Patient observed sterile treatment for child delivery
|POST for child delivery
|1. Avoid skin-piercing procedures
||(a) Your provider may offer an injection to reduce your pain during delivery. Consider ahead of time if you want to try to avoid such injections, and talk with your provider so that he or she understands what you want.
(b) To the extent possible, avoid an episiotomy (a small cut during delivery to enlarge the mouth of your vagina for the baby’s head). This has no benefit in routine deliveries, and is advisable only in extreme conditions. Your skin stretches for birth and shrinks afterwards.
|2. Use new disposable instruments
||(a) Disposables include:
- syringes and needles for injections;
- razors for shaving body hair prior to deliveries, and for cutting the baby’s cord;
- plastic clamps for baby’s cord.
(b) To reduce your pain in childbirth, your provider might inject an anaesthetic (usually lidocaine) into your lower back, near but not in your spine. Ask the provider to use a new syringe and needle, and to take the anaesthetic from a single-dose vial (see Injections section).
(c) After you deliver the baby, your provider might give you an injection of oxycotin to reduce bleeding and to help with the afterbirth (delivery of the placenta). The best option is for the provider to have a pre-filled disposable syringe ready if needed. If not, ask the provider to have a disposable syringe and needle and single-dose vial ready if needed (see Injections section).
|3. You sterilize the instruments
||(a) If you deliver at a clinic or hospital, you can shave your pubic hair at home.
(b) If you deliver at home, you can boil a blade to cut the umbilical cord.
|4. Ask providers how they sterilize instruments
||(a) For deliveries, you and your provider have time to plan ahead to take the precautions you request.
(b) For clinic or hospital deliveries, the bed should be disinfected by wiping with chemicals between patients. Reused linen should be boiled or autoclaved.
Additional information about child delivery
Caeserean deliveries: WHO, UNICEF, and the UN Population Fund estimate that at least 5 percent of births require caesarean sections to protect mother or child.[i] In some African communities, caesarean sections are already common. For example, a study in rural Zimbabwe in 1992-93 reported that 6.3 percent of 831 deliveries were caesarean.[ii]
Abortions: See discussion of abortions in section on Birth control and other women’s health care.
At the clinic you visit, how many women are HIV-positive? The risk to get HIV during child delivery depends in part on how many women in the clinic have HIV. In Southern Africa, you should estimate that 2-4 among the 10 women treated before you have HIV infections. In Eastern Africa, you can estimate that 1-2 among the 10 women before you have HIV.
Risk to get HIV during child delivery
If a previous woman was HIV-positive, and if the provider reuses syringes or needles with no effort to clean and takes medicine from an opened multi-dose vial, your risk to get HIV from each injection may be estimated at 3%-10% (see Table on Estimated risks in the section on Blood-borne Risks). If a previous patient was HIV-positive, your risk to get HIV from reused gloves, sheets, or cloth may be estimated at more or less than 1%, depending on wounds and bleeding during delivery.
For procedures that involve more instruments and blood, such as caesarean deliveries, the risk is much greater – and could well exceed 10%-20% if instruments are not cleaned or sterilized before reuse.
Evidence that procedures during child-delivery infected women with HIV
A number of studies in various African countries have found that women get HIV faster – they are at higher risk for HIV – during late pregnancy and in the months after delivery than at other times.[iii] In a national survey in Ethiopia in 2005, 9.9% of women who gave birth in the last 3 years with “delivery care by health professional” were HIV-positive, compared to only 1.2% of women who gave birth in the last 3 years, but had “no delivery care by health professionals.”[iv] Relative to risks for non-pregnant women, the risk for pregnant women seems to be greater in some places and years – which is what one would expect if unsafe health care was involved. Safety would vary from place to place and over time.
[i] AbouZahr C, Wardlaw T. Maternal mortality at the end of a decade: Signs of progress? Bull WHO 2001; 79: 561-8.
[ii] Nilses C, Nystrom L, Munjanja S, et al. Self-reported reproductive outcome and implications in relation to use of care in women in rural Zimbabwe. Acta Obstet Gynecol Scand 2002; 81: 508-15.
[iii] Gisselquist D, Rothenberg R. Potterat J, Drucker E. HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission. Int J STD AIDS 2002; 13: 657-666.
[iv] ORC Macro. Ethiopian Demographic and Health Survey. Calverton, Maryland: OCR Macro, 2006.