Is breastfeeding during the Covid-19 pandemic too close for comfort?

Abstract Purpose This study aims to assess whether Covid-19 has affected breastfeeding rates negatively in the Maltese neonatal population and how breastfeeding services have been impacted by the pandemic. Data was also compared to a nationwide study carried out in 2008 to assess whether any improvements in breastfeeding rates and service have been made. Methods It is a retrospective cohort study which used a questionnaire to obtain its data. The study was carried out in Mater Dei Hospital, the only local government hospital that serves as the main hospital of the island. Data of every birth in Mater Dei Hospital during the period August and September 2019 as well as August and September 2020 was collected and compared. This allowed the comparison of newborns up to 6 months of age prior to the first reported case of COVID-19 on the Maltese (7th March 2020) islands to newborns born during the COVID-19 pandemic. Data of each birth was collected from the Malta Birth Registry. Legal guardians of the child werecontacted via phone and asked to give verbal consent. Only authorised researchers contacted the caregivers. Results A total of 1481 mothers gave birth during August and September 2019 and 2020, of which 734 (50%) were in 2019 and 747 (50%) in 2020. Out of these 235 (32%) caregivers were reached in the pre-covid cohort and 228 (30%) in the covid cohort. During the Covid 19 pandemic mothers-to-be were significantly less likely to be informed of the services offered by Mater Dei Hospital, with 13% being informed of the services compared to 83% of mothers in the pre covid cohort (P<0.000). During the covid-19 pandemic 36% (n=83) of mothers continued breastfeeding until 6 months of age compared to 3% (n=6) pre covid pandemic. Conclusions Despite breastfeeding protocols, ambitions to become a baby friendly hospital and increased staff awareness to breastfeeding the general population is evidently not convinced. Covid-19 did not have a negative impact on the attrition rates in the Maltese population despite poorer health care services, however it did increased breastfeeding rates at 6 months of age. Community services and hospital services need to be improved to improve the poor breastfeeding rate on the Maltese islands. Increased awareness of breastfeeding in the workplace and in public areas would beneficial. Pre and postnatal education in the hospital environment should be enhanced.