How to Deal with Herpes and Pregnancy
Many women with herpes worry about the dangers it can cause to newborns. Women with herpes who are pregnant or plan on getting pregnant should not be overly alarmed. The great majority do not transmit it to their babies.
However, herpes does create a special set of concerns for newborns. Transmission to newborns can cause serious problems, including herpetic viremia, herpetic meningitis, chronic skin infection or even death.
Neonatal herpes is a rare occurrence considering the large percentage of women with genital herpes. It is not a reportable disease in many states, so accurate nationwide statistics are not available. However, with the 20-25% of American women with genital herpes, the incidence of neonatal herpes is estimated to be around 0.1%.
In about 90% of neonatal herpes cases, the newborn contracts HSV-1 or 2 on its way through the birth canal. If an outbreak is present, the rate of transmission is high because of the high risk of viral shedding at that time. It is also possible for an infant to become infected through asymptomatic shedding, though this is much less common.
If a woman has had a long-standing herpes infection, the baby gets some protection from the placenta, which provides antibodies from her blood. Even if there is some viral shedding present during delivery, the infant has some defense against transmission.
Women who contract herpes during their first and second trimesters usually have enough time to develop some antibodies that help protect the fetus. Babies who are born prematurely are at a higher risk of contracting the virus, even in mothers with long-standing infections, because it takes about 28 weeks for the antibodies to start transferring to the baby.
The risk is higher for women who contract herpes during the last trimester of pregnancy, as there is not enough time for an antibody defense to build up. In addition, people with new herpes infections have a higher rate of asymptomatic shedding for the first year after contracting the virus.
It is thought possible that up to 50% of neonatal herpes cases occur when the mother has her primary herpes infection within several weeks of delivery. If a mother has a primary outbreak during pregnancy, there is also a small chance that the virus can cross the placenta and infect the baby.
What Expectant Parents Can Do
If you know you have herpes it is important to tell your obstetrician or midwife about your condition so it can be monitored throughout your pregnancy. Some studies show that many cases of neonatal herpes occur in instances where the mother is not aware she carries the virus. In these cases, neither the doctor nor the mother is on the lookout for sores or other herpes symptoms.
Once the delivery date approaches, some doctors may do weekly viral cultures of the cervix and external genitalia to ensure that there is no virus present. Women who know they have herpes and are educated about it are usually in tune with their prodromal symptoms and the areas where lesions usually occur.
They can help their doctors by paying close attention to their bodies as delivery approaches. In the delivery room, doctors can use a strong light to inspect the mother for herpes lesions.
If lesions or prodromal (pre-outbreak) symptoms are present at delivery time, a Cesarean section is usually recommended to prevent transmission to the newborn. If no signs of herpes are visible, most doctors will recommend a vaginal delivery.
There is still a risk of transmission from asymptomatic shedding, but it is very small. Many doctors consider the risks to the mother from a C-section to be greater.
Fetal scalp monitors, used to monitor the baby's heartbeat at delivery time, are thought to increase the risks of neonatal herpes. The monitor places tiny punctures in the baby's scalp, which can give the virus entry points. An alternative to scalp electrodes is a device that monitors the baby's heartbeat externally through the mother's abdomen.
If the man has herpes, and the woman does not, extra steps should be taken to prevent transmission to her during the pregnancy. Using condoms during sex and abstaining from sex during outbreaks will help to ensure a healthy delivery.
If the man has oral herpes, he should avoid performing oral sex while cold sores are present. Couples may also consider abstaining from sex altogether during the third trimester since this situation creates the most risk for infants.
After The Birth
Once the baby is born, parents with herpes should be cautious to wash their hands if they experience an outbreak. To prevent transmission of oral herpes to the infant, parents should be cautious about allowing people to kiss the baby.
Breastfeeding is safe for women with herpes. It is a good precaution to watch the baby during the first month for any signs of infection. Some symptoms of neonatal herpes include blisters, poor feeding, lethargy, irritability and fever.
Although other problems could be the cause, it is best to be on the safe side and alert your pediatrician immediately if any of these symptoms occur. Educating yourself will help you take the precautions necessary to ensure a safe delivery.
Most importantly, be happy with the knowledge that most women with genital herpes give birth to perfectly healthy babies. So relax, enjoy your pregnancy and birth and look forward to the new addition to your family.