Looking for some advice.  I am currently caring for a woman who is HIV positive who is likely to deliver her baby before 28 weeks.  I feel that I stuck my foot in it when I asked her want her plans were about how she will feed her baby. (maybe I shouldn't have asked but I did)  Slight language barrier.  She replied by bottle.  I asked what would be in the bottle. I asked if the doctors had told her that she could not breastfeed.  Proceeded to tell her that under certain circumstances she might be able to breastfeed/breastmilk feed her child.  So now I am in a pickle as I feel I have raised her hopes.  Said I would find more info for her and that she needs to discuss this with her doctors.

Usual practice and recommendations here is to formula feed.  

So after I went home and had a chance to think about this I recognized that her baby will need to be fed in the nursery.  She can not bring her milk into the nursery (could not be stored in nursery as HIV pos))  and that we have donor milk available but an infant born very prematurely will likely need fortifier.  Once baby is given fortifier baby should not receive own mother's milk as the risk for transmission is higher, therefore it is likely that her baby would be unable to take breastmilk directly from the breast and if the mother were to pump and save her milk it would be a lot of work to store it flash heat ect (if this were an option) and baby would be home at least 3 months after birth, not sure how long it would be advisable to flash heat and fead breastmilk for.

So, what I am hoping for is some information to give to the mother so that she can make an informed choice as to what and how to feed her baby, the risks of her choice and if she even has a choice to make.  I am hoping that Pamela Morrison might contact me about this case and might be willing to speak to this mother via email.  

Today the mother asked me if she would still be able to be close to her baby if she did not breastfeed.  Of course I discussed skin to skin, wearing her baby and bathing with her baby.  I can see in her face and hear in her voice that it will be a loss to her not to breastfeed.  Having the information to make the right choice for her family may help her to come to terms with this.

Cordelia Merritt RN BSN IBCLC
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