Stress and adjustment of the postnatal period is likely to be intensified for the woman who is HIV positive, complicated by anxiety about her baby’s health and her own, uncertain about the future and long term well-being and care of her baby.
Elements to be addressed in postnatal care include the following:
Continued care at the MCH clinic for post-partum follow up and close coordination with the CTC staff to address HIV related emotional and clinical issues.
The health worker should be alert of the woman’s sense of isolation, loneliness and guilt and should support or make a referral to a counsellor, social worker or contact with self help group as appropriate
Postnatal examination should specifically be directed towards eliciting signs or symptoms suggestive of physical illness and emotional stress
Gloves should be worn when examining the perineum, caesarean wound, carrying out cord care, changing the babies diaper, or when carrying out invasive procedures such as collection of blood sample
The mother should be encouraged to take care of her baby if the condition allows
Plan for follow up care of mother and baby should be discussed prior to discharge, and the woman should be encouraged to consider the role that might be played by the community health workers for her ongoing care
Decision to inform other care givers of her HIV status should be left to the woman herself and arrangements for information should be discussed with the woman
Information on contraception should be offered before discharge. Some women will not have confided their HIV status to their partners, and this discussion might offer an opportunity to explore this difficult problem. Further formal counselling may assist a woman to find a way of discussing her infection with her partner
Information on any special requirements on child care including early signs of infections in infants
Women need to be fully educated about the symptoms of HIV infection, and encouraged to report to the clinic if she develops fever or any other symptoms/signs
The health worker should encourage the woman to talk about her feeding options and discuss the additional risk of breastfeeding. The decision not to breastfeed may be an additional source of disappointment, which she may want to talk about, along with it being a marker of her infection. For more information on infant feeding counselling, refer to infant feeding counselling section of the MTCT Guidelines, March, 2004.
Access to family planning should be promoted at every clinic visit
Health care workers have an essential contribution to make in coordinating appropriate care and providing accessible source of information and support after delivery. The health worker should plan with the woman for early and regular follow up of at the nearest Care and Treatment Clinic (CTC)