Should I have a pre-labour Caesarean section?
If you do not need treatment for your own health and choose to use AZT alone, a pre-labour Caesarean section will be necessary to reduce transmission risk to minimal levels. If a woman’s viral load is undetectable on HAART, there is such a low risk of transmission associated with either mode of delivery that no advantage in transmission risk occurs through pre-labour Caesarean.
If your viral load is detectable, greater than 50 copies/mL, a pre-labour Caesarean is recommended, especially if your viral load was undetectable and has become detectable.
What strategy is recommended?
Current British guidelines say: “Mode of delivery must be discussed with the woman and her wishes taken into account.”
A choice of either Caesarean section or vaginal birth is offered when a mother’s viral load is below detection on combination therapy.
If you have a high CD4 count and low viral load and choose to receive AZT, you will have the pre-labour Caesarean section at 38weeks. If your viral load is undetectable on treatment and you choose to have a pre-labour Caesarean section, you will have it at 39-40 weeks.
What is the likelihood of complications?
Caesarean section is major surgery. Therefore some complications—particularly the risk of infections—are slightly more common in women having Caesarean sections than women having vaginal delivery.
Caesarean sections appear to carry a slightly greater risk of complications among HIV positive women compared to HIV negative women. The difference is most notable in women with more advanced disease.
A pre-labour Caesaerean section will not offer protection to your baby if you go into labour earlier than expected.
If your waters break before your Caesarean section is due your medical team will consider managing you as though you had presented late in pregnancy with an emergency Caesarean section and additional anti-HIV therapy.
Will a Caesarean section now stop me having a natural birth in the future?
If you have a Caesarean section now, having a natural birth in the future is more complicated and difficult.
This is an important consideration.
You may be offered the choice of vaginal delivery but you will be more likely to need a Casearean section than a woman who has previously delivered vaginally.
This is important to know if you plan to have more children in a country where planned Caesarean section is not possible, safe or easily available and there is less access to obstetric care.
How do I make a decision?
If you have an undetectable viral load and have a choice, before making the choice, it is important that you are informed of the risks and benefits associated with each mode of delivery. You should spend time discussing any concerns that you have with either mode of delivery with your healthcare team.
It is also important that you and your doctor make sure that your HIV is well managed and that your viral load remains undetectable. This is not only for the risk of transmission but also for your own health.