Community Forum

Did any of you elect to have a vaginal birth with perianal disease? I am 34 years old and 10 weeks pregnant with baby #2.  I had a natural birth with a second degree tear with my 1st baby (8 lbs, 5 oz) in February 2014.

I was diagnosed with crohn's in May 2014.  I had a terrible flare (lost all my baby weight plus an additional 30 lbs within 6-8 weeks;  155 lbs pre-pregnancy and 123 lbs after flare)  My crohn's appears to be throughout my colon but not in my rectum.  I also have 4 perianal fistulas with 2 external openings.  I started on cipro/flagyl then moved on to flagyl/sulfasalazine.  The sulfasalazine helped with my GI symptoms (diarrhea) but my perianal disease did not improve.  I switched to humira, which mostly helped my GI symptoms and appeared to be helping my perianal disease.  I had a partial fistulotomy and seton placement in December 2014.  The colorectal surgeon advised me to leave the setons in place until I'm done having babies and then she may try to close them permanently with a flap.  I was scheduled to have a colonoscopy/EAU in May 2015 to check on the status of my disease but I got pregnant so it will be cancelled.  

My surgeon is adamant that I have a c-section but I really don't want to.  I dislike that c-section is major surgery with risks of additional complications for me/baby and it interferes with breastfeeding/bonding with baby plus there's a much longer recovery (not sure how I will be able to handle a toddler and a newborn on my own). I had problems with breastfeeding with my 1st baby and I ended up having to supplement with formula because I couldn't produce enough.  I know there are some serious risks from tearing with a vaginal birth.  I can't help but think I'm more stretchy (less likely to tear) after having at least one baby.  

accidentally posted a response to you but it went to a different poster...I'm new here!

 Reply posted for meggs313.

Because of a perianal fistula, I had three children by C-section in 1987, 1989, and 1990. (I know, crazy, but I was in remission).  I had epidurals and each time, the baby was brought right up to me and stayed in my room.  Being at home with the third one was harder because I had a one year old and a 2 1/2 year old, but it worked with support at home. The "kids" are in their mid-20's and happy and successful.  I have never regretted the C-sections.  After having the pain of Crohn's and the multiple surgeries to have resections and colostomies/takedowns, having the babies was not a big deal.  Good luck!

 Reply posted for josephinenyc.

Hi there!

I was pretty much in exactly the same position you are except I just had my first baby.  I was advised a long time ago before I even thought about having children that I would need to have a c-section by my GI doctor, OB-GYN, and surgeon.  I also have 2 perianal fistulas with openings to the skin.  My disease was in remission when I got pregnant and stayed that way throughout the whole pregnancy thank God!  I still had to have a c-section.  Honestly, after actually having constipation (never knew what that felt like!) while being pregnant and feeling what that pressure did to my fistulas I was glad I was having a c-section!  I had my c-section on March 20th of last year.  Exactly 1 year and 1 day after I had a colon resection.  The c-section was much less painful afterwards than the resection and I felt pretty normal pretty quickly after.  Took about 2 or 3 weeks before I didn't need pain meds anymore compared to 5-6 weeks with the resection.  Like the other poster said, please don't worry about it affecting the bond with your baby.  My daughter and I only took a little longer to bond because I suffered from horrible post partum depression but you wouldn't know it now!!!  It really is safer than trying a vaginal birth!  And just think, if you try vaginal and your fistulas rip open and you lose a lot of blood, it may be a long time before you get to hold your baby if they need to get you stable.  I know surgeries are scary but they do them all of the time :)  It really is your choice though!  If you don't feel right about it, it is YOUR body and baby no one else!!!  Congrats and good luck!

 Reply posted for jess785.

i had a flare up early on in my pregnancy so i was on a pretty high dose of balsalazide throughout as well as asacol suppositories and duloxetine for anxiety (unsurprising that most of us have pretty bad anxiety!). My gastroenterologist and obgyn agreed that it was less risky for the baby to be exposed to the meds than for me to have another flare up. i expect that some meds are safer than others though.  I also saw a obstetric physician who specialised in pregnant women with health conditions such as UC, diabetes etc and he said the same thing. Let me know if you have any other questions, happy to talk about anythng.

 Reply posted for jess785.

Thanks so much for your response. It's good to hear that you had a positive experience with c-section. Did you take meds while pregnant? My docs want me to take humira through the first two trimesters, stop for the third trimester and resume immediately after birth.

 Reply posted for josephinenyc.

Hi there,
I have distal ulcerative colitis and have suffered from anal fissures in the past.  I was strongly advised to have a c-section when i had my first baby last year and went ahead.  Please don't think that with a c-section you are any less likely to bond, breastfeed, etc.  There is no difference at all if you look at outcomes of c-sections vs vaginal birth.  although i wasn't able to hold baby right away because of the epidural, my husband and baby and i had lovely cuddles and skin to skin contact almost immediately and tried feeding soon after.  I also found that my recovery was very fast indeed, and I was moving around better and more quickly, and more comfortably than friends who had vaginal births with tears.  Each birth experience is of course an immensely personal thing, but risking a serious tear and slow/painful healing sounds awful to me, especially when you are trying to take care of a newborn. Either way, good luck and congrats!