CDC Clarifies H1N1 Recommendations in Obstetric Settings (11/17/09)
ILCA has learned that the U.S. Centers for Disease Control and Prevention has issued updated guidance regarding 2009 H1N1 Influenza in the early postpartum period. Interim Guidance: Considerations Regarding 2009 H1N1 Influenza in Intrapartum and Postpartum Hospital Settings is available at:http://www.cdc.gov/h1n1flu/guidance/obstetric.htm
The new CDC guidance clarifies earlier recommendations for labor and delivery, postpartum, and newborn care settings when new mothers have either confirmed or suspected 2009 H1N1 Influenza virus infection. As more is learned about the impact of H1N1 on infants and young children, CDC recommends a two-step approach to protect infants from exposure to infected droplets. In Step 1, CDC continues to recommend temporarily separating mothers who are ill with H1N1 from their infants immediately after delivery until they have met the criteria for contact with the infant outlined in Step 2. CDC recommends the mother be assisted to begin direct breastfeeding immediately upon meeting the criteria for contact, and that these precautions be followed for 7 days after symptom onset.
New recommendations regarding breastfeeding for the mother with confirmed or suspected H1N1 include:
- Counseling women beginning with the labor period about the importance of breastfeeding as the “best way to protect the infant against 2009 H1N1 virus and other respiratory pathogens”
- Assisting sick mothers with colostrum expression immediately after delivery
- Classifying newborns of mothers ill with H1N1 as “exposed” rather than “infectious” (which means babies no longer need to be isolated, opening opportunities to promote skin-to-skin contact by other caregivers)
- Providing lactation consultants to help mothers and infants establish breastfeeding
- Assuring adequate lactation follow-up following hospital discharge.
ILCA’s Response to CDC Guidelines: (11/17/09)
ILCA applauds the strengthened language supporting breastfeeding and the role of lactation consultants, but is concerned that the extremely cautious approach of temporarily separating mothers from their infants after delivery may be unwarranted, and may inadvertently introduce risks to the infant that outweigh the protection it affords. While we appreciate the seriousness of the 2009 H1N1 Influenza virus infection as a global health care concern, other groups such as the American Academy of Pediatrics and health ministries of other countries offer a less stringent approach. To learn more, see Influenza References, listed on the home page of the ILCA website at: www.ilca.org.
It is important to keep in mind that CDC is not a regulatory agency, and CDC recommendations are considered “guidance” to be used in conjunction with clinical expertise. The CDC expects that each hospital and birthing facility will establish its own protocols based on hospital configuration, staffing, and surge capacity. Other factors should include the risks vs. benefits of separating sick mothers from babies given the population groups served and availability of in-hospital and postpartum community breastfeeding support services. International Board Certified Lactation Consultants (IBCLCs) are vital members of the health care team, and are in a unique position to assist in developing evidence-based protocols that will help protect the breastfeeding relationship, providing staff training, and supporting families. Learn more about important opportunities for IBCLCs during flu season in ILCA’s revised document, Action Items for Lactation Consultants at www.ilca.org.