After Baby Is Born

• After the Baby Is Born
• Feeding Your Baby: Risks and Options
• Tips From the i-Base Guides
• Test and Treatment Records and Notes Pages
• Adherence Support Charts

After the Baby Is Born

What will I need to consider for my own health?

Adherence! This means taking your drugs exactly as prescribed. Your own adherence to your HIV treatment after the baby is born is critical. Many women have excellent adherence during their pregnancy. After the baby is born, however, it is easy to forget your own health.

This is hardly surprising. Having a new baby can be a huge shock and is always unsettling. Your routines will change and you are unlikely to get enough sleep. In serious cases, women can have postnatal depression.

You will need lots of extra support from your family, friends and healthcare team. You may also find a community group very helpful.

Many mothers find the best way to remember to take their own medication is if they link it to the dosing schedule of their new baby. So if your baby has two doses a day and you have two doses, make sure that they are taken at the same time.

Adherence Support Charts are charts to help you and your baby in the first 6 weeks.

The i-Base booklet Introduction to Combination Therapy has tips to help you with adherence.

How and when will I know that my baby is HIV-negative?

Babies born to HIV-positive mothers will always test HIV-positive at first if the usual antibody tests are used. This is because they share their mum's antibodies. If your baby is not infected with HIV these will gradually disappear. This can sometimes take as long as 18 months.

The best test for HIV in babies is very similar to a viral load test. Called an HIV PCR DNA test, it looks for virus in the baby's blood rather than at immune responses.

Good practice in the UK is to test babies the day they are born, and then when they are one month and three months old.

If all these tests are negative, and you are not breastfeeding your baby, then your baby is not HIV-positive.

You will also be told that your baby no longer has your antibodies when he or she is 18 months old. This exciting milestone is called seroreversion.

Will my baby need to take HIV drugs after he/she is born?

Your baby will need to take HIV drugs for probably four to six weeks following his or her birth.

The most likely drug will be AZT, which must be taken twice a day. In a few cases your baby may be given another drug or combination therapy if you are resistant to AZT.

As we suggested earlier, try and co-ordinate the baby's prophylaxis treatment with your own treatment schedule.

Will I need to use contraception after the baby is born?

To check the baby is HIV-negative HIV PCR DNA -- a polymerase chain reaction (PCR) test is a highly sensitive test that detects tiny amounts of HIV DNA in blood plasma. The test will "amplify" or multiply HIV DNA in the test tube so that it can be more easily detected.

You will be given advice on contraception after your baby is born.

It is possible that resuming or beginning oral contraception will not be recommended if you began using anti-HIV drugs in pregnancy. This is because some HIV drugs can reduce the levels of some oral contraceptives, which means they would not be foolproof birth control.

Please make sure your doctor knows about this and can advise you.

Feeding Your Baby: Risks and Options

There is also a risk of transmitting HIV from mother-to-baby via breast milk.

HIV-positive mothers living in industrialised countries can easily avoid this by using bottles and formula milk.

Bottle-feeding and free formula milk

Bottle-feeding is currently strongly recommended for all HIV-positive mothers.

After doing all the right things during pregnancy and delivery, you will not want to risk your baby's health now by breastfeeding.

If you cannot afford the formula, bottles and sterilising equipment can be provided by your hospital so that you do not need to breastfeed. But schemes vary from clinic to clinic.

Your midwife should discuss whether you need this extra support as part of your discharge package when you leave the hospital with your baby.

Medical treatment and provision of formula milk will be in confidence. Please make sure that you take advantage of this if you need to. None of the people who work at the hospital or support workers will have any connection whatsoever with the immigration department.

Can I breastfeed occasionally?

It is very strongly recommended that you do not breastfeed occasionally. In fact, one study showed that "mixed feeding" may carry an even higher transmission risk than if you breastfeed exclusively.

Sometimes people ask me why I do not breastfeed

Sometimes mothers can be worried that being seen to be bottle-feeding will identify them as HIV-positive.

It is up to you whether or not you tell anyone that you are HIV-positive.

If you do not wish to tell anyone that you are breastfeeding because you are positive, your doctor or midwife can help you with reasons to explain why you are bottlefeeding. For example, you can say you have cracked nipples or that the milk didn't come, both of which are common.

You are NOT a bad mother if you do not breastfeed.

Tips From the i-Base Guides

The following tips are taken from the i-Base booklets Introduction to Combination Therapy and Guide to Avoiding and Managing Side Effects. Both guides are available free by calling 020 7407 8488.

Tips to help adherence

First of all, get all the information on what you will need to do before you start treatment:

• How many tablets?
• How often do you need to take them?
• How exact do you have to be with timing?
• Are there food or storage restrictions?
• Are there easier choices?

Additional tips for once you begin treatment

• Use the charts below to plan your timetable. Use them to get used to the routine. For the first few weeks mark off each dose and the time that you took it. You can also use this to link your routine to your new baby's.
• Divide up your day's drugs each morning and use a pillbox. Then you can always check whether you have missed a dose.
• Take extra drugs if you go away for a few days.
• Keep a small supply where you may need them in an emergency. For example, in your car, at work or at a friend's.
• Get friends to help you remember difficult dose times or when you go out at night.
• Ask people already on treatment what they do. How well are they managing? Most treatment centres can arrange for you to talk to someone who is already taking the same treatment if you think that would help.

Make sure that you contact your hospital or clinic if you have serious difficulties with side effects. Staff members there can help and discuss switching treatment if necessary.

Tips to help with morning sickness or drug-associated nausea

• Eat smaller meals and snack more frequently rather than eating just a few larger meals.
• Try to eat more bland foods. Avoid foods that are spicy, greasy or strong smelling.
• Leave some dry crackers by your bed. Eat one or two before you get up in the morning.
• Ginger can be helpful. It can be used in capsule or as ginger root powder. Fresh root ginger peeled and steeped in hot water can help.
• If cooking smells bother you, then open the windows while cooking. Keep the room well ventilated. Microwave meals prepare food quickly and with minimum smells. They also help you eat a meal as soon as you feel hungry. Getting someone else to prepare your meals can help.
• Don't eat in a room that is stuffy or that has lingering cooking smells.
• Eat meals at a table rather than lying down. Don't lie down immediately after eating.
• Try not to drink with your meal or straight after. It is better to wait an hour and then sip drinks. It is important for pregnant women not to become dehydrated though so do remember to drink outside mealtimes.
• Try eating cold rather than hot food. Or let hot food cool well before you eat it.
• Peppermint is also useful. It can be taken in tea or in chewing gum.

Test and Treatment Records and Notes Pages

CD4 and viral load results

These blood tests are used to monitor your health and your response to treatment.

CD4 count -- This blood test checks your immune system

CD4% -- This is similar to the CD4 count but is often more stable

Viral load -- This test measures the amount of HIV in a sample of blood. It is used to decide when you need to start treatment, and whether the treatment is working effectively.

Even rough figures are useful from your previous history and your doctor can provide you with these.

The lowest CD4 count and highest viral load results when you were first diagnosed and before you started treatment are the most important.

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Antiretroviral treatment

Your choice of new and future drugs will depend on the drugs you have used in the past and the reason you stopped using them.

It is important to know whether this was because of resistance or side effects.

If you can't remember exact details, even rough dates are useful (ie taking AZT for 6 months in 1992 etc).

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Adherence Support Charts

Schedule Planner

Use the top chart to plan your pill timetable with your doctor, nurse or pharmacist. Use shading to indicate when you mustn't eat if you are using ddI without tenofovir or indinavir without ritonavir; and meal times for drugs you have to take with food such as lopinavir/r (Kaletra), nelfinavir, ritonavir, saquinavir, atazanavir and tenofovir.

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Adherence check

Once you have worked out a daily regimen above use the table below to mark off each dose after taking it for the first few weeks. Write the name of the drug and the time you need to take it in the top boxes. Use a different box for each drug. Then tick off the dose and write the time you took the dose in the sections underneath. Use a photocopy, or draw a new version yourself to use for the second and third weeks or if you need a larger table. This will help you know how well you are doing and this will be helpful when you next see your doctor.

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