Global Midwifery

AIDS, Birth and Women

One of the women in the doula training works at a regional AIDS treatment center. I have recently accepted that I need to devote more of my education time to AIDS, and since I have spent the last month reading The Band Played On for my public health school orientation, I was delighted to talk to her.

We compared treatment strategies for the women and children and were relieved to discover our protocols are the same. I should not have been surprised, much of the AIDS research leads to changes in treatment internationally and although I have not looked it up, I’ll bet the standards are set by the WHO, I just haven’t gotten that far into the research yet.

I asked about birth practices, specifically if the women were encouraged to give birth vaginally. In one of our lectures about women’s health and AIDS the NP explained that the infectious disease doctors agree there is less risk of transmission of HIV to the baby if the mother gives birth vaginally. Unfortunately, the obstetricians seem to believe the risk is less if she gives birth with cesarean surgery. I chalked it up to the American cesarean culture. To my surprise Lilian, the HIV worker, encounters the same attitude among Kenyan physicians and must fight to educate them about the importance of using vaginal birth to help prevent the spread of AIDS.

Then I asked about breastfeeding. I know there is little risk of transmission of HIV during the first 6 months, but that women in the USA are told not to breastfeed anyway.  I wondered how Kenya is handling the situation.  Lilian explained that the decision is made on a case by case basis. If the woman is poor, cannot guarantee clean water to prepare formula or to have access to formula if she runs out then she is counseled to breastfeed. Along with the counseling is support to help prevent cracked nipples and mastitis that would increase the risk of spread. But if a woman is wealthy enough, Kenyan medical authorities believe the risk (no matter how small) of transmission through breastmilk is not a risk a woman should take.  The risk of transmission goes up in the second six months (although it is only a small jump), but that increased risk is enough to encourage an HIV infected woman to stop breastfeeding at 6 months.

Today I was approached by another participant who also works with HIV infected women. She is similarly working to do all she can to prevent vertical transmission (that is, the transmission from mother to baby). It solidified in me the importance of spending as much time as possible learning how HIV impacts pregnancy, birth and breastfeeding. I am looking forward to my studies with an HIV women’s health nurse practitioner this fall.

Jennifer Vanderlaan (Author)


  1. renageibel

    Did it the topic of universal standard procautions arise during training? I wear protective clothing (scrubs actually) and washable shoes. I also put on gloves during second stage or when things really start getting messy. Some delivery settings may have the gloves there for you to use, but doulas should carry some in their bag just in case.

    1. Jennifer

      Yes, we did talk about universal precautions which would even be more important in East Africa than many parts of the United States. We also spent some time discussing the recommendations for HIV prevention with breastfeeding which is something that almost never comes up among doulas in the USA.

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