Transcript:
The āRONA Vaccine & Breastfeeding: A look at what we know today.
Hello, everybody. Welcome to a bonus episode of the Milk Minute Podcast. Maureen and I have been reading all of the most recent recommendations for pregnant and lactating people. There are separate recommendations, believe it or not… now… there haven’t been for the past few weeks, but now they have decided that you are two separate groups of people, not the same. So we now feel comfortable making, not so much a statement, but trying to bring everybody up to speed on what’s going on with the COVID-19 vaccine, as it relates to breastfeeding and lactation in general.
So, here’s what’s going on, Maureen, do you want to talk about the most recent recommendation that we actually liked? Yeah. Actually, do we want to start with a listener question? Yeah, let’s start with a question and then I’ll do what’s happened in the last five days that made us create this episode. So before we get into this, let’s take a listener question about the vaccine. Okay. and I will say we have had a lot of questions, so. We’re just going to choose one, but we could probably read out 50 different questions to you because this has been the most talked about topic in the past week, at least on our Facebook group.
Okay, so my buddy, Jamie in Southern West Virginia, she says, “I’m trying to do my research on COVID vaccines in breastfeeding, but I’m having little luck,” big shocker, “does anyone have any legit info? My PCP said it would be fine, and I plan to speak with our pediatrician about it too, but I wanted to do my own research first. This is not a vaccine debate.” We agree with that, and that’s not what this episode is either. She says, “I don’t plan to cut our breastfeeding short for the vaccine, but at this point I’m almost willing to give a kidney to be done with this. Also I work in healthcare and I’m pretty sure it will be mandatory for us unless we have a doctor’s note or a religious reason.”
Okay, Jamie, that is a great question, and I think that you covered all of the things in that one that we really need to address. So, Maureen, I’ll let you take it away here.
Yeah. So I’m just going to start by going back a few days. So for reference, it is December 14th when we are recording. And I think that’s important to note because pretty much every day for the past week, we’ve had new guidelines and recommendations come out. But last week the FDA met and recommended the Pfizer COVID vaccine for emergency use authorization. And then on December 11th, it was actually approved for emergency use. So let me clarify that the emergency use authorization is a little bit different than regular FDA approval.
It’s a little bit faster, technically, drugs, vaccines… whatever need to have the same requirements met as they would otherwise, but the process is a little bit different. It goes a lot faster. It’s also really nuanced and confusing. So that’s not what this episode is about, but I do want to clarify, they still have to have the same trials run.
Right. So yeah, December 11th that happened and we were all like, wow, hooray! We’re so excited this vaccine is going to be available in the United States. Prior to that, it had been approved for use in both the UK and in Canada. So leading up to it, I had been reading all of the guidelines for those countries or those regions, because the UK is not just one country. So yeah, it was approved in the UK and in Canada, previous to the United States. So we had been looking at those guidelines first to get an idea of what might happen here. And I will say those guidelines, for the most part have been very, very cautious when it comes to pregnant and lactating people saying for the most part, those people should either not get the vaccine or that they should talk to their healthcare provider, and that was kind of the end of the story.
Which is disappointing for us as healthcare providers, right? Cause we’re like, oh, okay… cool… so you’re just, we’re going to have that conversation? About what? Do the best you can, what? Right. Yeah, we’re like, I’m sorry… did you equip us to have that conversation with our clients? Not really.
And so after the FDA approved the vaccine in the United States, the CDC released guidelines that basically said the same thing… talk to your healthcare provider, because the reality is that, pretty much in every single drug and vaccine pregnant and lactating people are excluded from trials.
And we’re going to get into a little bit more about that later, but it’s essentially a liability issue, right? Nobody wants to be responsible for a fetal death or an infant death, right?
And now people had been pushing, so like ACOG had been pushing for those populations to be included in the phase three trials, but regardless it didn’t happen.
So here we are, it’s December 14th. Many people are going to be getting this vaccine in the next few weeks, and we have no data about the actual safety of this vaccine for pregnant or lactating people. We don’t have any trials that would give us data for that.
Right. So that’s today. And we won’t, just to be clear, don’t hold your breath for it either because it’s probably not going to happen, and you know, I’m not trying to point a finger or blame, I know why this is happening. I think they’re keeping it vague on purpose and kind of putting it more on the lactating parent and the provider to make that choice together. Because the more people that make the personal choice to get it, the more retrospective data they can use for free.
So what I don’t understand though, and maybe Maureen you’ve seen something, but I don’t, I have not come across anything that says, if you are pregnant or lactating and you choose to get the vaccine here is where you can report your symptoms or anything like that. So I don’t know how exactly they’re going to collect that.
Yeah, I agree. I mean, there’s always the vaccine adverse reaction place that you can report any issues with vaccines to. However, that’s just for like really bad reactions, right? And I’ve had a couple people ask me that too. They’re like, hey, if I get this, I really want to contribute to the data because I’m already doing it, other people should benefit from that.
And I do not have that answer, unfortunately. So I’m looking for it currently… I’m going to keep looking for it. If I get that answer, we will mention it on the podcast and in our Facebook group, because I think that’s really important that if you’re going to accept the personal risk, that you can then also contribute to making that risk less for other people in the future.
Right. And if we find it, we will update this episode and drop it in the show notes with like a little asterix, so you can find it. I assume that that will come to fruition shortly. I would hope. My guess is that it’s going to be the CDC, FDA or Pfizer itself that collects that data. Lord, I hope it’s not the health departments.
Oh God. Well, yeah. Anyway, whole different podcast.
But you know what? I did want to talk a little bit about what the kind of specific physiology, and risks might be to receive this vaccine as a lactating person, because like we said, the guidelines have kind of been lumping lactating and pregnant people together and physiologically they’re really different states and they present really different possible risks to a baby.
Right. Like the placenta, for example, is the thing when you’re pregnant, that is acting as a shield to filter out any bad things that should not be getting to your baby, but it doesn’t filter everything.
Right, and it goes right into baby’s bloodstream, which is really different than when we have a filter, say in the breast, right? On our lactocytes, something going into milk, and then that milk going into baby’s digestive system. Right. And then all of the acid in the digestive system really decreases any effectiveness of anything bad or anything good. Absolutely.
So very exciting. The whole reason that we are zooming at nine at night together for this episode is that the Academy of Breastfeeding Medicine released a statement today that I just think is phenomenal. It’s very informative. And I think it’s probably the first statement I’ve seen that would actually help me as a provider counsel my clients.
Let’s hear it! Okay. So, I’m not going to read the whole thing, but I am going to paraphrase the two most important parts. Okay. So first, it of course acknowledges we don’t have clinical data on the use of the Pfizer, COVID 19 vaccine on lactating people. But it acknowledges that many lactating individuals fall into categories that we’re prioritizing for vaccination like frontline healthcare workers.
And it’s one thing to consider the vaccine, just as you know, a stay at home lactating parent, it’s a really different situation if you are working in a COVID ward. Right? So I think it’s really important for you guys, nurses, doctors, midwives, people who work in hospitals, even janitorial staff in the hospital… to strongly consider what this vaccine could mean for you. So, basically, the most important part of this recommendation that I am pretty much going to read word for word, going to try to make it easy to understand is what this vaccine is going to do once it enters your body and how it might interact with your baby.
So, this vaccine is made of lipid nanoparticles and they contain MRNA. And I’m going to take an aside quick, and say that while I’m fairly certain, this is the first MRNA vaccine that we have that has actually passed through all the trials, and is effective enough, we have had this technology for over 30 years and it’s been experimented with, but never found to be effective enough for other diseases.
Okay, so not new, but sort of new… if that makes sense. So, anyway, it’s an MRNA vaccine specifically for the SARS COVI-2 spike protein. Okay? And these particles are injected into the muscle where then they’re absorbed by the muscle cells. So the muscle cells that are going to transcribe that MRNA to produce a spike protein… that protein made by the cell stimulates the immune response that is our goal with the vaccination. We want to see an immune response that is then going to create antibodies and protection for that individual from the COVID-19 illness. Okay? So right now, we have MRNA, and spike proteins in muscle cells, probably in your arm.
And so then we have this person who is lactating, and it’s pretty unlikely that the vaccine lipid itself… like the straight up vaccine is going to go through your muscle cell, into your bloodstream and then reach your breast tissue. It’s a very small amount of material and it’s supposed to be captured in those muscle cells where it’s then processed as part of an immune response.
So, you know, if we wanted this to enter directly into the bloodstream, we’d be injecting it directly into the bloodstream, right? The point is not for it to do that. So, but say a little bit does get into your bloodstream, manages to get all the way to the vessels that are in your breasts, and then what it would have to do is get through the selective barrier in your lactocytes, in your milk making cells, to enter breastmilk, it’s pretty unlikely that that would happen.
Because, you know, that barrier is only letting in really selective particles that we want in breast milk, this MRNA spike protein, or the MRNA lipid itself… those are kind of foreign things to the body, which our body doesn’t love to put those in milk, but again, it is theoretically possible that could happen in a very small amount, but unlikely.
So say it does though, right? Say we’ve got some of that MRNA lipid, or some of those spike proteins or whatever that are in the milk what’s then gonna happen is your baby is going to drink it and it’ll enter the digestive system. So what would most likely happen then is that it would get completely broken apart by digestive fluids and that would be it.
Right. So you’re saying there’s actually four different barriers to this vaccine getting from the syringe to your baby’s bloodstream. So just to review those, the barriers are your actual muscle cell which takes on the vaccine itself, which creates the immune response.
So it’s not like you have a vaccine floating around in your body forever. You have the vaccine in your muscle cells, and then what floats around in your body, hopefully for a long time is antibodies that your body itself makes. And then your breast tissue is another barrier. And then the lactocytes are another barrier. And then your baby’s digestive system is the fourth barrier. So there’s actually a lot of barriers to get this vaccine into your baby’s bloodstream.
Absolutely. Again, it’s theoretically possible, but I think that if it were to enter your baby’s bloodstream through their digestion, there would be such a small amount. I don’t even know what would be recognized in their body, but, you know, we don’t want to downplay the risk, right? There is some risk, but it’s pretty minimal. It’s really minimal. And on the flip side, we do have some plausible benefits, right? So antibodies and T-cells that the vaccine has then stimulated your body to circulate could pass through your breast milk. We have all these secretory antibodies that are always going through breast milk that are specifically made to survive digestion. That’s part of why breast milk is so beneficial for the baby. So, you know, in the plausible benefit category, we have the possibility that we could be transferring some immunity through breast milk.
Yeah. And we that’s information that we know for sure. Like you don’t actually have to be an expert to know how antibodies transfer from a lactating parent through the breast milk to the baby. This is something that we’ve seen over and over again with many, many, many different kinds of antibodies, especially in that first six months of life, that first six months that you’re breastfeeding baby, but they do continue beyond six months.
We just see the majority of them in higher quantities in the first six months of life. So that’s something we can pretty much count on. So if you are a person who is in a high-risk situation, who has a baby who especially maybe even a premature baby or a baby that really needs that extra benefit, and extra protection in the middle of this pandemic, you know, this might be a very good positive for you to think about.
Absolutely. You know, and I do want to add most vaccines are approved during lactation. The only exceptions that I know of are the smallpox and the yellow fever vaccines. And those are very different than this vaccine. You know, this is not a live attenuated vaccine. It is, you know, a technology that is very similar to other vaccines that are approved in lactation.
So, you know, it is my opinion that this ABM statement is probably about the best we’re going to get. It’s pretty reassuring to me. Of course, I’m never going to discount the potential risks and as always the choice to receive something like this is yours, it is not your employer’s choice. It is not your healthcare provider’s choice.
You always have the last say when it comes to your body.
I think that we need to address why this is a big deal though. And where a lot of these objections are coming from. And again, we’re not making a statement or a personal statement at all about what we think you should do, but we will tell you that the big deal is not that it’s like a live attenuated virus.
The big deal is that this is a new type of vaccine that is MRNA based, not DNA based. So it’s not, like Maureen had mentioned earlier, it’s not a new idea, but it is the first time it’s been pushed through by the FDA. So that’s where the big deal is coming from where people are like, oh wow, this is such a huge deal.
So don’t think that they’re going to be injecting a small amount of COVID into you and hoping for the best. That’s not what this is. That would be a live attenuated vaccine. This is not that.
Yeah, and I do want to say, you know, I did do some research into the previous uses for MRNA technology. Cause I was like, oh, if it’s been around so long, why haven’t we used it? And as far as I can tell the reason it was never used as not due to safety concerns, it was more about effectiveness. Like we didn’t have the technology or equipment to maybe make that effective for the viruses we tried it on, or it wasn’t effective for those specific viruses. It just wasn’t the right fit or it wasn’t the right time. We didn’t have the right equipment. You know, so I’m pretty sure that was the issue. I can’t be totally positive because I didn’t read through 30 years of research, I kind of skimmed it.
Right. But if you’re an epidemiologist listening and you want to talk to us about that and what, you know, we would love to have you on just as an aside. Abreast of the situation, please. But also, you know, I think another objection is that people in the middle of this pandemic have felt… some groups of people have felt like some of their civil liberties have already been compromised and people are genuinely afraid that they’re going to be forced to get this, you know, whether it’s statements like, oh yeah, the military is going to come and line you up and just give it to you one at a time. There has not been any evidence that that is going to happen, that your employers are going to force you to get it. And when Maureen and I were talking earlier, she made an excellent point. She was like, none of these employers are going to want to take on that liability of forcing a pregnant or lactating person to get this vaccine with no studies including either of those groups. So, you know, before you panic, take a deep breath, call your actual healthcare provider and talk about what your actual risk is, whether or not you’re able to isolate. And if you can’t then talking about, you know, in depth, what your concerns are and make your own personal choice.
And I really find it hard to believe now I’ve been surprised before, but I find it hard to believe that anyone would force you to get this. Right. I agree. And you know, the way that I’m approaching it with my clients, I just sent out a big email to everybody. I summarized every guideline I could find. I sent the links to it and I was like, hey, we’re going to talk about this next time I meet up with you.
And I sent this to some former clients too. I said, if you want to talk, give me a call. If you want to know more about this, why don’t you read this, and we’ll talk about it at our next visit. All of the guidelines that are available to me as a provider are also available to the public, you just have to know what to search for. So you can look on the FDA website, the CDC website, the ABM Academy of Breastfeeding Medicine website. If you’re pregnant currently, I recommend looking at the Society for Maternal Fetal Medicine and the American College of Obstetrics and Gynecology.
I also, I looked at the guidelines from the UK government, the Canadian government, which was just searching UK governmental health law, health department guidelines as to whatever combination of words got me that. And then, I looked at the Royal colleges recommendations also that was a UK, like that’s their ACOG equivalent and yeah. You know, they mostly said the same thing, but I tried to read them really carefully to see if anything had some new insight like this ABM guideline.
Yeah. I’m just excited. Like you said, that they have finally recognized that lactating people and pregnant people are different.
Right? I’m so relieved about that because it’s so different. It is so different. It’s really, I just want to reiterate that. Yeah. Like I want to reiterate it to you guys listening. It is really different to share your blood through your placenta, into your baby’s umbilical cord directly into their bloodstream versus sharing it through your breast milk, into your baby’s digestive system.
And on top of that, we are able to continuously monitor infants who are already born versus an infant in utero, unless you are hooked up to continuous monitoring equipment, that’s going to be impossible for somebody to do at home. So that represents a different risk category as well.
Right. So what we’re saying is, and I’m not going to make you read between the lines. It seems from a physiological standpoint, that pregnancy would be a riskier time to get the vaccine than lactation.
Right. And I will note that it appears that ACOG and the Society for Maternal Fetal Medicine are still recommending that pregnant people in a higher risk category like a health care provider or somebody with a comorbidity or, you know, another underlying condition that those people consider the vaccine and have that conversation with their healthcare provider.
They have been a little bit more standoffish on making that clear. There’s definitely been a step back to create some liability space, but Heather and I read these statements from them all the time and I think I’ve interpreted that correctly, that they’re still recommending that healthcare workers who are pregnant probably get it.
Sure. I mean, we have more information about what a vaccine, how a vaccine works in pregnancy than we do, how COVID works in pregnancy. So if you’re looking at the cost benefits scenario, if you are a pregnant frontline worker who is in a COVID unit, and you look at the cost benefit. What we know, we know a lot more about how that vaccine is going to work for you, than what COVID is going to do for you and that fetus.
So again, that’s not a choice that we’re making, it’s just something to consider. And that’s why these statements are so hard to make because we don’t know what your situation is. You know, we don’t know how risky this actually is. We don’t know if your employer is actually taking necessary precautions to protect you.
We don’t know if you have the PPE that you need, you know, we’re not going to say yes, you definitely need to get it if you’re working in a rural hospital using the same mask over and over again for three weeks at a time, you know? So, definitely consider these things, make the best choice that you can, but let’s end on a positive note and Maureen, what do you think we can look forward to from this vaccine?
Well, I’m really hoping that all of our healthcare providers are able to access this. And I think that that could really make a positive impact in first of all, the retention of healthcare workers, because we’re seeing a lot of healthcare workers quit right now. Understandably. And therefore, you know, that would have a positive impact on the care that every patient is getting, but particularly COVID patients.
And hopefully we will at least see our numbers start to plateau because we’re rising really quickly right now. And then, I think we’re going to have to wait awhile for a more universal rollout, but I really think that that one action is going to make a pretty big difference for us.
Yeah. I mean, hopefully it’s a lot like pulling out a domino, you know, and just hopefully changing the trajectory of this thing because everything else that we’ve done to this point does not. Seem sustainable by any stretch of the imagination. Healthcare workers just cannot do this anymore. It’s been a long time now that they’ve been functioning at this capacity that was impossible to begin with.
So I think that if nothing else change is good. Change for the better, hopefully, and also from a nerdy research standpoint, I think that for the first time, because this was a pandemic, we had the most brilliant minds in the world working together on the same thing. Which has really never happened before in our lifetime.
So I think that we can get some crazy research out of this, you know, how many more MRNA based vaccines can we get for other viruses? You know, what if this works? You know what I mean? Like what if, what if it works? Let’s just sit with that for a second. And, you know, what if we can all start going to live music again, and what if our favorite restaurants aren’t closing and what if we can eradicate Ebola and you know, what else who knows, but something will come out of this beyond what COVID has presented to us.
Absolutely. And you know, the way I see it, even if this vaccine isn’t the answer. It’s a step in the right direction, right? Even if we have to do more research and find one that transfers immunity for longer, you know, this is still helpful. This is still going to help us get there. It’s going to keep our health care workers helping people and healing people. It’s going to keep our researchers in their jobs, doing their jobs, you know, like that’s really key. We really need these people to keep doing their jobs if we’re going to survive this.
And if you need a helpful analogy, birth control when birth control first came out, boy, was that a domino? Did we crush it the first time? Did we have the perfect birth control the first time? Hell no, we didn’t. We were giving people 30 times the dose they needed, but they weren’t getting pregnant every year. And women were able to go to work and it changed the course of history because of that. And we were able to perfect it.
So, you know, I’m not telling you to lower your standards. I’m just telling you from a research perspective, everything can always get better and we have to change something. You know, I had a really funny conversation today with some friends who were joking about like all of the different kinds of slogans about science they’ve been seeing, you know, from the one end that’s like, how could you trust this to the other end of like, just look at the science and trust the science as if it’s like also that easy. And I was kind of like, well, you know, saying only trust really well conducted studies until a better study comes out that contradicts it and then trust that that’s just not real snappy. Is it?
Yeah. Not snappy and hard to fit on a meme. Yeah, exactly. But you know, that’s kind of where we’re at. Like, these are well conducted trials. This vaccine has shown that it is pretty effective and pretty safe, and we’re gonna go with it for now. And if we find something better, great. And if this is the best thing, awesome, then we already have it, you know? And that’s just, you know, a lot of people just don’t get to experience science in real time.
Whew. You know, baby’s first pandemic, right? Yay. Now that you could fit on a meme.
Well, thank you all for being with us. And for following the most up-to-date evidence-based research that we have, you know, that we try to bring you the most accurate information. It’s really important to us. And you know, we’re not going to do an award today except for a general sweeping award for everybody who is going through this and remaining positive and really trying to get the best information they can.
It’s the people that really care about the quality of their information that are going to make a difference in this. Yes. And we will keep making updates as we get the information. Thank you all so much. We love you and let us know how it goes. If you get it, if you don’t get it, keep us posted and always, always check the show notes.
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