Pregnancy and Birth

The Lord has given Anne Sokol the amazing opportunity to start a home for ladies in crisis pregnancies in Ukraine, and one issue that they need to face is what to do with HIV+ clients. That spurred her on to study the topic of HIV+/AIDS and pregnancy. At first, she found only the standard answers promoted by large, worldwide organizations, but as she dug deeper, she began to learn things that she had never heard before, information that surprised her greatly. Researching and writing about this topic has given her more reservations about the current protocols for treating HIV/AIDS women in pregnancy, and more confidence as a caregiver to address this issue.  Listen and learn from the following documented study she has done.   Thank-you, Anne!

Surprising Controversy Surrounding HIV/AIDS
By Anne Sokol, Charis student and missionary in Ukraine

To the average caregiver, it might come as a surprise to learn that the current information about HIV/AIDS is complex and contradictory. It’s like a huge puzzle with thousands of tiny pieces, some of which are not in existence yet, so trying to link information together to form meaningful conclusions is difficult, if not impossible. The questions of science are skewed by dogma, opinion, money, and dubious research. Many, however, have drawn definite conclusions on how HIV+ women should be diagnosed and treated in pregnancy, birth and breastfeeding. Others admit that the answers are not so clear, forming different hypotheses about testing and care. Midwives (and other caregivers) need to be aware of controversies surrounding HIV and AIDS.

Most of the world assumes that infection with the human immunodeficiency virus leads to AIDS. The Centers for Disease Control, March of Dimes, United Nations, and World Health Organization are a few leading organizations which support the theory that HIV causes AIDS, and they currently advise various levels of antiretroviral drug therapy during pregnancy and/or labor and/or postpartum to prevent HIV transmission from mother to baby. Two of these drugs are called Zidovudine (ZDV or AZT) and nevirapine.

It comes as a surprise to many caregivers when they find out that not everyone agrees with this theory. Alternative voices (“AIDS dissidents”) question the research and information commonly promoted about HIV/AIDS. For example, Anne Frye, a frequent and trusted source of knowledge for midwives, casts doubt on the HIV-leads-to-AIDS theory and highlights the work of Peter Duesburg, an early AIDS dissident, and she emphasizes the possible link between syphilis and AIDS, in particular. She also warns of the harmful effects of antiretroviral drugs for treatment. Many of these dissenters assert that the antiretroviral drug treatments themselves are extremely destructive to the human body and may, in some cases, be the instigators of AIDS.

According to a presentation at the AIDS Conference in Barcelona in 2002, and a scientific study published in the Journal of Acquired Immune Deficiency Syndrome (December, 2003), more HIV-Positives are dying from organ failure as a side effect from the HIV drugs than are dying from AIDS; and according to the largest and longest scientific study of HAART (Highly Active Anti-Retroviral Therapy), the drugs being given today are even more dangerous and offer no increase in longevity than those given ten years ago.” (Living Without HIV Drugs) Also, experts point out that drug use, anal sex, and other lifestyle choices do themselves give rise to serious immune deficiency issues (Gary Null).

To further understand this controversy, it’s helpful to understand the uncertain nature of HIV testing. The test itself is not to find the actual virus but its antibodies. Assuming the human immunodeficiency virus exists, which strangely has yet to be proven, a positive result for this test could just mean that the body has confronted HIV and now has immunity to it.

The proteins used in the HIV test kits have never been proven to be unique or specific for HIV. In fact, every one of the proteins used in the test has been found to be associated with conditions that have nothing to do with HIV -- and many of these proteins have nothing to do with illness of any kind. In other words, scientific evidence cannot prove that a positive HIV test means that you have HIV or AIDS or any other health problem.” (Help for HIV)  There are over sixty factors that can cause the body to produce the antibodies that will trigger a positive HIV test. Medical literature and drug companies admit this (Johnson). Also, the same blood tested at different places can have different results (Help for HIV).

For midwives who test clients for HIV, one of the many issues surrounding the controversies of HIV testing is pregnancy itself.

Routine HIV antibody testing for pregnant women raises particular concerns as pregnancy itself can cause positive HIV test results. Although cross-reactions due to pregnancy are documented in the medical literature and acknowledged by test manufacturers, HIV antibody tests have become part of standard prenatal screening, and are even mandatory in some states. A fundamental problem of routine screening using even the most accurate test is that low risk groups will have the highest rates of false positives. ( “Do Pregnant Women Who Test HIV Positive Give Their Babies AIDS?” emphasis mine) Many dissidents question the actual existence of HIV. The virus itself has never been seen or “isolated,” though antibodies are supposedly tested for. “The failure to verify the antibody tests against the gold standard of virus isolation is a serious omission of scientific method. In the absence of such validation, these tests should not be used to diagnose HIV infection.” (Turner, emphasis mine)

What is AIDS?

The definition of AIDS has changed over the years, and the Centers for Disease Control’s current, basic definition of AIDS is “a positive HIV blood test along with either a major opportunistic condition or a CD4 count less than 200/mm3.” Major opportunistic conditions include certain cancers, recurrent pneumonia, certain types of cytomegalovirus, and other uncommonly heard of illnesses. (American Cancer Society) If homebirth midwives are open to serving HIV+ women, what if the woman is already diagnosed with AIDS? A common sense course of action would be to determine the general health and lifestyle of the woman and if the presence and extent of the specific opportunistic infection(s) risks the woman out of her practice. For some midwives, the work required to understand and evaluate this in itself might be enough for her to rule out dealing with women diagnosed as having AIDS; however, each situation should be reviewed personally, as the AIDS diagnosis is itself a developing science. Also, once a person is diagnosed as having AIDS that label will never be removed, even if her health improves. So just having the label “AIDS” doesn’t always mean a person is very sick.

The CD4 count (in the CDC’s definition of AIDS) refers to one type of T-cells. T-cells (or T-lymphocytes) are white blood cells and are part of the immune system that attacks harmful invaders. (The other type of T-cells are called CD8s.) In the average person (HIV-), the CD4 count ranges between 600-1200/mm3. In the HIV/AIDS theory, the CD4 count falls gradually in HIV+ people making them more susceptible to serious infections and diseases. (NAM)

However, this method of evaluation is also under question:

A lot of emphasis is also placed on CD4 (or T-cell) counts to diagnose someone with AIDS. However, T-cell counts can fluctuate widely from day to day and hour to hour in even normal, healthy people. . . . Other studies have found perfectly healthy HIV-negative individuals with very low T-cell counts. And as recently as May 2007, from the Imperial College of London: ‘Our new interdisciplinary research has thrown serious doubt on one popular theory of how HIV affects these [CD4] cells.’” (Help for HIV)

So, if a person is HIV+ and one day tests with a low CD4 count, that person is labeled as having AIDS for life. Also, AIDS has been diagnosed with no HIV present (“Cause Unknown for AIDS without HIV” and Root-Bernstein). So the issue of being diagnosed with AIDS is not as simple as some present.

Drug Therapies Promoted for Use During Pregnancy

If a midwife serves HIV+ women, she needs to understand the nature of the drugs popularly promoted for use during childbirth to treat the woman and to prevent the transmission of HIV to the baby. Many national and international organizations promoting the use of these drugs say little to nothing about the side effects. For example, one site says, “For the fetus, AZT therapy can cause bone marrow suppression which can cause severe swelling (hydrops)” (”Hydrops Fetalis”). (See also Sinclair 368.) That is all. But these drugs are actually a type of chemotherapy. If a woman in a midwife’s care is currently taking drug therapy (like HAART), this probably puts the pregnancy in a high risk category because the effects of these drugs are generally toxic and they may have very serious negative effects on the woman and her pregnancy.

Expectant mothers who test HIV positive are commonly advised to abort or to take AZT, a highly toxic chemical compound originally created for use as a cancer treatment. AZT works by blocking the formation of DNA -- a process essential to sustaining life -- and destroying all growing cells, particularly new cells produced in the bone marrow where the immune system is generated. AZT is a known carcinogen, mutagen, and teratogen, and until recently it was contraindicated for use during pregnancy.

AZT was approved for expectant mothers based on the conclusions of a single trial, ACTG076, a trial sponsored by AZT's manufacturer. According to this study, transmission rates of HIV were 25.5% for infants of untreated mothers and 8.3% for children born to the AZT-treated women.

The results of ACTG076 have proved impossible to duplicate in further studies on pregnant women treated with AZT. In fact, other reports have shown that expectant mothers using prenatal multivitamins experienced lower rates of transmission than the lowest rate of those treated with AZT. One study determined that use of vitamin A correlates with a transmission rate of 7.2%.

The effects of AZT on expectant mothers include muscle deterioration, severe anemia, nerve damage, liver damage, muscle wasting, lymphoma, acute nausea, diarrhea and dementia. The effects of AZT on developing infants include misshapen heads, extra fingers, triangular faces, albinism, misplaced ears, cavities in the chest, webbed fingers, anemia, spontaneous abortion, chromosomal damage, and can result in the need for therapeutic abortions of severely deformed fetuses. (“Do Pregnant Women Who Test HIV Positive Give Their Babies AIDS?”)

If the woman is HIV+, is healthy and prophylatically caring for herself through nutrition and other natural means, a homebirth midwife might consider accepting her as a client. “Studies have shown that for properly nourished HIV positive expectant mothers receiving regular prenatal care, over 90% of their children test negative with no drug therapy” (“Do Pregnant Women Who Test HIV Positive Give Their Babies AIDS?”). The issues then become the extra sanitary precautions needed during prenatal care and the birth to prevent the possible spread of HIV. Breastfeeding will also need to be researched and addressed by both the mother and midwife.

The most important factor a midwife needs to consider is the woman’s lifestyle. Is this a situation where the HIV diagnosis is potentially accompanied by other sexually transmitted diseases? Is the midwife willing to test for all these, even knowing the often-uncertain results (like false negatives) of tests including serious infections like syphilis and gonorrhea, for example? Is the woman doing illicit drugs, smoking, or drinking? These and other lifestyle choices would risk out a home birth.

Finally, a midwife can consider the situation in which she works. So far, these scenarios assume a homebirth midwife with a private practice. In this setting, she may or may not be prepared to deal with the potential complexities that may face her in an HIV+ pregnancy. But in a medical setting, like on the mission field or in a hospital, this question may be viewed entirely differently. The midwife working in these conditions might be offering the best care available. Or she might be working in a high-level medical setting that enables her to test for and deal with more serious diseases and issues surrounding the HIV/AIDS controversies.

Resources for Midwives:

• Gary Null. “Deconstructing the Myth of AIDS.” <http://video.google.com/videoplay?docid=3983706668483511310>. This is a must-see video for those open to exploring the HIV/AIDS controversy. It’s thorough and it directly addresses some issues relevant to pregnancy.

• http://www.aliveandwell.org
• http://www.helpforhiv.com/
• http://www.reviewingaids.com/awiki/index.php/Main_Page
• http://hivskeptic.wordpress.com/
• http://aras.ab.ca/index.php
• http://www.immunity.org.uk/
• http://paganpressbooks.com/jpl/AIDS.HTM
• http://www.livingwithouthivdrugs.com/
• http://barnesworld.blogs.com/
• http://www.virusmyth.com/
• http://www.whatisaids.com/
• http://notaids.com/
• http://suppressedscience.net/aids.html
• http://rethinkingaids.com.93.seekdotnet.com/
• http://www.duesberg.com/
• http://www.theperthgroup.com/

For further information, see
http://www.tig.org.za/pdf-files/TIG_PRESS_STATEMENT_AZT_in_pregnancy.pdf
and http://www.tig.org.za/pdf-files/poc.pdf (p. 8)

Works Cited
American Cancer Society. “Definition of AIDS.” Cancer. 12 May 2008.
<www.cancer.org/docroot/CRI/content/CRI_2_4_1x_Definition_of_HIVAIDS.asp>
“Cause Unknown for AIDS Without HIV.” New Scientist. 20 Feb. 1993. 17 Nov. 2008.
<http://www.newscientist.com>
“Do Pregnant Women Who Test HIV Positive Give Their Babies AIDS?” Alive and Well: Mothers,
Babies, and AIDS. 17 Nov. 2008. <http://www.aliveandwell.org>
Frye, Anne. Holistic Midwifery. Vol. 1. Portland: Labrys Press, 1998.
Gary Null. Dir. “Deconstructing the Myth of AIDS.” 17 Nov. 2008. Online video.
<http://video.google.com/videoplay?docid=3983706668483511310>
Help for HIV. Home page. 17 Nov. 2008. <http://www.helpforhiv.com>
”Hydrops Fetalis.” University of Virginia Health System. 12 Feb. 2004. 17 Nov. 2008.
<http://www.healthsystem.virginia.edu/uvahealth/peds_hrnewborn/hydrops.cfm>
Johnson, Christine.“66 Reasons to Think Twice About HIV Tests.” Alive and Well. 17 Nov. 2008.
<http://www.aliveandwell.org>
Living Without HIV Drugs. Home page. 17 Nov. 2008. <http://www.livingwithouthivdrugs.com>
NAM. “CD4 T-cell counts.” AIDS Map. 19 July 2005. 17 Nov. 2008.
<http://www.aidsmap.com/en/docs/D2596CD3-B444-4F86-AE85-DDC5F048CEF3.asp>
Root-Bernstein, Robert. “AIDS Without HIV.” Rethinking AIDS. Aug. 1992. Virus Myth. 17 Nov. 2008.
<http://www.virusmyth.com/aids/hiv/rrbhivneg.htm>
Sinclair, Constance. A Midwife’s Handbook. St. Louis: Saunders, 2004.
Turner, Valendar. “Testing, Testing . . . Is a Positive Antibody Test Proof of HIV Infection?” Help for
HIV. 17 Nov. 2008. <http://www.helpforhiv.com/validated.htm>

Submitted with permission by Anne Sokol

Anne and Vitaliy are missionaries in Kiev, Ukraine.  Anne's personal passion and burden is childbirth.
Currently she is studying with Charis Childbirth to be a doula and childbirth educator.
She's also an aspiring midwife.