• The risks of vertical transmission. Based on current research these are six out seven chances the baby will be negative (one in seven it will be positive, and even less with interventions such as antiretroviral therapy, caesarean delivery and bottle feeding). Key factors in transmission seems to be the mothers' viral load and CD4 count, and general HIV disease status

• Possible interventions to reduce the risk of transmission to the baby – antiretroviral therapies, delivery by caesarean section, bottle/formula feeding. The aims of these interventions are to lower the viral load in the mother, and minimise the baby's possible contact with infectious maternal fluids, such as cervical and vaginal mucous, blood, and breast milk. If a woman takes up all these interventions it is possible to reduce the risk significantly. However, the risks implicit in taking ARV therapy both to the mother and the baby, and also in caesarean section, are present and must be discussed. The long term effects of giving an HIV–negative baby strong drugs are still unknown. It should not be underestimated how emotionally and culturally important breast-feeding can be for some women

• During the pregnancy there is no way of telling whether or not the baby is infected (see later section for details of tests to find out the baby's true HIV status).

• The possibility of a termination. A woman needs to understand the time-scales for decision making, and the reasons for these time-scales. For instance, there is a difference between early and late termination. Unfortunately, a woman who tests for HIV antenatally is not likely to find out the result until she is about 14 weeks pregnant. This would mean a late termination involving labour. What are her views on termination? Does she have religious beliefs which affect the issues? What support would she have if she terminated the pregnancy? HIV-positive women who decide to terminate a pregnancy will need extensive support and counselling. As with any woman who has just had a termination, they should not be immediately offered sterilisation. This is a contraceptive measure which may be regretted, and should not be considered until after adjusting to the trauma of a termination and HIV status if only recently discovered

• If this pregnancy were terminated what would be the chances of a future pregnancy? How important is child–bearing to this woman. Does she have any other children?

• Does her partner (if any) know about her HIV status? What are his views about continuing with the pregnancy? What support will he offer? Has he been tested himself? Does he want to be?

• What support would she have if she continues with the pregnancy? What implications would there be for the future? Who will care for the baby if she and/or her partner become unwell? How will she cope if they are all unwell?

• Who will need to know that the baby may be infected? Babies of HIV–positive mothers are normally advised not to have a BCG or to have live polio vaccine. This may mean the GP and Health Visitor who normally take responsibility for baby inoculations, will need to know, or steps taken to ensure that the baby gets appropriate inoculation at an HIV specialist family clinic

• What care and medical attention will the baby receive? If a woman follows the ACTG076 protocol, the baby will have AZT for about 1 month after birth. The baby will also receive PCP prophylaxis (treatment to prevent pneumocystis pneumonia) for up to six months until the child's HIV status can be established definitively. How will she cope with repeated medical attention to the baby?

• Has she considered how she will cope if the baby is HIV infected and needing treatment?

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