Pregnancy brings many considerations, and for individuals with a history of herpes, questions about childbirth often arise. While the prospect of transmitting the virus to a newborn can be concerning, a vaginal birth can often be safely achieved with careful management. This article provides information on how herpes is managed during pregnancy to support a safe delivery for both parent and baby.
Understanding Herpes and Pregnancy
Herpes simplex virus (HSV) is a common infection, with two main types: HSV-1 and HSV-2. HSV-1 commonly causes oral herpes, such as cold sores, but can also lead to genital infections. HSV-2 is the primary cause of genital herpes. Both types can be transmitted to a baby during vaginal birth, leading to a serious condition known as neonatal herpes.
Neonatal herpes is a concern because a newborn’s immune system is still developing, making them vulnerable to severe complications if infected. The most common route of transmission to the baby is during passage through the birth canal if the virus is present in the mother’s genital tract. The risk of transmission is highest when a pregnant individual experiences a primary herpes infection, a first-time infection, particularly late in pregnancy, as they have not yet developed protective antibodies to pass to the baby.
Managing Herpes for a Safe Delivery
Proactive steps are taken during pregnancy to minimize the risk of herpes transmission to the newborn. Open communication with a healthcare provider about any history of herpes is important for developing a safe birth plan. This allows the medical team to monitor the situation and implement preventive measures.
A primary strategy involves suppressive antiviral therapy, typically initiated around 36 weeks of gestation and continued until delivery. Medications such as acyclovir or valacyclovir are commonly prescribed. This therapy helps reduce the frequency of herpes outbreaks and the likelihood of the virus being present in the birth canal at the time of labor.
At the onset of labor, healthcare providers assess for any signs of an active herpes outbreak, including visible lesions or prodromal symptoms such as tingling or itching. Even without obvious lesions, the virus can shed asymptomatically, meaning it is present in the genital tract without causing symptoms. These assessments guide the decision-making process for the safest delivery method.
Delivery Considerations: Vaginal Birth vs. C-Section
The choice between a vaginal birth and a Cesarean section (C-section) for individuals with herpes depends on the presence of active viral shedding at the time of labor. A vaginal birth is considered safe if there are no active genital lesions or prodromal symptoms indicating an impending outbreak. This means the risk of the baby coming into contact with the virus during passage through the birth canal is low.
Conversely, a C-section is recommended when active genital lesions are present, or if prodromal symptoms suggest an outbreak is imminent. This surgical procedure helps prevent the baby from being exposed to the virus in the birth canal, significantly reducing the risk of transmission. A C-section may also be considered if a pregnant individual contracts a primary herpes infection late in pregnancy, even without visible lesions, due to the higher risk of viral shedding.
Recognizing Neonatal Herpes and Its Impact
Neonatal herpes is a serious condition for a newborn due to their underdeveloped immune system. Symptoms can vary but often include fluid-filled blisters on the baby’s skin, around the eyes, or in the mouth. Other signs may be less specific, such as lethargy, poor feeding, irritability, temperature instability (either too high or too low), or breathing difficulties.
These symptoms can appear anywhere from a few days to several weeks after birth. Skin, eye, and mouth (SEM) disease usually presents within days, while central nervous system (CNS) disease might show up later. Early recognition and immediate medical attention are important if any of these signs are observed. Prompt diagnosis and treatment with antiviral medication, such as acyclovir, are necessary for improving outcomes and can help prevent the infection from progressing to more severe forms that could affect the brain or other organs.