What can I do before getting pregnant to lower my risk of passing HIV to my baby?

If you plan to become pregnant, talk to your doctor right away. Your doctor can talk with you about how HIV can affect your health during pregnancy and your unborn baby’s health. Your doctor can work with you to prepare for a healthy pregnancy before you start trying to become pregnant.

Everyone living with HIV should take HIV medicines to stay healthy. If you are thinking about becoming pregnant and are not taking HIV treatment, it is important that you begin, because this will lower your chances of passing the virus to your baby when you become pregnant.

There are ways for you to get pregnant that will limit your partner’s risk of HIV infection. You can ask your doctor about ways to get pregnant and still protect your partner.

I do not have HIV, but my partner does. Can I get pregnant without getting HIV?

Women have a higher risk of HIV infection during vaginal sex than men. If you do not have HIV but your male partner does, the risk of getting HIV while trying to get pregnant can be reduced but not totally eliminated.

Talk to your doctor about HIV medicine you can take (called pre-exposure prophylaxis or PrEP) to help protect you and your baby from HIV.

You may also want to consider donor sperm or assisted reproductive technology, such as semen washing or in vitro fertilization, to get pregnant. These options can be expensive and may not be covered by your health insurance.

I’m pregnant. Will my baby have HIV?

If you just found out you are pregnant, see your doctor right away. Find out what you can do to take care of yourself and to give your baby a healthy start to life.

With your doctor’s help, you can decide on the best treatment for you and your baby before, during, and after the pregnancy. You should also take these steps below before and during your pregnancy to help you and your baby stay healthy.

Just because you have HIV doesn’t mean your child will get HIV. In the United States, before effective treatment was available, about 25% of pregnant mothers with HIV passed the virus to their babies. Today, if you take HIV treatment and have an undetectable viral load, your risk of passing HIV to your baby is less than 1%.¹

What can I do to lower my risk of passing HIV to my baby?

Thanks to more HIV testing and new medicines, the number of children infected with HIV during pregnancy, labor and childbirth, and breastfeeding has decreased by 90% since the mid-1990s. The steps below can lower the risk of giving HIV to your baby:

Step 1

Tell your doctor you want to get pregnant. Your doctor can help you decide if you need to change your treatments to lower your viral load, to help you get pregnant without passing HIV to your partner, and to prevent you from passing the virus to your baby. He or she will also help you get as healthy as possible before you get pregnant to improve your chances of a healthy pregnancy and baby. Don’t stop using condoms for STI prevention and another method of birth control for pregnancy prevention until your doctor says you are healthy enough to start trying.

Step 2

Get prenatal care. Prenatal care is the care you receive from your doctor while you are pregnant. You need to work closely with your doctor throughout your pregnancy to monitor your treatment, your health, and your baby’s health.

Step 3

Start HIV treatment. You can start treatment before pregnancy to lower the risk of passing HIV to your baby. If you are already on treatment, do not stop, but do see your doctor right away. Some HIV drugs should not be used while you’re pregnant. For other drugs, you may need a different dosage.

Step 4

Manage side effects. Side effects from HIV medicines can be especially challenging during pregnancy, but it is still important that you take your medicine as directed by your doctor. Talk to your doctor about any side effects you have and about ways to manage them.

Step 5

Do not breastfeed. You can pass the virus to your baby through your breastmilk even if you are taking medicine. The best way to avoid passing HIV to your baby is to feed your infant formula instead of breastfeeding.

Step 6

Make sure your baby is tested for HIV right after birth. You should choose a doctor or clinic experienced in caring for babies exposed to HIV. They will tell you what follow-up tests your baby will need and when. Talk to your doctor about whether your baby may benefit from starting treatment right away.

Step 7

Ask your pediatric HIV specialist if your baby might benefit from anti-HIV medicines before you know if your baby is HIV-positive or HIV-negative. Research has shown that giving combination HIV drugs to newborns is better at preventing HIV than taking AZT (azidothymidine, an antiretroviral medicine) alone.

Can I take HIV medicine during pregnancy?

HIV-infected pregnant women should take HIV medicines. These medicines can lower the risk of passing HIV to a baby and improve the mother’s health.

If you haven’t used any HIV drugs before pregnancy and are in your first trimester, your doctor will help you decide if you should start treatment. Here are some things to consider:

• Nausea and vomiting may make it hard to take the HIV medicine early during pregnancy.
• It is possible the medicine may affect your baby. Your doctor will prescribe medicine that is safe to use during pregnancy.
• HIV is more commonly passed to a baby late in pregnancy or during delivery. HIV can be passed early in pregnancy if your viral load is detectable.
• Studies show treatment works best at preventing HIV in a baby if it is started before pregnancy or as early as possible during pregnancy.

If you are taking HIV drugs and find out you’re pregnant in the first trimester, talk to your doctor about sticking with your current treatment plan. Some things you can talk about with your doctor include:

• Whether to continue or stop HIV treatment in the first trimester. Stopping HIV medicine could cause your viral load to go up. If your viral load goes up, the risk of infection also goes up. Your disease also could get worse and cause problems for your baby. So this is a serious decision to make with your doctor.
• What effects your HIV medicines may have on the baby
• Whether you are at risk for drug resistance. This means the HIV medicine you take no longer works against HIV. Never stop taking your HIV medicine without first talking to your doctor.

Can I get help paying for care during pregnancy?

If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and living with HIV, Medicaid might pay for counseling, medicine to lower the risk of passing HIV to your baby, and treatment for HIV. Each state makes its own rules regarding Medicaid. Contact your local or county medical assistance, welfare, or social services office to learn more. If you are unable to find that number, search your state’s department of health.

If you don’t think you qualify for assistance, check again. Sometimes states change their Medicaid rules. Under the Affordable Care Act, Medicaid eligibility expanded to cover many more people. Also, you may be newly eligible for Medicaid because of increased income limits for prenatal care and HIV treatment for pregnant women.

You may also access care through the Ryan White HIV/AIDS Program. Find a Ryan White HIV/AIDS Program medical care provider near you. 

Offsite Resources

For more information about HIV and pregnancy, check out the following resources from other organizations:

• HIV Among Pregnant Women, Infants, and Children — Fact sheet from the Centers for Disease Control and Prevention (CDC).
• HIV and Pregnancy — Information from AIDSinfo.
• Infant feeding and HIV — Publication from UNICEF.
• Elimination of Mother-to-Child HIV Transmission (EMCT) in the United States — Fact sheet from CDC.
• One Test. Two Lives. — Campaign information from the CDC.

The post Pregnancy and HIV; Here is What We Need to Know appeared first on Medika Life.

Before we jump into my tips and tricks, it’s very important to remember that your success and value as a human and your ability to be the very best you can be for your baby is NOT (and I repeat NOT) tied to your ability to adequately lactate.

The sad, old saying of “breast is best” is not always the case and has been replaced by the (much, much better) expression: FED is best.

Looking Back

Let’s have a quick aside — when my first baby was born more than ten years ago (gasp!), I wasn’t going to let anything stop me from nursing my baby and pumping to providing all the “breast is best” goodness. It all went great for the first three months (postpartum depression, learning the inequalities of a traditionally gendered household, navigating my new body, and sleep deprivation aside). Still, when I returned to work, I was in for a rude awakening: PUMPING IS ROUGH.

Or, at least it was for me. On my first full day back at work, I found myself stuck in a car with a single man in his 50s for the entire day, traveling hundreds of miles across the great state of North Dakota. Needless to say, I went all day without pumping. I was off to a not-so-great start already.

After that, my supply steadily dropped as I navigated tricky schedules and more mixed company car trips. Then, at the four-month appointment, I remember his pediatrician looking at his growth chart with her brow furrowed … “I am not sure he’s growing as much as I would like.”

I was frozen. I failed.

I sobbed the whole way home but refused to stop nursing. I refused to give my baby formula, or what my mother in law referred to as “sludge.” I couldn’t disappoint. However, he started waking hungry during the night. He cried after nursing because he was still hungry. And after many weeks of effort, I finally gave in and filled his bottle with formula.

He slept like a champ — we all did. We woke, fresh and happy. And, you know what, he’s amazingly healthy.

Tips of the Trade

So, lesson learned — FED IS BEST. However, if you have your heart set on breastfeeding (like me) and need some expert guidance on pumping at work, here we go!

1. Know your protections under the law. Many states have laws protecting lactating people and ensuring employers provide appropriate space and time for people to pump. Typically, these spaces are required to have a locking door, sink, and refrigerator. Employers are not allowed to make you pump in your car (I mean … I still do because my seat warmer feels so good on my sore back) or in the bathroom. Laws vary slightly from state to state, so double check your state’s laws and workplace protections.
2. Make a schedule and keep your plan. Law requires employers to allow reasonable amounts of time to pump breast milk. Typically, it’s best not to go more than 2–2.5 hours between pumping sessions. I usually give myself a little wiggle room and say 3 hours max. So far, that’s worked for me. I add my breaks into my calendar each week, working around meetings and adjusting by 30-minute increments if needed. If I go longer than I should between sessions for some reason, I make up for it with a Power Pumping session later in the evening.
3. Invest in a good pump and parts. Most insurances provide pumps and replacement parts at no cost. You can often find online retailers who supply the pump and parts and set up recurring shipments of replacement parts, including shields, valves, and tubing.
4. Have everything you need for a full day’s worth of pumping packed each morning. This will save you time between sessions otherwise spent washing parts and make storing milk easier. And keep extra supplies. I am not talking about only tubing and valves; I am talking about nursing pads, shirts, and bras. I can’t tell you how many times my body decided it was time to pump before I was ready, causing wet stains on my shirt. Sticking to tip number 2 will also help with this. Also … see number 8 below.
5. Get a jump start on your sessions. I like to do my first pumping session while driving to work. It helps because I have a good 2 to 3 hours at work before I need to step away and pump again. I will admit, the first time pumping while driving was interesting and a little embarrassing, but I got used to it quickly. Now it’s one of the easiest and best ways to squeeze in a quick session. Just don’t get too comfortable with driving while pumping and forget what you’re doing. I decided I needed a coffee and pulled up to a Starbucks with my shirt pulled up to my chin and my pump going full power … needless to say, I left a bit extra in the tip can. (Sorry baristo, dude!)
6. Try visualization and meditation to encourage let down and increase supply. Sometimes getting the ol’ let down to happen is harder when pumping. Let’s face it, that hard, cold plastic shield is far different than the soft, warm mouth of your baby. Try bringing photos of your baby to look at (it’s not like your phone doesn’t have hundreds of photos taken just yesterday!). If that doesn’t work, I enjoy visualization techniques that mix relaxation strategies with meditation. Here’s what I do: get comfortable, then close your eyes and visualize your baby in detail, starting with the very tip of the first tuft of hair, working down to the rest of the head, the forehead, the eyebrows, and so on. Try to think about how each part smells and feels. The only problem I have with this technique is not relaxing to the point of falling asleep (Surprise! Two hours have passed, and you’ve missed your meetings!).
7. Don’t be embarrassed by your efforts and goals. My first baby, I was modest and secretive. Remember my earlier story of going all day without pumping because I was stuck alone with a middle-aged dude? I should have spoken up! He could have waited outside the car and played Solitaire on his phone for 20 minutes. Pumping was more taboo, and I was not as open and honest with my coworkers and employer. Now, with baby three, I’ve gotten over the embarrassment, and it helps a lot. I’m not saying you need to announce to your coworkers that your milk just let down and you need a new shirt. But, it’s ok to tell people you’re pumping and need to excuse yourself or that you can’t accommodate a phone call at that moment. Remember, the law is on your side.
8. Don’t be afraid to ask for help. All successful breast milk pumpers have failed in some way or have a problem solved on the fly. Once, I forgot (FORGOT!) to bring lids for all my bottles. So, I pumped nearly 8 oz. Then, I realized I have no tops for my bottles. I had to ask a co-worker (see tip number 7) for one of their food storage containers. I cleaned it really well and dumped my milk into that container all day. Hey, my husband got a good laugh when I set the full container down on the kitchen counter that night …. Milk sloshing against a very tightly sealed lid (Nice job Rubbermaid brand storage container!). Additionally, find a lactation consultant who really knows their stuff. Trust me, even after three babies, I still have questions. It’s also ok to find other lactating people to reach out to — everyone has different experiences pumping and you never know what secrets they’ve uncovered.
9. Stay motivated — but for all right reasons. It’s going to be hard work, and you may want to quit. If you’re like me with baby number one (and honestly even with baby number three) you may want to keep going no matter what. That’s ok! Good for you! I find it helpful to keep notes for myself either on my phone or on little notes in my pumping bag, which reminds me why I am doing this. For me, it’s because I love nursing, and I cherish each minute I get to do it. Pumping is pretty much my least favorite thing in the world, but I do it because I don’t want to stop nursing. Only do it if it’s what YOU really want — it’s no one else’s decision (not even your partner gets a say in the matter).
10. Be kind to yourself. It’s ok if it doesn’t work out. Cut yourself some slack and remember you did your best (or maybe you gave sub-par effort, that’s cool too — who cares?!). So what if you only made it three weeks or three months. Your baby is important, and you want to do everything you can to provide the very best. Sometimes that just isn’t breast milk. Your well-being matters too. You are more than just a lactating person (even if it doesn’t feel like it sometimes). You’re many other things, and if the pumping-working-person title isn’t in the cards — oh well!

No matter what happens in this crazy life, remember that FED IS BEST and cut yourself some slack.

Keep a good relationship with your child’s medical care provider (if you need a good one — check out MacArthur Pediatrics and schedule an appointment today). Your child’s provider will help you monitor growth and development — ensuring that your baby is strong and healthy regardless of whether breastfed or formula-fed.

This article was contributed by MacArthur Medical Center’s Pediatric Nurse Practitioner Abby Boynton and manager Erin Cox.

The post 10 Tips for Pumping and Working appeared first on Medika Life.

What is RSV?

RSV or Respiratory Syncytial Virus is a common respiratory virus that typically causes mild cold symptoms but can cause more severe illness in children under two years old. Premature infants and babies with heart or lung conditions are more susceptible to severe illness caused by RSV.

Each year, RSV leads to 2.1 million outpatient visits and over 50,000 hospitalizations in children under five years old (CDC).

How is RSV spread?

RSV infection is passed from person to person through respiratory droplets. Tiny amounts of the virus spread from person to person when someone coughs or sneezes. We can reduce the risk of respiratory transmission by avoiding sick people, washing hands frequently, and wiping down surfaces and toys that your baby will touch.

What are the symptoms of RSV?

RSV shares many of the symptoms associated with the common cold. For many children, symptoms of RSV infection may include:

1. Runny nose
2. Cough
3. Fussiness
4. Poor feeding
5. Fever > 100.4

Sometimes a cold is not just a cold

Although most RSV children will experience mild symptoms, this viral illness can progress and cause a more severe disease called RSV bronchiolitis. The respiratory syncytial virus is the most common cause of bronchiolitis.

Bronchiolitis is when the lungs’ bronchioles become swollen and full of mucus, which may cause wheezing or difficulty breathing in babies. Bronchiolitis typically resolves on its own but sometimes requires treatment or hospitalization to monitor or provide respiratory support.

More severe symptoms of RSV and bronchiolitis may include:

1. Wheezing
2. Fast or labored breathing
3. Grunting or nostrils flaring
4. Lips or fingernails turning blue (caused by low oxygen level)

If your baby shows RSV symptoms or has any wheezing or labored breathing, you should call their healthcare provider.

You should also call their healthcare provider immediately if your baby is under three months old and has a fever of > 100.4.

Call 911 if your baby is struggling to breathe or if their lips are turning blue.

How can we manage mild RSV at home?

If your baby has mild symptoms, the illness can safely be managed at home.

Parents can use nasal saline and a suction bulb to remove mucus from their baby’s nostrils gently. Put 1–2 drops of saline in one nostril. Gently lean your baby back for a minute so the saline can thin out the mucus. Squeeze the suction bulb. Place the tip in the nostril and release the suction bulb to remove mucus. Then, repeat on the other side.

Nasal irrigation is most helpful before the baby breastfeeds or takes a bottle before going to sleep.

Parents can also use a humidifier in their baby’s room at night time. This will help thin out secretions and relieve congestion and cough.

If your baby has a fever and is fussy or uncomfortable, you can give them Motrin if they are six months or older or Tylenol if they are two months or older. Follow the age-adjusted dosing instructions listed on the bottle.

Many parents request prescriptions for antibiotics. Remember, RSV is a virus. Antibiotics only work against bacterial infections. Antibiotics will not treat a virus or help reduce the symptoms.

How can I prevent my baby from getting RSV?

It is important to remember that you can help prevent your baby from getting RSV by avoiding sick contacts and washing hands frequently. Breastfeeding is also protective against RSV.

RSV can also be prevented by a vaccine given as a monthly injection during RSV season (late fall to spring). We recommend the RSV vaccine for the following high risk groups:

1. Premature infants
2. Infants with chronic lung disease
3. Infants with congenital heart disease

This article was contributed by MacArthur Medical Center’s Pediatric Nurse Practitioner Abby Boynton. 

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