Client with HIV...

[BestBirth4You]

I have a client who has HIV, and I was just wondering if anyone has had any experience with this. I know that as long as her viral load stays below 50 she can have a vaginal birth, but will she be treated as high risk? She would like to be mobile, but I told her to talk this over with her OB as I am not sure if they will require constant monitoring? Any advice or anything?

[doula Michele]

No advice, but something I had always wondered about.
I would be pretty nervous about taking that one on...good for you!

[Ceci]

Back when I worked in the hospital, there was a client w/ HIV that had a doula. We all worked closely together and she was very grateful to be able to have a vaginal delivery.

Yes, she was treated as high risk b/c of her HIV status. The main thing at this birth was the dosing of the AZT. When pt's have a c/s they are given a huge dose of AZT aprox 2 hours before delivery so that the AZT is at it's peak when the baby is being born. Obviously, this is harder to time with a vaginal birth which is why some of the docs were reluctant to to try the vaginal delivery (they felt that not timing the AZT correctly would put the baby's health at risk).

This particular mom ended up getting induced to assure that the doc that was most experienced (and willing) would be the one to deliver her baby. She was on the monitors all the time but remained semi-mobile, by the bed most of the delivery. She ended up chosing an epidural and had a vaginal delivvery, although the doc was VERY strict about everyone in the room (inlcuding the doula) wearing face shields and gloves to touch the baby.

The thing is that although the doula felt that she was treated overly cautiously, the mom was so proud and happy of her birth b/c it was vaginal. And I guess that in the end, that was the most important thing.

The only other thing I would add would be to be sure to help mom with the baby's feeding (making sure that she finds a good way to bond and cuddle while bottle-feeing) and also make her as comfortable as possible while her milk is coming in until it all dries up.

Good luck!

[Mile High Doula]

Mothers with HIV can provide their own breastmilk to their babies. I remember working with a few moms who had HIV when I was a hospital doula. While they discourage actual breastfeeding, she can still pump and provide milk by scalding it. There are instructions all over the web on how to do this. I believe I JUST saw an article or study on this exact thing.

[Ceci]

While the risk is small, breastmilk is still a bodily fluid and it is possible to transmit the HIV and *I* don't think that is a risk worth taking, even taking into consideration all the benefits of breastmilk.

[Neshama]

Never had a client with HIV but I'm really interested in this thread!

[Mile High Doula]

Actually, studies show the benefits outweigh the risks when it comes to HIV positive mothers providing breastmilk for their babies. Since the milk is almost pasteurized the virus is killed and would not be transmitted via the breastmilk. I will see if I can find the studies and post it here.

[Mile High Doula]

Found the one I was referring to from May:

http://www.berkeley.edu/news/media/r...eastmilk.shtml

I would also add that if the mother was taking her anti-viral drugs and flash-heating her breastmilk, the transfer rate is very small to none, especially if she exclusively feeds breastmilk and does not supplement or add solids in the first 6 months. She will be taking all the precautions in order to not pass this on.

[AmandaB]

I think it is important to protect ourselves and be aware of any pathogens we are bringing home to our families. Hospitals are so icky with germs and disease that I bring a change of clothes and I shower before I go to bed when i return home from a birth. This has nothing to do with HIV itself, it is everyone else's cooties, Toronto was hit with SARS so I think protection is key.

I would wear gloves if holding a leg and if the doc requires that everyone wears a face shield then just simply abide by the rules. I would just treat her like any labouring mother and be very open and honest with her. I am sure she has heard and experienced alot in her life with HIV that she would probably appreciate the concideration. You will be great!

[Ceci]

Quote:

Originally Posted by Mile High Doula Found the one I was referring to from May: http://www.berkeley.edu/news/media/r...eastmilk.shtml I would also add that if the mother was taking her anti-viral drugs and flash-heating her breastmilk, the transfer rate is very small to none, especially if she exclusively feeds breastmilk and does not supplement or add solids in the first 6 months. She will be taking all the precautions in order to not pass this on.

I can appreciate the study and would support a mom who chose this, l was more talking about my choices (I went back and edited my post to emphasize that). HIV in this country has now become to be seen as more of a chronic illness but still thousands of people die every year from AIDS.

It is just not a risk *I* would be willing to take and could never live with myself if I had know I had not done everything in my power to reduce the risk of transmission wherever possible.

You say that she will be taking all the precautions not to pass along the HIV but the truth is that in this case, giving her baby BM, even after heating does not reduce the risk as much as not BF would. Yes, it is a small risk, but still a risk.

[bcarrera]

Quote:

Originally Posted by Mile High Doula Found the one I was referring to from May: http://www.berkeley.edu/news/media/r...eastmilk.shtml I would also add that if the mother was taking her anti-viral drugs and flash-heating her breastmilk, the transfer rate is very small to none, especially if she exclusively feeds breastmilk and does not supplement or add solids in the first 6 months. She will be taking all the precautions in order to not pass this on.

Thanks for this great info!!! I do agree with you!!!

[lia]

What a great topic to discuss.

I have had an hiv mother as a client and she had a natural water birth. The only difference between her birth and other births was that they placed sterilizing fluid into the bath water along with the salt. Otherwise she was well educated on the hows and whys and it was an awesome experience.

On the facts of BF here in South Afirca we have a lot of HIV/AIDS and the ? of BF with a +status is hot.
I belong on the Breast feeding forum here and studies have been carried out here on BM etc and the findings are exceptionally positive.
If an HIV mother exclusively BF, no formula, tea or additional extras she can BF for 6 months but once solids are introduced then she either weans off immediately and follows on with formula or she pasturises her milk. WE have 1000's of women doing this in the rural areas and ther have been no reported cases of cross contamination. Contamination occurs when there is mixed feeding.

It is a scary subject because there is still so much unclear info about it but it is working here.
A recent convention I attended the Dr heading this research was saying that we need to educate more people about the benefits of exclsive BF for HIV mothers, when exclusive BF is not possible then rather do the formula.

Check out this link for more info http://www.sabr.org.za/projects/feed-for-life/

[Mile High Doula]

- Thanks Rosalia!

I think my main point here is education. If I had a client who had HIV and assumed she could only formula feed, I would think that I would provide her with the alternative. It would be up to hear to determine whether or not this was a choice she wanted to make and if this is something that would fit into her lifestyle. Likewise, I wouldn't want an HIV client to assume she is safe breastfeeding either. I am here to present the risks and benefits of these alternatives.

One of the posts mentioned that she would need support while bottle-feeding and also while her milk dries up. I think that's what got me going was that there was an assumption that she had to formula feed (ie. milk drying up). She could also chose to find a mom willing to donate milk or give her baby milk from a milk bank if she was able to afford it or insurance covered it.

Again, the risk is small for transmitting it, especially when the study I cited was done in underdeveloped countries. I was hoping to find a US study on this because I am betting the risk of transmission is even smaller but with access to formula and clean water this is something many do not even consider. The babies in the cited study might have received HIV from other factors as well since it is so prominent in their daily lives.

[DoulaYvonne]

The topic of breastfeeding with HIV has been of interest to me for a number of months. One of my favorite websites is www.anotherlook.org.
I hope you find some information that will be useful there.

[Mile High Doula]

Thanks! I bookmarked it! GREAT site!