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Birth: Caesarean or vaginal
Apr 19, 2006

Hi, I'm due to give birth in June. This is a planned pregnancy, current cd4 around 450, vl belowlevel of detection for three years now. Am in very good health. I had originally opted for vaginal delivery of baby. However after considering the fact that current protocol in my area ( which has no experience of previous vaginal deliveries) insists that the baby must be delivered within four hours of spontaneous rupture of membranes. Also, other variables such as limited exams to check labour progression, no episiotomy etc have swayed me into the decision that elective c section is the better option.My section is booked in now, a decision which is not irreversible. The problem is that this is the hardest decision I have ever had to make. There still seem to be contrasting opinions about delivery. Indeed in Uk where I live Manchester recomment vag del if vl is <1000, yet LIverpool down the road will do nothing except c sections. I know it will appear to you that I have already decided but I wonder if you could say anything to reassure me, despite the risks of major abdominal surgery, that my decision to have c section is a good one. <any thanks for you reply and for the great work that you do.

Response from Dr. Luzuriaga

The risk of transmitting HIV from mom to baby is under 1% when moms have undetectable viral load on therapy. At that point, the potential risk of complications of C-section exceed the potential risk of transmitting the virus; for this reason, the ccurrent US guidelines (available under the "Treatment Guidelines" section of this web site) do not recommend C-section when VL is under 1000 copies/ml. I am assuming that antiretroviral therapy will be started on you when you present to hospital; if your labor goes over 4 hours, sufficient antiretrovirals will likely have been transferred to the baby to provide protection. So unless there are other obstetrical reasons that a C-section is recommended for you, I would feel comfortable going with the guidelines to recommend vaginal delivery.


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