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
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.