Questions for Midwives for a friend - Mothering Forums

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#1 of 6 Old 05-07-2010, 11:21 PM - Thread Starter
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A good friend of mine who has not yet had any children has become really concerned about whether she will be able to have a vaginal birth or not. Anyhow, she is nervous to ask people because she is still dealing with her own feelings about her health but I offered to ask these questions of midwives here and ones I know locally for her. Any info you can offer will be appreciated.

- Do you or have you worked with clients who are Herpes 1 / 2 positive with a history of internal lesions (i.e. not a primary outbreak)?
- Were they able to deliver vaginally?
- What kinds of suppressive therapy do you recommend?

Megan Davidson, Labor & Postpartum Doula, Breastfeeding Counselor, Anthropologist, Mom to August (9) and Clay (4), Partner to Shawn.

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#2 of 6 Old 05-08-2010, 09:51 AM
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I have worked with such women and they used, I believe, Valtrex (acyclovir?) during the last 4-6wks of pregnancy to assure prevention of an outbreak near/during birth. I don't have much experience with this, but so far, so good--no outbreaks, happy homebirths occurred, no side affects noted by anyone.

For one family, the dh had a greater tendency toward outbreaks than his wife, and if I recall correctly he tended to use the Valtrex as a daily preventive (there may be something I'm leaving out here, or getting not-quite-right). In general, even when not pregnant, the wife used it for a few days only when she felt an outbreak might be coming on--to good effect, she'd not had an outbreak in a long time.

Does your friend use Valtrex or any other anti-viral for her herpes? Has she ever checked into this?

Also, there are dietary measures she could try to increase her resistance to outbreaks--nutrients to increase, and foods to avoid, which together can make her system less friendly to the virus, and stronger in fighting it off. Is she doing anything--medical or natural--to help herself yet? Has she sought assistance from alternative practitioners such as Chinese, homeopath, naturapath, etc--if not then she should if she can. Such practitioners can help her to understand and effectively address her particular constitution and strengthen herself in all ways. My knowledge in this area is pretty 'basic'--but I'm sure there is some developed information out there.

There is really no reason to despair, I think. Of course I don't know her particular situation at all, but herpes has been around a long time now, and both the med world and the natural-healing field have been helping families to minimize the impact of herpes for quite awhile. Many many herpes + women deliver naturally every day.
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#3 of 6 Old 05-08-2010, 10:08 AM
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OMG--we have tons, TONS of HSV+ mamas deliver vaginally where I work! I've also had one doula client who was positive.

I personally have probably 3-4 patients per month who deliver (or plan to, but don;t for another reason) vaginally.

Yes, Valtrex is generally given to prevent outbreaks. When she should start should be discussed with her practitioner. I've seen some docs start it at the 1st prenatal and have mom continue post partum. Some start as late as 8 or 6 weeks prior. If it were me personally, and I didn't have any side effects from the valtrex, I think I'd start around 28 weeks maybe? Just in case of a preterm delivery. Idk, I haven't given it much thought as I'm negative, but its something your friend will have to decide herself after doing research.

In addition to that she should try to avoid extremely stressful situations and keep her nutrition up so as to minimize the chances of getting sick. Outbreaks often occur at a time of great physical/emotional stress and times of physical illness.

This is still no guarantee. Some moms come in in labor, having taken their Valtrex religiously, eating well and avoiding stress (as per the patient), and after a speculum exam were found to have internal lesions and were sectioned. So the possibility is always there.

Best Wishes to your friend!

Kelly, mama (12yoDS), doula, RN, and writer.
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#4 of 6 Old 05-08-2010, 01:46 PM
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SO many women are HSV positive. In the MW community in my area at least, there isn't any stigma attached to it anymore. Most MWs recommend some type of suppressive therapy; when women start it depends on their history and their own preference. Even without suppressive medication, vaginal birth in the absence of lesions or pre-outbreak symptoms is fairly safe; suppressive medication is going to reduce further the chances of baby encountering any of the virus. So far as I know, even the most conservative of OBs don't generally suggest c-section unless there is an active outbreak at term.

ETA - IME, women who take the acyclovir or valtrex and stop in the first couple of weeks postpartum often have outbreaks when they stop their meds. This makes sense because it is both a vulnerable time for the body and the body suddenly has to take care of the virus itself instead of relying on the meds.

Mama, homeschooler, midwife. DD (13yo), DS (11yo), DD (8yo), DD (3yo), somebody new coming in November 2013.

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#5 of 6 Old 05-08-2010, 01:56 PM
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CBE not MW here but a complementary way to suppress outbreaks is a high lysine, low arginine diet and/or lysine supplements. That mainly means lowering grains and eating more meat and veggies.
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#6 of 6 Old 05-12-2010, 03:01 PM - Thread Starter
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Thanks everyone! I will pass this on to her!

Megan Davidson, Labor & Postpartum Doula, Breastfeeding Counselor, Anthropologist, Mom to August (9) and Clay (4), Partner to Shawn.

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