Breastfeeding experiences during the COVID-19 pandemic in Spain:a qualitative study

Rodríguez‑Gallego et al. International Breastfeeding Journal (2022) 17:11 https://doi.org/10.1186/s13006-022-00453-0 Open Access RESEARCH Breastfeeding experiences during the COVID-19 pandemic in Spain:a qualitative study Isabel Rodríguez‑Gallego1* , Helen Strivens‑Vilchez2, Irene Agea‑Cano3, Carmen Marín‑Sánchez4, María Dolores Sevillano‑Giraldo5, Concepción Gamundi‑Fernández6, Concepción Berná‑Guisado7 and Fatima Leon‑Larios8 Abstract Background: The pandemic caused by COVID-19 has affected reproductive and perinatal health both through the infection itself and, indirectly, as a consequence of changes in medical care, social policy or social and economic circumstances. The objective of this study is to explore the impact of the pandemic and of the measures adopted on breastfeeding initiation and maintenance. Methods: A qualitative descriptive study was conducted by means in-depth semi-structured interviews, until reaching data saturation. The study was conducted between the months of January to May 2021. Participants were recruited by midwives from the Primary Care Centres of the Andalusian provinces provinces of Seville, Cádiz, Huelva, Granada, and Jaén. The interviews were conducted via phone call and were subsequently transcribed and analysed by means of reflexive inductive thematic analysis, using Braun and Clarke’s thematic analysis. Results: A total of 30 interviews were conducted. Five main themes and ten subthemes were developed, namely: Information received (access to the information, figure who provided the information), unequal support from the professionals during the pandemic (support to postpartum hospitalization, support received from Primary Health Care during the postpartum period), social and family support about breastfeeding (support groups, family support), impact of confinement and of social restriction measures (positive influence on breastfeeding, influence on bonding with the newborn), emotional effect of the pandemic (insecurity and fear related to contagion by coronavirus, feel‑ ings of loneliness). Conclusion: The use of online breastfeeding support groups through applications such as WhatsApp®, Facebook® or Instagram® has provided important breastfeeding information and support sources. The main figure identified that has provided formal breastfeeding support during this period was that of the midwife. In addition, the social restric‑ tions inherent to the pandemic have exerted a positive effect for women in bonding and breastfeeding, as a conse‑ quence of the increase in the time spent at their homes and in the family nucleus co-living. *Correspondence: 1 Maternal‑fetal Clinical Management Unit, Genetics and Reproduction, Virgen del Rocío University Hospital, Red Cross Nursing University Centre, University of Seville, Seville, Spain Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Rodríguez‑Gallego et al. International Breastfeeding Journal (2022) 17:11 Page 2 of 12 Keywords: Breastfeeding, COVID-19, SARS-CoV-2, Breastfeeding support, Community health services, Public health, Primary health care, Lockdown Background On 11th March, 2020, the World Health Organization (WHO) declared a worldwide health emergency and pandemic due to exponential number of contagions caused by the new type of virus from the family Coronaviridae, COVID-19 [1, 2]. In Spain, the first recorded case dates back to 31st January, 2020, after conducting case-study epidemiological surveillance [3]. Due to the exponential increase in the number of infected people, hospitalizations and deaths, the Spanish government imposed social containment and isolation measures from 14th March, 2020 onwards, as a control and protection measure against the disease [4]. Most of the scientific research studies initially published were focused on assessing the effects of COVID19 on the general population, reporting insufficient and unspecific data about the impact on specific populations, such as pregnant or lactating women [5–7]. At the beginning of the pandemic, information about this new coronavirus was limited: it was not known if it could be vertically transmitted from the mother to the baby in utero or after giving birth, through direct airways, inhalation, or breastfeeding (BF) [8]. This lack of information lead to the publication of misinformation and/or publication of contradictory information by institutions and caused the preventive interruption of the usual hospital practices, separating women from their newborns and partners during and after delivery, or even advising against breastfeeding [9]. Consequently, the pandemic caused by COVID-19 has affected reproductive and perinatal health both directly through the infection itself and, indirectly, as a consequence of changes in medical care, due to social policy or social and economic circumstances [10]. Currently, different international and national official entities state that breast milk is unlikely to be a source of infection and, therefore, it is not recommended to interrupt this practice, even in cases of confirmed maternal infection. Breastfeeding is thus advocated as the most adequate measure to protect the newborns’ health, encouraging that mothers continue breastfeeding as long as possible and in the exclusive modality, ideally during the first 6 months of life [11–13]. There is strong evidence that promotion of breastfeeding immediately after childbirth, skin-to-skin contact, mother-newborn rooming-in and support to initiate breastfeeding as soon as possible after childbirth, as well as community support, are favourable factors for breastfeeding success [14]. However, many of these aspects have been affected by the pandemic, both due to the adoption of new protocols in hospital centres and to the restrictive social measures imposed which have caused physical separation from family members, friends, and support networ (...truncated)