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Episode 34: COVID-19, the Vaccine & Breastfeeding

, , January 21, 2021

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Welcome back to The Breastfeeding Talk Podcast. I’m your host Jacqueline Kincer. And this is an episode I’ve been meaning to do for a while but I actually wanted to wait to fully put together this episode. Once we had a little more experience, I guess in the real world with some of the vaccines that are out there for Coronavirus. So this episode is going to be basically about breastfeeding and COVID or Coronavirus, and we’re going to explore a lot of different topics I’m going to be sharing with you just, you know, basically a culmination of all the knowledge I’ve been either able to gather on this topic for you. Now, I do want to make the disclaimer that obviously I’m not a virologist, I’m not a physician. I’m not a VAC sinologist.


You know, I am a healthcare provider. I’m an ibclc. So, you know, I’m a researcher, you know, there is a big part of my training and education that is involved, you know, research methods and reviewing science and what have you. So, I’m going to share with you my perspective from those viewpoints, and try to offer as much information as I can so that you can make informed decisions for yourself and your family. So I hope that that makes sense for you. Now, I do want to be clear that Coronavirus are SARS cov two, which is the specific Coronavirus that we’re all very concerned about causes the disease known as COVID 19.


So, a lot of people use those terms interchangeably. I think that we all know what we mean by that. But you could be positive for SARS, cov. Two and not really get COVID, if that makes sense. So like there’s people that have been positive on PCR tests, and never gotten any symptoms of the disease. So that’s not really the same thing. But regardless, the terms are pretty much interchangeable. Now, when it comes to breastfeeding, and COVID, you know, this is a special consideration, right? One of the considerations is, you know, can I breastfeed my child if I’m positive for SARS, cov? Two?


And so be exploring that topic, and then also can I get the vaccine. Now, I do want to make something very, very clear. Breastfeeding and pregnancy are not the same thing. So they seem to get lumped into the same category. Like when we’re looking at recommendations for things, even supplements that you buy, or medications, you know, please consult with your healthcare provider, if you are pregnant, or breastfeeding, or this is not approved for pregnant or breastfeeding women will see that kind of language. But pregnancy and breastfeeding are two very different things in terms of what’s going on physiologically.


You know, they’re two different points along the reproductive cycle. But they are not the same thing. So, you know, the foods that you might need to avoid during pregnancy don’t need to be avoided while you’re breastfeeding, the medications and supplements you might need to avoid while being pregnant are much more restrictive guidelines than what would occur during breastfeeding. So I want to make sure that when you’re listening to this podcast, I’m not really discussing recommendations or anything regarding pregnancy, and breastfeeding and pregnancy should be seen as two totally separate things in terms of what applies.


So, you know, breastfeeding and COVID are, you know, it’s a really novel topic. And it’s an awful virus. Right at this point, it’s not so novel, it’s can we’ve sort of been around the block with this for over a year now. But there’s still a lot to learn. They’re still new variants emerging. There’s a lot of things constantly coming out. So, you know, like, I feel like there’s never really a great time to make a podcast like this. And it may not be the last one I record on this topic. But I do know that there’s a lot of fear from parents that if they have SARS, cov two that they could give it to their baby through breast milk.


Now, there’s not a lot of research out there to show that that’s true or not, in fact, a podcast that I love listening to that was recommended by a colleague is called This Week in virology, and maybe I should even have one or some of those folks on here. This is a guest to speak On this topic, but in a recent episode, they reviewed the literature on this. And there may have been some detection of you know, SARS, cov to RNA in breast milk, but it was not infectious. So, just because there may be a presence of viral proteins or RNA does not mean that it’s infectious. So, so far, there is no data to show that there is any infectious virus in breast milk. So that is good news. Now, that doesn’t mean that data won’t come out showing the opposite at some point, you know, later in time. But so far, that has not been shown the case. And so far, the recommendations from the World Health Organization and other major medical organizations have been, you know, do not cease breastfeeding.


If you’re positive for COVID. They encourage you to breastfeed, we know that there are antibodies to COVID that end up in breast milk that are very important for babies, we don’t know what kind of immunity that confers on the babies or how long it lasts, but it’s certainly better than nothing. Right? So that’s good news. There’s but again, there’s not much research out there, there there are doing some research in terms of, you know, they have convalescent plasma, they have monoclonal antibodies that they can use as treatments for COVID. They’re looking at, you know, isolating antibodies from COVID positive mothers and using those as a treatment, but not necessarily for babies just, you know, for anyone overall, who has tested positive for COVID. So, you know, but it was back in June last year in 2020, that the World Health Organization recommended mothers should continue to breastfeed and the benefits of breastfeeding substantially outweigh the potential risks for transmission. As a lactation consultant, I would say that I believe that that is true.


Of course, everything has to be taken on a case by case basis. But so far, you know, we have not seen any any harm done to any babies that have been given breast milk or breastfed by mothers who are COVID Positive. And of course, you know, they do recommend precautions are taken like mother’s wearing a mask and things of that nature, you obviously cannot put a mask on a baby. So please don’t be doing that. That is not safe. They they cannot properly respirator with a mask on their face. So do we’ll just want to clear the air on that. I think most people understand that, but you never know.


But there was a study that was completed in May 2020, where 43 mothers gave breast milk samples. These mothers had previously tested negative for SARS, cov. Two but however, three mothers actually tested positive for viral particles, where they did the you know, PCR testing on that. Both of those three mothers who tested positive, one infant actually tested positive for COVID. But it was unknown if they were breastfed. And the two other infants tested negative one was breastfed The other was fed expressed breast milk. And the viral RNA particles were no longer detected.


So again, detecting RNA in breast milk is not the same. As you know, the virus being transmissible via breast milk. So it would have to be it would require that that viruses replicative and infectious and is able to reach target sites in the infant. What we do know from the latest research in terms of COVID is that viral replication is mostly done in the respiratory tract. There was actually a study done was a review done on where his viral replication happening in the body, they looked at several different organ systems, they looked at the skin and whatnot. And as far as they could tell, the only place that they really saw viral replication was in the respiratory tract. Now they may have found presence of viral proteins or RNA in other areas of the body. They found it in one urine sample, they found it in some stool samples, but there was no actual evidence of fecal oral transmission.


So just because, you know, we can see viral RNA or proteins in various cells of the body or fluids of the body, it does not mean that it’s transmissible from those areas of the body. So if we’re thinking about the gut route, while some people do get gastrointestinal symptoms with COVID infection, it does not mean that that is the route that they got infected by. So we do know that there’s a multi system inflammatory response and a lot of the COVID infections, and that could just be one other area of the body that’s affected. So, you know, we know that cardiac cells can be affected and what have you and that may not be from the virus directly. It may be from this multi system, inflammatory response that is affecting many different organs, you know, from the brain to the heart, the kidneys, to the gut, to the spleen to the skin. or even people that get rashes with COVID.


So, there’s a lot of things that we still don’t know. But just because those areas of the body are affected by the viral infection does not mean that those parts of the body can transmitted. So it’s very important to, you know, differentiate that. So, my point there being is that, let’s say, perhaps that you even had infectious, you know, virus in your breast milk and your baby drink that milk. Since there does not seem to be an oral route of transmission of COVID, as far as we know, and we’ve had over a year of research, you know, to try and look at these different aspects, most likely, you know, it’s it’s not a, it’s not a rotavirus, it’s not an oral virus, you know, it’s generally a respiratory tract virus COVID is, so most likely, that virus would not be infecting your baby’s gut. Now, we don’t know. Right.


But that is an unlikely route of transmission. So that’s something important to know. Now, Secretory IgA is an antibody that can appear in breast milk. And it’s been detected in breast milk of mothers who have had previous COVID infections, but we don’t know the strength and durability that it has on preventing COVID infection. So I like I said, we’re not sure how long that sort of immunity would last or what level of immunity it actually gives to babies. And babies, of course, are different than adult humans. And IGA is only one type of antibody, there’s also IgG. So there’s, there’s more to immunity, though, than antibodies. And if you’ve been following the science closely with this, you know, memory cells, T cells, there’s a lot of other cells involved in the immune system.


Those are some of the more major ones. But that contribute to you know, fighting off this virus or conferring immunity to people. So breast milk is really unique, and we still don’t actually fully understand all that’s in breast milk. In fact, I don’t think we actually know everything that’s truly in breast milk. And I’ll get to even more about that in a moment. But there’s many bioactive components that have been identified in breast milk, but not only protect against infection of anything, you know, but they improve neurocognitive and immunologic development of the child.


So, you know, this isn’t, you know, a formula versus breast milk podcast. But the science is overwhelmingly clear that breast milk is a living bioactive compound, that is, you know, basically programming our baby’s bodies to function in the most biologically optimal way. Right, it is, it is a very small portion of breast milk is something that we consider to be food and nutrition. Old nutrition is, is almost separate from food, to be honest, but the the nutritive bioactive components of breast milk, that go into your baby’s got to go into their bloodstream into their bodies, you know, it’s meant to direct the development of their entire system. So it’s, it’s important to consider that


there’s many immune benefits that come from just, you know, breast milk, regardless of COVID. So, you know, and as far back as August of 2020, do just want to point this out, I might be bouncing all over the place here, but I’m just trying to throw a bunch of facts and things that you guys, the CDC, here in the US said that it’s unclear as to whether mothers with COVID-19, can spread the virus to babies through breast milk, but current evidence does suggest that this is not likely. So that’s good to know, doesn’t mean they can’t spread it in other ways through respiratory droplets and whatnot. So the recommendation is that you wear a mask, you know, anytime that you are holding the baby are in close proximity to the baby.


And that would be I mean, you should just be doing that if you’re infected at home, you need to be doing that and isolating from other family members. However, if you’re obviously breastfeeding, you know, it’s important to continue to do that. But when you do it, you know, wear the mask. Typically, it’s a short term exposure. You know, it’s it’s very unclear as to what I would say recommend, normally doing lots of skin to skin with your baby would be beneficial. But if you have a current COVID infection, and you’re breastfeeding, I might recommend that you know, someone else who is not infected, does that with the baby. But you know, it’s hard to say we just don’t know enough. We don’t know enough, unfortunately.


Now, there have been some researchers that have concluded that mothers shouldn’t breastfeed while they’re ill. There was a researcher with last name Lu who stated that our advice is against the use of breastfeeding even through breast expression. Mothers with COVID-19 should not breastfeed until after full recovery. When breast milk tests negative for the virus, again, I think there’s a flaw in that argument though, that breast milk being you know, receiving a positive PCR test does not mean that that those viral particles are necessarily transmissible. So there is a difference. Really they need to do more research. Well, it sounds like they have done some research to see if it is actually transmissible virus in the breast milk and so far they have not found that.


And then there was another paper by fan and others that said in our cases, breastfeeding is discouraged even though we did not detect stars Kobe to in consecutive breast milk samples during follow up, Grobe was another paper and others suggested that more evidence is needed before health authorities can recommend whether mothers with COVID-19 Should breastfeed so you know to date just to be clear, so you can make an informed decision there is no SARS cov two has been isolated from breast milk, like the actual intact transmissible virus, no documented cases of transmission of infectious virus to the infant through breast milk. So that’s just, you know, if you’re worried about that, I think that’s important, just to, to just go through the evidence or lack thereof, to have a discussion about this very important topic. Something that again, I don’t want to go all over the place here.


But um, you know, if, if you do end up being COVID positive and you’re breastfeeding and you’re or you’re lactating, you know, and you’re very worried, again, just, you know, recommendation about you wearing a mask, but obviously, wash your hands very frequently with soap and water, you can use an alcohol based, you know, hand sanitizer, especially before touching your baby, you know, do wear a medical mask, during any contact with your baby. Now, in case you’re not aware, it is recommended to double mask. So even if you have an NIV five, putting another cloth or you know, a medical mask on top of that, or wearing two medical masks at the same time, that is actually shown to be more beneficial. And make sure it is secured tightly to your face, things of that nature. Obviously, if you’re sneezing or coughing, doing that into a tissue, dispose of it, immediately wash your hands again, routinely Clean and disinfect surfaces that you’ve touched. All those things are very important. So


just you know, being mindful, like if you are pumping, make sure that you thoroughly wash your parts with hot, soapy water. After pumping, make sure you’re sanitizing those pump parts more than you normally would if you were not positive for SARS, cov. Two, so it’s really important that you’re taking the utmost precautions, the last thing we want is to have a baby and some sort of respiratory distress because they were infected with COVID. And babies are getting COVID. So it’s not I know there’s been some, you know, information out there, children aren’t as affected, blah, blah, blah, maybe they’re not as affected, but they definitely are affected and they can be infected.


And in fact, children overall, I don’t know if it’s because of the new variants that are out there or what have you. But hospital admissions for children who are SARS cov, two positive are on the rise. So it was very scary, we are seeing higher prevalence of elementary age children were previously thought, you know, children under ages seven to 10, were not as affected because of a difference in h2 receptors. But we know now more about the infectivity of the virus and that it has not so much to do with those receptors, but what’s actually going on inside the cell. And, you know, some of these new variants apparently are affecting children more dramatically at younger ages. And so, you know, schools that were back in person are now sending kids home to be virtual school because of cases in these lower grades, younger children. So if you have a baby, and you have an older child, it’s going to school, it’s going to be really important, you know, make sure that your child is of course, you know, washing their hands when they arrive home, all of those things, you’re checking them for symptoms.


You know, if your child shows any signs of illness, you know, limiting their contacts with their younger baby sibling would be, you know, very, very ideal, of course. So it just, it’s unfortunate, folks, it’s so unfortunate, it’s sad. I wish that we didn’t have to recommend these things. But you know, the risk of getting this this virus is very substantial. So the the real effects out there, you know, yes, you may get a mild version of the disease, you might not and we really don’t have any way of knowing that at this point. So it’s best not to take our chances. Now I did want to just talk about this article that came out. This was from June 16 2020. They looked at control breast milk samples that were spiking. With a with SARS cov two virus and they were treated by holder pasteurization which is a common pasteurization method for breast milk, especially for like donor milk coming through milk banks, that there was no viral RNA detectable once it went through about holder pasteurization.


So if you’re worried about getting donor milk from a milk bank specifically, like if you have a preemie baby, and you’d have access to though, to that, just No, it would have already gone through this holder pasteurization method. So even if there was viral RNA in it, it would, it would now be gone. So if you are informally getting donor breast milk, or you are informally sharing donor breast milk, you know, probably, you know, you’re not going to get a SARS cov. To test right before you do that, donor breast milk, you know, always carries its risks. However, they’re usually pretty minimal if it’s handled properly. But if you’re concerned about receiving donor breast milk, and maybe potentially a SARS, cov, two exposure, you can always follow the holder pasteurization method or, you know, there’s some, you know, other pasteurization methods, you could, you could hold but or follow.


But there’s further research needed to confirm these findings, you know, we don’t want to just go off of one study, we’ll make sure we do multiple ones to validate this kind of thing. And, you know, we need to do more of an examination of convalescent milk, you know, someone who’s previously had the infection has antibodies, you know, for the presence of those antibodies and breast milk. So there’s doing a lot of research on that now. In fact, there are some ways to join these clinical trials, if you have had COVID In the past, and you can donate your breast milk to have them study it for antibodies and whatnot. So, so some pretty cool stuff coming out there. So


yeah, I think that there’s, you know, some good data out there to show that, you know, we shouldn’t cease breastfeeding, if we are positive for COVID. I think that there’s, you know, at least good evidence out there that that mothers who have been COVID positive, who have breastfed, you know, have not negatively affected their babies in any way. So, so far, that’s held true. Again, though, there’s new variants and mutations coming out of this virus. And so depending on those things, you know, we’ll need to keep studying all of those in relation to you know, just all of the things whole health of everyone, but specifically for breastfeeding mothers and babies. So everything that I’ve said is sort of true up to this point. But that’s based on what we know, that’s the body of science and data and evidence that we have now. That’s not, you know, necessarily going to hold true going forward, unfortunately.


So it is something to think about. Now, there’s a lot of questions about the vaccine, or the vaccines out there. Here in the US. Currently, we have two vaccines approved for emergency use authorization by our FDA. That’s the Maderna. One and the Pfizer, bio and tech one. These are both RNA vaccines. And so I will speak to those specifically. Because I don’t have a lot of information on the other ones out there. Now, originally, there was some caution, because in the UK, they had approved the Pfizer at biotech vaccine before we had here in the US, our FDA is much more thorough and restrictive than the one in the UK. So and it’s I forget the exact name of the organization there. It starts with an M, but they had recommended against pregnant or breastfeeding women getting the vaccine. And that was really based on a lack of evidence that that those population of people were not included in the trials. However, we have had people getting the vaccine who had been pregnant or breastfeeding, since it has been approved for UA here in the US, and so far, no adverse effects in those populations.


So I know there are very available reporting systems, the CDC has the V safe programs. So as soon as you get the vaccine, you can sign up for that and it will, you know, send you text message reminders and you will update your your symptoms and your reaction. Now, we do expect to get symptoms with these vaccines, so that would be a sign of a proper immune response. Again, I’m not a back sinologist or virologists. But the more that the general public can understand, you know, because healthcare professionals were the first round of people to get the vaccine. So we might have a better understanding than the general public. But if you if you know going into it, yes, you should expect to get a sore arm. You may have redness and swelling at the injection site, you may have a headache. You may have flu like symptoms for possibly more than 24 hours, depending on I’ve heard from people who have gotten both versions, the Maderna vaccine Seen a lot of people have a stronger reaction to the first dose and less so of the second dose.


The opposite appears to be true with the Pfizer one that you have more of a mild reaction on the first dose, and then possibly a more severe reaction on the second dose. So everyone’s different. Some people have, you know, no, no real anything to report, others have severe symptoms to report, that doesn’t necessarily mean that you shouldn’t get the vaccine, it doesn’t necessarily mean that anything is wrong. We do expect that the way that these RNA vaccines works, you know that they do stimulate a strong immune response to generate an adequate amount of antibodies for you to be protected from the virus. Now, just a basic primer, if you want to explore the vaccines themselves more in depth, I really would recommend that you go, Pfizer Maderna have both been very transparent, you can go look up their trials online and read through the entire document. There’s great information on the FDA site about this, they’ve been incredibly transparent. Other companies out there producing vaccines that are non RNA vaccines that are not yet approved, have not quite been as transparent. And so they do not have UA authorization yet at this point, at least here in the US. But you can go on there, you can read the trials themselves, you can certainly, you know, look up a lot of articles on the topic, I would encourage you to go to the source, go to a trusted validated source, try not to rely so much on news articles really go to the science itself.


You know, and some people go Why don’t want to read information from the company that made it? Well, the company that made it is the one who writes the clinical trial that’s reviewed by the FDA, I don’t know where else you would really go to get information on the clinical trial, other than reading the clinical trial itself. So you’re just going to have to go, you know, read that decide for yourself whether or not you think this is the right choice for you. But I will say get the gist of how the RNA vaccines work is that you know, the RNA, it’s mRNA, it gets injected into your into your muscle cells in your arm, those cells, and it starts to get taken up in the lymphatic system as well are then the viral RNA goes into the cell goes into the ribosomes, not the nucleus, where DNA is normally replicated, goes into the ribosomes of the cell. And it tells that cell to make a spike protein on the outside of the cell. So once that happens, that RNA is used up, it’s discarded the spike protein is made on that particular cell, then your body sees that spike protein has an antigen, and it starts to attack it. So this is where you get the cellular response.


This is where the antibodies get made. Right. And so that’s what happens now that cell is going to die. And that’s the end of the story. So it’s not like you have this continuing like, you know, runaway train of RNA, producing spike protein cells in your body. It produces it in the cell, this RNAs used up, it’s gone, the cell gets killed by your body, the end, now you have an antibody, now you have a T cell response. Now you have all these other responses. Right? So that is essentially the gist of how it works. Since the vaccine is injected into muscle tissue in your arm, and while eventually it goes you know, goes to the lymphatic system and what have you. And I obviously you’re going to get, you know, an immune response that circulates throughout the entire body, especially once you’ve had the second dose and in breast milk is made from blood. Okay, so yes, you know, you you may have, let’s say for instance, you had a spike protein cell that was made, because of the vaccine somehow enter the breast milk. While your baby is just ingesting a salt with Spike protein on it, that would not be problematic. Because it’s not the actual virus, it’s just a solid spike protein is going to get digested and pooped out. That’s it. That’s all that’s gonna happen.


Now there’s this fear that getting the RNA vaccine is somehow going to put the RNA in the breast milk and that your baby will ingest the RNA and that’s going to cause some sort of a problem. Again, the RNA is not the virus, the RNA is the program for the cell to make the spike protein that then your body attacks. It’s not the actual virus. It’s is the spike protein that gives the Coronavirus, its name because it’s spiky on the outside looks like a Corona k like a crown, essentially. So that’s the appearance of the cell. It’s not the actual virus itself. So even if your baby did somehow get it’s a long journey, I’ll put it that way. It’s a long journey to go from injecting into the muscle tissue in the upper arm to Yes, it gets the lymphatic system which is you know, in the armpit maybe let’s say as a closest area and then it’s you know, the breasts are nearby. i Yes, I suppose there is that potential. But I don’t know yet if there’s been research on this, but molecular weight matters when it comes to breast milk. So the reason why you can safely We take a lot of pharmaceuticals when you’re breastfeeding is because the molecular weight of the drug itself is too high, too big to actually enter the breast milk. So, meaning that you could take some many pharmaceuticals, and they never even enter your breast milk, or they enter it in such small quantities, that it’s really not something that matters a whole lot when it comes to the baby, and just in the breast milk with the drug in it. I don’t know, in terms of the molecular weight of this, you know, particular vaccine, how that works in terms of entering the breast milk, or if by the time


it would seem to me, and I don’t know, again, because I’m not a vaccinology. Some of Arabs, it would seem to me though, based on the point of injection, that there’s an immediate immune response and reaction happening there that it would be very difficult for the RNA to travel that far on its own without already going into another cell along the way before it gets the breasts, I think that would be really a rare thing. Again, they haven’t really looked at this or study that. But it seems to me to be a little far fetched. But let’s say it even goes in there. The vaccine itself is injected into muscle tissue, it’s not an oral vaccine. So something about that tells me that if it was an oral vaccine, maybe we should be more concerned about a baby drinking breast milk of a vaccinated mother. Because we don’t know, you know, how a vaccine like that would affect a baby at all, or what dose and all of those things that, you know, I don’t even though if they’ve begun to even study that or look at that yet at this point. But you know, perhaps they have, but if it was an oral vaccine, I’d be more concerned, it’s not.


So my thought is that even if the viral RNA or well, not even the spike protein, RNA, from vaccine went into the breast milk went into your baby’s gut, it should probably get pretty, you know, easily digested and pooped out. And it’s not really going to make any sort of, you know, weird changes to the baby. Now, again, pregnancy is totally different thing than lactation. So I can only speak to lactation when it comes to this. Again, that’s just sort of an assumption I’m making based off of what other scientists have said, and how the process of vaccination works. There’s been a lot of healthcare workers, especially colleagues of mine who work in the hospital, who then given the option to have the vaccine here in the US, most of them have taken it, most of them have not been to, you know, incredibly hesitant. They’ve done their research, they’ve, they’ve made the most informed decision that they possibly can.


And so that’s what I would suggest for you, if you’re a healthcare practitioner listening to this, and you’re presented with the opportunity to get the vaccine or, you know, maybe you’re just a breastfeeding mom, and you have the opportunity to get it or you’re thinking about this going forward, what I would say is just, you know, stay on top of the the research, you know, stay on top of, you know, these things will come out in the news, right, if there’s any sort of research or developments. And of course, I’ll definitely try to keep my audience posted, at least on Instagram, if not here on the podcast about things. But so far, from what we can tell, in terms of breastfeeding, probably a pretty low risk if you’re thinking about getting the vaccine and whatnot. Now, I do want to say that I understand a lot of people are very vaccine hesitant. I, myself have had been that way. Absolutely. But I have never seen the level of transparency, the level of sort of, you know, clean ingredients, so to speak. And in a vaccine as I have with these RNA ones. It’s been actually very interesting.


And I think that there’s why know that there’s been more funding put into the development of this than any other vaccine. So it’s, there’s a lot on the line here. And what I would say is that, although it seems like the development of this happened very quickly, the research and work on RNA vaccines even further coronaviruses has been in the works for years ahead of time. So it wasn’t like this just came out of nowhere. You can easily read about this, there was an excellent article in The New Yorker, that’s probably a three and a half hour long read on the whole history of this and kind of a summary of what’s happened since the beginning of the pandemic. But you can read about this in multiple places and whatnot. But, you know, this is just something that you’re going to have to make, you know, an individual decision for yourself. But there was an article that came out that I can link up here it was in stat news came out just two days ago on January 19.


From the date that I’m recording this podcast, and there was a perinatal epidemiologist Cristina chambers. She’s a Professor of Pediatrics at the University of California, San Diego. Basically agrees with me, she said, It’s never a good idea to lump together pregnancy and breastfeeding when asking whether something is harmful. Some drugs that are risky in pregnancy are also avoided by people who are breastfeeding, even when they’re perfectly safe for nursing baby. And that’s, that’s where we get into things. So she said that vaccines in general, especially those like COVID vaccines that contain no life virus are unlikely to harm a fetus or nursing baby. But they do raise some kinds of different issues and those who are pregnant or breastfeeding. So, you know, she kind of goes into the way that vaccines work in general and what have you. But


she did go into this that anything that goes through breast milk also then has to go through ate gut pay. So that was a Dr. Helen hare acute medicine in Edinburgh, Scotland. And she actually co authored a British Medical Journal opinion piece called health care workers who breastfeed should be offered the COVID-19 vaccine. So they say that the delicate mRNA molecules in the Pfizer Maderna vaccines, if they made it into the milk would next land into a baby’s stomach acid. And if this vaccine worked by the oral route, we would not be having injections. So they’re basically saying the likelihood of anything weird happening with breast milk going into baby’s body, you know, very, very unlikely.


I mean, I suppose you could pasteurize the milk if you’re really concerned, and then for sure, you know that RNA from the vaccine would not be in there. So that’s always an option, if you’re concerned about that. But the Academy of breastfeeding medicine, made a statement originally on December 14, they’ve actually now updated it, I believe, as of a couple days ago, as well, January 12 2021. They say the Academy of breastfeeding medicine does not recommend cessation of breastfeeding for individuals who are vaccinated against COVID-19. And a new statement, the ABM suggests that lactating women discuss the risks and benefit of vaccination with their health care provider within the context of their risk of contracting COVID-19. And of developing severe disease. And that’s according to the peer reviewed journal breastfeeding medicine. So, you know, again, every medical decision is really something that, you know, should be made in concert with your healthcare team, whether that’s one provider or many. And it’s really important that you just, you know, make an individual statement for yourself, you know, I think that there are people who are, you know, maybe ICU nurses caring for COVID patients, and they’re breastfeeding, and they’re, they cannot limit their contact with these patients. And so they’ve decided to get it, you who’s able to stay at home and get grocery delivery and maybe completely self isolates? You know, that that mean? Well, probably one, you’re not even eligible to get the vaccine yet, but but to your exposure risk is very low. So you may say, Well, you know, no point in me getting it because, you know, I really shouldn’t be able to get infected and, you know, I’d rather wait until I’m done breastfeeding, or there’s more data, you know, etc, etc. So, but they are saying that, you know, people who are breastfeeding deserve the right to make these medical decisions for themselves.


And that was a huge backlash when the UK state had come out with their statement saying that pregnant or breastfeeding people should not get the vaccine, they were saying, No, we should be able to decide. And so I think there was a lot of pushback, because, well, if there’s no data on how it acts in this population, you know, should we be doing something that, you know, we don’t know, the risk level, and we have no data at all. But the more you dive into the science of how these particular RNA vaccines work, again, I’m only commenting on those, not some of the other ones that have yet to be approved in the US. That the plausibility of something affecting your baby directly from that is very unlikely. And we do know that the antibodies you would make from the vaccine would go into your breast milk, and they would go into your baby. So there is that. So yeah, you know, it’s it’s all sort of up in the air. I feel like this podcast is basically me telling you, I don’t know, I can’t make any revocable recommendations to you in terms of, you know, the vaccine or in terms of if you are infected with SARS, Kobe to exactly what you should do.


You know, this, this podcast is not any sort of medical recommendation of any sort. But it is just me saying, Here’s the evidence, here’s what you might want to consider. Here’s what we know so far. Right? So the other thing they want to say in this academy of breastfeeding medicine statement, Dr. Allison stoop, who who kind of leads that there, she said, Without clinical data, the Academy of breastfeeding medicine relied on biological plausibility, and expert opinion to craft a statement on considerations for mRNA COVID, vaccines and lactation. The available information is reassuring, however, pregnant and lactating people deserve better than plausibility to guide medical decisions. I agree with that. Hence, forward phase three clinical trials should routinely include pregnant lactating participants. It’s time to protect pregnant and breastfeeding individuals through research, not from research. I really agree with her statement. I think that’s really bold. Yes, we should be including those people. I do know that there. There was some struggles and getting people into the clinical trials. In fact They were trying to get a large number of people of color in the trials. And they did not get as many as they’d hoped for now, that has to do with a long history, including the Tuskegee incident.


But there’s other ones as well, even with Native Americans in particular. So people of color, of course, are very wary and rightfully so of, you know, being tested on rights, because of our past history there.


So there’s a lot of social justice issues at play, and pregnant and breastfeeding people have also been sort of disadvantaged when it comes to medical research and what have you, which is why Dr. stem from the ABM is advocating for them to be included in the trials, right. It’s unfortunate that we don’t have a lot of research when it comes to breastfeeding. Sometimes people ask me about, you know, certain things regarding breast milk, right? And I go, you know, I don’t have an answer. There’s no research into that, because unfortunately, it just hasn’t gotten the funding. So this may be an opportunity to get more funding for things. I’m excited that they’re doing more research on breast milk, because of SARS, cov. Two, however, I’m also just hoping that we get more research on breast feeding in general, sometimes we just isolate the milk. And we do a lot of research on that, because it’s a substance that we can take, and we can isolate in a lab and what have you.


But there’s a lot more to breastfeeding than just the milk. So anyway, at the end of the day, basically all I have to say is that whether you’re infected, whether we’re talking about the vaccine, you know, whether you’re worried about your risk, you know, it’s always a good idea to follow the precautions that are put out there. We know now, without a doubt. And this may, this may piss some people off, I’m sorry, if it does, but you need to hear this. There is extremely strong evidence that wearing a mask helps reduce transmission of this virus. If you don’t like that, you don’t have to like it. But that’s true. That is what is true. And that is what is known. There is extremely strong evidence that the more that we move about in our communities, the higher the transmission rate is. So limiting your activities, anything unnecessary, all of that helps to reduce transmission of the virus. The other thing I’d like to point out is that just because you get the vaccine, that does not mean that you cannot transmit the virus to others, you still need to wear your mouse, you could also become infected or colonized with the virus. Now, if you do get infected with it, chances are you’ll have a less severe course of the virus. But being vaccinated with an mRNA virus does not provide sterilizing immunity, it provides protective immunity, or what’s the word, I think that’s the right word for it.


But meaning that you could still, you know, get the virus, you may not have any symptoms, you may have some milder symptoms. But certainly it’s a potential that you could pass it on to others, we just don’t have another enough research on that yet. So it’s not a free pass, it’s not a free pass for you to just go do whatever you want, it’s not a free pass to go without a mask. And with all these emerging variants, so far, we’re seeing that the vaccine should still work against them. But that may not always be the case. And so by the time you know, your number gets called where you’re able to go get it, you say I want to go get it, you know, hopefully that one is still effective for what the versions of, you know, SARS, cov, two that are out there, there’s so many unknowns, we’re trying to, you know, keep up with all the research out there. But there’s just a lot that we don’t know. But at the end of the day, what I would say is I’m comfortable making some recommendations, you know, based on, you know, the Academy of breastfeeding medicine, the World Health Organization, you know, lots of other groups out there that have done the studies is that even if you’re positive for COVID, I don’t think that you should stop breastfeeding your baby, some people recommend purely pumping, you know, that’s better than than nothing, of course, it’s going to be much better than formula formula is not going to provide any immunological benefits for your baby.


So let’s just be super clear about that. There is no immunological benefits from a formula, it is purely food, I don’t care if it has probiotics in it, probiotics don’t help fight off COVID. So I not to be harsh on formula, but that’s not going to save your baby. And not necessarily the breast feeding well either. But at least breast milk does have immunological components in it. So there is that, right. So beyond besides just antibodies, there’s a lot of other things going on in breast milk, you know, immunoglobulins you know, there’s, there’s cancer killing cells, there’s, you know, just all of those saccharides to nourish, you know, the gut and to feed those microbes. Right. So there’s, there’s a lot of amazing things going on there, especially the neurological benefits of breastfeeding and we know that you know, not necessarily in babies but for certain and adults that there are many neurological complications of COVID down the road. So one of the most important protective things we could do is to breastfeed our babies, whether or not your COVID Positive. You know, this may prevent your baby From from ever getting sick, even if you do have it, there’s been many COVID-positive mothers who have never passed this on to their babies and they’ve breastfed. So that’s very cool. So, you know, you’ve got to just make a decision for yourself, make it in concert with your healthcare team, make it in concert with the latest available evidence and research that’s out there, which is constantly emerging at this point. I hope that this episode has been, you know, informative and helpful to you. I don’t like to give my opinion on anything necessarily.


I like to just sort of state things as matter of fact. But I do think that the current recommendation to be made out there is that if you’re positive for COVID, if you’ve been exposed to COVID, it doesn’t mean that you should cease breastfeeding. It’s up to you at that point, if you want to breastfeed directly at the breast or to pump only or to do you know, a combination of the two. But do take those measures, you know, the hand washing, the covering sneezes, and coughs, the wearing a mask, all those things, you know, take extra extra precautions, when coming into close contact with any other human, obviously, including your baby, and just do the best that you can, you know, that’s really all we can do. So I know that everybody out there just wants the best for their baby. And, you know, if you’re like most mothers out there, you’ll do whatever it takes to ensure the best health for your baby. Often when I ask people, you know, Why have you chosen to breastfeed? Or why is breastfeeding so important to you? Most of the time? The answer is the health benefits.


And for sure, I seen an uptick in prenatal appointments with people where they’ve said, you know, I really want to breastfeed, I’m a first time mom. And with COVID, and everything, I want to make sure I’m giving my baby the best start, or maybe they’re not a first time mom, and breastfeeding did not go with it go well with their previous child or children. And they’re like, you know, I really got to get it right. This time, this is more important than ever. And I would agree. Breastfeeding is more important than ever, it’s always been incredibly important to someone like me, because I know how amazing it is.


But if you’re one of those people who’s like and take it or leave it now, you might be kind of switching your mindset. I’ve even had a lot of clients say, you know, I was thinking of weaning, because I’m kind of at that point and kind of feeling done. But gosh, I really don’t want to give up the immune benefits to my toddler, you know, so I’m going to keep breastfeeding for longer, you may be in that place, too. Now, just know, though, that if you’re at that point, this is a whole other discussion. But I do want to point this out. Let’s say you’re breastfeeding your two or three year old, and you’re really just feeling at your wit’s end, like, I just can’t do this anymore, but I want to do it because I know I’m giving my child these immune benefits. So I don’t quite want to wean. This is a personal decision for you to make, or maybe in concert with your lactation consultant. But


if you do wean, and you stop breastfeeding at that point, because you’re just done, you know, and I think it’s important to listen to our bodies, your body is telling you like if you get nursing aversion, your body is telling you, you’re done. This is like when we see Mom dogs who are like nipping at their puppies who are trying to come in nurse and she’s waiting them, like, we don’t want you to get to that point, okay, we don’t want you to be angry and like, nipping at your baby. Okay? Not that you’ll be nipping at your baby. But there are mothers that describe a sort of nails on chalkboard feeling or like they want to throw their babies across the room because they have such nursing aversion.


Now they’re not throwing their babies across the room, I want to make that clear. But it is a common feeling. And that is your body telling you it is time to be done nursing, you do need to listen to that. Or at least you know, maybe there’s some nutritional deficiencies going on in something else that can be addressed there. But if you’re if you’re sacrificing your own needs for your child’s needs, and let’s say your child is two or three years old, just know that those immune benefits that you already gave your child in the first six months of life, year of life, continue with them for years. So it’s not like just because you stopped breastfeeding at two or three years old that all the immune benefits of all that breastfeeding just stops, it doesn’t. You’ve set up a foundation for lifelong health. And there, the longer you breastfeed, especially once we know you get to the two year mark, and beyond that there are many antibodies that lasts your child for several years after that.


Now, we don’t know in terms of COVID necessarily how long antibodies last we just don’t We don’t even know when adults, right, because it’s only been around for a little over a year. But what I am saying is that the immune benefits that you gave to set your child up with a robust, healthy, optimal immune system from breastfeeding for that period of time, don’t go away overnight. So if you’re having guilt about weaning or thinking of weaning, what I’m trying to tell you is that you could you could tamp down that guilt a lot. Because your baby’s immune system, your child’s immune system is really, you know, set up optimally at this point. And also the normal age of Lean for humans is really anywhere from two to seven years of age. Now seven seems extreme for a lot of people.


I personally probably couldn’t see myself breastfeeding my child that long. Maybe that’s because of society or whatnot, but I got nursing version, you know, long before that age three or four is kind of max for me, I would say between ages two and four. Those are the most common times I see people, you know, engaging in full term breastfeeding. I, you know, I think for a lot of kids are going off to preschool or more active social lives, what have you. So things may be just different in our society these days. But those are, those are the more likely ages to wean. And I see, you know, excellent health and development from children who’ve been breastfed that long. So if you’re thinking about weaning, if you’re just really done with it, then I would say, you know, shed the guilt and just, you know, kind of be okay, with a foundation you’ve set up for your child. So I hope that that helps, I know that this podcast was a little bit all over the place, it’s a lot of different things in combination with one another, but I wanted to provide you with, you know, the basics in as much sort of plain language as I could.


I don’t like getting super sciency on people, and then you’re like, I have no idea what she’s talking about. So if there was anything I said in this podcast that you just didn’t understand a word that I use or something, you know, feel free, reach out to me on Instagram, just ask the question, what I would love for you to do is if you know anyone, if you’re a professional, and you’ve got clients who are wondering about, you know, COVID infection or vaccine, you know, send this episode their way. I hope that this is a reference point that you can provide to others. If you’re, if you’re a mom, and you’re listening to this, and you’ve got some friends who are worried or what have you, you know, share this episode with them. And hopefully, this can put their mind at ease. And if you want to get more updates on anything regarding this, make sure you are following me on Instagram over at holistic lactation.


Because you know AXA, an immediate place where I can help to get information out to people on various topics regarding breastfeeding, and I post a lot of fun stuff over there. And I’m super active. So if you need to get a hold of me, that’s a great way, just head on over to the DMS. And also, I know asking a lot of you guys. But if you if you enjoy this podcast, if you are a regular subscriber, I would absolutely love if you could leave a review on iTunes. For one, it definitely helps the ranking but not because I want to be at the top of the charts. I don’t I don’t think that’s really ever going to be a place that I’ll be just because most of the population is not breastfeeding. And I’m no Joe Rogan. But it does help the podcast get found. So if someone types in breastfeeding, when they’re looking for a new podcast, or new podcast episodes to check out because they want to learn more about the topic, the more positive reviews I have had, the more easily they’ll be able to find this podcast.


So even if it’s just a quick little one sentence, that’d be great. And if you don’t like the podcast, you know, I’d love to hear from you. But you probably didn’t even get this far as the episode goes if you don’t like it. But tell me what you want to hear more of, you know, send me a message. Like I said on Instagram. If there’s other topics, or if there’s people you want me to bring on to interview, I would absolutely love to hear that. I’m always open to ideas. And so, you know, I really, really do hope that you enjoy this podcast. I don’t make it for me, I make it for you. So thank you so much for listening if you’ve made it all the way to the episode or the end of the episode. Thanks for hanging in there with me. I so appreciate every single one of you as a listener, even if it’s only one-way communication. And I wish you all the best along your breastfeeding journey and I’ll see you on the next episode.



In this episode, Jacqueline Kincer, IBCLC reviews the most pertinent evidence to date regarding COVID-19, current vaccines for COVID-19, and breastfeeding. In June 2020, WHO (World Health Organization) recommended that mothers should continue to breastfeed, and that the benefits of breastfeeding substantially outweigh the potential risks for transmission.

A study done in May took breastmilk samples from 43 mothers that were negative for the COVID-19 virus but 3 mothers tested positive for viral particles by RT-PCR from those three infants one infant tested positive but it was unknown if they were breastfed. The other two tested negative as one was breastfed and the other newborn was fed expressed breastmilk after viral RNA particles were no longer detected.

RNA detection in the breast milk is not the same as the virus for transmission of COVID-19 to occur it would require replicative and infectious virus to be able to reach target sites in the infant.

Secretory IgA (the most abundant type of antibody in breastmilk, making up 90% of breastmilk antibodies) has been detected in breastmilk of mothers with previous COVID-19 infection.

The CDC says it is unclear as to where mothers with covid can spread virus to babies in breast milk but current evidence suggests that this isn’t likely. To date there is no SARS-CoV-2 that has been isolated from breast milk and there is no documented cases of transmission of infectious virus to the infant through breast milk.