Question
Can I have a vaginal delivery?
4 January 2016. Related: All topics, Pregnancy.
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.
Hi Nicole,
As long as your viral load is undetectable there’s no reason why you having HIV should prevent you from having a vaginal delivery.
Hi I am hiv positive been on treatment since may 2016 last time I checked my viral load was undetectable which was months ago now I am 32 weeks pregnant had previous baby with c section in 2013 now want to try VBAC is it safe?
Hi Lavon,
Because you’re viral load is undetectable, there’s no reason why you being positive should stop you from having a vaginal birth. Therefore, if this is how you want to give birth, then go ahead.
I’ve been on meds for 3 years. I’m undetectable. I’m 28 weeks pregnant, can I have a vaginal delivery?
Hi Lindiwe – thanks – this is great news for both you and our baby.
28 weeks my viral is lower than detacteble
Hi Lindiwe,
If you are experiencing pain you should go to a doctor. This may be a side effect of your medication, or it may be something else. We can not diagnose symptoms online and a very sharp pain which does not go away needs to be assessed by a doctor.
Best of luck, please let us know if you have further questions.
I’m HIV+ n 26 weeks pregnant I’ve recently started taking Aluvia n Lamzid 2 days ago but 2nd day after taking them I experienced diarhea,nauseas ,loss of appetite,dizziness n a very sharp pain on my righten side of de stomach to the back till today. What stressing me so much is that pain what might be the cause, and should I do
Hi
I think 84 is so close to 50 that this is still considered undetectable. The sensitivity of viral load tests mean that at these low levels a very low level blip is related to the test. If you were to test a new sample you may already be undetectable again.
UK pregnancy guidelines (BHIVA, 2012) recommend vaginal birth when viral load is less than 50 and C-section when viral load is above 400. On a quick look I couldn’t see a reference to blips.
Also, if your current HIV combination includes lopinavir/ritonavir (also called Kaletra or Aluvia) drug levels can drop in the third trimester. In women who blip or become detectable at this time your doctor should recommend increasing the dose to three pills twice a day (total 6 pills a day) rather than the standard two pills twice a day dose.
Im hiv positive my load is 84 copies is it save for viginal delivary?