|October 30, 2002|
Volume 4, Issue 35
|Midwifery Today E-News|
“HIV & Breastfeeding, an Update”
|Subscribe • Print Page|
Search Archive • Index
E-News is free! Pass it on to your friends and colleagues.
This issue is sponsored by:
Midwifery Today Conferences
Learn about the Dutch model of midwifery.
Get the full program online. A two-day midwifery education conference precedes three days of international conferencing.
Please note that only walk-in registrations are now being accepted.
Worried about prolonged labor? Concerned about shoulder dystocia? Attend the Eugene 2003 conference.
"Midwifery: With Woman"
THIS WEEK'S ISSUE
Send responses to newsletter items to firstname.lastname@example.org
Quote of the Week
"Research has shone bright lights on what women have always known: Dynamic systems are sensitive to start-up conditions. Thus, a gentle birth is life enhancing for the human organism."
- Robin Lim
The Art of Midwifery
I find the double-hip squeeze to be very effective at relieving back pain and discomfort at the end of latent stage and transition. Hot rice socks and cold back wraps are also sought-after comfort measures. The lap squat is great for supporting moms without tiring their bodies.
- KarieAnn, doula
Share your midwifery arts with E-News readers! Send your favorite tricks to email@example.com.
A study of British children suggests that women who have an infection or take antibiotics during pregnancy are more likely to have a child with an allergy-related condition such as asthma, hay fever or eczema. Researchers at the University of Nottingham evaluated the medical records of nearly 25,000 British children and their mothers. The study found that children exposed to antibiotics in the womb had a higher risk of developing asthma, hay fever and eczema than did children whose mothers did not take the medication during pregnancy. Because a person's immune system develops while he or she is still in the womb, some experts speculate that factors that modify microbial exposure at this time may have a long-term effect on the risk of developing allergic disease.
- Amer. J. Respiratory and Critical Care Med.,
HIV and Breastfeeding: An Update
At the International AIDS 2002 conference, breastfeeding by HIV-positive mothers received much attention in the maternal to child transmission (MTCT) discussions. According to figures published by the Centers for Disease Control (CDC), every day about 800 infants worldwide are infected with HIV via breastmilk. Moreover, bottlefeeding as a replacement feeding method can result in mortality of 2.5 to 20%.
Several HIV transmission-prevention approaches were discussed besides not breastfeeding. One approach is to give babies uninfected at birth prophylactic antiretroviral medication for the duration of breastfeeding. Nevaripine, an inexpensive drug for intrapartum prophylaxis for MTCT, will be given to infants in trials in South Africa. This means that 100 babies will be exposed to the drug to prevent 14 to 15 from acquiring HIV if the nevaripine as a single drug is effective. At present, the long-term adverse effects of the drug on infants are unknown.
Another approach is to treat the breastfeeding HIV-positive mother with highly active antiretroviral therapy (HAART), a combination of three antiretroviral drugs, to decrease the amount of virus in her blood and theoretically in her breastmilk. This approach will also treat the HIV infection in the mother, and if HAART is continued after weaning at 6 months, the treatment may allow her to live longer to raise her child. The amount of the drug exposure through breastmilk is presumably less than if the drugs were given directly to the infant. The main question is whether the drug exposure causes adverse effects in the babies. Again, 100 babies are exposed to possible adverse drug effects to prevent 15 from acquiring HIV. Some data are available for effects of some antiretrovirals on children whose mothers took the drugs during pregnancy. Children of mothers in the 076 trials (stopped in 1994) and exposed to zidovudine are 8 to 10 years old now. Documents available on the Web from the CDC (www.cdc.gov/hiv) give a good summary of what is already known about sequelae from in utero exposure and drug exposure of HIV-positive infants. The CDC is sponsoring studies in Kenya, Malawi and Thailand. WHO/UNAIDS is supporting research at multiple sites in Africa.
Another approach is pasteurization of expressed breastmilk. A small study of four women in Tanzania resulted in four healthy babies at the end of one year. A solar-powered device was developed that can pasteurize any kind of milk without power (wood fire, electricity or gas). This study was presented at the international AIDS conference 2000 in Durban; no further formal discussion about it took place at Barcelona.
Other approaches that were given less attention were trials of active and passive vaccines given to infants, exclusive breastfeeding, early abrupt weaning and various combinations. In Durban, South Africa, an ongoing study is following up on exclusive breastfeeding. In Zambia, an ongoing trial is comparing abrupt versus gradual weaning and the effect on transmission rates.
In my earlier report [E-News 4:22, May 29, 2002] I more fully discussed the study of exclusive breastfeeding and HIV. The results show that at six months infants breastfed exclusively for three months or more have no greater risk of HIV infection than those never breastfed—19.4% in both groups (neither mother or baby received antiretrovirals antepartum, intrapartum or postpartum.) Infants who had mixed feeding of breastmilk and other fluids or formula or foods had a higher risk of infection (24.7%). This is a small study; more research must be done to confirm or refute this data.
In the meantime the WHO, UNAIDS, UNICEF current policies for infant feeding remain as follows: Exclusive breastfeeding should be promoted, protected and supported for six months for women who are known to be HIV negative and whose HIV status is unknown. For HIV-positive women, the use of breastmilk substitutes is recommended where "acceptable, feasible, affordable, sustainable and safe"; otherwise exclusive breastfeeding is recommended for the first six months.
In spite of the fact that all of the trials previously cited are reviewed and approved by US interhospital review boards, I am still saddened that it is African women who are again being asked to take the risks for themselves and their infants to gather information that will benefit women and babies all over the world. Blessings to these women and their babies who will give us more information about this very important issue.
A Web site with good general information about HIV & breastfeeding is linkagesproject.org/pubs.html.
- Nancy Miller, CNM
La Leche League Statement on HIV and Breastfeeding
La Leche League International acknowledges the worldwide challenge of making informed infant feeding decisions when HIV transmission is a consideration. Parents and healthcare providers are urged to weigh the well-known, documented health and emotional benefits of human milk and breastfeeding for both mother and child against the known, documented health hazards of breastmilk substitutes, the rates of childhood illness and death from infectious diseases in the mother's area of the world, and the incomplete understanding of the risk of HIV transmission through human milk. La Leche League International challenges the scientific community to undertake the research necessary to fully define the role of breastfeeding and human milk in HIV transmission and infant protection.
In general, for women who know they are HIV positive and where infant mortality is high, exclusive breastfeeding may result in fewer infant deaths than feeding breastmilk substitutes and remains the preferred feeding approach. While breastfeeding where infant mortality is low may also carry a risk of HIV transmission for infants whose mothers test HIV positive, there is no clear, published evidence that feeding breastmilk substitutes results in lower infant morbidity and mortality in any infants. The social costs of not breastfeeding also must be considered. When a woman gives breastmilk substitutes in a culture where breastfeeding is traditional, her community may suspect that she is HIV positive, potentially putting her at risk for physical abuse, ostracism and abandonment. In most parts of the world women do not know their HIV status, therefore ongoing support of exclusive breastfeeding is most appropriate and much needed.
While current scientific thinking accepts a risk of vertical transmission with breastfeeding in general, research studies that fully define the role of breastfeeding patterns (particularly exclusive breastfeeding and optimal breastfeeding management) and related maternal and child health on HIV transmission have not yet been done. LLLI is not making a recommendation about breastfeeding for HIV-positive mothers at this time due to the inconclusive nature of the research and its various interpretations.
Please support our sponsors
"Doulas help families create happy memories...one birth at a time" according to a bumper sticker. If you have a heart for laboring women and families, train to be a doula. Bring emotional, informational and comfort support to birthing families. Learn hands-on techniques to assist families in birth. Attend a DONA-approved doula training November 21-23 in Davenport, Iowa. Contact Debbie Young at 1-866-941-5222 or firstname.lastname@example.org.
Bargains & Specials!
Limited-time offers for E-News Readers
Save $25 on your Netherlands conference registration! Just mention code 1926 when you register.
Note: Only walk-in registrations are now being accepted.
For more information, go here.
Save on Midwifery Today products and more! Take advantage of the savings in the Online Holiday Pack.
Other Products and Services of Interest
CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME
INTERNATIONAL ALLIANCE OF MIDWIVES
Forum Talk: Marketing Your Midwifery Business
I'm curious about how and if other midwives market their practices. I currently have an ad in one of our local alternative publications. I also have a Web site. I have attached my business cards to free pregnancy tests. I use the Citizens for Midwifery "Midwifery Model of Care" brochure with my business card attached on the back as my main method for leaving information in places. I encourage my homebirth clients to place their baby's birth announcement in the local paper. Any other ideas? I'm thinking about teaming up with a doula friend and doing a childbirth information night with videos on doulas and homebirth. Have any of you done this? Suggestions, ideas?
- Pamela, CPM, LM
To share your thoughts and experience, go to Midwifery Today's Forums.
Please support our sponsors
CERTIFIED NURSE MIDWIFE
|United States||1 year||$50|
|Canada / Mexico||1 year||$60|
|Other countries||1 year||$75|
Subscribe online: www.midwiferytoday.com/products/Sub.htm
Inquiries: email@example.com or call 800-743-0974
How to order our products mentioned in this issue:
Secure online shopping
We accept Visa and MasterCard at the Midwifery Today Storefront.
Order by postal mail
We accept Visa; MasterCard; and check or money order in U.S. funds.
Midwifery Today, Inc.
PO Box 2672
Eugene, OR 97402, USA
Order by phone or fax
We accept Visa and MasterCard.
Phone (U.S. and Canada; orders only): 1-800-743-0974
Phone (worldwide): +1 541-344-7438
Fax: +1 541-344-1422
E-News subscription questions or problems
Editorial submissions, questions or comments for E-News
Editorial for print magazine
For all other matters
All questions and comments submitted to Midwifery Today E-News become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today Web site.
This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.
Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.
The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.
© 2002 Midwifery Today, Inc. All Rights Reserved.