The pandemic has changed the delivery of health-care services, and for some mothers, the loss of in-person breastfeeding support groups has been keenly felt.
Gladys Legge has a seven-week-old baby, and is an active member of a 6,000-member Facebook support group for breastfeeding mothers in Newfoundland and Labrador.
In the weeks since her baby was born, Legge said, she's had a hard time getting the support she needs for breastfeeding.
"For us, our baby had a posterior tongue tie, which actually required three visits to a trained person who was a lactation consultant before it could even be diagnosed," Legge said.
The day after she got home from the hospital, Legge got a call from the public health nurse — standard procedure with Eastern Health — and then a followup phone call when her baby was six weeks old.
The pandemic is certainly exposing the fault lines of our current perinatal care system. - Deirdre Maguire
But it's those in-between weeks when Legge said she would have benefited from more face-to-face support. All of the in-person group supports for breastfeeding mothers have been moved to videoconferencing to fall in line with public health guidelines for the COVID-19 pandemic.
"We were faced with many issues, from tongue ties to over-milk supply, and that's just something that really needs a hands-on approach. A virtual Zoom meeting, it's hard to get the kind of help that you need from that," said Legge.
Legge was able to hire a doula to help her through the birth process — something she said was a huge help, but also something she knows not everyone can afford.
"My experience has been amazing. The doula has connected us to all the best people and, when we were faced with the issues of the tongue tie and over-milk supply and different things like that, she helped us herself, she forwarded us to the right people, a lactation consultant — she also connected me to the doctor that followed us during the pregnancy, and she was also a really big help," Legge said.
"But that's not something everyone has, and that's what I'm seeing in these Facebook groups. A lot of moms are reaching out — they don't have the support that they need and they're just quitting their breastfeeding journey."
If we could reinstate them tomorrow, we would. - Lisa Roberts
Deirdre Maguire is also concerned about what she's hearing from mothers having a hard time with breastfeeding.
A certified doula, Maguire has moved into advocacy work as the executive director of Birth Justice NL, a new group whose mandate is to work toward equitable access to family-centred perinatal care for families across Newfoundland and Labrador.
"A lot of the issues that are surfacing right now are not necessarily new issues, but the pandemic is certainly exposing the fault lines of our current perinatal care system," Maguire said.
"The increased social isolation facing parents right now is highlighting the need for more community-based supports for new parents, such as home breastfeeding support, but also access to home births and locally available fertility treatments."
In recent years, Maguire said, there's been a steady increase in the province's breastfeeding rates — she cites the work of the Baby Friendly Council of Newfoundland and Labrador — but she worries those gains will be lost.
"During the pandemic, where we were trying to limit contact between people, a lot of the breastfeeding support moved into a virtual sphere, which a lot of parents are expressing just isn't adequate," Maguire said.
"Parents have been saying for a long time that they want increased visits to their home in the early days, and that's just not something that's happening for a lot of parents right now during the pandemic."
In-hospital supports are good, Maguire said, but when new parents are sent home, they're at their most vulnerable and need the most guidance.
"In order to get that support, we really need more frequent visits by public health nurses and lactation consultants, but another thing that could really help with this is access to midwives, because breastfeeding education and frequent home visits are really built into their model of care, which helps us ensure that no parents are left behind."
Patient safety the priority
Lisa Roberts, Eastern Health's regional lactation consultant, said there's no doubt parents are struggling with the restrictions on in-person groups, but medical guidance is still available.
"We absolutely get that things are challenging for new mothers now, more than ever, and we get that mothers are anxious during this time because we hear from mothers more often now than we did before," she said.
"Our public health nurses are still providing breastfeeding support and still operating similar to what they were. What has been cancelled and what had to be cancelled, from a patient safety aspect, was our in-person breastfeeding support group. But breastfeeding support by the public health nurse is still there."
As a mother who used the breastfeeding support group herself 20 years ago, Roberts said she understands it's hard to lose that in-person, mother-to-mother experience.
Before the pandemic, in-person support groups could have anywhere from 20 to 40 mothers with their babies in a single room — and Roberts said that's just not possible during COVID-19.
"If we could reinstate them tomorrow, we would, but under our current situation, in order to ensure that our clients are safe as well as part of public health guidelines, this is where we are," she said.
"This is not how we want to operate and we wish we could change things tomorrow. We know our face-to-face breastfeeding support groups are very valued.… It's a very valuable service, and cancelling them is something we did because we had to."
Colleen Kearley, a parent and child health co-ordinator with Eastern Health, said there are online resources at the Health Information online portal for new and breastfeeding parents.
"There's a lot to learn when you're a new parent, we recognize that for sure," she said.
However, until public health guidelines shift, a lot of in-person health support services will remain in the virtual space.
"Client safety is the first plan — safety is the priority as we approach all of the services we offer in public health," she said.
"But we do want to assure new families that they are not alone, help is available. We are here — call, we will follow up on that 100 per cent. That's a message we definitely want people to receive."