Update: 27/10/2021
Now a clear yes as a recommendation
All adolescents and adults in Germany can now be vaccinated against the coronavirus easily and free of charge. According to the current recommendation of the Standing Vaccination Commission, this now also includes unvaccinated breastfeeding mothers (Epidemiological Bulletin No. 38 of 23 September 2021).
However, some breastfeeding mothers still come to me with their questions beforehand. Some are still unsure whether they should actually take up the offer of vaccination against Covid-19 infection as long as they are feeding their baby with breast milk.
I can well understand that you don't want to take any risks for you and your baby. But fortunately, science has already gained much more knowledge about the coronavirus and the tolerability of the corresponding vaccination than was the case at the beginning of the pandemic.
As with all other vaccinations, the Standing Vaccination Commission remains a good "beacon" with its recommendations. This 18-member committee of experts, which has been issuing immunisation recommendations for adults and children in Germany at the Robert Koch Institute since 1972, works completely independently. This means that neither political nor economic aspects play a role here. STIKO acts solely on an up-to-date scientific basis. Its recommendations are based on proven medical correlations and efficacy. The Standing Committee on Vaccination carefully weighs up the benefits and risks of a vaccination for the individual (or a group of people) and for society as a whole.
If you follow the STIKO recommendation, you can be sure that the greatest possible health and safety for you and your child are the central goal. In plain language: Vaccination is intended to reduce the risk of infection and prevent severe Covid-19 disease progression or even death in the event of infection. This also applies to pregnant women and breastfeeding mothers.
What does the STIKO say about the coronavirus vaccination during breastfeeding?
In the meantime, the STIKO has not only changed its recommendation for the corona vaccination for pregnant women. (Link to current text Corona vaccination for pregnant women) clear: even for unvaccinated mothers who are breastfeeding their baby, two doses of a mRNA vaccine recommended. The vaccinations should be administered three to six weeks apart if the vaccine from BioNTech/Pfizer called "Comirnaty" is used. If the mRNA vaccine "Spikevax" from Moderna is used, there should be four to six weeks between the two injections.
With this vaccination, the human body cells receive a kind of "construction manual" for a single building block of the coronavirus. This is a protein from the envelope of the virus, the so-called spike protein. After the "inoculated" building instructions have been "read" by the human cells, they produce the protein according to plan. This is then interpreted by the immune system as a foreign, dangerous protein invader. The immune system reacts promptly to this: it produces defence cells and antibodies. If it later comes into contact with the real Corona virus, it already recognises its protein and can immediately provide the protective immune response.
How an mRNA vaccine works in breastfeeding mothers and how safe it is for mother and child has now been further researched. Here are the latest scientific findings:
→ After a corona vaccination, you develop antibodies. These can also be detected in breast milk in breastfeeding women. The strongest concentration is one to two weeks after the second vaccination.
→ Babies absorb antibodies from their immunised breastfeeding mothers through breast milk. Whether breastfed babies are better protected against coronavirus as a result is likely, but has not yet been clearly proven.
→ New studies show: No serious adverse drug reactions occur after vaccination - neither in breastfeeding mothers nor in their breastfed children.
→ The researchers assume that the carrier of the inoculated "building instructions" - the mRNA - is broken down again very quickly in the mother's milk or in the baby's gastrointestinal tract. However, the final studies on this are still lacking.
As you can see, a lot has happened in the field of coronavirus vaccination for breastfeeding mothers. Until then, the STIKO had hesitated to issue a general vaccination recommendation for breastfeeding mothers. However, 11 professional societies had already called for breastfeeding mothers to be offered a general vaccination programme in May 2021. These included the German Society for Perinatal Medicine (DGPM), the German Society for Gynaecology and Obstetrics (DGGG) and the National Breastfeeding Commission (NSK) as advocates for better protection against the coronavirus for mother and child.
Outdated status: 05/05/2021
Nothing is currently more topical than the issue of coronavirus vaccinations
Not just on talk shows, in the news or on posters: The issue of vaccination against Covid-19 infection is gaining momentum. Especially since we know that vaccination prioritisation will be lifted in the foreseeable future and there will then be "vaccination offers for everyone". Everyone - including breastfeeding mothers. But should they also be immunised?
You probably also think about this question when you are breastfeeding. And you may be unsure about what to do. On the one hand, you probably want good personal protection against the coronavirus - on the other hand, you may be worried about whether your vaccination could harm your child. After all, your baby is drinking your breast milk.
So it's no wonder that many parents turn to me with such thoughts. They want to know, for example, whether there is an "official" vaccination recommendation for breastfeeding mothers. Or how they should ideally behave in order to achieve the best possible safety for themselves and their baby.
The good thing for me as a midwife is that there is a lighthouse with regard to immunisation that tries to provide the best possible safety with its recommendations.
What does the STIKO say about the coronavirus vaccination during breastfeeding?
In Germany, the Federal Joint Committee (G-BA) decides whether a vaccination is included in the immunisation guideline. If this is the case, the health insurance companies also bear the costs. The decision is based on the recommendations of the Standing Committee on Vaccination (STIKO). The Federal Joint Committee generally follows these recommendations, but can theoretically also deviate from them.
It is therefore important for you to know who the STIKO actually is - and what it says about the coronavirus vaccination for breastfeeding mothers.
The Standing Committee on Vaccination (STIKO) at the Robert Koch Institute consists of independent experts. The committee has been developing recommendations on which vaccinations adults and children in Germany should receive since 1972. The STIKO weighs up the benefits and risks of a vaccination both for the individual (or a group of people) and for society as a whole. The recommendations are based on proven medical correlations and efficacy. The latest findings are used for this purpose.
With the Corona vaccination for pregnant women the STIKO recommendation is clear (as of April 2021): It advises against a general Vaccination of pregnant women is not recommended because there is still a lack of relevant study data. Only pregnant women with special risks can be immunised - after detailed consultation and consideration. Incidentally, the medical associations see things differently. They are now (as of May 2021) explicitly calling for vaccination to be offered to all pregnant and breastfeeding women.
For breastfeeding mothers, the STIKO states that "currently only a few data" are available. In particular, there is a lack of data on the question of how safe a Covid-19 vaccination of the mother is for the breastfed baby and whether immunisation may have an effect on milk production. Nevertheless, the STIKO considers it "very unlikely that immunisation of the mother during breastfeeding poses a risk to the infant." That sounds reassuring, but somehow also vague.
What do the professional associations say about coronavirus vaccination during breastfeeding?
The German Society for Perinatal Medicine (DGPM), the German Society for Gynaecology and Obstetrics (DGGG) and the National Breastfeeding Commission (NSK) are more explicit in a joint recommendation. It states: "The potential benefits of vaccination outweigh the risks for breastfeeding mothers with increased COVID risk the theoretical concerns regarding the safety of the vaccination." At the same time, it is pointed out that the vaccination has the same protective effect in breastfeeding women as in non-breastfeeding women. It is also strongly suspected that immunisation of the breastfeeding mother also means more protection for the baby. Antibodies against the virus have already been detected in breast milk of mothers who are experiencing or have experienced a corona infection. The recommendation goes on to say that mothers who have an "increased need for safety" could possibly take a break from breastfeeding for one to three days after vaccination. However, this is not necessary.
At the beginning of May 2021, a total of 11 professional associations called for this, all offer breastfeeding mothers a vaccination programme - exclusively with an mRNA preparation. Reasoning: In addition to protecting the mother, the infant also receives antibodies against the coronavirus through breast milk. In addition, there is no need to stop breastfeeding after vaccination because the mRNA of the vaccine could not be detected in breast milk.
What to do?
Firstly, the most important thing: breastfeed your child! This is the best protection you can give your baby! After all, your baby needs protection against many bacteria and viruses. This protection is irreplaceable. Longer breaks from breastfeeding over several days jeopardise the success of breastfeeding. You should therefore only take well-prepared and well-considered breaks from breastfeeding in urgent emergencies.
Beyond that, you may be wondering what you can take away from the current findings and statements on the coronavirus vaccination. Let's summarise again:
There is still no general "official" recommendation for breastfeeding women to be vaccinated against the coronavirus. The situation is different if you belong to the group of high-risk patients (e.g. due to heart disease). In this case, the benefit of vaccination is considered to be greater than the risk of contracting the disease.
According to current knowledge, a corona vaccination (especially with an mRNA serum!) during breastfeeding poses no health risk to the baby. It is assumed that the opposite is true: your child will probably receive even more immune protection against the virus through breast milk.
Ultimately, however, no one can take the decision away from you as a breastfeeding mother as to whether you should be vaccinated against coronavirus or not. However, if you are breastfeeding, it can be assumed that your vaccination will not harm your baby. I can only advise you to discuss this with your midwife and doctor. And trust that you will find the right way for you.
However, if you decide to get vaccinated, one thing is clear: once vaccination prioritisation has been lifted, you will have to struggle to get vaccinated as soon as possible, just like anyone else who is not breastfeeding a baby. Unless, of course, the motto in Germany is: breastfeeding mothers first! If the assumption that breastfed babies are better protected by their mother's immunisation is correct, this would even make sense. After all, it is now known that infants in the first year of life are at great risk of having a severe course of Covid 19 if they become infected. In any case, it is important that you protect your baby from infection and carefully observe social distancing rules. To protect your baby, you should also demand this from the people who come into contact with you and your baby. Because even with immunisation protection, there is no 1001TP3 certainty. Neither against infection, nor for lasting immune protection against this new and still little researched corona variant.
