Childbirth, Crohn's disease

[londontowner]

I have Crohn's Disease (in remission at the moment) and I'm 29 weeks pregnant. The consultant obstetrician has recommended a c-section because he says there is increased risk of sphincter muscle problems and incontinence following vaginal delivery for people with Crohn's. I have lots of scar tissue from peri-anal absesses and rectal abcess and fistula, so bad tearing may also be an issue. I've read that anal-vaginal fistulas are a risk following vaginal delivery, and definitely want to avoid this too. I also had a hemi-colectomy (10 years ago).
I don't really have a problem with having a c-section, but I'm wondering what other people have been advised to do/experienced and what worked best for you.
Thanks!

This might not help much, but......

My cousin has Crohn's and has delivered two babies vaginally. This was in the US were things are generally more medicalized than in the UK. (To give you an idea she had a fetal MRI with her second child because of issues with her first.) I would say though that she has suffered less from her Crohn's than you. I wonder if that's partly influencing the recommendation here.

Have you spoken to the doctor who treats you for the Crohn's? It might be worth getting two perspectives on this.

I think it's a very good idea to get an opinion from the consultant who looks after your Crohn's. And you might want to think about getting another opinion from an obs/gynae. What might be a good idea is to try and see someone who deals with birth injury repairs, as they might be able to offer another point of view. Perhaps your Crohn's consultant can recommend someone? Otherwise someone who specialises in pelvic floor reconstruction would be a good starting point. Is there any Crohn's Society or some such organisation that might be able to point you in the direction of research looking at associations between Crohn's and bad outcome from VB? Personally, I;d just take the ELCS. But I'm speaking from the perspective of someone who has bad birth injuries and needs a lot of reconstructive surgery. Not everyone comes out of things as badly as me! Good luck X

Hi
I have CD and have a 2.5 year old DD and a 4 week (!) DS. Both were born by c-section, first emergency and second elective but neither because of CD. I think that you have had far more IBD issues than me so I can't offer much specific advice, but I would say that most people with CD are able to deliver naturally but my last consultant did mention that tearing could be an issue with certain disease patterns and if this was the case, to consider C-section.
I would say that you need to speak to your gastroenterologist and your obstetrician (you should be under consultant led care, and you may also want to ask for fetal growth scans, my first daughter was growth restricted, probably because of CD, and this was not monitored as it should have been) and crucially, get them to speak to each other to decide the best course of action.
C-sections are generally fine, although I've felt a bit ropey getting over this one for the last couple of weeks but if you can avoid one, you probably will want to (and remember they can contribute to problems with adhesions and be hard to do if there is lots of scar tissue present).
Best of luck. If it's any comfort I've found CD pretty compatible with birth and babies (although beware the postnatal flare up, seems very common).

Thanks very much for getting back to me, everyone. It's good to hear people's thoughts and intersting that people have had both vaginal deliveries and c-sections and managed pretty well. I had spoken to the gastro team and they're happy for me to have a c-section - mainly because of potential sphincter muscle damage and the need for many 'Crohnies' to have have good, strong muscles there. It's interesting though - no-one says 'do it', they just "suggest" it or "recommend" you to "think about it".
Cardamom - I am thinking that I'll go with the c-section at this point. My main concern really is that I have such a lot of scarring around my perineum and anus that I can't really imagine that I won't suffer pretty bad tearing otherwise.
Helzapoppin - congratulations on your new baby's arrival. I hope you start to feel better soon. Was your disease in remission when you were pregnant with your first baby? I ask because I'm wondering if it is only when the disease is active that there may be problems with fetal growth, or whether this is likely to be the case regardless of whether the disease is in remission or not.

I should add, I've been well for the past 7 years or so - the disease was particulalry unkind during my early 20s, but hasn't been too bad since. I've also felt incredibly well during the pregnancy - I'm dreading the potential post-natal relapse, Helzapoppin.

Hi there,
I was pretty much in remission when I fell pregnant (had been poorly the year before and had a couple of courses of steriods) but had no symptoms at all when pregnant. When I say DD was growth retarded, she was just a little on the small side (5lbs6oz), so no great disaster, but also my dodgy placenta which was not picked up on was reason for my EMCS (and her distress in labour). It may just be worth discussing the possibility of some extra monitoring, altough it may not be necessary for you. FWIW, although she was tiny, my daughter was successfully breastfed ( with me on azathioprine) for 12 months and is healthy (was thinking yesterday, she's only had to go to the GP twice in her life!), bright and active. This DS was 7lbs15oz and is now 9lbs8oz so all looking good so far.
Oh, and my consultant put me on low dose asprin to increase placental blood flow this time round and high dose folic acid.
Hope some of that helps. Good luck and enjoy pregnancy and your little one :)