First......breathe! It's all okay. Really.
As for your first question:
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If I had a recurrent ob shortly b4 I became pregnant, are my chances of infecting my baby higher or lower?
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The timing of an outbreak and/or the frequency of your outbreaks will not lower or raise the risk of transmitting hsv to your baby. What really makes a difference is when you were infected. If you acquired hsv prior to your pregnancy or even during the first two trimesters, your risk of transmitting the virus is very very low! In mothers with recurrent herpes who deliver vaginally with no symptoms, the risk of transmission is just under 1%. By taking suppressive doses of antivirals during the last several weeks of pregnancy, you can reduce the risk even further. Even in the worst case scenario, where a woman's lesion is overlooked at delivery and a baby is born vaginally, the risk of transmission for a mother with recurrent hsv is only around 5%.
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How and when should I go about using medications?
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You should really discuss this with your doctor or midwife. Most doctors will prescribe suppressive doses of acyclovir or valtrex beginning around 34-36wks of pregnancy. If you feel your outbreak is severe enough to treat, you should talk to your doctor about how s/he feels about episodic treatment during pregnancy.
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Should i take them starting now, since I just had an ob?
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You should really ask your doctor this question.
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What are my chances of having a normal, vaginal birth?
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As long as you are symptom free at the time of delivery, herpes will not prevent you from having a healthy vaginal delivery. Be sure to be very candid with your doctor or midwife regarding herpes. S/he will need to examine you with a very bright light and should ask you about any prodromal symptoms. If you are symptomatic, your doctor or midwife will probably recommend a surgical delivery.
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If my water breaks and I'm in labor for 24 hours, does that mean I have to get a c-section because the membranes are ruptured too long?
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Six hours is generally considered the longest time a woman with hsv should labor with ruptured membranes. After six hours, the risk of transmission begins to increase. Don't let this panic you, though! You could be in labor for 24 hours with your membranes completely intact or you could rupture and deliver within only a few hours. This is something about pregnancy that you won't be able to predict. Talk with your doctor or midwife about how s/he will manage your labor after your membranes have ruptured.
Try to relax about it. It is really wise to stay well informed and educate yourself, but because you had a history of herpes prior to your pregnancy, you don't need to worry about it. Neonatal herpes is not common and only about 2000 babies are infected in the US each year.
Best wishes!
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