Q and A

Question

Can I have a vaginal delivery?

Hi, I am 27 weeks pregnant and HIV positive.

I have been taking ARVs since I was 12 weeks pregnant.

What are my chances of having a vaginal delivery versus a c-section?

I would really prefer a vaginal delivery

Answer

Firstly, congratulations on your pregnancy.

In response to your question, your chances of having a vaginal delivery depends on a number of factors.

The first factor is what your viral load will be at the time of delivery. This is because an undetectable viral load is key in preventing transmission to your baby.

It is important to take your medication exactly as prescribed and following any diet restrictions. This is known as adherence. Good adherence will make it much more likely that you will have an undetectable viral load at the time of delivery.

The second factor is what the treatment guidelines in your country recommend.In your question, you did not specify where  you live.

In the UK, the BHIVA [British HIV Association] treatment guidelines recommend vaginal delivery if a woman has an undetectable viral load [under 50 copies], at around week 36.

The UK guidelines recommend a C-section (Caeserean-section) if the viral load is over 400 copies. If the viral load is between 50 and 399 copies, a C-section is recommended.

In this situation, a number of things will be taken into consideration before making the final decision on whether the woman will have a vaginal delivery or a C-section. These include: the actual viral load; the length of time a woman has been on treatment; how well you adhere to treatment and what the woman’s wishes are.

I can appreciate your preference for a vaginal delivery. This is also in line with the BHIVA guidelines. Given the choice, many women living with HIV would prefer the same option. However, if you did have to have a C-section, then this option is fine too as many women have safely delivered healthy HIV negative babies through C-sections.

You still have some way to go before delivery.  The important thing is to continue taking your medication as prescribed. Chances are that you will achieve an undetectable viral load by the time you are ready to deliver. In which case you would then be able to have a vaginal delivery.

Good luck for the rest of your pregnancy.

The i-Base guide to HIV and pregnancy guide answers a lot of other questions..

For more information on the importance of adherence, please follow this link to another guide.

This answer was updated in January 2016 to a question first posted on 28 February 2012.

20 comments

  1. Roy Trevelion

    Hi Jessica,

    Many congratulations on the news that you’re going to have a baby. It’s great that your viral load is less than 20. It looks like your HIV meds are working well.

    But please talk to your doctor about delivery of your baby. Here in the UK guidelines recommend vaginal delivery for mothers on HIV treatment with undetectable viral load of less than 50 copies/mL. This is unless there are other complications.

    You and your doctor can decide, at 36 weeks, how you plan to deliver your baby. This decision will be made after reviewing your viral load results. But your viral load looks great of course.

    Here’s the guide to HIV pregnancy and women’s health for more info.

  2. Jessica

    Thanks so much am really happy been here am pregnant and I am HIV positive with less than 20 viral load can I have a negative child? And vaginal delivery?

  3. Lisa Thorley

    Hi Patricia,

    As long as you start ARVs and your viral load is undetectable before you give birth, then unless there are other medical and health issues you’ll be able to have a vaginal birth. Please see here: http://i-base.info/guides/pregnancy

    Given that you aren’t due until December, there’s definitely time for your viral load to become undetectable.
    Due to you being pregnant, depending on where you live you should be being seen by a specialist team.

  4. Patricia

    Hi I’m a lady with 25 years and this is my first time pregnant. I’m 24 weeks just realise that I’m hiv positive. Soon on December I’ll be giving birth. Which method can I use to deliver coz I’ve also got STI’s.

  5. Roy Trevelion

    Hi Letsatsie,

    What HIV meds (ARVs) are you taking? They look like they’re working well.

    A viral load of 23 is undetectable. And although this can reduce the risk of transmission during breastfeeding, this risk is not zero.

    However, in some countries, where there isn’t access to formula, mothers breastfeed exclusively for 6 months and then wean baby onto soft food.

    It’s not recommended to mix feed with both formula and breastmilk.

    Please see what Angelina has answered here.

  6. Letsatsie

    Can I breastfeed at 23viral load

  7. Roy Trevelion

    Hi Rahul,

    Thank you!

  8. rahul

    I really enjoy this website. Lots of variety in articles on it. I wish I could pick and choose articles. All in all though, it gives me a lot of info and even answers a lot of my own questions. I would recommend for all the pregnant ones.

  9. Lisa Thorley

    Hi Funny,

    In the UK when someone has an undetectable viral load like you have, you wouldn’t be offered a C-section as there isn’t any need. That is unless there were complications during the birth. There’s more about this here:

    http://i-base.info/guides/pregnancy/can-i-have-a-vaginal-delivery

    http://i-base.info/guides/pregnancy/caesarean-section

    http://i-base.info/guides/pregnancy/why-is-a-caesarean-sometimes-recommended-if-you-are-hiv-positive

    Ultimately, it should be your decision on how you give birth, it is afterall your body and your baby. It might be a good idea to ask your doctor why they think you need a c-section when your HIV isn’t an issue.

  10. Funmilayo

    Am funny from Nigeria, HIV+ 37weeks in pregnancy and my viral load is understandable (zero level) since last year but Doctor told me that I should go for C-section, I don’t have any issue am ok, Doctor said because am positive I have to go for C.S of which I don’t to want. Please help me

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