Hesperian Health Guides
Prevent HIV from spreading to babies
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When a pregnant woman has HIV, the HIV lives in her blood, vaginal fluids, and breast milk. Especially if she is not taking ART, her baby can become infected during:
HIV spreads less often to a developing baby if the mother takes ART. ART is now recommended for all pregnant women with HIV. The earlier in pregnancy a woman starts, the better for both her and the baby. See ART for treatment and prevention for people age 11 and older and Chapter 11 for more about using these medicines.
A woman who does not have HIV cannot spread HIV to a baby. So the surest way to prevent HIV in babies is to prevent HIV in women before they become pregnant, and during their pregnancy if they do become pregnant.
- 1 Other ways children can become infected
- 2 Prevent HIV infection before pregnancy
- 3 How to prevent HIV during pregnancy
- 4 How to prevent HIV during the birth
- 5 How to prevent HIV after the birth
Other ways children can become infected
Most children with HIV were infected as babies, during pregnancy, delivery or breastfeeding. But children can also be infected through sex or contact with blood.
If a child is sexually abused or raped by a person with HIV, the child may become infected. If you know a child has been sexually abused or raped, seek medical care for the child immediately. A clinic may have medicines called PEP that can prevent HIV infection in the child.
Many children are sexually abused but we often do not find out until much later. Learn to be more aware of the signs of abuse and work with others to protect children. See Chapter 14 for more on sexual abuse.
Children can also become infected with HIV through contact with infected blood. Keep children away from sharp objects, and teach children not to play with them. If a child is going to receive medicine by injection, be circumcised, or have his or her skin cut or pierced for any reason, make sure sterile equipment is used.
Prevent HIV infection before pregnancy
Women can prevent becoming infected with HIV best when they know the status of their partners. If a woman’s partner has HIV, ART for the partner and safer sex can protect the woman from both pregnancy and HIV infection. If she cannot use safer sex, she can try to get PrEP.
If a woman wants to have a baby, there are several ways she and her partner can avoid spreading HIV while trying to become pregnant.
Safer sex while trying to get pregnant
In many couples, one person has HIV and the other does not have HIV. Safer sex prevents HIV from spreading during sex, but it also prevents pregnancy. If you want to have a baby, here are some ways to lower the risk of spreading HIV — both to the baby and to the HIV-negative partner — while you are trying to become pregnant.
How to prevent HIV during pregnancy
|All pregnant women need enough to eat, enough rest, and care for any illnesses they develop.|
If you do not know your HIV status, get tested as soon as you can. If you need treatment, starting ART as soon as possible will protect your baby from HIV and keep you healthy. Many clinics have Prevention of Mother-To-Child Transmission (PMTCT) programs where women can get tested and start treatment. Programs often have support groups for mothers with HIV.
Health care for pregnant women is called prenatal or antenatal care. Prenatal care is very important for pregnant women, especially women with HIV. Untreated infections of any kind increase the chance that a pregnant woman can get HIV, or that a pregnant woman’s HIV will spread from herself to her baby. So treating and preventing infections during pregnancy helps prevent HIV in babies.
Health care for pregnant women and protection from HIV, other diseases, and poisons, such as lead and toxic chemicals, help babies grow well in the womb. Babies develop all the basic parts of their bodies and minds in the womb. So health during pregnancy affects what babies will be able to do as children and adults after they are born.
Whether or not you have HIV, practicing safer sex and being tested for HIV early in pregnancy helps protect your own health and the health of your baby.
Prenatal care for women with HIV also includes:
- testing and treatment for anemia (weak blood, usually from lack of iron), which weakens women and makes bleeding worse after birth.
- help talking to sexual partners or family about HIV, and counseling and other support about feeding and caring for the new baby.
Tanya, do you take your ART every morning when you wake up, as we discussed? It protects both you and the baby.
I can help Tanya remember her ART.
Good, Sam. You can also help by making sure Tanya gets enough food and plenty of sleep.
Take ART during pregnancy
Antiretroviral therapy, or ART, started early in pregnancy, prevents almost all babies from being infected during pregnancy, birth, and breastfeeding. Most clinics provide ART to any pregnant woman if she has HIV and to the baby for a short time after the birth. This keeps the mother healthy and works well to prevent babies from becoming infected.
If you are already on ART and become pregnant, you will usually just continue to take your medicines.
|If the mother is already taking ART||If the mother is NOT taking ART yet|
Sex during pregnancy
A woman can have sex throughout her pregnancy. Sex is safe for the woman and the baby unless having sex infects the mother with a sexually transmitted infection, including HIV. Becoming infected with HIV during pregnancy or just before the birth strongly increases the chance that the baby will also become infected. Practicing safer sex during pregnancy is important for both women with HIV and without HIV.
Many women are afraid to talk about sex and condoms with their partners, but using condoms is a good way to keep women and their babies healthy.
You might not want to discuss this, but it is important. You can protect yourself and Tanya and the baby as well if you use condoms during sex. What do you think?
I do not like condoms. They are uncomfortable and do not feel right.
I understand. It is not easy to make a change in sex. But many men learn to be comfortable with condoms. Why don’t you try them for a month?
How to prevent HIV during the birth
The risk of HIV spreading from a pregnant woman to her baby increases during birth because the baby is in contact with blood and fluids in the mother’s vagina then. Mothers with HIV who are not already on ART can protect their babies by taking ART during labor and birth and giving the baby ART as soon as she is born.
|If the mother is already taking ART||If the mother is NOT taking ART yet|
Many mothers with HIV deliver their babies in a hospital or clinic. There, they can have better access to ART, sterile equipment, and other medical services to keep mothers and babies healthy if problems arise. In some cases, health workers deliver the baby by surgery called a Cesarean or C-section — taking the baby out through a cut made in the woman’s belly.
Midwives keep many women healthy through their pregnancies and then help deliver their babies at home. Because of HIV, now midwives also help women get tested, start ART, and arrange for hospital births if that will be safer.
If you are in labor and have not been tested for HIV recently or do not know your status, ask to be tested. If you learn you have HIV, you can still protect your baby by taking ART during and after the birth.
Birth practices can protect babies from HIV
Wherever you have your baby, talk with your family and midwife about other ways to lower the risk of the baby becoming infected with HIV.
If possible, try not to let labor go too long. Keep labor moving along by walking, changing positions, drinking water and juice often, and urinating. Get help if your labor lasts longer than 12 hours.
Try to avoid anything that causes extra bleeding.
- A doctor or midwife should avoid putting her hand inside the mother’s vagina unless absolutely necessary (and should always use gloves).
- Avoid breaking the bag of waters unless absolutely necessary.
- Avoid doing things to the mother or baby that might cut the skin, such as using forceps or a scalp monitor on the baby. Avoid cutting the mother’s vagina to make the birth opening bigger.
Also, any razor or knife used to cut the baby’s cord should be sterile. For more information about healthy births, see the New Where There Is No Doctor, Pregnancy and Birth chapter, and A Book for Midwives.
How to prevent HIV after the birth
After birth, both the mother and the baby need care. They each worked hard and need to rest. Here are some ways to help keep them healthy.
|Use a syringe with no needle to slowly squeeze medicine into the side of a baby’s mouth, back near his throat.|
- Give the baby ART to help prevent HIV infection. Any baby born to a mother with HIV should be given ART each day for at least 4 to 6 weeks and longer in some cases.
- Keep the baby warm.
- Help the mother start breastfeeding, and assure her that her milk is good for her baby — the best food possible.
Test babies for HIV
Finding out soon after birth if your baby has HIV can save his life, because he can be treated. A special HIV test called a PCR test is needed. See Chapter 8 for more on HIV testing.
Before HIV treatment was available, mothers with HIV were advised to avoid breastfeeding. But with ART, breastfeeding is safer and is healthiest for almost all babies. Formula and other milks have other dangers.
Many babies fed with formula become ill or die because families lack clean water or enough money to buy all the formula the baby needs to grow well. Also, formula and other milks do not provide the same nutrition and all the protections that breast milk does.
Here are two ways to help keep breastfeeding safe:
- Take ART and give ART to the baby. The mother’s ART protects her baby from HIV while she is breastfeeding, and ART given to the baby gives more protection.
- Give the baby only breast milk for the first 6 months. Other foods or liquids can cause problems in the baby’s stomach, making it easier for HIV to spread. After 6 months, add complementary foods and continue to breastfeed.
A woman whose HIV is well-controlled by ART can and should breastfeed for at least 1 to 2 years, weaning (stopping breastfeeding) only when there is enough healthy food to give the child.
Care for the mother after the birth
Check to see that the mother’s bleeding is not more than a heavy monthly bleeding (less than about 2 cups of bloody fluid over the first few hours).
Watch the mother for signs of illness: fever, foul-smelling discharge from her vagina, cough, shortness of breath, severe lower belly pain, burning when she urinates, or breasts that are painful, red, or warm. Treat any illness quickly.
Also make sure the mother keeps taking ART every day as usual after the birth, and has support to keep getting her medicines and enough food to eat. Treatment not only protects her health but helps her safely breastfeed her baby.