What Mothers Living with HIV Should Know about Safe Delivery and Newborn Care

The main concern of all mothers living with HIV is the health of their babies. The good news is that they can have a safe pregnancy and a healthy baby if they follow medical advice carefully. They owe this miracle to modern medicine and the advances made in this field.

The HIV-positive mothers who want a safe and easy pregnancy must be careful of their choices, take medical tests and checkups regularly, and follow the medical protocols just as ordered. In this article by Raadina Health, we have explained the best delivery type for HIV-positive mothers, how the C-section affects their bodies, when the baby should receive vaccines, and more.

Vaginal Delivery or C-section: Which One Is Better for HIV-Positive Mothers?

The type of delivery for women living with HIV depends on their viral load.

• Low viral load = Vaginal delivery

If the mother’s viral load gets so low that it cannot be detected on her blood test, she can have a vaginal delivery. Of course, it only happens if she undergoes antiretroviral therapy (ART) before and during the pregnancy. When the viral load is controlled, the risk of transmission during vaginal delivery is less than %1.

Note that vaginal birth has many benefits, such as a low risk of surgical infection, fast recovery, fewer anesthesia complications, and a shorter hospital stay. That’s why many women prefer it over a C-section.

• High viral load = C-section

Doctors usually recommend a C–section if:

• The mother’s viral load is above the standard level.
• She started the antiretroviral treatment late.
• Her clinical condition is unstable.

In a C-section, the baby has less direct contact with the mother’s blood and body fluids, which can reduce the risk of transmission by up to %50 compared to vaginal delivery. Doctors usually perform the C-section at week 38 of pregnancy to make sure the baby is well-developed inside the womb.

Complications of C-Section in HIV-Positive Mothers

Although a C-section can reduce the risk of passing HIV from mother to baby, it may have some risks and side effects for the mother, including:

• The surgical site might become infected after the operation.
•  Bleeding is usually heavier than in vaginal delivery.
• Its recovery time is longer compared to a natural delivery.
• The risk of uterine adhesions in future pregnancies is high.
• In rare cases, the mother might face anesthesia complications, such as dizziness, headache, and nausea.
• She must stay a bit longer in the hospital to be monitored by the healthcare staff. Women who undergo vaginal delivery usually go home within 24 hours.  

When Is the Newborn Tested for HIV?

Diagnosing HIV in newborns is more complex than in adults because the mother’s antibodies remain in the baby’s body for several months and may affect antibody test results. Therefore, instead of antibody tests, a molecular test called PCR (polymerase chain reaction) is used. This test has a higher accuracy and is more reliable.

The newborn is tested during these times:

• First test: 14 to 21 days after birth
• Second test: 1 to 2 months after birth
• Final test: 4 to 6 months after birth

If the baby has negative results in at least two tests, it is very likely that he/she is not infected.

When Should HIV-Exposed Babies Receive Vaccines?

Babies born to mothers living with HIV should receive the necessary vaccines (like measles, rubella, tetanus, and meningitis), just like other babies. However, depending on the baby’s health condition, the doctor may adjust the type of vaccine or the timing.

If the baby’s HIV test is not positive, he/she should get vaccines such as polio, hepatitis B, diphtheria, tetanus, and pertussis (whooping cough) according to the standard schedule. If the baby’s tests are positive for HIV or they have immunocompromised disease (severely weakened immune system), the medical team will make a careful decision about giving live vaccines such as BCG.

Follow-Up Care for Newborns

The HIV-exposed babies should be monitored more frequently than other children. As mentioned earlier, the doctor takes viral tests at specific times to check whether they are infected. All babies born to mothers with HIV receive antiretroviral medicines for 6 to 12 weeks after birth, even if their test results are negative. Depending on the baby’s condition and the mother’s viral load, this treatment may continue a bit longer.

Moreover, the infant's physical development should be checked regularly. This includes monitoring their height, weight, head circumference, and brain and cognitive development. By doing so, the doctor can detect the problems early and treat them in time. In some cases, the doctor orders additional tests to check the baby’s liver function, anemia, or possible side effects of medications.

How HIV-Positive Mothers Feel after Delivery

Studies show that women living with HIV have a mix of emotions after giving birth, from happiness to worry about their baby’s health. In fact, many of these women are more concerned about their child’s health than their own. Emotional and psychological support from their friends, family, and especially from their partners, is very important during this time. This period can be stressful, and mothers may need to spend more time and energy on medical follow-ups. If they get enough information about their body and the baby’s health, they can go through this stage with more confidence and less stress.

Postpartum Care for HIV Mothers and Their Babies

After delivery, both the mother and the baby need special care. Here are a few tips that might help:

• The mother’s viral load should be checked regularly.
• The antiretroviral treatment must continue exactly as ordered by the doctor.
• Mothers should consult a specialist about how to feed their baby. In many cases, the mother is asked to feed the baby with formula because breastfeeding can increase the risk of mother-to-child transmission.
• Mothers should visit their infectious disease specialist and obstetrician regularly to check their overall health.
• Visiting a psychologist or psychiatrist can help reduce postpartum anxiety and depression.
• Babies should take tests and receive vaccinations based on a fixed schedule.
• The mother should give her newborn the preventive medications from the first days after birth.
• The infant’s physical growth and neurological/cognitive development should be monitored carefully. If the doctor detects an abnormality, the treatment must be started immediately.

The Last Note

Thanks to modern medicines and advances in medical science, women living with HIV can now have a safe pregnancy and give birth to healthy babies. The important factors that reduce the risk of mother-to-child transmission to less than %1 are early diagnosis of HIV, finding the right treatments for the infected mother and her infant, choosing the right delivery method, and regular checkups.

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FAQs

1) Can an HIV-positive mother give birth to a healthy baby?

Yes. If she follows all the necessary medical advice, the risk of transmission from mother to baby will be almost zero.

2) Is vaginal delivery dangerous for mothers with HIV?

If the mother’s viral load is controlled, she can have a safe vaginal delivery; otherwise, she should undergo a C-section.

3) How long does an HIV-exposed baby need medical care?

Usually, the baby should be monitored for six months after birth, or until doctors are sure that he/she is totally healthy.