Delivery: Vaginal or Cesarean?
HIV can be transmitted from mother to baby during birth since the baby is exposed to the mother's infected blood and secretions. The risk of this exposure may be higher when procedures, such as an episiotomy (an incision made in the perineum) or equipment, such as forceps or a vacuum, are used to ease delivery. While you are giving birth, your doctor uses sterile equipment and makes every effort to protect your baby from exposure to infected blood and secretions. This lowers your baby's risk of contracting the HIV virus.
In several recent studies, researchers have tried to determine whether women with HIV should automatically give birth by cesarean section (C-section) to further reduce the risk of transmitting HIV to the baby. Prior to the use of highly effective antiretroviral therapies, C-section was recommended for every HIV-infected woman giving birth. However, if the mother can achieve an undetectable viral load on combination HIV therapy, vaginal delivery is as safe as C-section in terms of risk of transmission to the fetus. Elective C-section before the onset of labor or rupture of membranes is now considered appropriate for the following patients:
Safer sex practices include:
- consistently using latex condoms during intercourse, either vaginal or anal;
- avoiding intercourse during menstruation; and
- avoiding unprotected intercourse when either partner has open sores in the mouth or on the genitals.
- those receiving no antiviral treatment; or
- those receiving combination antiretroviral therapy who still have detectable viral loads (active virus in the blood).
If you are receiving combination antiretroviral therapy for HIV infection and have an undetectable viral load, delivering by cesarean does not seem to provide any additional protection against transmitting the virus to your baby. The rate of perinatal transmission in such patients, regardless of the mode of delivery, appears to be almost zero. Therefore, your doctor will most likely recommend that you deliver vaginally.
The most exciting new breakthrough in HIV research would be the development of an effective vaccine against the virus. However, several obstacles must be overcome before making this goal a reality. The first is the tremendous genetic diversity of the virus. A vaccine effective against one strain may not be effective against other strains. The second major obstacle is the fact that the virus can enter the body both through the bloodstream and through mucosal membranes. A vaccine that is effective in stimulating antibodies in the blood (IgG antibody) may not stimulate antibodies that protect against mucosal infection (IgA antibody). Finally, there is concern about the potential harm a vaccine may cause an individual if the virus is not properly attenuated (weakened) or killed.
After giving birth, you can help to control your infection and protect your baby and your partner by:
- continuing to take combination anti-HIV medications if your doctor recommends that you do so;
- avoiding contact between your body fluids and an open area on the skin or mucous membranes of your child-mucous membranes line parts of the body that open to the outside, such as the mouth, genitourinary tract, and rectum;
- not breast-feeding; and
- practicing ?safer sex? to prevent spreading the infection.