SR Burgie Ireland (nursing sister) answers:
It sounds like you are a well-motivated woman who has faced many challenges with a positive attitude. You also want to do what's best for you and your baby, so it's good to research your options and to ask questions.
Your doctor is always the best person to ask, because he knows more about your health, CD4 count and viral load and these records determine what decisions will be made regarding the best way to prevent mother-to-child transmission of HIV. The decision whether you should have natural childbirth or a caesarean birth will depend on:
- Whether you have private care or if you are at a government hospital
- Your state of health
- Risks to your baby
Women attending government hospitals do not have the choice of an 'elective Caesar'- caesareans are prioritised for emergencies only or when the risks of a natural birth outweigh those of a caesarean section. Private hospitals have easier access to operating theatres plus the additional staff that's needed for surgery.
Natural birth is the preferred way of delivering a baby because there are fewer risks when a mother has been for antenatal care and she has been screened to rule out the possibility of complications. An HIV positive woman can give birth naturally providing she has been monitored throughout her pregnancy, and if necessary been given ARV's (antiretrovirals) or HAART (Highly Active Antiretroviral Therapy). HIV positive women with a CD4 count more than 350 will be given AZT from 14 weeks of her pregnancy which is continued every three hours while she is in labour, with an additional single dose of Nevaripine and Truvada.
Women with a CD4 count of less than 350 will be started on ART (or triple-therapy because there are three different types of medicines) and these she will need to take for life. If a mother, for any reason, is not well enough to endure labour and natural birth, she will be given a c-section. The baby's health is carefully monitored during the pregnancy and labour, and if the baby's health is compromised in any way during this time, the baby will be delivered by c-section.
The best advice I can give you is to be prepared for the unexpected. At the time of delivery, put yor trust in the doctors and midwives who are there to help you. Make sure that you have support from family and friends.