by Shondra Mattos

Updated: Apr 11, 2020

We are excited to welcome Army spouse Shondra Mattos, IBCLC from Mattos Lactation as our guest collaborator on a special three-part series addressing the unique concerns the coronavirus COVID-19 brings to breastfeeding military families. In this blog series, we want to summarize the most current information we have, and we will be updating as more information becomes available. This first blog post will focus on breastfeeding. In next week's post, we will address the main concerns and questions regarding pregnancy and birth during this pandemic. And our final post will cover specific information for breastfeeding military servicemembers who may be activated, mobilized, or deployed in response to the COVID-19 crisis.

COVID-19 presents a unique situation for military personnel and their families. Not only do we have to deal with any requirements our city/state imposes, but we also have to sit back and wait as the military finds the right balance of protecting public safety and maintaining the mission. Many of us are also put into an indefinite holding pattern as all military movement has halted, including PCS’s, deployments, trainings, and homecomings. All of this can lead to a feeling of instability, but if there’s one thing military families are good at, it’s resiliency! As of this writing (3/19/2020), very few service members have tested positive for Coronavirus. Considering the proximity in which most military personnel work to one another, it is quite reassuring news.

However, as parents, we are highly concerned with the spread of this illness, especially to our vulnerable babies and children. Though few children under the age of 9 have tested positive, with no cases [UPDATE: conclusively] resulting in deaths, the worry remains. Understandably so. For expectant and breastfeeding parents, this fear is heightened tenfold as some organizations have added pregnant parents to the "at-risk" category, and we’re receiving mixed recommendations regarding the safety of breastfeeding during illness.

During a time where everything feels out of your control, it may be comforting to know breastfeeding is something you have control over- and it not only creates a sense of normalcy but provides important immune protection for your baby.

Which brings us to the first and most crucial point:

Don't stop human milk feeding, even if you become symptomatic or test positive.

Though we know very little about Sars-Cov-2 (the name of the virus that causes the illness COVID-19), we know enough about the protective effects of human milk on respiratory illness, how this virus is transmitted, and the transmission of viruses in the same family to recommend the continuation of providing human milk.

Things to consider:

The virus can be transmitted before symptoms develop -or in the absence of symptoms - therefore, if you come into contact with the virus, your baby is exposed well before you know you have Covid-19.

This is true, regardless of how or what you feed your baby. Babies fed human milk have a better chance of fighting and beating any illness due to the immune-boosting properties and tailored antibodies provided in human milk

Parents are currently experiencing difficulties in obtaining formula due to bulk buying and disruptions in supply chains due to the economical and logical impacts this pandemic is having.

It is VERY tempting to consider weaning for fear of exposing your baby once you have any symptoms that could point to COVID-19 or if you test positive.

And even though we can rationalize that our babies have been exposed before testing positive, it might feel dangerous to feed human milk for fear of exposing them further. Thankfully all of the samples of breastmilk taken of parents positive for Covid-19, tested negative for Sars-Cov-2, reinforcing the belief that this virus is NOT spread via human milk.

The WHO, CDC, UNICEF, ACOG, AAP, and ABM all suggest the continuation of breastfeeding for COVID-19 positive parents and encourage the proper precautions to be taken to reduce the potential spread. These precautions include:

wash your hands for at least 20 seconds before handling your baby
avoid breathing, coughing, or sneezing directly onto your baby. This direct exposure can be limited to covering your mouth and nose with a mask. If a mask is unavailable, a barrier such as a scarf may work in a pinch.

Note: These precautions are not exclusive for breastfeeding parents. All parents who test positive should follow the above recommendations regardless of how or what they are feeding their babies.

Take care of your mental health

The entire world has changed, and none of us is unaffected by it. Lactating parents and military families already live with high levels of stress, and experience greater rates of depression, anxiety, and other common mental health conditions than the general population. Many lactating parents are also living with postpartum depression or anxiety. Now, when the media is filled with endless reports of the global pandemic, normal daily activities are cancelled, and we’re all being told to stay inside away from others, these conditions are on the rise. Although military families are still afforded some security when it comes to knowing we will keep our jobs and income sources, DOD civilians, contractors and military spouses who work in the civilian sector may be faced with financial hardship due to their workplace being closed or hours being cut. Here are some practical things you can do to make sure that you are staying healthy and strong:

Seek help!

TRICARE covers Telemental Health Services, which provides free, confidential behavioral health care with a licensed mental health care provider. Family members and retirees do not need a referral. Active duty servicemembers normally require a referral for this benefit. Contact your local MTF or civilian PCM if you need behavioral health care, as many clinical facilities have gone to telemedicine appointments as part of the COVID-19 response. Most Federal Health Benefits Plan insurances also cover mental health telemedicine, so GS civilians and contractors have access to these resources as well.
MilitaryOneSource has free counseling services through the Military Family Life Counselor program, available by phone and video.
Coast Guard offers CG SUPRT, a free confidential counseling service.
Domestic violence has spiked in locations affected by COVID-19. If you are experiencing domestic violence, there are resources available to help you with your situation.

Social Distancing doesn’t mean Isolation!

It’s tempting to sink away, feeling afraid of the world “out there”, but we live in a time when technology keeps us connected like never before. Social media, text messaging, video chats and apps give us the opportunity to stay connected to our social support groups, which is vitally important for breastfeeding parents.
Create a check-in group. It can be just you and your BFF, or small group of friends who always make you feel good when you’re with them. Start a group chat and make a point to go in at least once a day and leave a message. Ask them to commit to daily contact as well--it’s amazing what a difference it will make.
Find online support! Mom2Mom Global chapters have switched our regular in-person breastfeeding cafes and meetups to virtual cafes via video chat. Many other breastfeeding support groups are doing the same. Postpartum Support International has a weekly online support group just for military parents. If you’re on WIC, check to see if their Peer Counselors are doing virtual support.

Find ways to have normalcy.

Go outside. Follow proper social distancing protocols and guidance from your local installation command and local authorities, but if possible, get outside for at least a half an hour a day. Wear your baby in a carrier or sling, or take them in a stroller and walk around the block or around the yard. If you have a back yard, balcony, or patio, make a point to sit outside--in the sun if possible, and set up a play area for your little ones.
Take advantage of shortened work hours (if available) and have your spouse care for the kids while you go out for a walk by yourself. If you want some company, do a video call with a friend or relative while you’re out. Make time for YOU.
Limit media exposure. Set an alarm, use the screen time limits on your phone & tablet, do whatever it takes to turn off the constant stream of headlines and information overload. Commit to checking the news once or twice a day, and stick to it. Give your brain time off.
You probably already have a routine that basically involves going with your baby’s flow, but now is the time to stick with it. If you have older kids who are home from school, create structure in their day. Include free time for them, time for schoolwork, and responsibilities for them to help out around the house--they live there too!
Do what makes you feel good. If you miss your gym time, hop online and do fitness classes. As long as you’re healthy you can still go for a run, a walk, or a bike ride. Ask your yoga instructor if they’ll teach online classes, or check with your local MWR or family support organization. Some installations are now offering free classes, meditation, storytimes, music, etc for families through live-streaming while fitness centers, libraries, and youth services are closed.
Loosen up. Although it’s frustrating to be cooped up and not be able to go anywhere, it can also be a bit liberating not to be tied to deadlines, appointment times, worried about being late. Keep your routine for some normalcy, but also let yourself be a little flexible and enjoy the freedom from the clock. If you have to continue working from home, make sure that you also schedule adequate breaks for food, childcare, and your own well-being.

Be mindful of your milk supply

Many military families are displaced at this time (Thanks travel ban!), which poses specific challenges for breastfeeding families. There are many resources available to help you navigate this time period such as Military One Source, National Military Family Association, and TRICARE, as well as your local chain of command. If your family is displaced because of the travel ban, the Department of Defense has issued updated guidance, and Move.mil has also published information on the Stop Movement order.

But even if you're self-quarantining at home, this time is very stressful, which could affect let down response.

The following suggestions apply whether you're looking for a place to stay until the ban is lifted or you're currently at home:

Make an active effort to relieve stress daily, especially before nursing or pumping. This is undoubtedly easier said than done, but it is a way you can combat the negative effect stress can have on milk production. Strategies include deep breathing exercises, music therapy, and laughter. (If you needed an excuse to turn binge-watch your favorite comedy, here you go!) Looking to connect with others? Lots of artists, special interest groups, and parents groups are offering free live videostreams, so catch up on a workout, get in some music time with your baby, or watch a live concert--whatever you enjoy doing to relax.
Set a timer if you're pumping. We all have been there--a super busy or stressful day occurs, and we express less than usual. A few days of that in a row, and not only may you see a negative impact on your overall milk supply, but you increase the risk of needing a trip to the doc due to mastitis. The last thing anyone needs during a pandemic is to get sick and require medical intervention. Setting a timer may help you maintain your proper pump schedule.
Return to the basics. As our babies get older, we tend to encourage longer stretches of sleep or forget that skin to skin is even a thing. Both skin to skin and middle of the night feeding (or expression if that's the method of choice for nighttime) are strategies that have proven beneficial effects on milk supply. If you've skipped either in the past, now is a great time to begin again. You can sleep in a little or nap during the day, since you won’t have to stick to scheduled appointments or school pickup times.

Ensure proper milk handling & storage

The vast majority of breastfeeding parents in the United States express milk at some point or another, with the use of a hand pump or an electric pump being the most common method.

As we work towards reducing the spread of this virus, ensuring proper milk storage and handling is vital. The CDC and the Academy of Breastfeeding Medicine have created guidelines that you can read.

Quick summary: Wash your hands and pump parts before each pump session, put your milk in the fridge or freezer soon after expression (within 4 hours), and use refrigerated milk within 4-5 days and frozen milk within 6-12 months.

Consider donating

Human milk is THE MOST crucial resource for infants during emergency situations. As was touched upon in "Are You Prepared? Infant and Young Child Feeding in Emergencies," human milk feeding during disasters saves lives.

While this pandemic may feel very different from natural disasters of the past, this is unquestionably an emergency situation. There are many families in desperate need of food for their infant as formula shortages increase thanks to a combination of bulk buying and disruptions to the supply chain. Without human milk, the babies that usually rely on infant formula for some or all of their daily needs face a real danger of being underfed.
In the past few days, Facebook groups have popped up geared towards supporting those who are building supplies to donate or relactating for emergencies. They are great resources if you have any questions or concerns regarding how to get started.
Informal milk sharing does not come without risks, and it's important that you (as a donor or recipient) understand the risks and steps you can take to mitigate them. Eats on Feets, an organization that connects milk donors and recipients, has great resources regarding community milk sharing including the pillars of safe milk sharing, which covers everything you need to know.
While Mom2Mom Global is not a milk-sharing organization, we have a milk-sharing policy. You can also find a Mom2Mom Chapter near you to join for support and to connect with other breastfeeding military families.
If you're a combo feeding or exclusively formula feeding parent and are facing formula shortages in your area, please reach out to your local breastfeeding support professionals or organizations. Even if you don't want to use donor milk, many lactation professionals and volunteers are working endlessly to find and obtain formula in their communities for families in need.

Though these are challenging times, we of all people know how to persevere, and our community is strong. We’ve all learned how to make the best of uncertain situations. In some ways, we may be more equipped to deal with these rapid changes and unpredictable circumstances than most. Wherever you are in the world, however, you are affected by the pandemic, remember, you are not alone--we're all in this together! Follow Mom2Mom Global/Breastfeeding in Combat Boots and Mattos Lactation for updates and share your #COVID19 survival tips, questions, and concerns on our social media.

Author Shondra Mattos.jpg — Shondra Mattos

*Shondra Mattos is a veteran and military spouse, an International Board Certified Lactation Consultant (IBCLC), La Leche League Leader, and owner of* Mattos Lactation. After serving her country in the US Army for three years, Shondra transitioned into birth work. She continues this spirit of service by supporting breastfeeding and lactating families all across the country. Shondra currently resides in Monterey, CA, with her husband and 4-year-old daughter. When she's not working or spending time with her family, she can be found watching YouTube and eating too many cookies.