A woman who is infected with herpes before pregnancy has antibodies in her bloodstream, which are the body’s immune response to infection and offer protection against new herpes infection. These antibodies (and the immunity they convey) are transmitted to the fetus in the womb, so there is a low risk of the fetus becoming infected in the womb if the mother had herpes before she became pregnant. The greatest risk of infection in this situation occurs during delivery, when the newborn may be exposed to a large quantity of virus, especially if the woman is experiencing an outbreak. If a woman with herpes is having an outbreak at the time of delivery, then a cesarean section is recommended to prevent the passage of the baby through the infected birth canal. (Rarely, babies born by cesarean section are nevertheless infected with HSy probably because they were infected in the womb or during premature rupture of the membranes.) If the mother is not having an outbreak, there is a very small chance (0.35-1.4%) that she will be shedding virus through the birth canal at delivery; if she is shedding, there is a small chance (probably less than 1%) that the child will become infected. So, for women who have herpes and who give birth vaginally the overall risk is less than 1 percent that the baby will become infected.
The decision whether or not to perform a cesarean section is an individual one, and it must be discussed with one’s health care provider. Cesarean sections are not routinely performed on all pregnant women with herpes, since this procedure is not in itself without risk, and the risk of transmission to the baby when there is not an outbreak is very low. A woman who knows she has herpes can prepare for this decision well in advance.
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