6 HIV and pregnancy

6.12 Choices for delivery and use of C-section

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The way a baby is born – whether to have a vaginal birth or Caesarean section – is controversial for HIV-positive women.

Caesarean or C-section is a procedure to deliver a baby that involves making a cut through the abdominal wall to surgically remove the infant from the uterus.

The operation must be carried out before the onset of labour and ruptured membranes. This is called elective or scheduled C-section.

• Several early studies showed that an elective C-section significantly reduced mother-to-child transmission compared to vaginal birth. But these studies were before combination therapy and viral load testing were routinely used.
• Whether or not an elective C-section offers any benefit to babies born to mothers using combination therapy is unknown.
• Complications, particularly infections, are more common in woman having C-sections than woman having vaginal delivery.
• If a woman's viral load is undetectable, there is such a low risk of HIV transmission for C-section and vaginal delivery that it may never be possible to show an advantage for either.
• HIV transmission to the baby is rare among mothers who are taking combination therapy, even when their viral load is greater than 50 copies/mL.
• Having a natural birth after a C-section is more complicated and difficult.
• Babies delivered by C-section are more likely to receive ventilatory support.

It is very important that a woman makes her own informed decision in association with her healthcare team concerning mode of delivery.