Pregnancy

It really annoys me when people start taking the moral high ground around HIV and motherhood because, in most cases, attitudes are not based on clinical or research evidence, but on some deep-rooted moral belief that is often misinformed.1

HIV and pregnancy

All pregnant women in Canada are supposed to be advised that they should get tested for HIV. Along with the test, women should receive pre-counselling and post-counselling. Approximately 98% of women who have become pregnant in Ontario have undergone HIV screening.2 No one can be forced to be tested against her will.

It is often with this test that a woman learns that she is HIV positive.

Pre-test counselling

The health-care practitioner explains to the pregnant patient that she is being tested for HIV. At this time, it is important to let her know that a healthy pregnancy is possible for HIV-positive women.

Pre-test counselling also leads to increased knowledge regarding transmission and higher contraceptive/condom use.3

Post-test counselling

This happens after the test results come back. If the results are positive – meaning the woman has been found to be HIV positive – it is important from the beginning to reassure her that she has options. The woman should be told again that she can have a healthy pregnancy, and a healthy baby. With proper anti-HIV treatment, there is very little chance her child will be born with HIV, or that the baby will get it afterward.

Of course, for many women – whatever their HIV status – pregnancy could be an unplanned surprise.

HIV positive and planning

Women who know they are HIV positive might also want to get pregnant. Motherhood is as much her right as it is any other woman’s. Treatments given during pregnancy can benefit her health – and reduce the chances of passing HIV to the fetus and newborn.

In fact, today, the vast majority of HIV-positive women in Canada give birth to healthy negative babies. Although more infants than ever are exposed to HIV as the numbers of HIV positive women continue to rise, there has been a dramatic decrease in the number of babies who are infected.4

In 2001, a total of 168 infants were perinatally exposed to HIV. Out of these, 17 (10.1%) were confirmed to be infected. By 2008, only four out of a total of 238 exposed infants (1.7%) were confirmed as infected. Statistics of  2012 indicate that 225 infants were exposed and less than 2%  of newborn were positive.

A supportive health specialist can discuss the best ways for a woman who is HIV positive to plan a pregnancy – including an evaluation of her viral load (the amount of HIV that is present in her blood), possibly changing drug treatment regimes, diet and so on.

It can be a challenge to get information about reproductive health technologies or what medications could prevent perinatal transmission of the virus. This kind of information is especially helpful during the first trimester, though medical treatment can reduce the odds at any time in the pregnancy.

Anyone who knows some of the facts can pass along the news:

  • many HIV-positive women can get pregnant easily, and carry the pregnancy to term if they choose
  • with proper care – including healthy support systems, good relationships with health-care practitioners and the right medications – HIV-positive mothers can have HIV-negative babies!

A healthy pregnancy

The following is a brief, general guide outlining the approaches used to reduce vertical (mother to child) transmission:

  • anti-HIV drugs prescribed for the pregnant mother
  • delivery by C-section
  • an anti-HIV drug treatment designed for the newborn to take over the first months after birth
  • no breastfeeding

Treatment can differ depending on the case of each individual.

Any woman who wants to get pregnant or who thinks she might be pregnant should be encouraged to meet with a non-judgemental, knowledgeable health-care provider as soon as possible.

HIV is present in breast milk, and researchers estimate a 29% HIV transmission rate from HIV-positive mothers who consistently breastfeed their children. The most recent information suggests that the risk of HIV transmission from breastfeeding is highest in the early months after birth.5

Breastfeeding

In Canada, the baby of an HIV-positive women should not be fed mother’s milk. Instead, formula feeding is a healthy alternative. There are situations where formula is not an option. This would be really exceptional in Toronto. A specialized counsellor, health-care worker or nurse could talk about other choices.

A more common struggle comes as a result of societal assumptions that “breast is best.” People in many social circles and communities react negatively to a mother who feeds a child formula.

Women can feel huge pressure to breastfeed. The pressure can range from questioning, humiliation, open disapproval and judgements.

For a woman who has not disclosed her HIV-positive status to family and friends, it can be extremely hard to justify her choice, and respond to such open criticism. She might isolate herself or create cover stories to keep her privacy. These strategies make it even more important for her to have a place where she can talk honestly and without fear to peers and service providers who understand and support her.

More from Shared Health Exchange

___________________________

1Positive choices about pregnancy, Tracy Barnes, +ve, December 2006 (no longer online)

2HIV/AIDS Epi Updates, Surveillance and Risk Assessment Division, Centre for Communicable Disease and Infection Control, Public Health Agency of Canada, July 2010

3 Issues about Perinatal HIV in Ontario in 2010, Lindy Samson MD FRCPC, 2010

4HIV/AIDS Epi Updates, Surveillance and Risk Assessment Division, Centre for Communicable Disease and Infection Control, Public Health Agency of Canada, July 2010

5Pregnancy and HIV Disease, Project Inform, August 2005