.
He said mothers should be given pain and relief support during delivery for them to be able to initiate breastfeeding immediately after delivery.
“Lactation nurses need to support all new mothers after delivery so that the mothers can learn the optimum breastfeeding technique,” he said, adding that paternity leave for fathers was important to allow them to support their wives during the initial stage of breastfeeding.
Other types of support for breastfeeding mothers include helpline and support groups to advocate for breastfeeding, as well as accessibility of nursing rooms at all public areas.
“Details on breastfeeding should be readily available to all mothers so that they may seek immediate help when needed,” he said.
Gynaecologist Dr Milton Lum Siew Wah said breastfeeding is best supported by practices that keep the mother and baby together, in addition to providing quality professional and peer support.
He said many studies had reported decreased face-to-face professional support, in addition to decreased or absent face-to-face peer support during the pandemic.
“Others report the negative impact of maternal postpartum depression on breastfeeding,” he added.
Dr Lum, however, noted that there were no Malaysian studies on the Covid-19 impact on breastfeeding in general.
“A Thai study had reported a switch to bottle and mixed feeding. This was associated with decreased contact with professionals, family support and help,” he said, adding that Malaysia needed to establish a national database on breastfeeding practices.
He advised breastfeeding mothers to consume a balanced and varied diet from preconception for the wellbeing of the mother and new-born baby.
“The risk of inadequate nutrient supply for breastfeeding is increased in certain groups, for example, those on exclusion diets, underweight, overweight, smokers, adolescents, as well as mothers with multiple or close pregnancies,” he said.