I did a bit of googling about on this and found something interesting - in the US about 1 in 3200 mothers pass herpes on to their baby, but in Japan it is 1 in 15,000 and in England it is 1 in 65,000, and neither Japan nor England have lower rates of herpes infection in the adult population or reccommend c-sections for all women with herpes...in america they do however.

Apparently 30-50% of babies of women having their 1st herpes outbreak in the 3rd trimester get herpes IN THE WOMB and mode of delivery makes no difference. In one study of 202 women 85 delivered by c-section and 117 delivered vaginally. One (1.18%) c-section baby contracted herpes, nine (7.69%) of vaginally born infants contracted herpes. NONE of the vaginally born babies' mothers had active lesions at the time of labour and the study did not report on use of forceps, ventouse, scalp monitoring or AROM, all of which vastly increase transmission risk. 70% of the babies who were infected had mothers suffering their first (albeit asymptomatic) outbreak with viral shedding. Testing for viral shedding was found to be unreliable as it usually lasts 2 days at most and testing every 2 days from 38 weeks - birth is prohibitively expensive and the results usually take 5-9 days to come back from the lab...

Because the risk is substantially lower of transmitting if the woman has had the infection longer than she has been pregnant, and if she is aware of her infection, and extremely high and most problematic/dangerous in women who do not KNOW they have herpes at all, the only realistic way to make infants safer is to deliver EVERYONE by c-section JIC. This is obviously not a realistic option.

I would say if you prefer to birth vaginally and are supported in that decision by your care givers and family, that is probably the best thing to do. The risks of c-section for mothers and even the risks of the c-section to the baby are significant enough that one doctor felt that if they sectioned all women with herpes they would be killing as many women as they saved babies. There is also the factor to consider that if there is accidental laceration of the infant (where the surgeon cuts through the uterus and into the baby, which occurs in between 2% and 6% of c-sections) during a section where herpes is present and the membranes have ruptured already (and possibly, even if they haven't, given some babies are infected in utero) the risk of transmission is higher and the implications more serious since there is an open wound present.

I have talked to other women (with herpes, HPV and recurring BV) about how they feel about vaginal delivery. It is VERY important that women are well-supported and cared for when dealing with STD's and pregnancy. In this society there is a huge stigma attached to what are in fact very common STD's, and this makes too many women feel their vaginas are not "fit" to push a baby out of. Your vagina is PERFECT and in the vast majority of cases is the best passage for your baby to come to earth. If you are very high risk (under 21, first outbreak in 3rd trimester, high-risk in other ways which would mean scalp monitoring advisable or forceps/ventouse likely) then a section is the safer option, but it is better to make that decision based on the medical fact than because of any stigma or feelings of (unjustified) self-disgust.

Good luck with your pregnancy and birth (how YOU want it).

Bx