Motherhood and the war on AIDS

In the United States, since the beginning of the epidemic, AIDS has been diagnosed for an estimated 8,460 children who were infected perinatally. Of those, an estimated 4,800 (57%)have died.
Perinatal HIV transmission is the most common route of HIV infection in childrenand is now the source of almost all AIDS cases in children in the United States (CDC 2007 p.1). Having HIV does not need to end people’s lives, mothers can still have happy, healthy families.Preventing mother-to-child transmission (MTCT) of HIV can be done with antiretroviral therapy (ART) medications, cesarean section (CS), and bottle feeding instead of breast feeding. These three strategies will greatly reduce the risk of transmission of HIV to the infants. The CDC states, ART administered to the mother during pregnancy, labor and delivery, and then to the newborn, as well as elective CS, can reduce the rate of perinatal HIV transmission to 2% or less (2007 p.1). This paper first will explain the need for antiretroviral medication. Also, it will show the need for cesarean section. Last it explains the need to bottle feed to help reduce the risk of HIV transmission.
Giving antiretroviral therapy medications to mothers before and during pregnancy and to the infant after birth reduces the risks of transmitting HIV. Pregnant mothers, who are HIV-positive, should begin to take ART medication as soon as they find out they are pregnant. Also, they need to have it given intravenously while giving birth, and the infant needs to take ART medication for 6 weeks to help reduce the risk of transmission. ZDV is started orally at 14 to 34 weeks gestation, given intravenously to the mother during labor and administered to the infant for six weeks. In the United States, taking prophylactic medication during pregnancy can dramatically reduce, but not eliminate, the risk of vertical transmission. The reported rates of MTCT of HIV are less than 2% for women who begin treatment early in pregnancy, 12-13% among women who do not initiate treatment until labor, delivery, or after birth (Kirshenbaum 2004 p.106). One common ART medication is Zidovudine (ZDV). Kirshenbaum states, four out of five women pregnant at diagnosis of HIV reported taking ZDV as a vertical transmission risk reduction strategy. Women voiced trust in the medication and seemed to contemplate a wide array of vertical transmission risk reduction strategies (2004 p.110). After 2000, in the United States, when ART became widely used in pregnant women, 1,839 infant infections were averted (Walensky 2006 p.16). One of the major achievements in HIV research was the demonstration that administration of ZDV to the pregnant women and her infant can reduce the risk of perinatal transmission by nearly 70%. In the United States, without ART approximately 25% of pregnant women infected with HIV will transmit the virus to their child (CDC 2007 p.1&2).
Another way to reduce mother to child transmission of HIV is to have an elective cesarean section. Children who are vaginally delivered have a high risk of becoming infected with HIV due to the vaginal secretions and bleeding during delivery. Vaginal delivery is associated with increased risk of MTCT, this increased risk is ascribed to increased exposure to infected genital secretions and micro trauma during birth (Mohlala 2005 p.488-490). The greatest benefit in preventing transmission is associated with cesarean delivery performed before the rupture of membranes or to the onset of labor in conjunction with ART prophylaxis (CDC 2007 p.4). The most potent predictors of perinatal HIV transmission are prolonged rupture of the amniotic membranes, and mode of delivery. Several studies done in South Africa have demonstrated that delivery by CS reduces MTCT significantly. Recruited into the study were 26 HIV-positive pregnant mothers. For 23 of the 26 fetuses, fetal cord blood samples obtained at birth were negative for HIV RNA. Their findings demonstrated that women with healthy pregnancies who underwent elective CS before labor, at 38-40 weeks of gestation, almost all gave birth to HIV free children (2005 p.488).
The last thing to do to prevent mother to child transmission of HIV is to bottle feed and to not breast feed. There is a high risk of transmission of HIV through breast milk. Though it is healthy for mothers to give their child the first milk, which is colostrum, with HIV-positive mothers the risks outweigh the benefits. Since HIV can pass through breast milk, it is safest for HIV-positive mothers not to breast feed (Boston Women’s Health Book Collective 2005 p.304). More than one-third of all MTCT of HIV in breast-feeding population is estimated to occur via breast milk (Rousseau 2004 p.1880). During 1992-1998, a randomized clinical trial was conducted of breast feeding versus formula feeding in infants of HIV-infected mothers in Nairobi, Kenya, and found the frequency of breast milk transmission to be 16%. MTCT of HIV through breast feeding led to 44% of infants being infected (Richardson 2003 p.736). In 1998, United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) revised their guidelines on feeding infants of HIV-positive mothers in developing countries. Previously breast feeding was recommended for all mothers including HIV-positive mothers. Now with more understanding of disease HIV the revised guidelines recommend “avoidance of breast feeding” to prevent MTCT of HIV even in the developing countries (Whitney 2001 p.244).
In the absence of interventions, the rate of mother to child transmission of HIV is 15-25% in Europe and the United States and 25-40% in Africa and Asia. WHO estimated that, in 2002, HIV-infected children accounted for 10% of the infections in developing countries. Perinatal transmission accounts for more than 90% of HIV infections in infants and children, and it is also responsible for almost all new HIV infections in preadolescent children (Mohlala 2005 p.488). MTCT of HIV is a complex process that can occur while the fetus is in utero, during
delivery of the infant, or through breast feeding (Richardson 2003 p.736). The first thing to do to reduce the risk of mother to child transmission of the disease pregnant mothers should take antiretroviral medications. Second, pregnant mothers need to have a cesarean section delivery. Last, mothers should bottle feed their babies and not breast feed.

Reference Page
Center for Disease Control and Prevention. (October 2007). Mother-to-child (perinatal)HIV transmission and prevention. CDC HIV/AIDS Fact sheet. Retrieved November 17, 2007 from http//:www.cdc.gov.
Kirshenbaum, S., Hirky, E., Correale, J., Goldstein, R., Johnson, M., Rotheramborus, J., et al. (2004). Throwing the dice: Pregnancy decision-making among HIV-positive women in four U.S. cities. Perspectives on Sexual and Reproductive Health, 36 (4), 106-113. Retrieved on November 12, 2007 from CINAHL database.
Mohlala, B., Tucker, T., Besser, M., Williamson, C., Yeats, J., Smit, L., et al. (August 2005). Investigation of HIV in amniotic fluid from HIV-infected pregnant women at full term. The Journal of Infectious Diseases, 192, 488-491. Retrieved on October 28, 2007 from CINAHL database.

Richardson, B., John-Stewart, G., Hughes, J., Nduati, R., Mbori-Ngacha, D., Overbaugh, J., et al. (March 2003). Breast-milk infectivity in human immunodeficiency virus type1-infected mothers. The Journal of Infectious Diseases, 187, 736-740. Retrieved on November 20, 2007 from CINAHL database.

Rousseau, C., Nduati, R., Richardson, B., John-Stewart, G., Mbori-Ngacha, D., Kreiss, J., et al. (November 2004). Association of levels of HIV-1-infected breast milk cells and risk of mother-to-child transmission. The Journal of Infectious Diseases, 190, 1880-1888. Retrieved on November 2, 2007 from CINAHL database.

The Boston Women’s Health Book Collective. (2005). Our bodies, ourselves. New York: Simon & Schuster.

Walensky, R., Paltiel, A., Losina, E., Mercincavage, L., Schackman, B., Sax, P., et al. (July 2006). The survival benefits of AIDS treatment in the United States. The Journal of Infectious Diseases, 194, 11-19. Retrieved on November 2, 2007 from CINAHL database.
Whitney, E., Cataldo, C., DeBruyne, L., Rolfes, S..(2001). Nutrition for health and health care. California: Peter Marshall
Socioeconomic status is a barrier to bottle feeding instead of breast feeding. Baby formula is very expensive and many low income mothers can not afford it. Instead it is very cost effective for them to breast feed because it doesn’t cost anything and it is easy to access. Also, in many third world countries, like Africa they do not have access to clean water and using the water they have with formula will make their child very sick. In America we have running water to almost every building but in other countries the women have to walk miles to just get water. Walking to get water is not feasible when you have a crying child. Cesarean sections(c-section) are very expensive and if you don’t have insurance most people can’t afford it. In many third world countries there is no choice but to have the baby vaginally because they have very limited resources when it comes to doctors and nurses.


A. Cesarean delivery instead of vaginal delivery

I. Infection of the abdominal incision.
1. Being a mother brings many obstacles and is life changing. Just to take care of the baby is an all day job but then if you have a c-section you have a huge abdominal incision. The incision is painful and requires you to not lift heavy things like the baby and to not twist your body. This makes it very difficult to take care of the babies day-to-day needs. Also, the incision has many potential problems like infection. Taken care of properly the incision can heal nicely but taken care of in an unclean way is very dangerous and will cause an infection which will cause a delay in healing.
2. “Numerous factors have the potential to delay healing and cause infection. These should be identified as early as possible, ideally pre-operatively, to optimize post-op care and recovery. Over a period of 35 weeks, data was collected from 715 women undergoing c-section. Of these 80 developed surgical incision infections and for 57 symptoms were not identified until after discharged(Gould 2007).”

II. Obesity
1. A major problem in America is obesity. Being obese and pregnant puts you at high risk for surgical site infections after c-sections. Due to the excess belly fat it is hard for the incision site to heal due to the extra fat and weight.
2. “Obesity has been associated with a higher rate of infections after c-sections. It puts greater mechanical stress on the wound and this delays healing, even when there is no sign of infection(Gould 2007).”


B. Bottle feeding instead of breast feeding

I. No weight reduction
1. Breast feeding helps mothers to take off the weight they gained to conceive the baby. Many women fear getting pregnant just because they do not want to gain weight. Let’s face it we live in a world where beautiful means being a size 0-5 so many women have a hard time choosing to have a baby so if they do they want to breast feed right away to help lose the weight.
2. “Believing that breast feeding allow mothers to get back their figure more easily and protects from breast cancer is linked to the choice to breast feed. Indeed, mothers that breast feed return faster to pre-pregnancy weights and may be protected from developing breast cancer (Chabrol etal).”

II. Bad, unmoral mothers
1. Breast feeding is a healthy, bonding experience for mother to child. So mothers who do not breast feed are seen as depriving their child what they need. Many mothers are seen as uncaring and lazy if they don’t breast feed. The first day of colostrum is very boosting to the babies immune system but beyond that there a very few differences with bottle or breast feeding.
2. “The relationship between the moral reasoning factor and bottle feeding may reflect guilt in the mother if she doesn’t breast feed. It was found that many mothers associate bottle feeding with feelings of guilt and failure. Many mothers feel an obligation to breast feed or to be a perfect mother. They also may feel inadequate or fear of failure to breast feed (Chabrol etal).”

References
Chabrol, H., Walburg, V., Teissedre, F., Armitage, J., & Santrisse, K. (2004) Influence of Mother’s Perceptions on the Choice to Breast Feed or Bottle Feed: Perceptions and feeding choice. Journal of reproductive and infant psychology 22:3 August 2004 pgs.189-198. Retrieved Jan. 30, 2008 from cinahl database

Gould, D. (2007) Cesarean Section, Surgical Site Infection and Wound Management. Nursing Standard 21:32 April 2007 pgs.57-66. Retrieved Jan. 30, 2008 from cinahl database