This data analysis highlights a very specific consequence of the COVID-19 contact restrictions in the perinatal breastfeeding environment. After more than a year of pandemic experience, maternity ward staff clearly viewed the visiting restrictions as being positive for both, mothers and staff. The fact that staff reported having more time to support mothers may have made it easier for mothers to focus on breastfeeding.

The mothers’ views on the hospital visiting restrictions confirm the results from the hospitals: mothers experienced a calm hospital atmosphere and often felt that they could breastfeed well. These positive experiences in the hospital may also have motivated mothers to maintain visiting restrictions, at least partially, at home. Despite the more permissive contact opportunities at home, a catch-up effect of missed hospital visits does not appear to have occurred.

The desire of the ward staff to at least partially maintain the restrictions beyond the pandemic confirms their positive assessment of the restrictions on breastfeeding success.

Overall, some important aspects of our findings for hospitals and mothers are reflected in the pandemic experiences reported by lactation consultants in hospitals in the US [19]. They reported that babies tended to be poorly breastfed when visitors were around and mothers did not rest. In contrast, when no visitors were around, mothers felt comfortable with the baby and parents attempted to breastfeed for longer periods of time before asking for supplemental feeding to be introduced. At the same time, lactation consultants found it difficult to find a good compromise of visiting arrangements that would ensure both optimal professional breastfeeding support and the satisfaction of the families.

The COVID-19 pandemic has led to various interventions that could be relevant for breastfeeding, thus making it difficult to compare research results. Clearly describable measures such as official contact restrictions have rarely been addressed in relation to breastfeeding [20]. In particular, the experiences of hospitals in limiting visits have not been adequately studied, although these policy factors of hospitals have a significant influence on the initiation of breastfeeding [1, 12].

Similar to our quantitative survey, the authors of a qualitative study in Spain reported that visiting restrictions tended to be positively perceived in relation to breastfeeding outcomes [21]. Mothers perceived contact restrictions as predominantly positive for breastfeeding and bonding with the child because disturbances from outside were eliminated. However, as in our study, feelings of loneliness and missing the family were also expressed [21].

The severity of hospital visit restrictions also seems to play a role, as two studies from Italy have suggested [11, 22]. In one hospital in which partners had no access, breastfeeding rates after birth and in the following three months were lower than those reported several years earlier [22]. In another hospital where the presence of the partner was only partially restricted, breastfeeding rates at discharge were not affected, although mothers felt more anxious and less supported by hospital staff [11].

In a nationwide online survey of maternity hospitals in the US in 2020, hospital self-assessed breastfeeding rates at discharge remained approximately the same in 68.9% of hospitals and increased in 11.3% of hospitals since the outbreak of the pandemic [23]. Although this is only an estimation, the ward staff of our hospitals were more optimistic (37.5%) that breastfeeding rates at discharge increased during the pandemic.

The COVID-19 pandemic, with its unprecedented and stringent visiting restrictions in hospitals is akin to an ‘experiment’ born out of necessity, wherein there were interferences with the social life of patients and the daily work of medical and care staff. Such clearly defined and abrupt interventions in the breastfeeding environment would neither be feasible as a formal research study, nor ethically acceptable under Western perinatal conditions. Therefore, the experience with the pandemic could help to identify favorable and unfavorable social conditions for a smooth breastfeeding initiation. Moreover, our ‘mother study’ suggests that younger, single and non-employed women might be target groups for specific research on the influence of social factors in the perinatal situation on maternal wellbeing.

In the SINA study, the hospital stay after a vaginal birth was 2.5 days before the pandemic and was estimated to be even shorter by 60% of hospitals during the pandemic [13]. In the US, the vast majority of hospitals (72.9%) have shortened their hospital stays to less than 48 h due to the pandemic [23], which is a duration defined as ‘shortened stay’ [24] and which requires increased breastfeeding support.

With approximately 50% of mothers in Germany reporting breastfeeding problems in the first two weeks postpartum [13, 25], the need to improve early breastfeeding support is evident. Breastfeeding problems have been associated with a shortened duration of exclusive breastfeeding [26]. It would be interesting to have data on whether effective perinatal breastfeeding support would be enhanced by limitation of visitors in the immediate postpartum period and whether avoidable disturbances of the maternal-child interaction would be less frequent, and could help to prevent the development of problems around breastfeeding.

One of the strengths of the study is the transferability of the findings to countries with similar social and healthcare systems. Although the rather low participation rates of hospitals and mothers may have favored an overrepresentation of breastfeeding friendliness, the pandemic restrictions equally applied to all hospitals and mothers, thus the consequences are likely to be transferable.

A further limitation of the data is that the changes in breastfeeding rates perceived by maternity ward staff during the pandemic could not be verified because a control situation was not feasible. Data reported by hospital staff may have resulted in social desirability bias. Confirmation of the findings in further studies is needed.

Visiting arrangements may be one of the underestimated socioemotional components of breastfeeding support, as they may have an impact on maternal wellbeing thus affecting the probability of successful breastfeeding initiation.

Further studies are needed to distinguish the specific role of postnatal visiting regulations from other factors of breastfeeding support. At present, it can be suggested that visiting regulations in the maternity ward should combine the clinical and social needs of the young family. Practically, this could mean that visiting arrangements in the maternity ward should be reasonably channeled, even if this may seem surprising in a liberal social environment. In this way, new perspectives for postpartum breastfeeding support could be developed from the pandemic experience.