If a woman is diagnosed with HIV during routine antenatal screening, undoubtedly she will have a number of conflicting emotions and stressors. At this time, nursing support is critical. The woman and her partner may need support and guidance in terms of adjustment to a new illness, while also dealing with their pregnancy.
Many issues may come up during this period: confusion, guilt, anxiety, fear of transmission to the unborn child - all of these require sensitive handling, negotiation, potential referrals, and support. The nurse's role can include linking the woman, and her family if necessary, to appropriate counselling, peer support, and culturally-specific care and providing education to help overcome problems around the time of diagnosis. The nurse can also be the key worker in advocating for the woman and family when dealing with external agencies or other health facilities.
In principle, the nurse should support the mother to:
- make informed choices about pregnancy care
- make informed choices around treatment choices
- access intensive HIV monitoring to confirm that she has achieved HIV viral suppression (that her HIV viral load is at an undetectable level)
- choose how, when and where her baby is born in collaboration with other health professionals
- receive the best information on care for herself and her baby through pregnancy and beyond
- ensure optimal adherence to her prescribed antiviral agents
- ensure attendance at appointments and avoid loss to follow-up after the birth.
In seeking to achieve these principles, the nurse may identify that the woman needs assistance to navigate a complex health system, with competing priorities. Appointments and procedures are best streamlined as much as possible to avoid unnecessary hospital visits and stress; this becomes particularly important if the woman has other children to care for with competing parenting demands.