Genital Herpes & Vaginal Birth

[skg_7]

Wondering if any experts and/or herpes-affected mothers can weigh in here...

I have had recurrent gential herpes (HSV-1) for 16 years. I'm 17 weeks pregnant and beginning to have nearly constant warning signs of recurrences, or actual recurrences. My old standby of L-Lysine is not doing the trick.

In any case, I'm heart-set on having a natural labour and delivery here at home (legal where I live) and yet I worry a great deal about the odds of having a recurrence. My midwife has suggested I think about a 4-week course of acyclovir starting at 36 weeks. But I sure hate the idea of taking an anti-viral when pregnant.

I know the odds of transmission are very low in my circumstances (long-standing infection) but if my current status as a walking herpes outbreak is a foreshadwing of things to come, I may have to take the anti-viral medication afterall....

[kailotus]

i know it seems terrible to take a drug while pregnant, but if you are having break outs during your pregnancy, than taking a prescription during the last few weeks is the best way to insure against transmission to the baby or caesarian. i know moms with herpes who didn't take the prescription, but they also didn't have any break outs while pregnant. it also depends where you have your break outs- my midwife said you can put betadine and band aids over an affected area and still deliver safely, but not if your break out is around the vaginal opening. by 36-37 weeks your baby is already developed and supposedly it can handle you taking the prescription for a few weeks.
its a depressing thought for moms who are anti-drug, but the thought of caesarian or transmission is also depressing. i delivered my son naturally with a midwife, and my next baby is due any minute to be born at home...both times i have taken valtrex and HATED it, but it seems the best choice and all of my health care providers also feel its the best choice, and have assured me that valtrex is pretty safe to take for a few weeks at the end of pregnancy. i still say a little prayer everytime i take the stupid pill, just to say that i am taking it to heal and not to hurt my pregnancy!

[Nicole B]

I don't like the idea of taking anti-viral meds the last month of pg either but I know that the risks of the Valtrex to my baby at that stage in the game is very minimal but the potential risks of having a C-sect because of a stupid outbreak I'd think would put you and baby at a much greater disadvantage.
The risk for a host of other germs and viruses would be so much greater in the hospital and especially with the c-sect for you!

I want my baby's first view of his/her world to be one of peace and tranquility and love so I'm taking the round of Valtrex at the end to ensure that environment cause the tiny risks of taking the pills are so much less in my eyes than facing even the slight possibility that his/her first breath might have to come fresh off a cold metal slab in a bright cold harsh room and having to adjust to life under a warmer surrounded by strange faces instead of transitioning in the warm embrace of his mother's arms and chest.

To me there isn't even a question to weather I'll take the pills or not

[skg_7]

Thank you both so much for your replies. It helps to know there are other like-minded women facing the dilemna and choosing the path of least resistance. You're so right about the potential problems from a c-section (not to mention how heartbreaking it would be to go that route after working so carefully towards a natural homebirth).

I think I'll just do a little research on acyclovir and valacyclovir in pregnancy -- hopefully to put my mind at ease.

[nashvillemidwife]

I agree with the above posters. Any risks of taking acyclovir are outweighed by risks of not taking it.

[gurglebaby]

I just delivered naturally 6 months ago. I have had genital herpes for 5 years now and I also found during my pregnancy that I was having signs of recurrences, especially in the early months.
Lucky for me my midwife was all for a drug free birth as well. I did a few different things to prevent an outbreak including diet and if you'd like to discuss it in further detail you can send me a private message.

[ErinsJuneBug]

I'm pretty sure that since you have had it for so long your antibodies are large enough to give your baby almost no chance of catching it through shedding (if you dont have an outbreak at the time of delivery)....if you do have a sore i've heard of midwives just covering it with nail polish or a gloved hand so it doesnt touch baby during delivery.

What does everyone think about eye drop at delivery with a mom who has herpes? Is that something that should be done?

[mendomidwife]

Originally Posted by nashvillemidwife

I agree with the above posters. Any risks of taking acyclovir are outweighed by risks of not taking it.

I agree also, and I do offer treatment at 36 weeks - but I have always questioned how we treat herpes in pregnancy. Remember when we cultured everyone who had a positive history at 37 weeks? In theory, that was to determine if they had lesions on their cervix that could potentially transmit the virus to the infant during delivery. (Why does this remind me of GBS????).
Don't you think that we missed A LOT of women who never even knew they had herpes because their outbreaks were only cervical?
I've never seen a case of disseminated herpes in the newborn - I don't even know what the % is for women with a positive history. It must be very low - if not it seems we would be seeing it more.
Sorry if this isn't the most articulate post - lack of sleep....

Carla

[kate3]

Neonatal infection is rare, but devastating. In almost 18 years of being a RN/NP, I have seen disseminated neonatal HSV only twice, both in women who had no obvious outbreak at the time of labor. One knew she had HSV but never told us, the other denied knowing she was infected. Both infants had significant complications.

Considering that you have had symptoms throughout your pregnancy thus far, the virus is obviously active in your body. Remember, there can still be shedding when there are no lesions. In this case, the risks of the acyclovir or valacyclovir outweigh the risks of no treatment.

[mendomidwife]

Going on the assumption that we treat everyone with a positive history - and considering the previous post....."you can shed when there are no lesions"...then why don't we include a IGG/IGM Herpes screen for everyone when doing the prenatal lab - and treat accordingly?
I'm not saying I am lobbying for this - I just have never understood the logic behind how we choose who to treat.
Carla

[nashvillemidwife]

mendomidwife, I have always thought that herpes should be just as big a concern as GBS. How many women out there are infected and never know it, and therefore putting their baby at risk?

GBS got to be the issue it is partly because of advocacy by parents who had GBS babies. But how many moms are going to be publically vocal that their doctors didn't do enough to save their babies from contracting her sexually transmitted disease?

[ErinsJuneBug]

Also - how accurate are the tests for herpes? I was SURE i had an outbreak in college and had a culture that infact confirmed that i did. My entire pregnancy i had 6 blood tests to check for antibodies and they always came back negative. I continue to have outbreaks several times a year so i know i DO have it, but my OB says that i dont. hmmm... I even had DH get tested and he came back positive for oral herpes but not genital herpes, arent they the same thing?! And HE has never had an outbreak.

[mendomidwife]

Hmm....I know that doing a culture of the lesion could be a false negative, but I assumed a serum test for antibodies would be fairly accurate.

Carla

[ishereal]

Originally Posted by ErinsJuneBug

Also - how accurate are the tests for herpes? I was SURE i had an outbreak in college and had a culture that infact confirmed that i did. My entire pregnancy i had 6 blood tests to check for antibodies and they always came back negative. I continue to have outbreaks several times a year so i know i DO have it, but my OB says that i dont. hmmm... I even had DH get tested and he came back positive for oral herpes but not genital herpes, arent they the same thing?! And HE has never had an outbreak.

same here !!!

[nashvillemidwife]

You can have the virus forever without having an outbreak. You can get a false negative on any culture but not a false positive (unless the specimen was contaminated or mixed up at the lab).

Genital and oral herpes are related but different viruses

[mendomidwife]

There is HSV1 and HSV2 -
HSV1 is oral herpes, HSV2 is genital - although either can be found in either place if the person is having oral sex - or touches a lesion on their mouth, and then touches their genitalia, or visa versa.
Both can cause problems in the newborn.
I would think that if you had either you would have antibodies in your blood if there was a sufficient period of time for your body to produce antibodies.
From my understanding these virus' look alike under a microscope - but they differ in their latency periods.

Carla

[doulawendy3]

Cream

http://www.moonlodge.biz/market/herbs.cfm?catid=4#4

Check out this web site a midwife friend of mine makes and sell a cream for herpes. She is a Midwife in Oregon and she is also a herbalist. She swears by it.

[Doula Dani]

I would highly suggest the acyclovir. It would be better to take it while pregnant and have an unmedicated vaginal birth, then not take it, have an out break, then end up with a cesarean and all of the medication and implications that go with that.

Good luck!

[skg_7]

It seems like the general consensus here (which matches the research I've done) is that the risk of transmission to a newborn from a mother who's had genital herpes for a long time -- like I have is -- extremely low, but that the risk is not worth taking.

Thanks everyone for weighing in.

[skg_7]

Originally Posted by skg_7

It seems like the general consensus here (which matches the research I've done) is that the risk of transmission to a newborn from a mother who's had genital herpes for a long time -- like I have is -- extremely low, but that the risk is not worth taking.

Thanks everyone for weighing in.

I didn't really finish my thought very clearly on that last post! What I meant was that the risk of not using an antiviral like acyclovir is not worth it, even if the odds of transmission are slim.