“In the early years the baby has an intense need to be with his mother, which is as basic as his need for food.” – La Leche League International
Babies are separated from their birth parents at varying degrees for many reasons, including maternal or infant contagious disease, traumatic birth, surgical birth, adoption or surrogacy, NICU stay, travel, return to work, quarantine, imprisonment, detainment, natural disaster, maternal medical emergency, and more.
I’ll expand upon a few of these here, but in general I hope the resources and tips can be adapted as needed. I intend to update this article with attention to other reasons for separation and their respective resources.
For the purpose of this post, I’m focusing on the effects of separation in infancy specifically on breastfeeding / feeding.
Why the topic of early separation matters, particularly in forced or avoidable circumstances:
- Maternal separation is “a major physiologic stressor for the infant.” (source)
- Mother-child separation causes neurobiological vulnerability into adulthood (source)
- “At birth, the brain is the most underdeveloped organ in our body. It takes up until our mid-20s for our brains to fully mature. Any serious and prolonged adversity, such as a sudden, unexpected and lasting separation from a caretaker, changes the structure of the developing brain. It damages a child’s ability to process emotion and leaves scars that are profound and lifelong.” (source)
- “[Baby’s e]xposure to maternal fear activates a number of areas involved in processing threat, stress, or pain.” (source)
- In countries where rooming-in is a post-birth routine, breastfeeding rates are high and infant mortality rates are low. “Newborn infants deprived of self-regulatory (on cue) access to their mothers are considered at increased physiological and developmental risk.” (source)
- Nursing people are at risk of mastitis — an excruciating, dangerous breast infection — when suddenly separated from their nursling.
- Especially in certain communities, a breastfed infant separated from its mother is at risk of food insecurity.
- Separation of an infant from its mother in the immediate postpartum for several weeks can lead to “lowered feelings of maternal competency.” (source)
Why extended mother-child separation isn’t easily avoided:
- financial security is needed
- trusted, reliable child-minders are needed
- political, social, and other systemic threats must be eliminated
- perinatal incidence of maternal trauma and threat to life, often preceded by normalization of high-intervention birth
- birthing parents are often assumed primary caregivers or sole nurturers without regard for the role of their autonomy
Separation Policies at Birth
At the time of this writing, we’re sitting in the eye of the COVID-19 storm. We’re seeing policy overhauls this way and that, with providers and institutions handling their business in ways they never before dreamed.
But don’t forget, you are currently and will always be “allowed” to advocate for yourself in birth & postpartum — you needn’t be given permission to speak up for yourself and your baby! Get some self-advocacy ideas here and more information on COVID-19-prompted hospital restrictions here.
Do figure out your birth place’s protocols for newborn separation before the 11th hour (namely, you should be keeping tabs on any policy changes for the duration of your pregnancy).
QUESTIONS TO ASK:
- Under what circumstances do they mandate separation of newborns from the birthing parent?
- Where will the baby stay if NICU isn’t warranted?
- Are you allowed to visit the NICU? For how long and how often?
- Do they impose special feeding guidelines?
- Can you still room in together, but minimize physical contact? What degree of separation is expected?
- If infection transmission is a concern, what are your other options? Can you compromise with specific PPE?
- Are you allowed to stay onsite overnight with baby? Are you able to stay onsite for the duration of separation? Is a nearby hotel that will allow you to remain as close as possible to baby?
- Can you adhere to separation guidelines at home versus in hospital?
- Does your birth place provide trauma-informed care?
- Are they following the medical directives / mandates of a particular health organization?
THINGS TO DO:
- Write a Preferences Plan for the immediate postpartum “in case of separation.” Show your provider — how did they respond? Take note of red flags and feel out your options for a change in birth place if needed.
- Utilize this free sample form “Informed consent form for refusal to separate birthing parent and infant” here (by Evidence Based Birth)
- Make a plan for your transition home.
- Make an appointment with an IBCLC or other lactation specialist early on to create a personalized feeding plan.
Separation Due To Maternal Illness
“Over the years, far too many women have been wrongly told they had to stop breastfeeding. The decision about continuing breastfeeding when the mother takes a drug, for example, is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother, the baby and the family, as well as society.
And there are plenty of risks in not breastfeeding, so the question essentially boils down to: Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than formula feeding? The answer is almost always: Almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping.” – “You Should Continue Breastfeeding (Illness in Mother or Baby” by Jack Newman, MD, FRCPC
Newman further explains that not only is the advice to stop breastfeeding usually wrong, it’s also “impractical” as pumping and bottle-feeding are not always easy or feasible.
If the mother realizes she is sick (with viral infection, bacterial infection, even strep throat), by this time she has already exposed her child to the sickness during stage of contagion. Passing along the antibodies in her milk will protect the child or at least allow for milder symptoms should he get sick, too. The mother can in this way think of having the double role of both patient and doctor.
Foodborne or waterborne illness is also not a reason for a mother to stop breastfeeding; in fact, increased nursing can protect the child, according to the CDC.
In regard to COVID-19:
Thus far (4/1/20), COVID-19 has not been detected in breast milk of infected mothers, though data is still limited. As far as we know at this time of writing, infectious spread is mainly caused by person-to-person contact through respiratory droplets.
The CDC advises that those confirmed or suspected of having a COVID-19 infection and are planning to breastfeed or are currently breastfeeding should CONTINUE to do so. There are very few medical conditions in which breastfeeding is currently considered contraindicated.
Health Organization Guidelines
From Melissa Bartick, MD, MS, FABM at Harvard Medical School:
WHO: At this writing, the World Health Organization advises that infected mothers can share a room with their infant and breastfeed but should practice “respiratory hygiene.” They should wash their hands and wear a mask, acknowledging that a mask might not be available.
CDC and ACOG: The Centers for Disease Control and Prevention (CDC) advises that facilities should “consider temporarily” separating mothers and newborns after “discussing the risks and benefits with the mother and health care team.”2 Mothers can breastfeed with respiratory hygiene. A separated infant must be isolated from other infants. The CDC makes provisions for rooming in if “it is in accordance with the mother’s wishes” or if it is unavoidable due to facility limitations. In such cases, the infant should be kept more than 6 feet (2 meters) from the infant with a curtain or barrier separating them if possible, and respiratory hygiene measures apply. The American College of Obstetricians and Gynecologists (ACOG) refers to CDC guidelines.3 ACOG is not recommending routine COVID-19 testing for pregnant women.
ABM: The Academy of Breastfeeding Medicine emphasizes mothers’ choice and notes that breastfeeding and rooming in are “reasonable” choices, and also refers to CDC and WHO guidelines.1 Wearing a mask, and washing hands as well as pump parts are advised.
Chinese Consensus: The Chinese Expert Consensus on Perinatal and Neonatal Management from February 7 recommended no breastfeeding or breast milk feeding and full separation,4 as authors said “virus may be excreted into the milk.” This has not yet been updated.
Other resources specific to COVID-19:
Separation Due To Different Location
Some nursing parents find themselves separated from their breastfed baby due to being in different locations, either prompted by long work shifts, traveling, following stay-at-home orders, and other scenarios.
For brief separations (such as due to work or taking personal time):
- Ease into separations, if possible, by first practicing time apart in shorter spurts
- Schedule separations after naps or feedings
- Nurse before leaving and upon reuniting
- Develop a positive “hello”/”goodbye” routine; leave quickly without excess fanfare
- Learning how to nurse well in a parked car is handy
- Try reverse cycle nursing
- Keep baby’s environment familiar and consistent
- Sleep close to your baby to compensate for missed day feeds
- Breastfeed frequently when back together
If far away from baby:
Separation Due to NICU Stay
Please read: Breastfeeding a Premature Baby
Separation Due To Cesarean Recovery
Please read: Breastfeeding After a Cesarean
Even while separated, you can follow typical guidelines for successful pumping.
THINGS TO LEARN (BEFORE PUMPING):
- how long you should expect to spend on the pump each session, depending on the time of day and other factors
- how to set a pumping routine in relaxing conditions
- how to hand express
- what is the “magic hour”
- how to massage your breasts before / after pumping to increase milk
- how to avoid ‘nipple confusion / nipple preference’
- milk storage guidelines
- best bottle feeding practices
Ensure that you’ve established a solid milk production, then taper down pumping sessions to maintenance level (at least 7 times in a 24 hour period every 3-4 hours, day and night).
THINGS TO DO (AFTER BIRTH):
- Ask the hospital to loan a hospital-grade pump. Check with insurance about covering a supplemental full-size electric pump.
- Make an appointment with an IBCLC or other lactation specialist early on to create a personalized feeding plan.
- The first round with a pump should ideally be within 6 hours of birth.
- While separated, it’s recommended to pump often enough to mimic a newborn’s typical nursing pattern (8-10 times per 24 hour period, every 2-3 hours during the day and 3-4 hours at night or during work).
- Time pumping sessions from the start of the last one. For example, if you start at 5 p.m. you would start again between 7 and 8 p.m. Don’t forget overnight pumping sessions as these will help prepare you for middle of the night feedings once you’ve reunited.
INCREASING MILK OUTPUT
- Consider combining hand expression with pumping to maximize production.
- Listen to classical music while you pump.
- Look at photos of your baby while you pump.
- Cover the bottle with a clean sock while pumping. This helps take your mind off how quickly it’s filling up, thus reducing “performance anxiety.”
- Manual nipple stimulation (using your hand) is a great way to boost oxytocin signals between pumping sessions (do be aware that milk must be removed for your body to make more).
- Whenever possible, protect yourself from distressing news, bad attitudes, negative or emotionally draining people.
Staying Involved In Feeding While Separated
Your role as your baby’s primary caregiver should still be honored, even when you cannot be physically present. A few things you can do to feel involved and in control:
- Choose who will be the baby’s trusted caregiver in your stead. This person should be supportive of your breastfeeding goals and desire to preserve this part of the relationship.
- Explain to your baby’s caregivers about how you want him/her to be fed.
- Insist on being consulted before a change occurs in the feeding plan. Evaluate other feeding choices should they become necessary and give permission for your preferred alternate route. If you wish to avoid bottles, can baby be fed by cup, spoon, or syringe?
- If you’re able to nurse your baby right before separation and immediately after, do so.
Bonding With Baby While Separated & Beyond
- Some mothers find pumping near baby in the NICU room to be a very healing activity.
- Take care of yourself mentally, emotionally, and physically. You want to resume your physical relationship with your baby in the best condition you can be. YOU are your baby’s first home; self-care in this sense is a way of extending love to your baby.
- Your baby’s caregiver should be encouraged to do skin-to-skin time (especially if baby is newborn) and babywearing. For now you will have to live vicariously, but knowing your baby is still bonding with other loved ones can put your heart more at ease.
- Request videos and photos of your baby. You can also snuggle with an outfit worn by your baby, capturing his sweet scent and training your brain’s recognition of his pheremones.
- Study up on how to read baby’s cues — becoming a pro at this helps speed the attachment process.
- Spend time on projects devoted to your baby, or stay busy with unrelated things — whichever helps you feel energized and refreshed when it’s time to see or hold your baby again.
- Wrap baby in something that smells of you (ensure it’s sanitized if infection transmission is a concern).
- Have positive rituals for cleaning pump parts, expressing milk, and storing it. Find ways to make the act of providing for your baby a special and sacred one.
- Record yourself singing songs or reading books to your baby.
- Have you considered designating someone close to your family to wet nurse?
- Make up for the time you missed by building roots in attachment: safely share a sleep space, babywear, learn infant massage, etc.
- Consider allowing your child to self-wean.
While separated from your baby, or anticipating a separation, you may encounter feelings of:
- catastrophic thinking
- and other emotions, even sharply contrasting ones
There are a wide range of feelings you may experience while separated from your baby. Whatever you are feeling, it is valid, important, and not to be trivialized. I want to emphasize the importance of regularly checking in with yourself and self-screening for PMAD, Separation Anxiety Disorder, and PTSD. Please review and utilize the following mental health resources:
- Mental Health Resources for NICU Parents
- Support 4 NICU Parents
- NICU Self Assessment
- Edinburgh Postnatal Depression Self-Assessment
- PTSD Self Screening
Who is your shoulder to cry on? Who will listen to you without judgment? Who can you rely on to help without needing to ask? If help is offered, accept the help! Direct helpers to assist with errands, chores, meals, anything you think will promote welcome relief while you remain focused on caring for baby even from afar.
WHO CAN HELP YOU:
- Trusted support person