Understanding Health Services for Mothers Living with HIV in Ontario

Women living with HIV are increasingly having children due to advancements in medical treatment, the evolution of HIV infection into a chronic health condition, and increasing acceptance and normalization of parenthood among people living with HIV and advocates working within HIV services. At the same time, pregnancies among women living with HIV continue to be classified as “high risk.” An HIV diagnosis channels women into a system of specialist care that involves specific medical procedures and recommendations, and the expectation that women interact with a tertiary, academic teaching hospital to access maternity care. As a result, women living with HIV do not have the same freedoms as other women to utilize alternative maternity care including midwifery and community-based obstetricians. Furthermore, the specialist perinatal care women living with HIV are expected to utilize is organized by bodies of knowledge and practice guidelines that direct healthcare providers to monitor women’s bodies and their behaviour throughout pregnancy and postpartum. This paper will describe an institutional ethnographic inquiry that was conducted within a regional hospital in Hamilton, Ontario and focused on the organization of perinatal healthcare for women living with HIV. This inquiry was conducted to make visible how women who receive care within this institution coordinate their lives to attend their medical appointments. The inquiry also sought to uncover who is involved in the delivery of care and support for women during the perinatal period; how tasks are delegated and organized within the hospital among those delivering care; and how medical discourses, language, and education influence how healthcare providers operate within this system of care. By uncovering how perinatal care is coordinated and organized, this research has the potential to optimize institutional policies and practices, as well as enhance the experiences women have when they receive care during pregnancy and early postpartum.