Do I need to have a caesarean delivery?

There used to be a blanket recommendation that all women with HIV have a caesarean delivery to minimise transmission risks. The evidence that opting for an elective caesarean before you go into labour (called a pre-labour elective caesarean, or PLEC) reduces transmission is strong. As women with HIV are more likely to go into labour slightly prematurely, it will be recommended that your caesarean be scheduled at 38 weeks rather than the standard 39.

Opting to have an emergency caesarean after your labour has started is not associated with the same reduction in transmission, so if complications are likely, scheduling the delivery prior to your due date is preferable.

It is likely, however, that there is a low level of viral load [1]A measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma. (a viral load ‘nadir’) below which a pre-labour caesarean doesn’t offer any extra protection from transmission. In other words, if your viral load is undetectable throughout pregnancy and prior to delivery, it is unclear whether there is any additional protective benefit in having a caesarean.

Women who have caesarean deliveries are recommended to take intravenous antibiotics to avoid postoperative infection.

Caesarean delivery is recommended if:

• You have detectable viral load before delivery
• You have detectable HCV [2]Hepatitis C virus. levels in the blood
• You are taking no ARV [3]A medication or other substance which is active against retroviruses such as HIV., or AZT monotherapy
• Delivery complications are anticipated (multiple births, breech position, other gynaecological issues)

Disadvantages of caesarean delivery

A caesarean section delivery is major surgery and it can be at least six to eight weeks before your body recovers enough for you to do basic things like drive a car — this can be particularly hard while having a tiny infant to look after! The recovery time is a particular disadvantage for women who have other dependent children, or other additional caring responsibilities.

There is also the risk of post-operative infection, a reaction to the anaesthetic, and surgery itself is a risk.

Some women get a sense of achievement from vaginal delivery, and some have a pronounced dislike of surgery.

Advantages of a pre-labour elective caesarean

• It reduces transmission risks;
• You know when the baby will be born;
• You will avoid episiotomies or tearing that can occur with vaginal birth, and subsequent incontinence problems.