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Lactation Information and Discussion <[log in to unmask]>
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Wed, 28 Jul 1999 17:41:37 EDT
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Hi!  This is in today's Buffalo News from the AP!  Someone asked about this
recently on Lactnet and this must be what they were referring to.
"New State Rule on HIV testing seen putting undue stress on pregnant women"
    Rochester - In addition to laborious Lamaze breathing and the chaos and
pain of labor, women could soon face required counseling on the dangers of
HIV.
    Doctors say the new state requirement, effective Sunday, could frighten
many parents unnecessarily during an already stressful time.  That's because
the expectant mother would be urged to take a quick type of HIV test with a
relatively high rate of erroneous results before her child's birth if she
hasn't already been tested by her doctor.  If the mother refuses, the newborn
will be tested and mother and child will remain in the hospital to await the
results.
    The new requirement is a modification of the current practice of testing
all newborns for HIV.
    The regulation also could interfere with breastfeeding, because a mother
who tests positive will be encouraged to delay feeding until - and unless -
she gets a negative test.  That could take a week, said Dr. Frank Gigliotti,
chief of pediatric infectious diseases at the Children's Hospital at Strong
Memorial Hospital in Rochester.
    "I am really outraged about this because I think they are manipulating
the public health law," said Marilyn Menegus, chief of the microbiology lab
at the University of Rochester Medical Center.  The physicians' oath "first,
do no harm" should apply to public health measures, she told the Rochester
Democrat and Chronicle.
    Dr. David Gandell, a Rochester OB, says while the state's motivation is
admirable, the means is "dangerous".  If somebody is in labor, that is not
the time to do a sexual history and tell them how they can reduce risk by
using condoms," he said."Now every woman will have to have HIV counseling and
urged to get tests when she comes in for labor, even if she is 8 centimeters
dilated."
    The law aims to reduce the number of HIV-positive infants by encouraging
every expectant mother to get HIV testing during pregnancy - either during
prenatal appts. or at the hospital just before childbirth.
    The state Health Dept. says the new policy is needed because only 53% of
pregnant women in the state now get prenatal HIV testing.  Using '97-'98
data, the state determined that, each year, up to 200 of those women may be
HIV positive and unaware they have the infection.  " I think they want to
make hospital testing so unappealing the OBs will just test everybody
beforehand," Gandell said. "If that happens, it would be a good thing."
    Newborns in NY state are already tested for HIV but are allowed to go
home before the results are in, said Dr. Maggie Vill, a perinatologist at
Rochester General Hospital.  If the result is positive, the pediatrician
calls the parents and the baby is retested.
    The first HIV test on a newborn is not conclusive because it is done on
cord blood, which contains antibodies from the mother, Dr. Vill said.  Rapid
HIV tests and cord blood test have high rates of false positives, she said.
    HIV infection can be passed to the baby in the womb, during delivery or
through breast milk.  About 30% of HIV infected babies experience a rapid
decline, dying by age 5 or 6, Strong Memorial's Gigliotti said.  the others
have a slower disease process similar to AIDS in adults.
    Early diagnosis is important because the drug AZT can prevent
transmission to the infant.

Katie Constantino
LLLL of Amherst, NY    Waiting for scared Moms to start calling!

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