Should you get the Covid vaccine if you are breastfeeding?

I receive daily queries from breastfeeding moms around Covid vaccination. Should they take the vaccine, and can it in any way harm their babies?

Although all the official guidelines state that breastfeeding moms can get vaccinated, mothers want to hear this from someone that they know and trust. As a lactation consultant and a well-baby clinic sister that works with vaccinations every day, many clients turn to me.

Of course with both Covid as a disease, and vaccination as a preventative measure, there are still so much we don’t know. I realise that there are also big controversy around Covid vaccination. The purpose of this blog is not to enter this debate, but rather to give moms some facts and information on what we do know. I will also offer my own (humble) opinion and perspectives. Hopefully this information will help moms to make an informed decision on what is best for them and their families. So here goes.

Understanding research on medication and breastfeeding

It is very difficult to do research on medication in breastfeeding mothers. It would be unethical to give a medication to a pregnant or breastfeeding mom to see if it has a negative effect on a baby. For this reason, the package inserts of most medications will state ‘safety in pregnancy and breastfeeding not established’.

But many breastfeeding moms will need to take medication for various medical conditions. One of the biggest resources that healthcare professionals can use for safety data on the use of medication during breastfeeding is The InfantRisk Center, a world-wide call centre located in the Texas Tech University Health Sciences Centre’s School of Medicine. The InfantRisk Centre pulls together evidence on medications used by breastfeeding mothers. They also conduct their own research. They assign lactation risk categories to different drugs and provide guidelines on the true risk of using the drug, which side-effects to be on the look-out for, and how to decide if the medication is safe to use.

Some drugs have been proven completely safe, while others have shown to cause so much harm that the mom needs to stop breastfeeding immediately. Many lie in-between – there are some side-effects, but the benefit of breastfeeding may still be bigger than the risk of taking a medication.

This page on their website offers valuable and up-to-date information on what we do know about Covid-19 vaccines in breastfeeding moms, and I would encourage moms to read it. In short, they state that the risk of vaccination during breastfeeding is low and recommend that breastfeeding mothers do receive the vaccine. They present evidence showing the following:

• No vaccine mRNA has been found in breastmilk after vaccination
• Neutralizing antibodies were found in milk as soon as 7 days after vaccination
• The vaccine does not show any impact on milk supply
• Breastfed babies of mothers who received the vaccine showed minimal to no symptoms.

Know that the vaccine is no longer new

Many people fear receiving the vaccine because they feel it is still new. But Covid vaccines have now been administered to more people worldwide than most other medications and vaccines we use. According to www.ourworldindata.org, at the time of writing this blog 39,9% of the world population has received at least one dose of a COVID-19 vaccine, and 5,38 billion doses have been administered globally. With so many people receiving vaccines it would be virtually impossible to hide side-effects. What we know is that serious side-effects beyond simple flu-like symptoms are extremely rare.

Although this vaccine is new, vaccination in general is not

We have been vaccinating against various diseases for many decades. No disease has ever been eradicated without the use of vaccination. The technology and knowledge basis used to develop new vaccines are far greater than it was 50 years ago.

At the same time, coronavirus outbreaks are also not new. There are hundreds of coronaviruses that circulate amongst animals and occasionally make a jump to humans. Since the SARS coronavirus outbreak in 2002, and the MERS coronavirus outbreak in 2004 scientists have been working on coronavirus vaccines. This means the footwork was already done.

What is the status on the use of other vaccines for breast feeding moms

Breastfeeding moms can receive all other vaccines without significant risk to them or their babies. According to the US Centers for Disease Control document General Recommendations on Immunization (February 8, 2002):

“Neither inactivated nor live vaccines administered to a lactating woman affect the safety of breast-feeding for mothers or infants. Breast-feeding does not adversely affect immunization and is not a contraindication for any vaccine.

It always is about risk versus benefit

All medications and vaccines have side-effects. The question is always whether the benefits outweigh the risk. You may not wish to risk a vaccine side-effect, but you need to realise that the risk of Covid-19 is very real.

We know by now that one cannot really say beforehand how Covid is going to affect you. The Delta strain affects younger people and even children more seriously than the original outbreak. Young, healthy people can also get seriously ill. You may contract the virus and give it to a vulnerable person in your family. Millions of people have died from it already, and as it continues to spread new mutations form.

Another grave reality is that we simply do not know enough about the longer term effects of Covid yet. A recent study published online in The Lancet found that nearly half of people hospitalized with Covid-19 still experience symptoms like muscle pain, fatigue and shortness of breath one year after infection.

Another study published online in June 2021 in Nature showed profound molecular changes in the brain tissue from people who have died from Covid-19, similar to changes seen in people with Alzheimer’s and other degenerative diseases.

These are only two examples; there are many studies and papers published on the longer term effects of the virus. Only time will tell to what degree people will fully recover, or which health problems may emerge in future due to Covid-19 infection.

Getting vaccinated reduces the risk of getting Covid, or getting seriously ill if you do, and of transmitting it to others. I personally do feel these benefits outweigh risks.

Lastly, by vaccinating you also provide your baby with some protection

This is another topic on which more research is needed, but recent reports have shown that breastfeeding moms who have received mRNA-COVID-19 vaccines have antibodies in their breast milk which could help protect their babies.

Click here to read more on how antibodies in breast milk works.

Why am I passionate about this?

This is my personal blog, so I have decided to share something personal. I have empathy for people struggling to make decisions around vaccination. I was very hesitant to vaccinate my first baby, as I have heard and read so many scary things on the topic. I was really scared to do harm.  

What I found most challenging was that I didn’t know how to find accurate information. On the one hand there was information provided by companies who make money from their vaccines. On the other hand, a lot of the anti-vaccine information available is not backed by any scientific evidence, and mostly shared by people without any medical knowledge. How to find the full picture?

How I ended up working in a well-baby clinic is a long story for another time. I have learned so much though, and three things really changed my view on this topic:

1. I gained real knowledge. I learned more about how vaccines were made, and about the trials and measures taken to ensure safety. I also learned more about the realities of the diseases we immunise against. Many of these, like Polio and Diphtheria are no longer a real threat to us because we’ve never experienced outbreaks of these diseases. This wasn’t the case before vaccination started.
2. I realised that companies take side-effects seriously. All adverse reactions and events should be reported, and a full investigation is launched. Of course the responsibility lies with healthcare professionals to report adverse events.
3. Lastly, I have been working in a baby-clinic since 2017, and I have immunised thousands of children. I see my clients for all their child’s vaccines, and always ask about the baby’s reaction to the previous immunisation. The fact is that most children don’t have any side-effects. In the last four years I can count the more serious side-effects seen on one hand.

I encourage my clients to be critical of all information, and to choose carefully who they listen to. Not everything that you read and hear on social media is true. You can speak to a lactation consultant if you have any further concerns.  There also comes a peace of mind from knowing that you have done all you could from your side to protect yourself and those around you.