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National Cervical Cancer Coalition


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PostPosted: Tue May 24, 2011 2:25 pm 

Joined: Mon May 23, 2011 7:08 pm
Posts: 11
Location: San Francisco
I had a prior c-section approx. 2 years ago. I'm due Aug. w/ my second. My OBGYN is giving me the option to VBAC (vaginal birth after casearean), however I'm EXTREMELY nervous for the two following reasons:

1. VBAC - there is a 1% risk of uterine rupture which could result in the death of you, the baby or both. Even though such a small percentage, worth the risk? I know there is risk w/ a C also....

2. HSV2 - I would take antivirals but they aren't fullproof and neonatal herpes, if contracted, is almost a death sentence or worse your baby has an affliction from the disease that affects him/her for their entire life (mental retardation, etc.). I know this risk is approx. 1% as well, but again, the bad that can come out of it can affect the child for a lifetime.

I already have a wild two year old and I HATED my first c-section even though I healed ok. I just felt kind of like a failure as a Mother and had some pretty hefty PPD which I attribute to the c-section, or at least some of it. Caring for my son and an infant this time around will be much more difficult while recovering from a c-section (although I never had a vaginal birth, so I know recovery on this end can be rough also). Part of me just wants to throw in the towel and go for the repeat C, the other part says I'm being ridiculous and paranoid and to take my antivirals and go for the vaginal birth. My doctor says I can decide at 36 weeks. Thoughts, advice? ..


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PostPosted: Tue May 24, 2011 6:26 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
well for starters - congrats on being pregnant with your 2nd child!!

So can you vbac? you sure can! It's recommended that you try to avoid a fetal scalp monitor but other than that, no reason not to. It is truly a less than 1% risk of transmitting your hsv2 to your child. I actually attempted it myself with my 2nd pregnancy but my daughter had other ideas and stubbornly stayed in there until I had a repeat c section ( stubborn seems to be an ongoing theme for her actually...he he he ). I actually had similar reasons for wanting to do so - I had been on suppressive therapy most of my pregnancy so that I wasn't having multiple recurrences of my herpes like I had my 1st pregnancy and I was jealous of how my friends who had vaginal deliveries were all up shopping and looking terrific a few days after giving birth and I was doing the c section shuffle around the house. It's certainly worth trying - the risk is far too low of transmitting your herpes to worry that much about it.

keep asking questions!

betsy

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PostPosted: Wed May 25, 2011 11:59 am 

Joined: Mon May 23, 2011 7:08 pm
Posts: 11
Location: San Francisco
Thanks Betsy. So my question is this, even w/ the antivirals and even with passing the antibodies from Mother to baby, I understand there can still be active viral shedding at the time of labor. IF the baby were to god forbid contract neonatal herpes, is it in fact a death sentence? If they catch it early enough (obvs. I would be watching my baby like a hawk and report it in an instant) are they able to quickly and effectively treat it?


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PostPosted: Wed May 25, 2011 12:50 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
Prompt treatment certainly does help to keep the long term effects from herpes infections in newborns in many cases. It's usually in premature infants that it does the most damage.

betsy

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PostPosted: Thu Jun 02, 2011 3:31 pm 

Joined: Mon May 23, 2011 7:08 pm
Posts: 11
Location: San Francisco
Hi Betsy. A follow up question. So I am one of those lucky ones who have only had two remarakable outbreaks (the primary and one recurrence two years later). It's been about 4 years since my primary. I do however feel tingling down there from time to time and sometimes when I'm walking if or if I twist or turn a certain way I will feel a little ouch down there (kind of like how it feels when you have a lesion except for me one doesn't exist). The problem is that when these episodes happen they take seconds if that long and are not consistent and then I never have a full blown outbreak so they aren't "prodomal" symptoms I assume. I assume this is me noticing viral shedding. So given that I could very well have something like this happen in the midst of my vbac, (I highly doubt I will have a remarkable outbreak at the time of my delivery and I plan on taking the anti-virals as prescribed), what are the chances of the baby contracting it in this way? I know they will let you labor if no lesions are present, but yet 70% of those w/ HSV contract it from someone who is only shedding the virus. So why is vaginal birth considered safe just w/ the absence of lesions? I also heard from my doctor et al. that my baby will have my antibodies to virus as of the 28th week of gestation, however, you mentioned premature infants are most at risk. Even at full term how well do these antibodies protect? As horrific as a repeat c section sounds (I know your experience was better than mine), I am willing to go that route if it is absolutely the safest route for my baby. I just feel like I will not be able to enjoy the first month after birth b/c I'll be waiting for the other shoe to drop i.e. my newborn son to appear fully consumed physically by HSV2 or worse, disseminated neonatal herpes. I'm terrified even w/ the risk as low as it is. I guess what I want to know is if these are irrational fears. Why do 1% of babies contract it? I wish they documented when these women acquired their HSV (while baby was in utero, etc.) as this plays an important role in the risk to your child. I mean, 1% is a comforting statistic unless it is your child who ends up falling in that 1%. I could never forgive myself.


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PostPosted: Fri Jun 03, 2011 4:39 am 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
usually the babies who contract hsv2 during birth are ones from mothers who weren't aware of their infections or the virus was contracted during the 3rd trimester. Neither is an issue with you.

symptoms for seconds isn't likely to be herpes related.

betsy

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PostPosted: Fri Jun 03, 2011 12:56 pm 

Joined: Mon May 23, 2011 7:08 pm
Posts: 11
Location: San Francisco
Thank you. Have you ever heard of or seen a case of neonatal herpes where the Mother had an established infection, was on antivirals and her baby still became infected? The message boards on babycenter etc. all have women saying to just have a c section (they are obvs. lay people so I take it w/ a grain of salt but it can be daunting to hear over and over again - some made comments I am being selfish for wanting the vbac), but I don't think they understand there are risks from major abdominal surgery! I don't understand why many OB's advertise c sections as this "all safe" method for birthing a child! I have read that even vbacing w/ HSV-2 is safer. I'm just trying to make the right decision for my baby and my family.


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PostPosted: Fri Jun 03, 2011 2:59 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
I'm guessing the folks on the pregnancy forums really aren't up to date on herpes and just go by generalized fear of it. It's better for mom and baby to have a vaginal birth as long as no active herpes lesions present. The overall risk of a baby having a birth defect is 3% but yet I'm betting most of those women never said they'd not get pregnant because of the risk of a baby that isn't "normal" but yet the less than 1% risk of transmitting genital herpes they consider too much of a risk. Makes no sense.

All of the cases of neonatal herpes I've seen professionally have been in women unaware of their infection genitally or from hsv1 transmitted post birth to baby.

betsy

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PostPosted: Fri Jun 03, 2011 9:41 pm 

Joined: Mon May 23, 2011 7:08 pm
Posts: 11
Location: San Francisco
Out of curiosity, how many cases of neonatal herpes have you professionally come across and in how many years? My OB has only seen one case in fifteen years and the newborn did not make it. The mother was unaware of her infection. In the cases you have seen were there any faforable outcomes for any of the babies especially if there was an early diagnosis?


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PostPosted: Sat Jun 04, 2011 7:18 am 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
I've seen about 5 now in 25 years. All of them did well except 1 who their home pediatrician misdiagnosed the child and we didn't get him until he had been very ill for several weeks without treatment :( Most of what I see is hsv1 contracted after birth and out of the hundreds of children I take care of each year, obviously only a handful in all the years I've been a pediatric nurse is very low compared to everything else I see week after week after week.

betsy

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