Between personal wishes and medical "prescription": mode of delivery and post-partum sterilisation among women with HIV in Brazil.

HIV-positive women are confronted during pregnancy with a range of medical information and prescriptions that substantially affect the experience of pregnancy and birth. Based on antenatal and post-partum interviews with 60 HIV-positive pregnant women from São Paulo and Porto Alegre, Brazil, this article presents evidence of some of the factors that affect mode of delivery and access to post-partum sterilisation, and the implications of these. Whether women gave birth vaginally or by caesarean section was medically prescribed, with women's own preferences taking second place. Some were advised that caesarean section was the only option with HIV in pregnancy; others were told it should be used only for medical indications, even if the woman wanted to be sterilised at the same time. The women in Porto Alegre were less likely to get a sterilisation than those in São Paulo, even with caesarean section, as sterilisation was not encouraged locally. Many of the women who accepted a caesarean had been convinced before they gave birth that it was the best choice for them, either because it reduced the risk of perinatal HIV transmission or because it facilitated tubal ligation, or both. However, after they gave birth, the women judged their experience of delivery and the post-partum period mainly in comparison to previous deliveries, and many of them viewed the birth experience with HIV as more difficult than previous deliveries and worse than they had expected.