30 Something Baby Doc

Of course you would! That's a ignorant question, right? Then why do so many HIV positive pregnant mothers do nothing to aid in the prevention of HIV in their unborn child. Analysis of data from fifteen studies in more than 8500 non-breastfeeding mothers and their children demonstrated that elective cesarean section prior to labor decreased the likelihood of prenatal HIV transmission by about 50 percent. The combination of elective (planned) cesarean section and therapy with ZDV (an antiviral medication) (ie, during pregnancy and labor and in the newborn) reduced HIV transmission by approximately 85 percent when compared to other methods of delivery and no administration of antiretroviral agents.

Several times a year pregnant mothers who have been previously diagnosed with HIV show up to our hospital in labor without any prenatal care whatsoever. Many of the women know the risk of vertical transmission (from the mom to the baby) can be reduced significantly but still make no attempt to seek appropriate prenatal care.

When HIV positive patients present to us in advanced labor like this, it then becomes necessary to perform and urgent C/S (cesarean section) to decrease the transmission risk. A C/S under these rushed circumstances increases the chance of a needle stick or blood splashing and places the providers under greater risk. A planned and controlled C/S before labor in a women receiving appropriate prenatal care and antiviral medication would be the optimal situation.

How should we respond to these patients that knowingly avoid intervention that could prevent HIV in their newborn child? Should we treat this situation as we would if it were maternal drug abuse in pregnancy? Is this a form of child abuse and neglect? Should we involve child protective services and separate the child from the mother? Should we encourage criminal prosecution of the mother in these situations? I wish I had the answers to a situation I unfortunately see more often than I would like.