Q: Could anyone provide information on herpes and vaginal birth vs.
c-section? A client is considering opting for a c-section rather than risk
the possibility of transmitting it to her newborn (She is currently at 27
weeks). Any suggestions or information/resources would be appreciated.
My first experience with the issue of vaginal herpes outbreak (subsequent,
not primary) just prior to delivery was my own birth. I was attended by an
OB/GYN and had a hospital birth. I was afraid to tell him that I thought I
was starting to get an outbreak, but with all the risks I'd heard about, I
knew I had to. The day before I went into labor, I showed him the blister
during an exam and he told me it was small enough and far enough away from
the birth canal, that he could just cover the area with a 4x4 pad during
the delivery. The blister was inside the labia majora near the clitoris. I
was very relieved! I had a vaginal birth the next day.
The second time I encountered the situation was with a client who had
contracted herpes many years previous. She had one outbreak around 22 weeks
and she too was very worried. She was aware of what foods and stressors
triggered her outbreak and avoided them, but ended up having another at 39
weeks. I called a family physician (who delivered babies) at the clinic in
the woman's town to ask if the woman could have an internal culture done to
rule out an internal lesion. He told me that internal lesions nearly always
ONLY occur with INITIAL outbreaks, and the risk of internal lesions with
subsequent outbreaks (especially if she's had herpes for several years) is
miniscule. He told me that if the lesion is not on the perineum, she could
deliver vaginally virtually without risk. I was a little surprised, as this
contradicted a lot of the information I had read about the seriousness and
fear of herpes and vaginal birth.
Finally, just recently, I had a client who (as she had done with her last
pregnancy with a CNM) decided to take a viral suppressant beginning at 38
While I can't recall the source of the information, I remember reading a
while back of midwives administering superglue during labor over the herpes
lesions to prevent transmission from mother to baby. It's worth looking
My question is how often is this woman having outbreaks? Also, did she have
her first outbreak during this pregnancy or is she just having secondary
outbreaks? If she is having secondary outbreaks, then perhaps a change in
stress levels, diet, exercise could help her have less outbreaks. If all
else fails and she is having frequent outbreaks I would offer to put her on
Acyclovir, oral, for her last trimester, thus avoiding an outbreak at term.
-Annette Manant CNM
Order the Midwifery Today conference tape "Herpes" (Item No. 941T79).
Andrea Dixon discusses symptoms, how to help infected women avoid
outbreaks, and what conditions may activate the virus. Regular price $9;
E-News special $7.50 (plus shipping & handling) when you mention Code 940.
Call 1-800-743-0974 to order. Offer good through March 17.
Reprinted from Midwifery Today E-News (Vol 2 Issue 9 March 3, 2000)
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