Hesperian Health Guides
Pregnancy, Birth, and Breastfeeding
Contents
Pregnancy
Being pregnant does not make HIV worse. But a pregnancy can be more complicated for a person with HIV, especially if they are not on ART. They may:
- have a miscarriage (pregnancy ends early by itself) or give birth too soon.
- get infections after birth that are harder to cure.
- give birth to a baby infected with HIV.
It is your right to decide whether or not you want to become pregnant, and when.
Even so, many people with HIV still want to get pregnant and have a child.
If you want to get pregnant and you do not know if you or your partner has HIV, get tested and start taking ART if you have HIV. You can also reduce your risk of getting HIV while trying to get pregnant by having penis-in-vagina sex without a condom only during your fertile time. At all other times, use a condom or practice safer sex in other ways. And do not have unprotected sex when you or your partner have signs of an STI.
A very sickly baby born to someone with HIV may have HIV too. Take the baby as soon as possible to a health center for testing and treatment.
ART protects both you and your baby
Without treatment, 1 out of 3 babies born to HIV-positive people becomes infected. Anyone who is pregnant should get tested for HIV and start taking ART if they are HIV-positive, for their health and their baby’s. A baby can become infected with HIV in the womb, during birth, or while breastfeeding. When HIV is well-controlled by ART, it rarely spreads to a baby. Check with a health worker trained in preventing mother-to-child transmission.
Birth
Most transmission of HIV to babies happens during birth. The risk is greatest if the waters break more than 4 hours before birth, or if the baby has more contact with blood and vaginal fluids than usual during the birth, such as when there is tearing of the birth canal.
If you are pregnant or have a new baby, and you have HIV, it is especially important to take care of yourself—to eat well, prevent and treat other illnesses (like other STIs, malaria, and TB), and to keep taking ART. Get treated immediately for any infections after birth, which can be more dangerous if you have HIV. See more ways to stay healthy in pregnancy.
More Information
infections after childbirthFinding out if a baby has HIV
During pregnancy, a baby gets antibodies from the pregnant person’s blood. A person with HIV shares HIV antibodies, but usually not HIV itself. Because of these shared antibodies, the baby will test positive after birth with the HIV test most often used. After 12 to 18 months, the shared antibodies disappear and this HIV test will be positive only if the baby has HIV. A different blood test that costs more and takes more time can show if a baby younger than 18 months is HIV-positive.
HIV infection can be passed to the baby in breast milk, but usually only if the person breastfeeding is newly infected or is very sick (the virus level can be very high then), and is not taking ART. To reduce the risk of infecting a baby:
- Start taking ART as soon as you find out you have HIV.
- Give nothing but breast milk—not even water—until the baby is 6 months old.
- Prevent breast and nipple infections, and cracked or bleeding nipples. See a health worker right away if you have any signs.
- Treat for thrush if the baby’s mouth has white spots or sores.
- Only give replacement feeding, such as formula, if you will be able to do it safely for the whole time the baby needs it (see below).
In many places, the risk of diarrhea and malnutrition from other foods and unclean water is greater than the risk of HIV, especially in the baby’s first 6 to 12 months.
For this reason and because breast milk protects the baby from so many illnesses, giving only breast milk for the first 6 months is usually safest. After 6 months, add complementary foods, and then wean the baby at 12 months, if you can meet the baby’s nutritional needs. It can take 3 days to 3 weeks to wean a baby.
You might consider these questions:
- Do children in your area often get sick or die from infections, diarrhea, or poor nutrition? If the answer is yes, then breastfeeding may be best.
- Do you have access to ART treatment? This makes breastfeeding much safer.
- Are clean, nutritious milks or formula and water available to replace breast milk? You will need supplies for 6 to 12 months, which is very costly. You will also need fuel for boiling water, containers for mixing, and the baby must learn to feed with a cup. Animal milks lack nutrition babies need and should be a last choice. You will need to add vitamins, sugar, and clean water. Ask a health worker for the recipe for the kind of milk you have.