Ros Escott is an ABA counsellor & Lactation Consultant (IBCLC) in private
practice Hobart. She sends this information.
I understand that having a caesarean is safer because possible infection may
occur during delivery. There are medications they sometimes give around the
time of delivery, and to the baby after delivery, that can minimise the risk
of infection to the baby. In some parts of Africa, that's all the medication
they can afford to give.  I read the other day of a trial with multivitamins
that decreased infection rates - seems like nutrition and infection may be
part of the equation.

Yes, HIV can be passed on through breastmilk in some circumstances. It is a
matter of weighing up the risks and benefits. In Australia, where
artificial feeding is considered relatively "safe", mothers are  encouraged
to bottle feed. However, I think there have been cases where women have
insisted on breastfeeding. In Africa, where a huge percentage
of the population is HIV positive, bottle feeding can be more of a risk.  In
trying to save a baby from HIV you can kill it with diarrhoea.

 The evidence coming through now is that mixed feeding may be the greatest
risk, and that exclusive breastfeeding for 6 months appears to be no more of
a risk than formula feeding. Mixed feeding may be a risk because the
microscopic bowel bleeding that occurs in all formula fed babies may be a
portal of entry for the virus in the human milk.  The trouble with telling
an African woman to bottle feed is the social stigma - it is a sign she is
HIV positive. So she keeps her milk supply going so she can breastfeed when
anyone else is around, and at other times she uses the formula that has been
supplied to her. Mixed feeding!

Ros

Helen Grainger

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