Natural Birth with Genital Herpes

Hi All,
I have had a wonderful pregnancy and enjoyed pretty much every moment. I am now 35 weeks and have what I think is a bit of a touch decision to make. I have genital herpes, and have had lesions present for most of my pregnancy (since about 18 weeks). I have been on an anti viral medication but can not shake them.

I was always told that if I had a lesion or lesions when it came time to have the baby, I would have to have a cesarean, as there was a risk of passing the virus on to the baby (which can be very dangerous and sometimes fatal). I am now told that because I have had the virus in my system for a long time (I have had the virus for 14 years) and because I have had lesions during the pregnancy, the baby will have an immunity which should protect it during a natural labor. The anti viral medication that I have been taking should help things a little too.

I have spoken to two mid wives, my GP and an obstetrician, and they have all agreed that the risk is still present, but minimal. They have also said that the mortality and complications rate for cesareans is higher than the risks of me passing the virus on to the baby.

It sounds like a pretty easy to make decision, but I just want to do what is right for my baby. I would love to have a natural birth too, and I am hoping that this is not making me bias in my decision.

If there is anyone out there who has had a lesion during birth or who has gone through any of this, I would really appreciate your words of wisdom.
Thanks
Louisa L

hmmmm can't say I know much about this but wanted to wish you well & hope you can have the birth you want while keeping your baby safe.

Oh & Happy Holidays!

there has been a thread about this before.
I've just dug it up for you
https://www.bellybelly.com.au/forums...ad.php?t=38224

Hi Louisa

I have had 3 births - 2 with lesions and was forced to have a C S with those two. The other birth I was lesion free and allowed to have a natural birth. I would and should have questioned it more and requested a natural birth especially with my last birth as I was almost in transition and was forced to have an ECS.

Good Luck

Hi Louisa

Sorry, no words of wisdom but lots of sympathy for your predicament! I have a similar problem - didn't know there was medication one could take, though. I read the thread dachlostar put up and am now feeling quite worried. I wasn't too concerned when I had DS - my ob just said, if lesions are present when I go into labour, they may do a caesar, which is how he ended up being born (but for other reasons). This time round I'm going for a VBAC but am now wondering if I shouldn't just have an elective c/s instead.

It sounds like you've done your research - maybe you just have to trust in your ob and go for the VB which is what they recommend.I don't know exactly where you get the lesions but perhaps they can be covered to reduce the chance of transmission?

Let us know how you go in making your decision.

Thank-you to every one for your quick reply. It is so great to have some support and I really appreciate everyones help.
Dachloster, thanks for the link. I have now read through it twice and it was very helpful.

AustraJoey, I can relate to how you feel as I am worried that if I have a CS then I will regret not going for the natural birth. If the professionals are telling me to go for it, I probably should.

Mgm I will be sure to let you know how I go as it sounds like you are in a similar predicament, (just ten weeks after me). I am sorry if I have made you worry. Apparently the transmit ion rate is extremely low, so I probably shouldn't be so concerned about it, nor should I be making others worry. I just want to make the right decision.
The name of the drug that I have been taking is Famvir, and my doctor said that it has been trialed with no deformities/side effects to the babies whose mothers have been on this drug. There was another alternative but I can not remember the name of it, but it had a slighly lower safety rating for pregnant women.
Went to my midwife today. She said the my last swab showed no virus present. She said that because I have been on the anti viral medication, this has helped to keep the virus at bay, even though I have been unable to get rid of the lesions.
I will have another swab at 37 weeks and if this is all clear I think I will go for a natural birth. If the virus is present then I will request a cesarean.
From what I can gather, the baby will be checked at birth for any infection and treated immediately with the antiviral medication if there is any transmition. Apparently the more serious risks are for the babies of mothers that do not even realise that they have genital herpes and find that their babies are sleepy and unresponsive 2 or 3 weeks after birth. I think early detection is very important. (I will be doing a bit more research on this over the next few days).
I know the risks are very small, and really I probably shouldn't be worrying too much about it. Just making sure I give my baby a good start.
Thanks all. Any more info or input would be great.
Lou

Louisa L
i know that this is not really related to the topic, but i just want to say THANK YOU for talking about genital herpes, i have been suffering from this for the last few yrs and have never EVER told a soul, i cant tell you how many tears i have shed over it, it was passed on to me my gorgoues husband to be who i love very much. we both knew he had it and i knew the risk but we wanted to have kids and a little while later i started getting blisters, my dp feels like he is to blame and he feels terrible when i have a break out but i dont blame him not at all the, if it means that we can have beautiful children together then i dont mind having it :) small price to pay really.

You have no idea how comforting it is to me to read this, i have wanted to start a thread on bb about herpes but was a bit worried as i didnt know how to word it and was a little worried about being judge and thats pretty silly of me cos the people on here are just amazing with there kind words and support, but then i suppose i just didnt want anyone to know, but you know now and i feel so good to actually let it out and speak about it woohoo

thank you so much, this isnt just going to help me but is going to help my dp, so once again for being so brave and strong to come on here and talk about it, you have really helped me.

take care

I haven't read the other thread but there is a medication you can take. Also some women have has c/s where the baby has had lesions so the c/s is not foolproof. Avoid having your waters broken, they will be keen to hurry you along once that happens and do your research - I have supported clients with STDs before and its all been fine :) Again, do your research, get lots of opinions, but the medication should help.

Genital Herpes is present in approx 1 out of 8 of Australians. It is very common, probaby more common than we think it is and unfortunately there is a huge social stigma about it in society where quite often, people who have genital herpes are seen to be 'dirty' or 'promiscous (sp)' whereas this is not the case at all hence why so many people who have this virus, feel so ashamed (louisa, im not saying you feel ashamed) when really it's very quite easy to come in touch with and not just through sexual intercourse. Many people live with this virus in their body and do not even realise they have it as they have never had any symptoms so they are 'asymptomatic'. Mummy2chloe, well done on posting :)

Louisa - I wish you all the very best with the birth of your beautiful baby and hope that you can make the right decision for you and your baby, with the help of those around you :)
ps i hope i didnt crash your thread by saying all that, i just wanted to add that thats all :hug:

Thanks to everyone for your support.
Mummy2chloe, I hope I have not made you worry. From what I have been told, there is such a small risk of passing it on to bubs. I think with herpes there is this real sense of guilt that comes with it. I am not sure why. I met my husband just after high school, and we have been together ever since, and for some reason when I get an ob I still feel like I have done something promiscuous or dirty to deserve these blasted things. hahaha. A couple of years ago, I began to talk about it a little more (I had never told a soul up until then), just with my really close girl friends. And guess what, two of my friends have it as well. We felt like such fools not being a little more open about it earlier, and even though all of our cases and experiences are different from each other it is just nice to know that your not alone.
One word of advice. I have been on other forums for this topic. American forums seem to be very anti vaginal birth and everyone who has posted has said "C SECTION' loud and clear. In Europe and the UK however, the general view of health care professionals there is that vaginal birth is fine, even with a lesion as you pass on an immunity to your baby.
I feel good that I have research it quite a bit, and I now feel a lot more relaxed. I will let you all know how it all goes.
Thanks again everybody...

Louisa I just want to wish you all the best with the birth of your baby!

Its interesting how there are different medical opinions out there. For my booking in appt at the public hospital, seeing a regular midwife, she in no uncertain terms told me that if I had a lesion at the time of going into labour then I would need a c/s. I was also told this when pregnant with Aidyn last time.
Even though from 37 weeks I plan on taking the Valtrex medication, which works really well for me. I think I am lucky in that the virus only affects me a couple of times a year anyway.

At later midwife appts - this time with the midwifes in the Birth Centre, I was told that as I have had genital herpes for many years, the risk of transferring the virus to baby, even with a lesion present is very very minimal.
The midwifes went so far to recommend that I didn't even need to take the anti-viral medication, however I will be - as that is what I feel more comfortable with.
I took the Valtrex for a few weeks leading up to Aidyns birth, and never had any issues with it, and was able to have a VB.

Funnily enough last time (when pg with Aidyn) when I went through the regular public hospital system, no one really seemed to know much of anything about genital herpes during pregnancy at all, it was so frustrating! They couldn't even tell me if it was safe to take the medication or not - and actually advised against it, but luckily I was able to find the correct information elsewhere.

There are a few useful bits of info that I have learnt from my midwifes at the birth centre too.
There are recommendations that during an active outbreak the use of instruments should be avoided during birth. These include things such as fetal scalp monitors, ventous, forceps, as they can cause breaks in the babies scalp, allowing the virus to enter.
Also as Kelly said, it is advisable not to have your waters broken manually, as they act as a protective barrier for baby.

I think the biggest risk with genital herpes during pregnancy is if you actually contract the virus and have your first outbreak whilst you are pregnant, especially during 3rd trimester, as this poses more significant risks to baby.

Mummy2chloe - I'm glad that you feel a sense of relief in being able to talk about this now. I remember when the first topic was posted earlier last year on this, I kept thinking 'should I respond?', as I was so worried about being judged.... There definitely is a lot of guilt that goes with having an STD, even though its actually fairly common - its just that people don't feel comfortable/safe to talk about it, which is a shame, as its important to receive accurate facts and information, as well as support from people who understand what you are going through!

Mummy2Chloe, I second your thankyou to Louisa L! I'm glad this topic was raised. Like you, Louisa, it's something I've not generally spoken to friends about, although I do know that one very close friend has herpes (albeit asymptomatically).

I've spoken to my ob who said we can consider the medication as I get closer to my due date; she also doesn't think there's much to be gained from having an elective c/s unless I have an active lesion at the time that can't be covered up. So I'll just try to reassure myself that the risks are very low either way.

Louisa, I wish you the best of luck with whatever kind of birth you choose (assuming you haven't already had your baby!) Do let us know how you go.

Ambah, I see you're due next month, so best wishes to you too.

hi louisa. I have had GH for 20 years. When pregnant with my daughter 12 years ago, I had it back to back, and after doing lots of research decided that the best option for me was to have a c-section. As the virus can shed without there being any visible symptoms, plus pressure from DD's father,felt "safer" delivering that way. When pregnant with DS1 I also had reoccurring attacks, and ex husband also wanted me to deliver that way again. As it was i went into labour with him, and had an emergency c-section due to placental abruption. With DS2 i didn't have an attack at all. I still delivered by C-section, mainly because that was the option available to me after having had 2 other csections. Aston's birth was my best btw... but that's another story.

Whatever decision you make, it is yours alone to make, and you have to feel ok with it. I did feel pressured by my DD's father to have a c-section due to the herpes, and at times after having her I felt "ripped off" but having had labour with Nathan don't feel that way anymore. For me personally I don't think its the way the baby arrives in this world that makes you a mummy - its everything afterwards.

Hope the rest of your pregnancy goes quickly and stressfree.

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

Bec - what I would have done for all these facts 12 years ago!... but wasn't to be. no matter. The information was insightful, as I have a young friend who has just contracted it, and is feeling all the normal reactions that you get when it happens. I think I will pass on the info to her. Thanks

Bec - that's great advice!!! :)

Thanks for the research- I wish I'd known this 12 years ago, would have saved myself 2 CS. Very interesting stuff!!

Hi Everyone,
Just wanted to let you know what happened in the end.

I had a natural birth three weeks ago. Just before I had my baby I was lucky enough to go to a new obstetrician. He was amazing and I really wanted to pass on what happened in hope that it may help someone else out there, just like it helped me.

I told him my symptoms (very itchy areas that wont get better), and I explained how I had been on the anti viral medication since about 20 weeks. He was confussed, and said to me "from what you have told me it does not sound like herpes'm he went on to say that when a woman is pregnant, it is pretty common for her to have vaginal complaints. Be it thrush, herpes, vulvadinia, etc. The area (vagina) is engorged with blood during pregnancy and this makes it more sensitive and susceptible to irritation. When he told me this I got a flutter of hope and I told him that I got the distinct feeling that he was just telling me exactly what I wanted to hear. He and another doctor took a look, and found no lesions. They did a swab and he said that these swabs could be redone right up to the birth.

Now I know this all sounds a little crazy. But when I heard all of this, the more I thought about the sensations that I had been feeling down below, I realised that it didn't feel like herpes at all. It was more of an irritation like thrush (but it wasn't thrush) I think that when you have herpes and you know that you could pass it on to your child, that if there is any irritation in the reigion, you just think the worst. This is exactly what I did. I did not take the time to ask myself "what does this actually feel like?" ...
This is why I wanted to pass on my experience, maybe someone else out there might experience the same thing as me. Thanks to the doctor taking the extra time to double check, I was lucky enough to have a natural birth. I had a beautiful healthy baby boy named Archie and he is just wonderful. Good luck to others out there, and I hope this thread has helped others to make an informed decision. I was so worried a few weeks ago, thanks so much for your help and kind reply.
Cheers