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Subject: "Questions about giving birth"     Previous Topic | Next Topic
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canadagirl06
Member since Feb-22-10
97 posts
Feb-02-12, 08:04 PM (CST)
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"Questions about giving birth"
 
   Hi everyone,

I am 27 weeks pregnant with a baby boy (YAY!), and am starting to worry a bit about delivering vaginally. I contracted GHSV2 two years ago and had a horrible primary (6 weeks of needing a catheter and very sick). I was told to take 2000 mg for a year to reduce the likelihood of having another outbreak. Since then, I have lowered the dose.

I have a few concerns:

1)I did IVF to get pregnant and the egg retrieval was very painful. I am pretty sure that during the embryo transfer 3 days later I was having an outbreak. I upped my dose to 1500 mg for a few days and things settled down. Could this have hurt my baby ? Logic tells me heís fine, but I wake up at night fretting about it!

2)I took 500 mg once a day until about November/December and was noticing little twinges, so I have been taking 1000 mg per day. My OB recommends upping my dose to 1500 mg closer to the birth. My concern is not with the drugs, but with my ability to tell what is going on with my body. I have always been on suppressive therapy and Iím not really sure about when Iím having possible outbreaks. The primary manifested itself mainly in my bladder and urethra. Iím pretty sure I have had outbreaks because my bladder hurts. But more recently, I have had twinges, but have no idea if they are really herpes related or not. Is there any way for them to check to be sure Iím fine for giving birth naturally? What will be the protocol when I go into labour? How do they check? How do they check for viral shedding if they donít see lesions (and in my case, they might not because it could be in my bladder).

Thanks for your thoughts and expertise!

CG

canadagirl06


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  Subject     Author     Message Date     ID  
  RE: Questions about giving birth starrattadmin Feb-05-12 1
     RE: Questions about giving birth canadagirl06 Feb-06-12 2
         RE: Questions about giving birth graceadmin Feb-07-12 3
             RE: Questions about giving birth canadagirl06 Feb-07-12 4
                 RE: Questions about giving birth graceadmin Feb-08-12 5
  RE: Questions about giving birth rebecca Mar-03-12 6
     RE: Questions about giving birth canadagirl06 Mar-15-12 7
         RE: Questions about giving birth rebecca Mar-15-12 8
             RE: Questions about giving birth canadagirl06 Mar-18-12 9

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starrattadmin
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2012 posts
Feb-05-12, 10:57 PM (CST)
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1. "RE: Questions about giving birth"
In response to message #0
 
First things first, congratulations. I know you have been wanting a baby for a long time.

Second, I am assuming you are taking Valacyclovir (Valtrex).

If you haven't already, switch to 500 mg twice a day (i.e. total of 1000 mg/day). Your immune system changes and blood volume while preggers make this necessary to keep OBs at bay.

If that isn't enough, follow your OBGYN's advice and think about doing it as a split dose (i.e. 750 mg in the a.m. and 750 mg at night).

There are no official studies that prove that Acyclovir/Valtrex are safe for pregnant women, but there were registries for pregnant women taking acyclovir / valtrex. (Most drugs never get tested on pregnant women for some obvious ethical reasons.) In essence, all the data that came back indicated that there was no risk associated with taking either acyclovir or valtrex when pregnant. (The data for acyclovir was better because that registry followed more women, but since valtrex is a prodrug version of acyclovir nobody is overly concerned).

Many OBGYN's recommend that pregnant women with HSV2 take valtrex during the last weeks of their pregnancy to avoid an OB during delivery.

Since you have had HSV2 since prior to becoming pregnant, you are at lower risk for passing herpes onto your baby because your baby will have received from you the antibodies for herpes. This protection only lasts for something like 2-3 months after birth, but it is in place when you deliver.

If you take valtrex up until you deliver it will reduce your shedding.

Trust me, once labour starts the last thing you will be able to sort out is whether or not you have an OB going on. When you check into hospital the doctors will look with nice bright lights down yonder to see if there is anything resembling an OB going on and carry on from there. They aren't going to be worried about some shedding happenining in your bladder. Subclinical shedding won't be a big concern since you will be on valtrex and your baby will have the antibodies as I described above. The only thing that will get the medical staff concerned is an actual visible lesion.

Women who contract HSV2 during their last trimester, especially those who have a primary OB at the time of delivery are at the greatest risk for passing herpes on. This is NOT YOU.

For what it's worth I did take valtrex throughout both of my pregnancies. This was my choice, and I do not claim it is the best choice for pregnant women. Both of my children are doing fine and I have no concerns that valtrex affected them inutero in any negative way. The doctors and midwives I dealt with were all very aware of my choice and voiced no concerns. I lowered my dose during the first part of my pregnancies to 500 mg daily and then increased it during my last trimester as I started battling OBs. I had vaginal births both times.

My last little point. About 25% of women who give birth are likely to be positive for HSV2 (if you go by overall averages), most of them will not know this. So there are a ton of women out there giving birth with no valtrex and no knowledge of their condition. It's a very rare occurrence for babies to contract neonatal herpes. There isn't a decent percentage for Canada, but the USA rate is 0.2% to 0.5% of live births (it's likely that our stat is a little lower on the whole).

I hope this helps.

Be well,
Lorraine

Hoe eet jy 'n olifant? Bietjie vir bietjie.
(Translation from Afrikans: How do you eat an elephant? Bit by bit.)


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canadagirl06
Member since Feb-22-10
97 posts
Feb-06-12, 08:31 PM (CST)
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2. "RE: Questions about giving birth"
In response to message #1
 
   Hi Lorraine,

Thank you for all the information. You have really put my mind at ease.

I'm taking 500 mg morning and night and it seems to be going okay outbreak-wise. I've been taking valacyclovir throughout my pregnancy and I'm pretty comfortable with my decision. Of course I would prefer to use no drugs at all, but considering my history I don't think it was possible.

The information about the shedding is very helpful. I think that is what I was most worried about - the stuff you can't see, but that makes perfect sense. I really really want to have a vaginal birth and this makes me feel so much more comfortable with it.

I'm also hoping to not need an epidural. The drug will for sure shut down my bladder. The drugs used during the egg retrieval stopped my bladder from functioning for a bit too. I still feel very protective and stressed about my bladder. Not exactly the best thing - I know that even a normal run-of-the-mill pregnancy and delivery can do a number on your bladder, but I'm trying to stay positive about it - and logical. This is nothing like, or comparable to what happened during my primary.

And, on a happy note, I'm so excited about this pregnancy! I feel so lucky that I was able to get pregnant and that everything has gone so well. I feel him kicking and moving around and I love the feeling. It's so special.

Thanks again for all the info. I really feel so much better about my delivery.

CG

canadagirl06


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graceadmin
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13334 posts
Feb-07-12, 05:57 PM (CST)
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3. "RE: Questions about giving birth"
In response to message #2
 
well we actually do have 1 study that showed that valtrex wss safe for mom and baby during pregnancy. it only was 4 weeks ( the last month of pregnancy ) but combined with the valtrex/acyclovir/penciclovir registeries, it was shown to be safe which is why they have a pregnancy category B rating.

we don't do any testing at the time of delivery to check for shedding. it takes a minimum of 4 hours for pcr swabbing to return results which is our quickest way of detecting shedding and until you get results, either baby is already out or shedding could've begun so we don't waste time or money on it. No obvious lesions at the time of delivery and the risk is less than 1% of transmission to baby. Not perfect, but it's the best we are able to do at this time.

sometimes the herpes antivirals can actually cause twinges down yonder. I'd stick to the 500mg 2x/day dose at this point and if you are having symptoms down yonder that last more than a day or two, be seen and make sure you don't have a vaginitis going on or an uti. It can get very confusing with all the changes during pregnancy as well as the stress on the body and honestly aches, pains and being generally uncomfortable kinda comes with the territory so odds really are it's pregnancy, not herpes at this point .

congrats on your pregnancy

grace

The first step in stopping the perceived stigma about genital herpes - is to stop believing in it yourself


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canadagirl06
Member since Feb-22-10
97 posts
Feb-07-12, 08:12 PM (CST)
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4. "RE: Questions about giving birth"
In response to message #3
 
   Hi Grace,

That makes sense about the pcr swabbing. My OB seems to be totally unconcerned with my herpes history which is reassuring on one level, but then on the other, he doesn't want to take the time to discuss it. What you and Lorraine have told me has really made me feel better about it, and a lot more comfortable.

As for the aches and pains with pregnancy - I had no idea how much my body would change and how different I would feel, and really how crazy it feels lugging around all that extra weight all of a sudden!

But it really is the coolest thing what a woman's body can do.

CG

canadagirl06


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graceadmin
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13334 posts
Feb-08-12, 04:52 PM (CST)
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5. "RE: Questions about giving birth"
In response to message #4
 
it really is that low of a risk in general.

pregnancy and aging - not our body's friends....lol.

grace

The first step in stopping the perceived stigma about genital herpes - is to stop believing in it yourself


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rebecca
Member since Feb-14-12
9 posts
Mar-03-12, 10:31 PM (CST)
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6. "RE: Questions about giving birth"
In response to message #0
 
   First of all, Congratulations!

I'm very thankful to you for posting your questions because they mirror what will be going on in my life so much

You sound like me in the sense that I too had a horrible primary. From Feb 06-Oct 06, I had non stop outbreaks until they put me on 2000mg a day.

Fast forward, found my husband, life goes on and this fall we are going to try for a baby. I am excited but still very nervous about it because I still get over 27 outbreaks a year. (every time I ovulate and every period and sometimes just because I don't bother with suppression at this point in time because we just wait for a non outbreak week, and it seems to work for us.

There is a chance that we will have to do IVF as well because my husband will be getting his vascetomy reversed this summer and my doctor mentioned because of my husbands age and how long ago his vascetomy was done, we may have some problems.

I will for sure go on suppression therapy if I get pregnant, and your post hit every question that I have had running through my head these last few weeks since we decided to do it! I am so thankfull to everyone that posts on here. The support and shared stories really makes moving forward with life so much easier


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canadagirl06
Member since Feb-22-10
97 posts
Mar-15-12, 10:39 AM (CST)
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7. "RE: Questions about giving birth"
In response to message #6
 
   Rebecca, just saw your post, and wanted to wish you luck! I hope the reversal of the vasectomy goes well. Did your doctor talk to you about doing IUIs? It's cheaper than IVF and way easier on your body - no drugs if you want. I did 6 IUIs with no results before going for IVF. The IUIs didn't work for me, even with ovulation drugs later on, but I met a woman at my clinic who also did 6 IUIs and now she is pregnant. Fingers crossed for you!

I am now 33 weeks, and just had an outbreak which is really freaking me out. Things have been really quiet down south and I was feeling really good about things. This was the most painful outbreak since my primary two years ago, and it was external - usually it happens in my bladder, but this time it was on the left side. I upped the valacyclovir to 1500 mg for two days. I had a lot of nerve pain down my left leg and a lot of skin sensitivity on the left side too. For about 3 days it was so painful it was difficult to walk.

I told my OB about it, and he is concerned. We have decided to up my dose to 1500 mg per day when I reach 36 weeks, hoping that things settle down and I go back to normal until then. I also suggested that when labour pains start that I start taking 2000mg and he was open to that.

I really thought this herpes thing was under control and I could feel safe and secure about it, but this outbreak has really rattled me.

Any thoughts would be greatly appreciated! Take care everyone.

CG

canadagirl06


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rebecca
Member since Feb-14-12
9 posts
Mar-15-12, 11:36 AM (CST)
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8. "RE: Questions about giving birth"
In response to message #7
 
   2000mg is my normal dose to make things go away if that makes you feel any better. I usually have to do that for about 2-5 days. I have 2 outbreaks a month, they seem to follow my hormones (oh fun) lol

I'm happy to hear your OB seems to be on board with everything, that is half the battle! I've been on Rate my Md trying to find the best rated Ob's in the Ottawa area who have nice comments about c section's. I just can't shake the feeling I will need one, so instead of worrying I thought I would just nip it in the bud and find one who has nice comments about his "c-section" skills.

I think Grace is a good one to ask if 2000mg is safe while pregnant, but like I said that is the dose my Dr got me on to finally get mine under control and that seems to be the magic number for me

I usually take them for 5 days or less. As soon as the tingling and pain starts to diminish I stop. So sometimes I only have to take it for 2 days.

Other than the outbreak how are you doing? Are you able to get comfortable to sleep?


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canadagirl06
Member since Feb-22-10
97 posts
Mar-18-12, 09:13 AM (CST)
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9. "RE: Questions about giving birth"
In response to message #8
 
   Sleeping is not so comfortable. I am up every night between 3 and 6am. Totally wide awake. Then the alarm goes off at 6:30 for work. I've decided to go off work next week until the baby is born because it's just getting to be too much.

I have also developed severe groin pain on the left side which makes turning over in bed a major excruciating event, so that doesn't help. I have indigestion and heartburn. But even with these symptoms, I still think being pregnant is the coolest thing ever. Feeling my little boy move around is the best. I also feel so lucky that I was able to get pregnant and that I haven't had any serious complications. In the world of pregnancy, I feel like how I'm feeling is not so bad.

I'm all belly - giant belly - so much so that the maternity wear is getting to be too small!!! How crazy is that?!

In terms of giving birth, I am really hoping for a vaginal birth. That is the goal. I hope that the 2000mg will do the trick and all will go fine. I have very bad reactions to anesthetics, so I am focusing on having a vaginal delivery. I felt pretty confident about it until this last outbreak, but I'm still hoping. Also being off work should help so I can be a little more well rested.

CG

canadagirl06


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