40 Weeks to a Healthy Baby

When Alice Stek started delivering the babies of HIV-positive mothers in 1991, hers was a field where life left the world as frequently as it entered. 'We had many infected babies, and mothers who were dying,' says Stek, MD, the director of perinatal services at the Maternal-Child Adolescent HIV Program at Los Angeles County'University of Southern California Medical Center. 'And so many of these mothers died while their children were young. We even had some children dying of AIDS early in their lives.' As medications for people with HIV have improved, there also has been progress in helping HIVers safely bring life into the world. Stek and her team are approaching 15 years of healthy births, and her facility has delivered dozens of HIV-negative babies to HIV-positive mothers. Just 20 miles south in Long Beach, the Bickerstaff Pediatric Family Center at Miller Children's Hospital in January celebrated its 400th baby born in 15 consecutive years without the virus to an HIV-positive mother. Audra Deveikis, MD, the center's medical director, credits the advances in HIV medication as well as the center's in-depth prenatal and postnatal care program that ensures pregnant HIVers get to the hospital for regular screening and treatment. Bickerstaff Pediatric also provides other services such as social work, housing, and regular transportation to and from the hospital. These programs, and others like them across the country, are helping children of HIV-positive mothers grow up to live healthy, HIV-free lives. During the peak of mother-to-child transmission in 1992, one fourth of babies born to positive mothers were positive as well. Now, with advanced care options, highly active antiretroviral therapy (HAART), and better management and understanding of the virus, fewer than 2% of births among HIV-positive women yield an infected baby. Mothers and doctors, albeit cautious, can have high expectations for a healthy, safe pregnancy and birth. 'Even one transmission is one too many,' Deveikis says. Profiled in the following pages are two women who, despite their HIV-positive status, gave birth to HIV-negative sons. They've asked that only their first names be used. KATE, 30, PARALEGAL Like many couples before they exchange wedding vows, Kate and her husband took blood tests; theirs indicated a clean bill of health. The tests were especially important to the couple as they wanted to have children right away. It only took a few months for Kate to get pregnant in 2007. She then went back for a blood test and found out she was HIV-positive. She got the news while she was at work. 'The other women in my office heard how upset I was, so they rushed over to comfort me,' she says. 'They asked me what was wrong, and honestly, I didn't know what to say. I was in such shock that I told them the truth.' It turned out that both Kate and her husband had HIV. They are not completely sure who gave the virus to whom, or when it happened, but their theory is that her husband was the first to be infected. 'I was not promiscuous, I never used needles,' she says, 'but my husband led a little bit of a party lifestyle'he was more promiscuous.' While she says she confided in her parents and grandparents for strength and support, her pregnancy was still difficult emotionally and physically. 'I simply prayed. A lot. I was so scared,' she says. 'I cried, and I prayed every single day.' In addition to her regular obstetrician-gynecologist, Kate began seeing an ob-gyn who specialized in high-risk pregnancies. At first, she went in weekly for monitoring, but in the last few weeks of her pregnancy she spent as many as three days per week in the hospital. Starting in her second trimester Kate was given large pills, which caused dizziness to the point where she had to ask her husband to drive her to work and to the grocery store. She even started traveling with an extra set of clothes as a precaution, since she read that her pills could also cause incontinence. 'I had read that the side effects of my pills were explosive diarrhea,' she says, laughing. 'Fortunately, I didn't need the extra outfit, but it was very scary. You're reading every little thing you can find about your disease and the drugs you're taking'you never know.' By the time delivery day came, Kate was completely prepared. She says aside from the fact that she opted to have a cesarean section and that she had to have an AZT drip during labor to protect her son, she felt like any other woman giving birth to her first baby and was treated as such in the delivery room. For the first six weeks after the birth, Kate had to administer AZT in drop form to her newborn son every six hours to make sure he didn't contract the virus. Luckily, she says, he liked the taste. 'I was basically fine after giving birth, but I felt such guilt because I had to give him drugs,' she says. Tests were also administered. 'My son was tested at birth and at two months, four months, and at six months,' she says. 'I was so happy every single time it came back negative. You have to do work to make sure your baby is healthy, but it can be done as long as you stay on your regimen.' Kate is now able to look at life with gratitude, and she writes about her experiences with the virus at GirlLikeMe.org, a group blog coordinated by the Well Project. If anything, she says, the fact that she and her husband are living with HIV has helped her enjoy life more, all while keeping up at work, paying bills, and scouting out the right preschool for their son, who is now 3 years old. 'When other people are frazzled and busy, and don't have time to take in everything, I think I'm able to open up and enjoy more,' Kate says. 'I thank God that I have every day.' LAVERA, 37, YOUTH COUNSELOR During a 2005 trip to Nigeria when she was about 16 weeks' pregnant with her second child, LaVera couldn't ignore her fatigue and enduring cold, so she went to a doctor. After two weeks in a hospital bed, she was told she'd have to return home to Los Angeles to continue treatment. As soon as she got back, she was admitted to another hospital, where she learned she was HIV-positive. 'I was shocked,' she says. 'I was expecting to hear there were complications with my pregnancy, but not that I had HIV. I was worried about my baby, I did not know what to expect. And I did not want people to find out or to feel like they didn't want anything to do with me, so I just kept it a secret. I didn't talk about it to anyone.' Initially, LaVera disclosed her status only to one close friend and to her doctors. She didn't even want to tell her husband, a Nigerian native, who was in Africa when LaVera learned her status. She decided to wait until he returned to the States to share the news. 'I told him I was positive with an IV drip in my arm,' LaVera says. 'He hadn't been here for 48 hours. He didn't yell and scream, but it was kind of scary for him on the inside. For a long time I had to understand that where he's from, being HIV-positive is a death sentence. People will stop buying things from you if you're a business owner. If you have any social status, your whole family will lose everything if it gets out that a member of the family has HIV.' LaVera carefully planned and monitored the remainder of her pregnancy with a doctor who she says helped ease her worries and got her through the tough times. The doctor especially helped her understand her condition so she was better able to help her HIV-negative husband deal with her status. 'My doctor is really good at educating,' LaVera says. 'She's not one to just give you your meds and get rid of you. She talked to me, she explained so much, and she just kept reassuring me that there was less than 2% of a chance that my baby was going to be infected. Letting time go by and her explaining the protocol was what really got me through the fear of having HIV and being pregnant.' Since giving birth to D.J., now 5, LaVera has become vocal not only at her job but at home. She signed up for a class on HIV basics with her husband to allay his fears about the virus. She also talks to her sons, D.J. and 16-year-old James, about being healthy and taking care of themselves. Neither of them is aware of his mother's status, but LaVera knows that the time is coming soon when she must tell her oldest. She says being an HIV-positive mother makes her more aware of certain aspects of health and safety that other mothers aren't necessarily thinking about. One recent incident with D.J. at school, in which he bit another boy in self-defense, led to a mother-son talk. 'I had to tell him that when he bites people, he leaves himself open to being hurt,' she says. 'He bit him to the point where he almost drew blood, which could lead to him getting hepatitis or something like that. It's not just sex where parents have to stress safety, but we have to tell our children to protect themselves in other ways too.'