Postpartum care
The postpartum care of HIV positive women should be similar to
that for uninfected patients. They do not require separate nursing facilities.
Women may, however, require private facilities to lessen the social stigma
associated with not breastfeeding if this is the choice they make in a culture
which is likely to condemn such behaviour.
HIV positive women are more prone to postpartum infectious
complications – including urinary tract, chest, episiotomy and Caesarean
section wound infections. Health workers should be aware of this and observe for
signs of infection. Mothers should be given information on the early symptoms of
infection at the time of discharge, especially where the postpartum hospital
stay is short. All mothers should be given instructions on perineal care and the
safe handling of lochia and blood stained sanitary pads or materials.
Mothers should be given information on how to care for their
babies without the risk of exposure to infection, and full discussion on the
risks and benefits of infant feeding choices. If, after counselling, the mother
chooses not to breastfeed, she should receive full information on adequate
replacement feeding up to two years of age, and guidance on breast care, until
lactation stops. Mothers who choose to breastfeed should be advised of the
possible increased transmission risk in the presence of cracked nipples,
mastitis, breast abscess or of oral lesions in the child and should be taught
how to prevent such problems through adequate breastfeeding techniques. Reduced
duration of breastfeeding and early cessation may be encouraged to reduce the
risk of transmission where this can be achieved safely. The mother should be
counselled on the need for follow-up care for her and her child, and the
available options for testing of the child. She should be given information
about and referred to local HIV support groups. Contraceptive advice should be
given and early arrangements made to start with an appropriate method.
Contraceptive advice is particularly important when a mother does not breastfeed
because of the loss of the contraceptive properties of
breastfeeding380,381.
