HIV Positive: Caesarean or natural birth?
Did you know that before ARVS, an expectant woman found to be HIV positive was advised against carrying her baby to term? They were advised to terminate the foetus as soon as possible or risk losing their lives and/or bringing forth a HIV positive baby. Surprised? Well I found out why.
Pregnancy in itself is an immune suppressant. This means that expectant mothers are prone to more infections. According to Dr. Edmond Barasa an obstetrics/ gynae in Nairobi, pregnancy exposes women to a variety of infections such as candidiasis, malaria, the common cold and many more diseases that are infectious. In an HIV negative individual, an illness is just an illness, which the body organises to fight off. In people living positively, any illness is an opportunistic infection and therefore a big threat to the immune system. So why was it advisable back then for HIV positive women to abort their babies?
Dr. Barasa explains that having HIV and carrying a pregnancy to full term without any medical interventions could bring the mother’s immunity down very fast resulting in full-blown AIDS and an HIV positive baby. However, thanks to ARVS and the Prevention of Mother to Child Infections (PMTCT), we can tell a different story.
In the PMTCT programme, one of the biggest interventions is to prevent HIV infection to the unborn baby at birth. During the routine antenatal visits, HIV positive mothers are advised to consider a caesarean section as opposed to natural birth to minimize the chances of the virus transmitting to the baby during birth. However, natural birth is still an option with several factors in check. Dr. Barasa explains that these factors include CD4 levels and viral load. If the viral load is undetectable, chances that a baby will get HIV during birth are minimal. However, if the mother has full-blown AIDS, or is suffering opportunistic infections especially of the genital area, vaginal birth is discouraged.
I met Lucy Akinyi at the Pumwani Maternity Hospital. Lucy is the proud mother of three-year-old twin girls.
She found out that she was HIV positive when she was expecting the girls. That was her second pregnancy. With PMTCT, her daughters are totally healthy and free of HIV. She says, ‘Saa hii ningekuwa na watoto watatu lakini yule wa kwanza kijana alikufa.’ (I would be having three children now, but I lost my first son).
She recounts that she gave birth to the boy in the house since she did not have money to go to hospital. Six weeks later, the baby was sick with pneumonia coupled with many other infections and eventually died from a severe pneumonia attack in January 2003.
When she found out that she was pregnant a second time, she decided to attend the antenatal clinics for fear of losing her baby again. She attended Pumwani Maternity Hospital for her clinics. That is how she found out about her HIV status. She was put on the PMTCT programme immediately.
She says, ‘Nilifanyiwa counseling, nikapewa madawa. Sikuwa na otherwise juu nilikuwa naogopa kupoteza mtoto mwingine.’I was counselled and put on ARVS, I didn’t have a choice because I was afraid of losing another baby).
At the onset of labour, she rushed to the hospital where she was given Nevirapine immediately. She gave birth to the first baby 4 hours later and the second just 30 minutes after.
’Daktari alikuwa ameniambia nifikirie juu ya kupasuliwa lakini singeweza juu ya doh.’ (The doctor advised me to consider caesarean but I could not afford it). However, she did not breastfeed her girls, as she was provided with formula milk by the institution for six months.
Though natural birth does not always mean a baby will get HIV from the mother, doctors advice HIV positive mothers to opt for C-s to minimize the chances of mother to child transmission (MTCT). Medical researches have shown that with the three main PMTCT interventions i.e. use of ARVS, caesarean birth and formula feeding, the chances that the baby will be born free of HIV are between 98-100 per cent. In developed countries for example, the rate of MTCT has been lowered to as much as 2-4 per cent thanks to PMTCT.
What form of birth is recommended for an HIV positive mother? Three different doctors had varied answers but they all concluded it is important for a mother to understand the pros and cons of each to make an informed choice. Talk to your doctor today before you make the choice.
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