HIV/AIDS and Elective Cesarean

Since today is World AIDS Day, ICAN of DC is discussing elective cesarean for HIV positive mothers. This is a topic most people do not think about when they think about cesarean or women healing from cesarean. But it is one worth discussing, especially in the District of Columbia where the HIV/AIDS rate is at at least 3% of the population which is on par with certain areas of Africa.

So what special considerations does an HIV-positive woman have during pregnancy? During pregnancy she should be taking antiretroviral drugs to lower her viral load. In doing this she can lower the risk of transmitting the virus to her fetus in utero and at the time of birth. She should also be avoiding unnecessary tests that would disrupt the membranes within the womb and potentially expose the fetus to maternal blood (ie. amniocentesis,etc). And of course a healthy diet is essential since the mother will have increased nutritional needs and lower immune response compared to a mother who is not HIV-positive.

But what sort of birth is appropriate for a mother who is HIV-positive? According to this article, if the mother's viral load is less than 1000 copies/ml, then she may attempt vaginal birth. But that birth must have special considerations as well. The less interventions the better to keep the likely hood of maternal blood/cervical fluid transmission low. If a woman's viral load is above 1000 copies/ml, then an elective cesarean prior to rupture of membranes is the course of action recommended to bring risk of transmission to 8%. But of course cesarean and HIV-positive status means a longer and more difficult recovery time for a woman who has a compromised immune system.

So where does that leave most HIV-positive women who are pregnant? Without the proper resources the mother is staring down an elective cesarean. With proper treatment and a care provider who is knowledgeable about HIV transmission and pregnancy, the same mother could have avoided a major abdominal surgery. Ultimately the decision is up to the mother and her decision for what is best for the health of herself and her child, but it is nice to know that there is a choice and different paths to follow safely.