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HIV and Women

Preventing Mother-to-Child Transmission of HIV During Childbirth

(Last updated 8/17/2015; last reviewed 8/17/2015)

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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 consider 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 who are already taking HIV medicines should continue taking their HIV medicines as much as possible during childbirth. Women who have a high or unknown HIV viral load near the time of delivery should receive zidovudine (brand name: Retrovir) by intravenous (IV) injection
  • A scheduled cesarean delivery (sometimes called a C-section) at 38 weeks of pregnancy (2 weeks before a woman’s expected due date) to reduce the risk of mother-to-child transmission of HIV is recommended for women with a high or unknown HIV viral load near the time of delivery.

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?

During childbirth, women with HIV receive HIV medicines to prevent mother-to-child transmission of HIV.

In some situations, a pregnant woman with HIV may have a scheduled cesarean delivery (sometimes called a C-section) at 38 weeks of pregnancy (2 weeks before a woman’s expected due date) to reduce the risk of mother-to-child transmission of HIV. 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 are made jointly by a woman and her health care providers.

Which HIV medicines do women with HIV receive during childbirth?

The choice of HIV medicines to use during childbirth depends on a woman’s individual situation. Recommendations on medicines to use consider 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. Women who have a high or unknown viral load near the time of delivery should also receive zidovudine (brand name: Retrovir) by intravenous (IV) injection.

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

How does zidovudine prevent mother-to-child transmission of HIV during childbirth?

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 with high viral loads near the time of delivery. 

When is a scheduled cesarean delivery recommended 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 the time of 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 of 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 not reduce the risk of mother-to-child transmission of HIV. In this situation, the decision whether to deliver the baby by cesarean section depends on a woman’s individual circumstances.

This fact sheet is based on information from the following source:

From the Department of Health and Human Services:

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