Genital Herpes and Waterbirth? - Mothering Forums

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#1 of 9 Old 05-23-2006, 06:27 PM - Thread Starter
 
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Now that I have changed to a midwife who 1. doesn't give Cytotec at 38 weeks, and 2. does waterbirths , I am trying to consider all of my options. I kind of like the idea of a waterbirth, but need to do more research on it. I have read however that having genital herpes is a risk factor, as the virus is supposed to be easily transmitted in water. Does anyone have any info on this/personal experiences? Thanks!

Amy, mommy to Ava, 6, Gavin, 4, Lila, 2, and Baby #4 due in early November! joy.gif
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#2 of 9 Old 05-23-2006, 08:41 PM
 
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Goodness where to start, I will have to find the stuff I printed but off the top of my head here it is.....

The big risk comes from active (weeping cancers) from a primary (first outbreak) infection of Simplex II (HSVII). So the fact that you are asking now I'm assuming means if you were having an outbreak it would not be the first one!

Second, where are your sores when you do have an outbreak? In the vaginal canal, the cervix, the labia, elsewhere? The concern here is viral shedding in the birth canal.

There are some that suggest water is not good during an active outbreak - but I couldn't find any studies that backed up that statement. And honestly I don't get it how could it be more contagious diluted in water than it might have been in the birth canal??????

I did however find some articles about sealing the sore with surgical superglue (you can get it at the drug store!).

Also if you have had Herpes for awhile you have antibodies, thus you will pass those along to your child.

Also keep in mind that any trauma to the babies skin increases the risk of transmission - more an issue in the hospital - forceps that nick, fetal monitor in the scalp etc. Also there seems to be increased risk the longer your waters have been broken for.

There is a swab they can do of the birth canal when you are close to your due date, to tell you if you are shedding, however the data is only good for 24-72 hours (average length of shedding). After that you would have to be tested again.

I listed some web sites too - but me personally, and my midwives agree, I will be doing a water birth. But here is my situation - HSV-I (the kind we think of as cold sores), 8 years since first outbreak, the lesions are on my perineum not in the vaginal/birth canal, I can "feel" an outbreak comming on, I have medical "super glue" ready to go just in case. Hope that helps!



Study on Herpse transmission during birth:
http://www.washington.edu/newsroom/n.../k010703b.html

Only paper I could find on water birth and Herpes - one transmission (no details on when she got Herpes etc)
http://bmj.bmjjournals.com/cgi/conte...l/319/7208/483

A study and a Q&A toward the bottem of the page
http://www.midwiferytoday.com/enews/enews0433.asp#news

From a drug company, but it does talk about transmission rates
http://www.famvir.com/hcp/about/gh/p...44946301356941


OHHHHHHH - found more:
http://www.gentlebirth.org/Midwife/herpes.html
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#3 of 9 Old 05-23-2006, 09:57 PM - Thread Starter
 
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Wow, thanks for all the great info! I have had HSV-2 for about 3 years, and unfortunately do have frequent outbreaks, especially now in pregnancy- it is weird though, because I have only had a few "classic" (with actual sores) outbreaks since becoming pregnant- mostly in the 1st trimester, but there are a lot of times I have what is similar to a papercut, or its just itchy down there, so who knows- it feels like I am always having an outbreak. I do get prodromes too, so I can usually tell if I am shedding. I have been putting off taking Valtrex, but am thinking of starting it soon...I HATE thinking of taking meds in pregnancy, but I also hate the thought of a c-section. Thanks again!

Amy, mommy to Ava, 6, Gavin, 4, Lila, 2, and Baby #4 due in early November! joy.gif
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#4 of 9 Old 05-23-2006, 11:01 PM
 
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I totally understand the concern - but before you run for the Valtrex check out the link below:
http://www.emedicine.com/med/topic3554.htm

Towards the bottom you will find a great chart that shows that suppression therapy will reduce, but not eliminate viral shredding. It also states that Valtrex accumulates in the amniotic fluid and the baby's blood. It should also be noted that in all the studies this paper looked at (women with Herpes) 799 births, not a one passed Herpes onto her child. Just food for thought.

Before I started reading I too was all for doing supression the last month, "just in case" - I have since rethought that position.


Drug info and Study excerpts
__________________________________________________ ______________
Teratogenic Effects: Pregnancy Category B. Valacyclovir was not teratogenic in rats or rabbits at 10 and 7 times human plasma levels, respectively, during the period of major organogenesis.

There are no adequate and well-controlled studies of VALTREX or ZOVIRAX in pregnant women. A prospective epidemiologic registry of acyclovir use during pregnancy was established in 1984 and completed in April 1999. There were 749 pregnancies followed in women exposed to systemic acyclovir during the first trimester of pregnancy resulting in 756 outcomes. The occurrence rate of birth defects approximates that found in the general population. However, the small size of the registry is insufficient to evaluate the risk for less common defects or to permit reliable or definitive conclusions regarding the safety of acyclovir in pregnant women and their developing fetuses. VALTREX should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Acyclovir (B)

Acyclovir was not found to be teratogenic in pregnant mice, rats, and rabbits at doses resulting in systemic exposures similar to those achieved in humans with therapeutic dosing. Dosing in mid-rat gestation, however, did result in skull, eye, and tail defects. Acyclovir readily crosses the human placenta to the fetus. Numerous reports involving well over a thousand cases (the majority in the manufacturer's pregnancy registry) have described the use of acyclovir during all stages of gestation. As expected, birth defects have been reported in exposed pregnancies, but none of these have been attributed to acyclovir. The primary uses of acyclovir during pregnancy have been for the treatment of primary infections of genital herpes simplex virus (HSV) type 2 or for life threatening disseminated HSV infections. In both of these infections, the benefits of acyclovir for the mother and fetus far outweigh any known risk. Prophylactic use of acyclovir to prevent recurrent genital HSV infection, however, is controversial because a clear benefit has not been established. Acyclovir is concentrated in human breast milk, reaching levels exceeding those found in maternal serum. No adverse affects from acyclovir in milk have been reported in nursing infants or in neonates given the drug directly. The AAP classifies acyclovir as compatible with breast-feeding.


Valacyclovir therapy to reduce recurrent genital herpes in pregnant women.

Andrews WW, Kimberlin DF, Whitley R, Cliver S, Ramsey PS, Deeter R.

Department of Obstetrics and Gynecology, Center for Research in Women's Health, University of Alabama, **********, AL, USA.

OBJECTIVE: The purpose of this study was to estimate the efficacy of valacyclovir suppressive therapy in pregnant women with recurrent genital herpes. STUDY DESIGN: At 36 weeks' gestation, herpes simplex virus (HSV)-2 seropositive women were randomized to receive oral valacyclovir 500 mg or placebo twice daily until delivery. Genital tract and neonatal specimens were collected weekly for HSV culture and qualitative polymerase chain reaction (PCR) assay to detect viral DNA from the time of randomization to delivery. Both maternal and neonatal toxicity measures were obtained. RESULTS: The 112 enrolled women (57 valacyclovir, 55 placebo) had similar HSV recurrence risks, including mean number of active HSV recurrences before randomization during the index pregnancy (1.1 +/- 1.9 vs 1.5 +/- 2.1, P = .308) and days between randomization and delivery (20.3 +/- 10.2 vs 22.0 +/- 8.9, P = .344). The number of women with clinical HSV recurrences between the time of randomization and delivery was significantly lower in the valacyclovir versus placebo group (10.5% vs 27.3%; P = .023, RR 0.4, 95% CI 0.2-0.9). Shedding of HSV within 7 days of delivery was similar in the valacyclovir and placebo group (10.4% vs 12.0%, P = .804; RR 0.9, 95% CI 0.3-2.7), as was the number of women with clinical HSV lesions at delivery (5.3% vs 14.6%, P = .121; RR 0.4, 95% CI 0.1-1.3). No neonates had symptomatic congenital HSV infection before discharge or up to 2 weeks' postpartum, and no clinical or laboratory safety concerns were identified. CONCLUSION: Administration of valacyclovir beginning at 36 weeks' gestation to women with a history of recurrent genital HSV reduced the number of women with subsequent clinical HSV recurrences.
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#5 of 9 Old 05-24-2006, 01:57 AM
 
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From one of the studies:
"Seventy-five to ninety percent of infants with neonatal HSV are born to infected asymptomatic mothers who have no known history of genital HSV."

I found that to be very interesting...My SIL is due in July and her Dr is putting her on suppression therapy in the last weeks. She was sure she would just get to walk in and have a C-section (first time mom...very mainstream...thinks I'm crazy for breastfeeding past 6 wks etc...), but she was a bit disappointed when her Dr said that many women have HSV and deliver naturally and without any HSV complications.
From many of these studies it seems that the chances of transmission is very rare unless it is a first episode...to people who had NO IDEA they were carrying the virus.

The only thing I would mention is this--keep up good handwashing discipline after the baby arrives...you have probably heard of being able to transmit to your hands (open sore on a finger) and also to a nipple. These things are RARE, but you definitely don't want a nursing baby to come in contact with a sore on your nipple...of course, no one would want a sore on your nipple in the first place! It isn't 'easy' to transmit from A to B, but wash hands to be on the safe side!

I do wonder if baby has any natural antibodies to the HSV virus (at least whatever strain mom has)...and maybe they will have a less likely chance of getting it later in life? If so, good for you mama! You are protecting your baby from HSV by suffering with it yourself! hehahaha
This may have been mentioned in the reading, but I haven't gotten thru it all yet.
Very interesting tho...and good for you for looking for answers instead of just assuming you have to take some pill the Dr told you to take! (or going strait for the c-section!)
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#6 of 9 Old 05-24-2006, 03:02 AM
 
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I had a waterbirth and I have type 2. My midwife did not seem overly concerned about it and never mentioned water being an unsafe thing.
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#7 of 9 Old 05-24-2006, 06:43 AM
 
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Have you looked into taking the supplememt Lysine?
From what I have read it's safe to use at the end of pg.
Personally, I take it daily and it's the most wonderful thing...truly fights off any recurring outbreaks for me.
Best of Luck....
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#8 of 9 Old 05-24-2006, 07:27 PM
 
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Eliminating foods in your diet that are high in argenine is also helpful.
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#9 of 9 Old 05-24-2006, 09:10 PM - Thread Starter
 
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I was thinking about the L-Lysine thing, but when I compared it with Valtrex on www.safefetus.com it was a Class C versus Valtrex which is Class B so I was a bit wary. Then again I guess natural is probably better than pharmaceutical...I am going to discuss it with my new midwives who I meet tomorrow- thanks!

Amy, mommy to Ava, 6, Gavin, 4, Lila, 2, and Baby #4 due in early November! joy.gif
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