HIV and Pregnancy

Preventing Transmission of HIV During Labor and Delivery

I am HIV infected and pregnant. Will I need anti-HIV medications during labor and delivery?

Women infected with HIV take anti-HIV medications during labor and delivery to reduce the risk of mother-to-child transmission of HIV. (See the "Mother-to-Child Transmission of HIV" fact sheet.) During labor and delivery, women continue to take the anti-HIV medications they took throughout their pregnancies. They also receive an anti-HIV medication called AZT intravenously to protect their babies from HIV in the mother's genital fluids or blood during labor and delivery.

Talk to your health care provider about the use of anti-HIV medications during labor and delivery well before your due date.

Will I have a vaginal or a cesarean delivery?

The risk of mother-to-child transmission of HIV is low for women who take anti-HIV medications during pregnancy and have a viral load less than 1,000 copies/mL near the time of delivery.

For some HIV-infected mothers, a scheduled cesarean delivery (also called a C-section) at 38 weeks of pregnancy (2 weeks before the due date) can reduce the risk of mother-to-child transmission of HIV. A scheduled cesarean delivery is recommended for HIV-infected women who:

• have not received anti-HIV medications during pregnancy;
• have a viral load greater than 1,000 copies/mL or an unknown viral load near the time of delivery.

If, before her scheduled cesarean delivery, a woman's water breaks (also called rupture of membranes) or she goes into labor, a cesarean delivery may not reduce the risk of mother-to-child transmission of HIV. If there is not another pregnancy-related reason to have a cesarean delivery, the risks of going ahead with the scheduled cesarean delivery may be greater than the benefits. Depending on an individual woman's situation, a vaginal delivery may be the best alternative to a planned cesarean delivery.

What are the risks of delivery?

All deliveries have risks -- even for mothers without HIV infection. In general, a cesarean delivery has greater risks than a vaginal delivery.

For the mother, the risk of infection or a blood clot in the legs or lungs is greater with a cesarean delivery than with a vaginal delivery. All women who have a cesarean delivery, including women infected with HIV, should receive antibiotics to prevent infection. For the infant, the risk of temporary breathing difficulties may be greater with a cesarean delivery.

Talk to your health care provider about the risks and benefits of each type of delivery early in your pregnancy.

For More Information

Contact an AIDSinfo health information specialist at 1-800-448-0440 or http://aidsinfo.nih.gov. See your health care provider for medical advice.

This information is based on the U.S. Department of Health and Human Services' Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States (available at http://aidsinfo.nih.gov/guidelines/).