You and your doctor should discuss your options for delivery in the early stages of pregnancy and also review your viral load when you are around 36 weeks pregnant to discuss your best options for delivery at that time.
There used to be a blanket recommendation that all women with HIV should have a caesarean delivery to minimise transmission risks. This is no longer the case, and caesarean delivery is usually only offered to women with a detectable viral load prior to delivery, so many women are now choosing to have vaginal deliveries. As women with HIV are more likely to go into labour slightly prematurely, if a caesarean (called a pre-labour elective caesarean) is needed it would be scheduled at 38 weeks rather than the standard 39 weeks. Having an emergency caesarean after your labour has started is not associated with the same reduction in transmission risk, so if complications are likely, scheduling the delivery prior to your due date is preferable.
Caesarean delivery is recommended if
- You have a detectable viral load before delivery, especially if it is above 1,000
- You have detectable Hep C levels in your blood
- You are not taking antiretroviral therapy
- Delivery complications are anticipated, for example, multiple births, breech position, other obstetric issues of concern.