You and your doctor should discuss your options for delivery in the early stages of pregnancy and also review your viral load when you are around 36 weeks pregnant to discuss your best options for delivery at that time.
There used to be a blanket recommendation that all women with HIV should have a caesarean delivery to minimise transmission risks. This is no longer the case, and caesarean delivery is usually only offered to women with a detectable viral load prior to delivery, so many women are now choosing to have vaginal deliveries. As women with HIV are more likely to go into labour slightly prematurely, if a caesarean (called a pre-labour elective caesarean) is needed it would be scheduled at 38 weeks rather than the standard 39 weeks. Having an emergency caesarean after your labour has started is not associated with the same reduction in transmission risk, so if complications are likely, scheduling the delivery prior to your due date is preferable.
Recent research has shown that caesareans may not add additional protective benefit if you have maintained a low or undetectable viral load throughout pregnancy. A caesarean is major surgery and it can be at least six weeks before your body recovers enough for you to do basic things (like drive a car). This can be particularly hard while looking after a tiny infant. Recovery time is a particular disadvantage for women who have other dependent children or other caring responsibilities. There is also the risk of post-operative infection and other standard risks associated with surgery. It is important to talk to your doctor and make plans before your delivery date.
It can be useful to have a small bag packed in advance including things like pyjamas, toothbrush and importantly, your HIV antiretroviral treatments. Even as you begin the important process of having your baby, it is important to remember to take your treatments on time. Make sure your partner or health care team understand your treatment schedule.
If you have not been on HIV antiretroviral treatment during your pregnancy you will be advised to have intravenous antiretroviral drugs during delivery. Most HIV transmission to infants takes place during the time of labour and delivery (rather than in the uterus in the early part of pregnancy).