Would you opt for c-section in these circumstances?

[TruffleMama]

I'm aware that I can opt for a C-section. As my midwife put it, "If you want one, you can have one" ..but I would like your views on whether YOU would opt for a C-section in my circumstances...

I have genital herpes and Group B Strep. Lucky me, ey!

I contracted genital herpes in 2006 from my then long-term partner who had no idea he had it.

I didn't know I had Group B Strep until last month when I visited A+E due to an ectopic pregnancy scare. Thankfully my pregnancy is not ectopic, but my blood results revealed Group B Strep.

The NHS does not usually recommend a C-section unless you are experiencing first episode genital herpes in your third trimester, or you have an active outbreak near the time of delivery.
For someone like me, they would offer antiviral medication in the run up to the birth to help prevent an outbreak from occurring. However, my history with antiviral meds isn't great - basically they don't work for me. My outbreaks are sporadic. I can go years with nothing and then be hit be several outbreaks in a small space of time. Stress is a trigger.. and we all know pregnancy, especially the birth can be a stressful time.
As well as these active outbreaks that I can feel.. a few days a year, the genital herpes virus can present itself on your skin without there being any outbreak or other symptoms at all.. it's called viral shredding. What if this is occurring when I give birth?

As for Group B Strep, again, the NHS doesn't recommend a C-Section. Instead you are offered antibiotics through IV during labour to reduce the risk to baby. You are required to get to hospital ASAP if your waters break to minimise the risk to baby.

I know the risk of passing herpes and/or Group B Strep to my baby through a vaginal birth is low.. but there is still a risk.

A C-section does not remove the risk, but it does reduce it - but of course, comes with it's own risks.

What would you do?

Personally I would go for the c section.
Too many variables to go wrong, but ultimate you need to do the risk/reward analyst

Speak to a consultant perhaps and evaluate the combined risk vs the risk of c section complications. I've had both extremes of c section recovery, my first was 5 months, mega infection, needed a machine to suck me back together. My second I was up and back to normal in 6 weeks.

Personally I'd go for the section. I've only had one EMCS for very different reasons, but my own recovery was fantastic and I was back up and felt normal after 2 weeks. This isn't true for everyone unfortunately

Is this your first baby? It sounds like you are going to have to be in hospital regardless which does not make for a fun labour in my experience.

So I'd go for a c section, hands down.

No, the NHS does not recommend a c section if you have an outbreak at birth, unless it’s your first one, which in your case it’s not. That is old advice that has been updated.

The NHS also does not recommend a c section for GBS.

So no I wouldn’t opt for a section.

I'd go for c section

Can’t comment on the herpes but I’ve been step B positive with all 3 of my pregnancies (tester just before birth with my younger 2 u known with my eldest)

Eldest became sick but recovered younger two I had antibiotics with both and 24 hrs observation. All fine

Personally my experiences of care was very positive and I wouldn’t chose a section as the recovery can be harder

My heart say vaginal birth. You need to ask to see a consultant and ask them for the % or risks which come with both types of births.

In that situation I’d personally want to avoid those risks and go for a c-section, not least because you say anti-virals don’t work consistently for you.
I’ve been consented for a section and in many ways there are more risks to the woman but I’m happier with this because I’m well informed and would prefer the risks to be more to me than to my little one.
My section is for medical reasons btw but it is pre-emptive and so elective for that reason.
In your situation I would make sure I have all the facts and medical recommendations and go from there.

I had group b strep with my 1st but labour was too fast to get the antibiotics. Baby was on antibiotics for a few days just to make sure we had to stay in for it. Personally I would give it a try 1st see what's happening.

I general from my my experience I wouldn't opt for a c section unless absolutely necessary. I've had a natural birth and an EMCS (a very relaxed affair, contractions had halted and it was the best way to get baby out), the section was much harder and recovery took a lot longer.

However, if the thought of a vaginal delivery causes you stress to the point you have an outbreak or are suffering then it is worth considering.

Do your research, chat with your midwife and make your call as it's a deeply personal choice. The experience of giving birth, however it happens (because it rarely goes exactly to plan!) and you should be able to relax and enjoy it. I would recommend looking into hypnobirthing whatever you do, it helped me a lot.

Hey OP, I have both these things too. I opted for ELCS for my 1st DC, as I was not happy with the small risk of passing on HSV in labour if I was having an outbreak. I couldn't cope with the worry however small the risk is and like you, my outbreaks are bought on randomly by stress. My recovery was quick and easy and I don't regret my decision. I did however find I was questioned by every single healthcare professional leading up to the birth as to why I had opted for a section - all but 1 were silenced quite quickly with a stare and the words "I have herpes"

Second time around I find out I have group B strep as well and my recovery was much harder. I would still have opted for a second ELCS rather than VBAC but you should prepare yourself that sometimes the recovery from a c section can be tough! I'm 8 weeks on now and recovered thankfully, but it took weeks rather than a few days this time.

That's interesting @TwinkleStars15 - so if I have an active outbreak at birth, the NHS still wouldn't recommend a C-Section.
Hmm.. considering herpes simplex virus is incredibly contagious.. I am quite surprised by that!
We're advised to abstain from sexual activity during an active outbreak due to the high risk of passing herpes on to our partner.. so surely the risk of passing herpes to a vulnerable new born is just as high.
I know I would not feel comfortable having a vaginal birth if I had an active outbreak. There is every likelihood that baby would come into direct contact with the virus

Could you not take anti virals anyway and then wait until closer to the time to see if you have an outbreak ? Quite a big percentage of people have genital herpes ( I think the World health organisation says in the UK it's one in four) and a lot probably have no idea so I would think if there was a big risk more would be done in general to test for it before birth?

And then standard treatment for step b is antibiotics like you said .

@lockdownseperation

I've done some research but I have a telephone appt with a Consultant tomorrow morning. I will make sure I am given all the facts, pro v cons of both options and then I will be better informed to make the right decision for me and baby.

@PoodlesAreMySpiritAnimal

I totally understand your point about knowing there are risks from C-Section but they are more so for mum rather than baby - and you would rather any risk at birth be a risk to you rather than baby. I get it. If I can minimise any risk to my baby.. then I will.

@truffleMama yes, that’s the up to date guidance. The chances of passing it to your baby is so minimal that they do not think it warrants a surgical birth.

@majesticallyawkward

Thanks for your reply.

I should have mentioned in my first post that this is my first pregnancy and I suffer with anxiety. I usually take medication but am uncomfortable taking my meds during pregnancy so am off them and trying to use Cognitive Behavioral Therapy techniques to help at the moment.

The thought of my baby becoming unwell or worse due to contracting Group B Strep or herpes during birth is something I am struggling not think about almost constantly. It is causing me quite a lot of stress which is no good for me or baby. And this is why I am considering opting for a C-Section.

@TruffleMama There are risks to baby from a section birth, that aren’t present from a natural delivery so have a look into these as well. It’s completely your choice how you birth your baby.

I’d go for a vaginal birth. A C section isn’t a walk in the park and carries risks for the baby too. I know you’ve said you suffer from anxiety and so I’d get an opinion from a consultant and a midwife about what they’d recommend.

TBF, you sound a little like you’re ‘punishing’ yourself by considering a Section. It’s not your fault you have these issues at all. There’s nothing to say you won’t have a good birth and a perfectly healthy baby. XX

I would have a c section in your circumstances provided you don’t want a large family (they don’t recommend more than 3 c sections in total). It’s very hard to get straight forward logical advice about cs vs vaginal births so be wary. In my experience the Midwives were very pushy towards vaginal births regardless of the risks and the hospital had to record stats on their cs rate which they were keen to keep down. I felt like the doctors were more logical and based their advice on risk vs benefit. All the conflicting info made it very difficult to make an informed decision. How you feel about it is also very important so don’t let anyone belittle that or pressurise you to opt for one or the other

@WitchitaMickey

Thanks for your reply. It's great to hear from someone who has been in the same situation.

Like you, I know the risk is small, but I am struggling to cope with the constant worry. I suffer from anxiety and over-worrying and this sometimes leads to associated depression if the anxiety goes on for too long. I really do not want to be in a constant state of anxiety and stress all throughout my pregnancy. It's obviously not good for me or baby, and like you, stress and anxiety are a trigger for me. Before becoming pregnant I had not had any outbreaks for almost a year. Since I found out I am pregnant (I'm 12+3), I have had 2 outbreaks.

I also have a friend who knows a woman who passed Group B Strep onto her baby during vaginal birth. Her baby developed sepsis and meningitis and was in intensive care. She survived but now has multiple issues including blindness and bad scarring to her limbs.
Again, I know the risk of passing Group B Strep onto baby is rare, but there is still a risk and it is greater during a vaginal birth. Hearing her story just brings it closer to home for me and adds to my constant anxiety.

I've only had one appointment with a midwife so far and that was over the phone to book my 12 week dating scan (in 2 days time). I've got a telephone appt with a consultant tomorrow so will ensure I get all the facts to weigh up both options.

@surreymum89

Unfortunately, antiviral meds do not work for me. They actually trigger outbreaks, so they have the opposite affect. So I will not risk taking them.
Other than the meds, my main trigger is stress and anxiety. I am currently suffering anxiety due to worrying about infecting my baby during a vaginal birth.. I'm almost certain I will have frequent outbreaks as the due date gets closer and closer and there is no way I would be comfortable giving birth vaginally if I had an active outbreak at the time.

Just because you had Group B strep earlier in your pregnancy doesn’t mean you have it now or will have it at full term. It’s something that comes and goes.

@TruffleMama your consultant will give you the pros and cons but if you still feel a section is what you want then they should book you in for one - herpes or not, the NICE guidelines say that women are entitled to a c section if they request one. It varies from trust to trust but with my first I was given my date around 28 weeks - I know from reading on here though that some trusts will do this much later on (36+ weeks). They will usually do the section no earlier than 39 weeks to give the baby's lungs a chance to mature.

For me personally, having a section helped me to feel in control as I knew what date it would happen and knew roughly how long it would take etc. I am pretty anxious generally and this took away a huge amount of worry.

I hope your consultant appointment goes well!