Hello and thanks to Naomi, Jack, Cathy, Pamela, and All the Rest:
Jack, your question (why has this mom not been offered the option of feeding
her baby her own heat-treated milk?) is an excellent one, and in fact we've
been asking this question since the day of baby's birth.  Apparently, there
is nothing in the literature which will support this practice.  All of the
research which has been written up has involved Holder pasteurization
process, which requires fancier equipment than most folks have in their home
kitchens (even in the US!). It is extremely frustrating to me to hear (from
Pamela M) that home heat treatment is routinely recommended to HIV+ mothers
by the Zimbabwean Ministry of Health, then to run aross info that was
presented at the 1998 ILCA conference (Breastfeeding and HIV, speaker: Thom
Thiele) that says "...due to the lack of reasearch in this area, it would
not be prudent to suggest home boiling of mechanically pumped breast milk
with the hopes of feeding it to ones infant.  Caregivers who give out
suggestions without a strong scientific background expose themselves to
legal issues."
  Yes, we have referred this mom to her ped with a strong suggestion that
she get a scrip for banked human milk.  I'm not sure what her progress is on
this one to date.  And yes, we are aware of the Maine case.  Can't say
anymore right now.
  You can reach George Kent at <[log in to unmask]>  for anyone who is
interested.  His paper, once again is entitled "HIV/AIDS and the Nutrition
Rights of Infants", and you all should get a copy and read it.
  Thanks for all the responses,  let's keep our collective mind cranking on
this one, it is a case that I think will set some legal/ethical precedents.

Martha Johnson RN IBCLC


> ----------
> From:         NECSI[SMTP:[log in to unmask]]
> Sent:         Thursday, February 04, 1999 7:02 AM
> To:   Martha Johnson; [log in to unmask]
> Subject:      Re: HIV+ In Oregon
>
> Martha and Lactnetters,
>
> This situation is a tough one. Does anyone know where
> there is some literature on where informed consent
> leaves off and mandating particular kinds of care
> starts? Is it in the legal literature? What do
> various state DSSs have to say about mandated
> reporters reporting this kind of "abuse and neglect"?
>
> Sometimes the medical knowledge is wrong, in which case
> we congratulate the people who bucked the system and
> gave their children (or themselves) what they thought
> was the best care. Other times medical knowledge is
> right and we criticize the same people for their
> "selfishness" etc. etc.
>
> As far as I understand, we know that HIV can be transmitted
> throught breastmilk butit isn't always transmitted and
> we don't really have a good understanding of when it
> transmits and when it doesn't. However, we do know the
> effects if it does transmit  - pediatric AIDS. and we
> know that the prognosis on pediatric AIDS is usually deadly.
>
> For this particular mother, is milk from a milk bank an option?
> I , too am interested in other's thoughts and resources on this
> issue, both medical, ethical and legal.
>
> I assume that you are familiar with the similar case
> of the woman in Maine who took DSS to court and won.  The details
> are probably different, but it may give some guidance here.
>
> Naomi Bar-Yam PhD
>
> P.S. Does anyone know where I can get a copy of
> "HIV/AIDS and the Nutrition Rights of Infants"?
>