I’m HIV positive. How will HIV affect my birth options?

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What’s the safest way to deliver my baby if I’m HIV positive?

That depends on your health and individual circumstances. The decision to have a vaginal birth or a c-section is one to make with your healthcare provider.

Discuss the risks and benefits of each type of delivery with your healthcare team early in pregnancy. It’s an important decision because the risk of passing HIV on to a baby is highest around the time of delivery.

Experts aren’t sure why the risk of spreading the virus is greater during birth. It could be that some of the blood containing the virus crosses the placenta during contractions. Another possibility is that a baby becomes infected from contact with body fluids during birth.

In the past, HIV-positive women were usually advised by their provider to have a c-section. But these days, controlling HIV with antiretroviral therapy (ART) reduces the risk of transmitting the virus to a baby. When you have a low enough level of the virus in your blood, the benefit of a c-section isn’t as clear.

Will I be able to have a vaginal delivery?

If you’re on ART, a vaginal delivery is possible. The option of a vaginal delivery depends on how much HIV is in your blood (what your viral load is) at the end of your pregnancy. Your provider will likely also consider how long your immune system has been suppressed.

It also depends on whether your pregnancy is otherwise uncomplicated. A vaginal delivery may not be possible for reasons unrelated to HIV, like, if you have placenta previa, for example.

Your provider measures your viral load regularly throughout your pregnancy. The lower the load, the better it is for your baby.

Viral load is measured by counting the number of HIV particles (or copies) in a milliliter of blood (copies/mL). Toward the end of your pregnancy, this measurement helps you and your provider decide how to deliver your baby.

If your viral load is 1,000 copies/mL or less, the risk of your baby being infected with HIV during birth is low.

When is a c-section necessary?

If you’re not on ART, or if your viral load is above 1,000 copies/mL, a scheduled c-section is recommended to reduce the risk of transmitting HIV to your baby during labor. Taking a drug called zidovudine can also lower the risk of transmission.

Your c-section will be planned two weeks before your due date (when you’re 38 weeks pregnant). This is done before labor starts naturally because a cesarean delivery reduces the risk of transmission most when you’re not yet in labor and before your bag of water has broken. (If your viral load is low, and you’re having a scheduled c-section for other reasons, it will be planned for when you’re 39 weeks).

A c-section is major abdominal surgery, so there are risks associated with giving birth this way. This is the case for all women, but being HIV positive makes you more likely to have complications.

Your provider will discuss what this means for you. Getting an infection from surgery is the biggest risk for most women with HIV. Your healthcare team can give you antibiotics during surgery to prevent infection.

Do I need to take HIV medication while I’m in the hospital?

Yes – pack all your medication in your hospital bag. Continue taking your medication as regularly as you can to keep your viral load as low as possible and reduce the chance that your condition will become resistant to drugs.

It’s not always easy to remember to take your medication when you’re in an unfamiliar environment, not to mention also dealing with contractions or preparing for a c-section.

Tell your birth partner and the members of your healthcare team where you keep your medication and when you need to take it.

If you’re having a c-section, you’ll need to talk to your healthcare provider about the safest way to take your medication. Women preparing for a scheduled c-section generally should not eat anything for six to eight hours before their surgery or drink anything in the final two hours.

You’ll be allowed to take your oral medication with sips of water. If your medication needs to be taken with food, work with your provider to come up with the best solution.

Visit the Society for Maternal-Fetal Medicine’s website for more information and to find an MFM specialist near you.

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