Question
Why am I being advised to have a vaginal delivery?
8 November 2011. Related: All topics, Pregnancy.
Hello,
I am 23 weeks pregnant with a CD4 count of 500 and an undetectable viral load. I have been on treatment since April 2009 and quickly responded positively to my treatment combination until today.
I have from the start been told that when I became pregnant, I would have a C-section, but now with my current results, my midwife reckons I could have a safe vaginal delivery ( for the baby) and even advised it strongly.
I would just like to have a opinion on that, please.
Thank you.
Answer
Thank you for your question
Congratulations on your pregnancy.
In terms of having a vaginal delivery, your midwife is correct in saying that you can safely have one. This is because your CD4 count is good and even more important, your viral load is undetectable.
One of the main factors that determine whether you can have a vaginal delivery is if you have an undetectable viral load at the time of delivery. Caesarean sections or C-sections as they are generally referred to, have over the years been offered to women in order to minimise even further, the risk of transmission of HIV to the baby. This was even more important in the days when pregnant women were taking only one drug.
However, as more and more women are taking combination therapy [3 or more drugs] during pregnancy, studies have shown that where a woman achieves an undetectable viral load by the time she is ready to deliver, then, a C-section does not offer any additional protection. Hence the move towards recommending natural delivery. Please follow this link for more information on delivery options https://i-base.info/guides/pregnancy/delivery
You mention that your midwife has strongly advised you to have a natural delivery. Do you have concerns about this? Do you have a preference to a C-section? Can I also ask what treatment you are taking?
I hope this information is useful.
Please let us know if we can help further, or again in the future.
Best wishes
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