Practice recommendations
The discussion has raised many issues that can be
applied to both the case study and practice
generally.
Analysis of the evidence has firstly highlighted
the differences globally between the risks in
different parts of the world and hence the
difference between two major sets of guide-
lines namely WHO and BHIVA. There is a need
for staff to be aware of both guidelines
particularly when faced with mothers who are
experiencing conflict between national policy
and internal, culturally based beliefs that
strongly influence individual choice. Health
professionals should be aware of potential
conflicts between national and international
guidelines so that they can understand the
needs of women from other countries than the
UK or similar. According to the current guide-
lines within the UK, health professionals would
in all cases advise HIV positive mothers not to
breast-feed. However, in the light of evidence
on HAART/START as discussed and the effect on
lowering transmission rates, healthcare
workers need to know how to help some
mothers, such as Zola, minimise the risks of
breast-feeding. Based on new evidence, atti-
tudes may start to change among healthcare
workers when breast-feeding is chosen in
a well managed setting.
This case highlights the importance of good
communication and how this can help to
reduce stress among parents. Compromise
between staff opinions and/or guidelines and
that of parents is not always easy or possible.
However it is possible to provide parents with
enough information and time to process the
information before making decisions. This
could have been done with Zola as soon as
possible during her pregnancy for information
to be assimilated early and avoid the stress of
discovering the advice not to breast-feed.
Also of utmost importance is to continually
strive to provide holistic family centred care,
to be mindful of the motherechild bond and try
to enforce this where possible. This was central
to the care of Zola who clearly felt bonding was
of great importance to her.
The case also offers a new perspective in
relation to infant feeding from a global view-
point. Making global comparisons stresses the
importance of an international perspective on
maternal and infant health. This is not only so
that we recognise diversity and individual
cultures such as that illustrated by Zola’s case;
also so we are aware of the stark differences
there are across the world and the inequalities
in access to health and simple basic care and
equipment that we may take for granted in the
western world.
Practice recommendationsThe discussion has raised many issues that can beapplied to both the case study and practicegenerally.Analysis of the evidence has firstly highlightedthe differences globally between the risks indifferent parts of the world and hence thedifference between two major sets of guide-lines namely WHO and BHIVA. There is a needfor staff to be aware of both guidelinesparticularly when faced with mothers who areexperiencing conflict between national policyand internal, culturally based beliefs thatstrongly influence individual choice. Healthprofessionals should be aware of potentialconflicts between national and internationalguidelines so that they can understand theneeds of women from other countries than theUK or similar. According to the current guide-lines within the UK, health professionals wouldin all cases advise HIV positive mothers not tobreast-feed. However, in the light of evidenceon HAART/START as discussed and the effect onlowering transmission rates, healthcareworkers need to know how to help somemothers, such as Zola, minimise the risks ofbreast-feeding. Based on new evidence, atti-tudes may start to change among healthcareworkers when breast-feeding is chosen ina well managed setting.This case highlights the importance of goodcommunication and how this can help toreduce stress among parents. Compromisebetween staff opinions and/or guidelines andthat of parents is not always easy or possible.However it is possible to provide parents withenough information and time to process theinformation before making decisions. Thiscould have been done with Zola as soon aspossible during her pregnancy for informationto be assimilated early and avoid the stress ofdiscovering the advice not to breast-feed.Also of utmost importance is to continuallystrive to provide holistic family centred care,to be mindful of the motherechild bond and tryto enforce this where possible. This was centralto the care of Zola who clearly felt bonding wasof great importance to her.The case also offers a new perspective inrelation to infant feeding from a global view-point. Making global comparisons stresses theimportance of an international perspective onmaternal and infant health. This is not only sothat we recognise diversity and individualcultures such as that illustrated by Zola’s case;also so we are aware of the stark differencesthere are across the world and the inequalitiesin access to health and simple basic care andequipment that we may take for granted in thewestern world.
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