It include the Defination of MTCT, risk of MTCT through breastfeeding, and feeding option to reduce MTCT

2. Breastfeeding among HIV
positive or HIV unknown
mother
Prepared by :
Kalpana Kawan
BNS 2nd year
Roll no. - 06

3. General objective
At the end of session, the Bsc Nursing 3rd year student's will be able to
explain about 'breastfeeding among HIV positive or HIV unknown
mothers. '

4. Specific objectives
• define Mother to child transmission of HIV
• list the estimated risk and timing of MTCT in the absence of
intervention.
• state the risk of HIV transmission through breastfeeding
• describe breastfeeding among HIV positive or HIV unknown mother.

5. MTCT
• Mother-to-child transmission of HIV (MTCT) is the transmission of
HIV from an infected mother to her baby during pregnancy, labour and
delivery and breastfeeding
• Also known as “vertical transmission” or “perinatal transmission”
• Most children with HIV acquired the virus through MTCT

6. MTCT
•MTCT can occur during
• Pregnancy or antenatal
- In utero by transplacental passage
• Labour and delivery(the most
common way babies get infected)
• - Exposure to maternal blood
and vaginal secretions during
labor and delivery.
• Post natal- Postpartum through
breastfeeding.

7. Contd.......
• Breast milk is the best food for newborns. It acts as a first vaccine to
the baby.
• Those who do not receive breast milk have much greater risk of dying
from other infections in the 1st 2 months of life.
• HIV in breast milk does not transfer as easily to the baby as HIV in
blood or other body fluids. Only 1 out of 7 HIV positive mothers who
breastfeed will infect their babies through breastfeeding.

8. Estimated risk and timing of MTCT in the
absence of interventions
Timing Transmission rate
• During pregnancy - 5–10%
• During labour and delivery - 10–15%
• During breastfeeding - 5–20%
• Overall without breastfeeding -15–25%
• Overall with breastfeeding to six months - 20–35%
• Overall with breastfeeding to 18–24 months - 30–45%
Note: Rates vary because of differences in population characteristics
such as maternal CD4+ cell counts, RNA viral load and duration of
breastfeeding.

9. HIV-Exposed Infant Outcomes
100 infants born to HIV-
infected women who
breastfeed, without any
interventions
55- 80 infants will
not be HIV infected
5- 10
Infants
infected
during
pregnancy
5-20
infants
infected
during
breast
feeding
10-15
infants
infected
during
labour and
delivery
20 - 45 infants will be HIV -infected
here BF is
mixed
feeding up to
24 months

10. Risk of HIV transmission through
breastfeeding(PMTCT)
 HIV in breast milk does not transfer as easily to the baby as HIV in
blood or other body fluids.
 Only about 15%HIV positive mothers who breastfeed will infect their
babies through breastfeeding.

11. Contd......
The risk of HIV transmission is more
 Maternal factors
• Maternal seroconversion during breastfeeding
• High viral load
• poor maternal nutritional status
• If a mother becomes infected while breast feeding

12. Contd....
• If there are problems or infections such as mastitis or cracked nipples
in the mother.(breast health)
• If the mother shows signs of AIDS.
Infants factors
• Duration of infant feeding- Longer duration of breastfeeding (the
longer the period, the greater the risk, as transmission is cumulative)

13. Contd....
• Mode of infant feedng- Mixed feeding (giving water, other liquids, or
solid foods in addition to breastfeeding)
• Integrity of mucus membrane- Mouth disease in the baby (e.g.
thrush or sores) can also lead to maternal nipple thrush and fissures.

14. The risk of HIV transmission is less
• If the baby breastfeeds exclusively.
• If the mother seeks immediate care for cracked nipples or breast
infection
• If the baby is breastfeed for only a few months.
• If the mother and baby are given antiretroviral medication.

15. Breastfeeding among HIV positive or HIV
unknown mother
If a mother known and accept she is HIV positive,
• Inform her about options for feeding with advantages and risk
involve.
• Help her assess her situation and decide which option is the better
for her( breast feed or replacement feeding).
• Support her choice about the breast feeding option for her baby.

16. Infant Feeding recommendations for Mothers who have been
tested for HIV and found to be HIV positive
Women who is HIV
Positive
Breast milk only replacement food only
Exclusive
breast
feeding with
early
weaning
Heat
treating
expressed
breast milk
Having an HIV
negetive
women
breastfeed
the newborn.
Replacement
feeding with
commercial
infant
formula.
Replacement
feeding with
home
modified
animal milk.

17. Contd...........
• WHO and the joint UN Programs on HIV/AIDS and the UN Children
Fund recommends that health workers should give a woman with
information on the risk and benefits of the different feeding options
and then support the woman’s feeding choice

18. Option 1 : Exclusive breastfeeding with early
weaning.

19. Option 1 : Exclusive breastfeeding with early
weaning.
• Exclusive breastfeeding means giving only breast milk and no other
drinks or foods, not even water , with the exception of drops or
syrups consisting of vitamins, mineral supplements, or medicines to
the baby.
• Breastfeeding is stopped as soon as the baby can be weaned to a
nutritionally adequate replacement food, which is AFASS criteria.(
Acceptable, Feasible ,affordable,sustainable, and Safe).

20. Contd...
• The baby receives only breast milk for a limited time until AFASS
criteria are met or it becomes safe to give other foods ( about 6
months)

21. Contd......
Benefits:
• Exclusive breastfeeding and early weaning by 6 months reduce the
risk of HIV transmission, compared to mixed feeding.

22. Contd.....
• The mother gives all the benefits of breastfeeding during the critical
early months of life (best food for baby, protection from infection,
supports best growth and development)
• Breast milk is the perfect food for babies and protects from many
diseases, especially diarrhoea and pneumonia and the risk of dying
from these diseases.

23. contd.......
• Breastmilk gives all of the nutritions and water they need. So
breastfeed babies do not need any other liquid or feed.
• Breast milk is free, always available, and does not need any special
preparation.
• Many women breastfeed, so people will not ask why you are doing it.
• breastfeeding helps you recover from childbirth and protects you
from getting pregnant again too soon.

24. Contd......
Risks or Disadvantages
• As long as you breastfeed, your baby is exposed to HIV.
• People may pressure mother to give water, other liquids, or foods to
the baby while you are breastfeeding. This practice , known as mixed
feeding, may increase the risk of diarrhoea and other infections.
• Mother need support to exclusively breastfeed until it is possible to
use another feeding option.

25. Contd.....
• It may be difficult to do if the mother work outside the home and
cannot take the baby with her and if mother get very sick.
• Early weaning creates more work for the mother who must prepare a
breast milk substitute.
• Feeding with a breast milk substitute is expensive.

26. Contd......
• Feeding with a breast milk substitute increases the baby's risk of
other infection and poor nutrition.
• Early weaning is difficult for both mother and baby.The mother
breast will be painfully engorged for a few days; the baby may cry a
lot; and the mother may be very upset.
• AFASS criteria may be difficult to meet.

27. Option 2 : Expressing breast milk and heat
treating it before feeding.

28. Option 2 : Expressing breast milk and heat
treating it before feeding.
Benefits:
• There is almost no risk of transmitting HIV.
• The baby gets nutritional benefits of breast milk although boiling
destroys some properties of breast mik, it is still better for the
newborn than formula prepared from animal milk.
• Breast milk is always available and do not need to buy it.

29. Contd.........
• The risk of infection is less from cup feeding than from bottle feeding.
• Other responsible family members can help feed the baby.

30. Contd......
Risks or Disadvantages:
• Although heated breast milk does not contain HIV, it may not be as
effective as unheated breast milk in protecting the baby from other
diseases, but it is still better than formula.
• The mother need to spend a lot of time expressing breast milk, heat-
treat it, and cleaning the container and cup.

31. Contd......
• The mother must spend money on fuel to heat-treat breast milk
every day.
• Need clean water and soap to wash the baby's cup and the container
used to store the breast milk.
• The breast milk needs to be stored in a cool place and used within an
hour of heating because it could spoil.

32. Contd.....
• The baby may be stigmatized for not breast feeding directly.
• There is cultural barriers to this practice in some countries.
• People may wonder why you are expressing your milk, which could
cause them to suspect that you have HIV.

33. Option 3 : Having an HIV negetive women
breastfeed the newborn (wet nursing)

34. Option 3 : Having an HIV negetive women
breastfeed the newborn (wet nursing)
• A wet nurse is a women who breastfeeds a baby for another women.
• The mother finds a women who tests HIV negetive and is not likely to
be exposed to future HIV infections to breastfeed baby.
.

35. Contd.......
Benefits:
• Breastfeeding by another women gives the baby nearly all the same
protective benefits as breastfeeding with the mother.
• There is no risk of transmitting HIV through feeding.
• The risk of infections from use of a feeding bottle is avoided

36. Contd......
Risks or Disadvantages
• It may be difficult to be sure another person is HIV negetive and stays
negetive.So the wet nurse must be tested for HIV and confirmed to be
HIV negetive.
• The wet nurse must be able to protect herself from HIV the entire
time she is breastfeeding. This means not having sex, using condoms
every time she has sex, or having sex with only one partner who has
also tested HIV- negetive and remain faithful to her.

37. Contd.........
• The mother need to spend focused time with her baby to help their
relationship stay close.
• The wet nurse must be available to breastfeed the baby frequently
throughout the day and night or able to express milk if she and the
baby are seperated.
• It is not always easy to find a women willing to take on the
responsibility of wet nursing.

38. Contd.............
• There are cultural barriers to this practice in some countries.
• People may ask why you are not breastfeeding. This could cause them
to suspect that you have HIV.
• The mother may need to pay the wet nurse.

39. Contd.......
• The mother may be stigmatized for not nursing her own baby.
• If the baby is born with HIV, there is a very small risk that
breastfeeding may transmit the infections to the wet nurse. The risk
is higher if the baby has oral thrush or other mouth lesions, or if the
wet nurse has a cracked, bleeding nipple.
• If the mother does not breastfeed, she loses the child spacing
benefits of breastfeeding ( Mother may get pregnant again too
soon.)

41. Post test

42. Contd........
• Choose the best answer from the given alternatives and circle (O) it.
a) All of the following are options for feeding among HIV positive or HIV
unknown mother Except.......
i) Exclusive breastfeeding with early weaning.
ii) Heat treating expressed breast milk.
iii) Having an another HIV positive women breastfeed the newborn.
iv) Replacement feeding with commercial infant formula.
v) Replacement feeding with home modified animal milk.
Ans: iii)

43. Contd.......
b) Benifits of wet nursing are...................
i) There is no risk of transmitting HIV through feeding.
ii) The risk of infections from use of a feeding bottle is avoided.
iii) Breastfeeding by another women gives the baby nearly all the same
protective benefits as breastfeeding with the mother.
iv) All of the above.
Ans: iv)

44. •Summary

45. Home assignment:
• Read about breastfeeding among HIV positive mother.

46. Plan for next class:
• We will discussed about Role of the health care provider in
counselling an HIV positive mother

47. References
• Prasai( Subedi) D.,"Textbook of Midwifery Nursing(Postpartum
care)part III",Akshav Publication,Kathmandu, 1st edition,2018,page
no. 190-195.
• Prasai (Subedi)D,"Textbook of midwifery Nursing Part I"Medhavi
publication,Jamal,Kantipath,Kathmandu,3rd edition,Jan 2016, Page
no. 502-511.
• Awasthi Sherpa M." Essential Textbook of MIdwifery Nursing Part I"
Samiksha Publication Pvt.Ltd. 1st edition 2074,page no. 354- 356.
• Tuitui R." Manual of Midwifery-C (postnatal)",Vidyarthi Pustak
Bhandar,bhotahity, kathmandu,10th edition,2014,page no.110- 115
• Retrived from https://who.int on 2977/07/28
• Retrived from www.unicef.org on 2077/07/28