Breastfeeding taskforce

COVID Pandemic Pushes CT Breastfeeding Services Online

Kathryn Phillips gave birth to her son in 2019, spending the first few months bonding with other new mums at a breastfeeding support group in Guilford.

But when her baby was six months old, the pandemic hit, shutting down much of the state and moving her group, and many other aspects of life, online.

“It’s a lot harder to be social on Zoom,” said Phillips, an associate professor at Fairfield University. “You’re right there in your little box.”

This is one of the ways the pandemic has affected breastfeeding and access to lactation services in Connecticut, which Phillips and co-author and Fairfield University colleague Jennifer Schindler-Ruwisch point out. in a new study.


The study, billed as one of the first of its kind in the country, surveyed dozens of breastfeeding specialists in the state, including women’s, infants’ and children’s groups, about what they have lived. He concluded that while there are benefits, including more convenience, the shift to telemedicine has exacerbated existing barriers to breastfeeding and presented a number of challenges.

A decrease

“What we saw across the board was a significant decrease in the frequency of lactation visits,” said Schindler-Ruwisch, also a member of the Connecticut Breastfeeding Coalition.

She said most women had four or five breastfeeding visits before the pandemic and only have one now. There were also more referrals for infant formula because the initial point of contact was not there.

Helen Wilde LaPlant, program manager for Hispanic Health Council’s Breastfeeding Heritage and Pride, said they lost all in-person contacts early in the pandemic. They still cannot do home visits, but staff can once again visit clinics at participating hospitals.

“Unfortunately, there has been a slight drop in caseloads and overall attendance,” she said, adding that recruitment is much more effective when it can be done in person at clinics.

The pandemic has also led to a decrease in the number of women who wanted to breastfeed.

Dr. Mary Marshall-Crim, a gynecologist at Hartford HealthCare, said her hospital had had great success with the shift to telehealth, but they still saw a drop of about several percentage points in rates of intention, going from around 90% or higher before the pandemic to the low and mid 80s now.

She said people were particularly scared at the start of the pandemic of the spread of COVID and there was confusing information coming from the various organizations that are offering the health recommendations.

“People don’t know what to do,” she said, adding that research now shows that if the mother is vaccinated, antibodies will be delivered to the baby through the milk.

Another challenge was getting people out as soon as possible initially, with vaginal deliveries after 24 hours and cesarean births after 48 hours, compared to the usual 48 hours and 96 hours, respectively, before the pandemic. Marshall-Crim said they weren’t always able to identify there was a need for lactation specialists, with women leaving earlier.

Instead, they sent mothers home with articles and then specialists followed up with a Zoom call. Marshall-Crim said he received 120 telehealth calls in the first month alone, which remained fairly steady until things started to open up again and mothers were more comfortable masking up and go out again.

Challenges

Schindler-Ruwisch said the study’s survey responses claimed telehealth was not as effective as the person would have been, but it was better than nothing. About 70% of responders used telehealth only, with most connecting with the mother on whatever technology she had.

“It was really an informal process,” she said, adding that some could only speak on the phone and had no visuals.

The lack of the in-person element was highlighted as the biggest challenge, especially since much of the help is offered based on what the lactation specialist sees.

“You miss all the body language to see if they need encouragement or if they understand,” Schindler-Ruwisch said.

The virtual element made it more difficult for the specialist to reposition the baby or see how the baby was latching or if his tongue was tied. It also meant that the baby could not be weighed to see how it was growing or how much milk it was getting.

“It’s sometimes hard to tell in telehealth,” LaPlant said.

Providers have had to be creative in offering distance learning courses. For those at Hartford Hospital, that included cloth dolls and boobs, Marshall-Crim said.

There were also logistical challenges, including how to hold the phone for a conference with the specialist while breastfeeding.

Access to technology was another challenge, although some places lent phones to those who needed them so they could use the services.

In other cases, translation services were also more difficult to obtain remotely, adding to the language barrier, Schindler-Ruwisch said. She added that insurance doesn’t necessarily cover virtual programs, preventing people from using it because they can’t afford it.

Even when it was in person, people wore masks and the specialist couldn’t demonstrate how the baby should latch on, Phillips said. Experts also said the pandemic had created a sense of isolation.

Phillips said support is an important component, with women more likely to continue breastfeeding if it’s there.

“It’s always good to have this network of other moms and specialists,” she said.

Advantages

But while the remote elements present challenges, experts say there are also positives, including reaching people outside their direct service areas and adding some kind of convenience for mothers.

Especially in the beginning, mothers didn’t want to take their babies outside and risk them catching COVID, so it allowed them to see specialists at home.

“For the most part, people really wanted it,” Marshall-Crim said, adding that it removed transportation barriers and helped mothers who were struggling with physical recovery.

She said the hospital provided cell phones for people who might not otherwise have access to them and made sure the hospital’s translation services were available, so she didn’t see these obstacles highlighted in the study.

The extra services were so popular that she had to hire three more full-time employees and three per diem employees to keep up with demand, as well as to cover others who were absent due to COVID.

Shannon Chaiklin, assistant zone online coordinator for La Leche League of Connecticut, said the organization has seen its reach expand during the pandemic.

Before the pandemic, La Leche League of Connecticut offered 18 in-person meetings and one private Facebook meeting per month, as well as email and phone support, she said.

She currently oversees groups in Shelton, Orange and Milford. Other groups take place throughout the state, including Fairfield, Greenwich, Stamford, Ridgefield, Wilton, Hamden, Madison, New Haven, North Haven, and Westport.

“Once the pandemic started, all in-person support was quickly suspended and a small group of leaders went into crisis mode offering increased support through the Facebook group,” Chaiklin said.

Since then, the organization has been offering six to seven virtual meetups a month at different times of the week, split between Zoom and the private Facebook group. There is also more interaction in the Facebook group and a new Zoom meeting in Spanish.

“Our increased virtual presence, no doubt, has been incredibly valuable to leaders and parents,” she said.

Chaiklin said the group has expanded its online reach beyond Connecticut with parents around the world coming to them for information and peer-to-peer support.

For now, most experts see virtualization as a way to expand their offerings, but not as a total solution.

“I hope we never have to give up on Zoom when it comes to the world of breastfeeding,” Marshall-Crim said. “I think it was so well received.”