Resultados a nivel general de la aplicación del Bachillerato Internacional:

Breastfeeding and Breast-Milk Options for HIV-

infected Women

Objectives

After completing this session participants will be able to:

ƒ

explain the advantages and disadvantages of breastfeeding and breast-milk

feeding options for HIV-infected women

ƒ

explain the method of early cessation (stopping breastfeeding early)

ƒ

discuss wet-nursing and finding a wet-nurse

ƒ

demonstrate how to heat-treat expressed breast milk

We mentioned in Session 18 several breast-milk options that HIV-positive mothers may choose. These include:

.

exclusive breastfeeding for the first few months followed by early cessation

.

expressing and heat-treating her breast milk

.

wet-nursing (breastfeeding by another woman, who is HIV-negative)

In this session we will discuss how to help a woman to use any of these options, and to do it as safely as possible.

The Advantages of Breastfeeding

A mother who is HIV-positive may decide that breastfeeding is her best option and she should be supported to establish and maintain it.

110 Session 19: Breast-milk Options for HIV-infected Mothers

Infant and Young Child Feeding Counselling: An Integrated Course. Participant’s Manual

A

DVANTAGES AND

D

ISADVANTAGES OF

E

XCLUSIVE

B

REASTFEEDING FOR AN

HIV-I

NFECTED

M

OTHER Advantages:

ƒ

Breast milk is the perfect food for babies and protects them from many diseases,

especially diarrhoea and pneumonia, and the risk of dying from these diseases.

ƒ

Breast milk gives babies all of the nutrition and water they need. Breastfed babies do not

need any other liquid or food.

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Breast milk is free, always available, and does not need any special preparation.

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Exclusive breastfeeding for the first six months lowers the risk of passing HIV, compared

to mixed feeding.

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Many women breastfeed, so people will not ask why mothers are breastfeeding.

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Exclusive breastfeeding helps mothers recover from childbirth and protects them from

getting pregnant again too soon.

Disadvantages:

ƒ

As long as the mother breastfeeds, her baby is exposed to HIV.

ƒ

People may pressurize her to give water, other liquids, or foods to the baby while she is

breastfeeding. This practice, known as mixed feeding, may increase the risk of diarrhoea and other infections, and increases the risk of HIV transmission.

ƒ

The mother will need support to exclusively breastfeed until it is possible for her to use another feeding option.

ƒ

It may be difficult to do if the mother works outside the home and cannot take the baby

with her.

ƒ

It may be difficult to do if the mother gets very sick.

If a woman does breastfeed, it is important for her to breastfeed exclusively. This gives protection for the infant against common childhood infections and also reduces the risk of HIV transmission.

Counselling on infant feeding may need to take into account her disease progression. Recent evidence suggests a very high rate of postnatal transmission in women with advanced disease. An HIV-infected mother who chooses to breastfeed needs to use a good technique to prevent nipple fissure and mastitis, both of which may increase the risk of HIV transmission.

Infant and Young Child Feeding Counselling: An Integrated Course. Participant’s Manual

Early cessation of breastfeeding

HIV can be transmitted at any time during breastfeeding. Early cessation reduces the risk of transmission by reducing the length of time the infant is exposed to the virus in breast milk. However, stopping breastfeeding also increases the risk of other illnesses and death.

The most appropriate time to stop breastfeeding depends on the mother’s particular situation, and may be at any time between 0-6 months. The most appropriate time is as soon as

replacement feeding becomes acceptable, feasible, affordable, sustainable and safe for her and her baby.

The period of time during which a mother stops breastfeeding and changes to replacement feeding is known as the transition period. Preliminary experience indicates that mothers can stop breastfeeding in a period of 2-3 days to 2-3 weeks with counselling and support. Some mothers may not be able to provide replacement feeding for an infant even from six months onwards. Among other factors, suitable replacement foods may not be available. In that case the mother should consider other breast-milk options such as expressing and heat-treating breast milk from six months onwards. For some infants, the risk of malnutrition and other

morbidity may still be greater if they are not receiving breast milk, than the risk of HIV transmission through continued breastfeeding, even after six months.

112 Session 19: Breast-milk Options for HIV-infected Mothers

Infant and Young Child Feeding Counselling: An Integrated Course. Participant’s Manual

H

OW TO

S

TOP

B

REASTFEEDING

E

ARLY

ƒ

While a mother is breastfeeding, teach her baby to drink expressed, unheated, breast

milk from a cup (see Cards 10 and 13).

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This milk may be heat-treated to destroy the HIV (see Card 14).

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Once the baby is drinking comfortably, replace one breastfeed with one cup-feed using

expressed breast milk.

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Increase the frequency of cup-feeding every few days and reduce the frequency of

breastfeeding. Ask an adult family member to help cup-feed the baby.

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Stop putting her baby to the breast completely as soon as she and her baby are

accustomed to frequent cup-feeding. From this point on, it is best to heat-treat her breast milk.

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If her baby is only receiving milk, check that he is passing enough urine - at least six wet nappies in every 24-hour period. This means that he is getting enough milk.

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Gradually replace the expressed heat-treated breast milk with formula or home-modified

animal milk.

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If her baby needs to suck, give a clean finger instead of the breast.

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To avoid breast engorgement (swelling) express a little milk whenever her breasts feel too

full. This will help her to feel more comfortable. Use cold compresses to reduce the inflammation. Wear a firm bra to prevent breast discomfort.

ƒ

Do not begin breastfeeding again once she has stopped. If she does, she can increase

the chances of passing HIV to her baby. If her breasts become engorged, express the milk by hand and discard it.

ƒ

Begin using the family planning method of her choice, if she has not already done so, as

soon as she start reducing breastfeeds.

You may have noticed that there is much information to provide. You may want to use the relevant take-home flyers to explain to the mother while showing her what to do. Card 17 talks about how to stop breastfeeding early. Remember to use your counselling skills when talking to a woman. Try to use suggestions rather than commands.

Infant and Young Child Feeding Counselling: An Integrated Course. Participant’s Manual

Breastfeeding by another woman who is HIV-negative

Asking another woman who is HIV-negative to breastfeed the baby may be an option. When a woman breastfeeds a baby to whom she did not give birth, it is called wet-nursing.

W

ET

-N

URSING

(B

RESTFEEDING BY

A

NOTHER

W

OMAN

)

ƒ

To protect a baby from HIV, the wet-nurse must be HIV-negative. The only way for her to

know for sure that she is negative is to be tested at least three months after the last time she had unprotected sex or any other possible exposure to HIV.

ƒ

The wet-nurse will need to protect herself from HIV infection the entire time that she is breastfeeding.

ƒ

This means:

.

not having sex, or

.

using a condom every time she has sex, or

.

having sex with only one partner who has tested negative for HIV and who is being

faithful to her, and

.

not sharing any razors, needles or other piercing objects.

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The wet-nurse should be available to feed the baby on demand, both day and night.

ƒ

The wet-nurse should receive counselling about how to prevent cracked nipples, breast

infections and engorgement.

ƒ

If a baby is already infected with HIV, there may be a very small chance that he can pass

the virus to the wet-nurse through breastfeeding. The wet-nurse needs to know about this small risk and avoid breastfeeding while the baby has oral thrush or she has cracked nipples.

114 Session 19: Breast-milk Options for HIV-infected Mothers

Infant and Young Child Feeding Counselling: An Integrated Course. Participant’s Manual How to heat-treat expressed breast milk

Expressing and heat-treating breast milk is another option to consider:

.

if a mother wishes to give her baby her own milk - either in the first few months or later on

.

if alternative milks are too expensive or difficult to get

.

for sick or low-birth-weight infants who are more at risk from artificial feeding and may otherwise require special types of formula

According to available research, heat-treatment destroys HIV in breast milk making it safe to feed to the woman’s own baby. Heat-treatment reduces the level of some anti-infective components of breast milk. However, heat-treated breast milk remains superior to breast-milk substitutes.

H

OW TO

H

EAT

-T

REAT AND

S

TORE

B

REAST

M

ILK Before heating milk, gather the following:

ƒ

clean containers with wide necks and covers, enough to store the milk

ƒ

a small pot to heat the milk

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a large container of cool water

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a small cup for feeding the baby

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fuel to heat the milk

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soap and clean water to wash the equipment.

Follow these steps:

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Wash all the pots, cups and containers with soap and water.

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Only heat enough expressed milk for one feed.

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Heat your milk to boiling point and then place a small pot in a container of cool water so that it cools more quickly. If that is not possible, let the milk stand until it cools. Store the boiled milk in a clean covered container, in a cool place and use it within one hour.

ƒ

A mother can store unheated breast milk for about eight hours at room temperature or

up to 24 hours in a refrigerator.

A mother may be able to follow her infant’s sleeping pattern and prepare feeds ready for when she expects the infant to wake. If necessary, to avoid leaving the milk too long, or wasting it, she may sometimes have to wake her infant for a feed. To avoid having to use more fuel than necessary it may be possible to heat-treat the milk while cooking the family’s meals.

Infant and Young Child Feeding Counselling: An Integrated Course. Participant’s Manual

In document Propuesta de una unidad didáctica de Biología en el Bachillerato Internacional (página 46-48)