skip navigation

Skip Nav

Education Materials

Skip Navigation

HIV and Women

Preventing Mother-to-Child Transmission of HIV During Childbirth

(Last updated 10/1/2013; last reviewed 10/1/2013)

PrintHelp

Key Points

  • Pregnant women with HIV receive HIV medicines during childbirth (also called labor and delivery) to reduce the risk of mother-to-child transmission of HIV
  • Recommendations on the use of HIV medicines during childbirth take into account whether a woman is already taking HIV medicines when she goes into labor and the level of HIV in her blood (HIV viral load). 
  • Women already taking HIV medicines should continue taking their HIV medicines as much as possible during childbirth. In addition to taking their HIV medicines, women who have a high viral load near delivery may also receive zidovudine (brand name: Retrovir) by intravenous (IV) injection injection. Women who did not take HIV medicines during pregnancy may also receive IV zidovudine during childbirth. 
  • In some situations, a pregnant woman with HIV may have a scheduled cesarean delivery (also called a C-section) at 38 weeks of pregnancy (2 weeks before a woman’s expected due date). A scheduled cesarean delivery is planned ahead of time.

Childbirth (also called labor and delivery) is the process of giving birth. A pregnant woman with HIV can pass HIV to her baby at any time during pregnancy, including during childbirth. The risk of mother-to-child transmission of HIV is greatest during delivery when a baby passes through the birth canal and is exposed to any HIV in an HIV-infected mother’s blood or other fluids. 

How is the risk of mother-to-child transmission of HIV reduced during childbirth?

Pregnant women with HIV receive HIV medicines during childbirth to prevent mother-to-child transmission of HIV.

In some situations, a pregnant woman with HIV may have a scheduled cesarean delivery (also called a C-section) at 38 weeks of pregnancy (2 weeks before a woman’s expected due date). A scheduled cesarean delivery is planned ahead of time.

All decisions regarding the use of HIV medicines during childbirth and the choice of a cesarean delivery to prevent mother-to-child transmission of HIV should be made jointly by a woman and her health care providers.

Do pregnant women with HIV all receive the same HIV medicines during childbirth?

The choice of HIV medicines to use during childbirth depends on a woman’s individual situation. Recommendations on medicines to use take into account whether a woman is already taking HIV medicines and the level of HIV in her blood (HIV viral load). 

Women who are already taking HIV medicines when they go into labor should continue taking their HIV medicines as much as possible during childbirth. 

In addition to taking their HIV medicines by mouth, some women may also receive zidovudine (brand name: Retrovir) by intravenous (IV) injection. For example, women who have a high viral load near delivery may also receive IV zidovudine. 

Women who did not receive HIV medicines during their pregnancies may also receive IV zidovudine during childbirth. 

Why does zidovudine prevent mother-to-child transmission of HIV even in women who did not take HIV medicine during pregnancy?

Zidovudine is an HIV medicine that passes easily from a pregnant woman to her unborn baby across the placenta (also called the afterbirth). Once in a baby’s system, the HIV medicine protects the baby from infection with any HIV that passed from mother to child during childbirth. For this reason, the use of zidovudine during childbirth prevents mother-to-child transmission of HIV even in women who did not take HIV medicines during pregnancy. 

When should a pregnant woman with HIV have a scheduled cesarean delivery to prevent mother-to-child transmission of HIV?

A scheduled cesarean delivery at 38 weeks to prevent mother-to-child transmission of HIV is recommended in the following situations:

  • When a woman has a viral load greater than 1,000 copies/mL near delivery 
  • When a woman’s viral load is unknown
In these situations, a woman with HIV should have a scheduled cesarean delivery even if she took HIV medicine during pregnancy. The cesarean delivery should be performed before a woman goes into labor and before her water breaks (also called rupture of membranes).

The risk of mother-to-child transmission of HIV is low for women who take HIV medicines during pregnancy and have a viral load less than 1,000 copies/mL near the time of delivery. In this situation, a woman with HIV should have a vaginal delivery unless there are other medical reasons for a cesarean delivery. 

What happens if an HIV-infected woman goes into labor or her water breaks before her scheduled cesarean delivery?

Once a woman goes into labor or her water breaks, a cesarean delivery may no longer prevent mother-to-child transmission of HIV. In this situation, the decision whether to deliver the baby by cesarean section is based on medical reasons and not to prevent mother-to-child transmission of HIV.