Well Woman Weekly: Dr. Jessica Madden

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Dr. Jessica Madden is a board-certified pediatrician and neonatologist, International Board Certified Lactation Consultant (IBCLC) and Medical Director of Aeroflow Breastpumps. We asked Dr. Madden about the coronavirus vaccine for pregnant and breastfeeding women, as well as those trying to conceive.

I feel like in my personal life, there’s been a constant buzz around who’s getting the coronavirus vaccine—I’m at an age where many of my friends are pregnant or brand new moms still breastfeeding. How are you advising your own pregnant and breastfeeding patients when it comes to the vaccine?

I am advising all breastfeeding mothers to get the vaccine when it is available to them because, based on how the mRNA vaccines work, there should not be any effect on breastmilk production or composition of milk. The Centers for Disease Control (CDC), Academy of Breastfeeding Medicine (ABM), and the American College of Obstetricians and Gynecologists (ACOG) have also stated on their websites that it is safe for breastfeeding mothers to get the vaccine.

COVID infection during pregnancy is associated with an increased risk of miscarriage/stillbirth, preterm labor, pneumonia, and ICU admission while pregnant. I am encouraging pregnant women who are at high risk of infection (i.e. who work in health care, nursing homes, or as “first-responders”) to get the vaccine as soon as it is available to them. Women with high-risk pregnancies (i.e. with problems such as diabetes and/or high blood pressure) should also consider getting the vaccine as they are at a much higher risk of developing COVID-associated pregnancy complications. 

If you have a low-risk pregnancy and limited exposure to the general public, I think it makes sense to consider waiting for more safety data before getting immunized. By the time the vaccine is being offered to the general public (summer 2021), we should have a lot more information and data about the COVID vaccines and pregnancy to base decision-making on. 

Does this advice differ for someone actively trying to conceive?

Yes. Knowing that both pregnant women and newborns are at higher risk of getting very sick with COVID, I would recommend that women trying to conceive get the vaccine before they get pregnant. Vaccine will be the best way to protect against COVID-related pregnancy complications and also infection in babies.

What are your thoughts on a herd immunity approach, i.e. “if everyone around me is getting the vaccine and I stay relatively hunkered down, I can wait to get it myself?”

This virus is so highly infectious compared to most other respiratory viruses, seems to be mutating quickly, and we know that antibodies can decrease over just a few months, that I think the only way we will achieve true “herd immunity” will be when most people have received the vaccine. 

Is there a difference between the Pfizer mRNA vaccine and Moderna mRNA vaccine that pregnant women or new moms should consider?

Both of the vaccines have the same mechanism of action: the mRNA in the vaccine makes local muscle cells produce a “spike protein” that then stimulates COVID antibody production. Both vaccines require two doses to achieve full immunity, the Pfizer doses are given 3 weeks apart and the Moderna doses are 4 weeks apart. 

Vaccine questions to one side, you’re also a lactation consultant. I know it may be challenging to give blanket advice if someone’s having trouble physically breastfeeding, do you have any advice for new moms struggling with the mental and emotional effects of breastfeeding? 

Breastfeeding, especially for the first 4-6 weeks, truly is a full-time job and requires help and support from others. Please reach out and ask for help if you are struggling. It seems like a lot of new moms’ in-person “villages” to help out during the postpartum period have shrunk due to pandemic-related travel and gathering restrictions. So a lot of moms who would have had enough help with their newborns in past (i.e. having their own moms, sisters, and/or friends stay with them for the first few postpartum weeks) are now trying to do everything on their own. It’s too much of a load for a new mom to bear without help.

People who can help you include all of the following: lactation consultants and counselors, pediatricians, therapists, friends, postpartum doulas, and other moms in virtual breastfeeding support groups. If you have a friend with a newborn it’s more important now than ever, during the pandemic, to frequently check in to see how she is doing.  A lot of moms are struggling alone right now.

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