The Pandemic’s Effects on Breastfeeding Are Still Being Felt

A new Cleveland Clinic study found low rates of infant SARS-CoV-2 transmission among full-term newborns in a COVID-19-positive cohort, while also highlighting the significant stress and breastfeeding barriers families faced during the pandemic.

“Not surprisingly, our focus on this topic has really evolved over the past several years,” explains first author Heidi Szugye, DO, Section Head of Breastfeeding Medicine at Cleveland Clinic Children’s. The study was recently published in BMC Pregnancy and Childbirth.

Early in the COVID-19 pandemic, Dr. Szugye and her Cleveland Clinic colleagues were focused on understanding, and preventing, transmission. As early data assuaged fears about infectious spread through breastmilk, new concerns emerged about disruptions in breastfeeding support and outcomes.

The research team identified a cohort of 72 full-term infant-parent dyads in which the parent tested positive for SARS-CoV-2 within seven days before delivery or immediately after birth between March 1, 2020, and January 1, 2022.

Their findings revealed an overall low transmission rate with only two (2.8%) infants testing positive for SARS-CoV-2 at 24 hours of life, which the authors note is consistent with similar studies. At discharge, 38 patients (53%) were exclusively breastfeeding, while 18 (25%) were combination feeding or otherwise receiving human milk.

“These rates are pretty comparable to our overall breastfeeding rates at that time. So, this population didn’t seem particularly affected by COVID at the time of discharge,” explains Dr. Szugye.

The research team also administered a survey, which was completed by five parents, to identify key barriers to successful breastfeeding. Some included population-specific challenges, including wearing personal protective equipment and managing their COVID-19 symptoms. But most reflect nonpandemic-related issues breastfeeding parents may encounter such as:

• Low milk supply
• Lack of breastfeeding support
• Conflicting advice from providers
• Difficulty accessing lactation support
• Difficulty maintaining adequate nutrition
• Difficulty obtaining formula

Survey participants also reported feelings of guilt, stress, inadequacy, regret, loneliness and desperation.

“In addition to the COVID-19 pandemic, a formula shortage was occurring at that time. That also compounded some of the stress that parents felt, especially if breastfeeding wasn’t going well, and formula was their only option,” says Dr. Szugye. “In general, this was just a really stressful time for parents.”

Acknowledge the impact of the pandemic when counseling

Now, in 2026, Dr. Szugye’s practice looks much different. She is still caring for patients who have breastfeeding challenges, but now in an outpatient clinic and not a hospital setting. Also, many of her patients are now having their second or third children since the COVID-19 pandemic.

“That experience was so stressful and traumatic for many families,” Dr. Szugye says. “We always ask, ‘How did breastfeeding go with your other children?’ So many of them say, ‘I had a COVID baby. It was terrible.’”

She also sees patients on the opposite side of the spectrum.

“They are really motivated because now they have better access to support and they’ll say, ‘I want to do this differently this time. I want the lactation support. That's why I'm here. That experience did not go how I wanted it to.’”

She says these varied reactions should serve as a reminder to providers that for many parents who were delivering children during the pandemic, the event has almost certainly shaped their current perspective and decision-making about breastfeeding.

“Ask them about it,” she urges, especially if you are involved in prenatal or postpartum patient care. Understanding how the pandemic shaped previous experiences and current expectations can help providers meet patients where they are.

Stay updated on the evidence

Study findings also highlight common patient-reported issues when breastfeeding, including stress induced by conflicting advice from clinicians. Dr. Szugye invites providers to be familiar with current evidence on breastfeeding to avoid giving overly cautious or conflicting guidance.

“Parents may often hear, ‘Oh, you're on that medication, you can't breastfeed.’ When if you really look at the evidence, the contraindications we assume may not be supported by the data,” she says.

Focus on what you can control

Early referral to lactation support, clear communication and individualized feeding plans can improve both outcomes and patient confidence.

“An early referral to get patients plugged into resources and a plan that works for them can help breastfeeding go much smoother,” concludes Dr. Szugye.

Dr. Szugye’s research collaborators and study coauthors include Suet Kam Lam, MD; Anika Kumar, MD; Jameson A. Mitchell, MD; and Wei Liu, MS.