Crohn's & C-Section

[Pauline91]

I am 36+3 weeks pregnant and have until Monday to decide how I want to give birth. I have Crohn's disease and have had surgery in the past a ileostomy bag and then a reversal of the bag. Having a natural/vaginal birth could leave me with bowel incontinence but with a c section there is a risk of them cutting the bowel and having to have the ileostomy bag back on. They have said it is up to me which I would rather do and gave me a week to think it through. Does anyone have any experience of this or any advice please ?

I'm 18+6 with my first so still some way to go, so not sure how helpful this will be for you!

I had bowel cancer when I was 20, which included an ileostomy which was subsequently reversed. Because of all my surgeries, I have bowel incontinence now (without even having had a baby!) so I've been advised to have a c-section. My situation is slightly different because I already suffer from incontinence, but the level of incontinence I have now is manageable and the risk is any further damage from a vaginal birth will lead to more severe incontinence which would not be manageable at all.

Because of my history, my consultant is going to arrange for a bowel consultant to be in the room during my c-section just in case something goes wrong. Is this an option they can offer you?

Also, (stressing that I am still early on in my pregnancy so inexperienced in this area), I think the risk of an ileostomy after a c-section is really low, but even if it did end up happening, would it not be a temporary one?

Hi @MsHedgehog thanks so much for your advice even just hearing someone in a similar (although i understand not the same position) is some comfort.

Yeah they have said that with a c-section there would be a bowel surgeon on hand just in case. It was hard to get them to do a reversal the first time because of the risk of another Crohn's flare up which makes me think they would definitely say no this time.

I am not sure about how high the risk is either this is something I think I need to ask about because if it were low I would be a lot less stressed

Hi,

I have ulcerative colitis - I haven’t had surgery but I decided to have a c section which I had last Friday as I didn’t want to risk having a severe tear that could lead to continence issues etc. Also got told that a difficult labour could bring on a flare. Obviously I was warned about the risk of them accidentally cutting my bowel but decided to take the chance. Everything went fine and I’m recovering well. Hope all turns out well for you whatever you decide

Hi @Givemeabreak45 firstly congratulations!! It's so nice to hear a positive story so thank you! This is making me feel a lot less anxious I think sometimes it's easy to just focus on the worst case scenario! I hope you and your baby are doing well. If you don't mind me asking how long did you have to stay in hospital afterwards?

Hi. I don’t have any digestive disease however I did have a bad natural birth which resulted in severe tearing and mild incontinence. I have recovered better than most but still opted for a section for my second baby . After the birth I remember thinking a lot about how hard it would be if you had crohns Or IBS so I’m glad to hear that it is something that was discussed with you pre birth. Nothing was ever mentioned to me about the long term impact from such severe tears. Annnnnyway , my c Section was a lovely experience (I was worried it would feel weird or unnatural or something ) but it really really didn’t. I wish you all the best!

@Pauline91 I was discharged the next day! It has been quite tough though but I’m on the mend

@Jalu47 I don't know if you've seen this thread but thought it may be useful for you

Couple of thoughts for you- no personal experience though! how strongly do you feel you want to experience natural birth? How many kids do you see yourself having? And did the obstetrician talk through with you the chances of emergency CS (Ie- are they higher than normal for any reason eg big baby, high BMI?). Have you had a chance to talk to a colorectal surgeon during the pregnancy at all? Do you have any perianal disease?
Lots of pros and cons - definitely if you have perianal crohns I’d go for CS though. In terms of risk to bowel from the CS it will be pretty low, esp if they have a bowel surgeon present. It will be higher if it is an emergency CS - because the surgery is often more hurried (if worried about baby for example) and also because in an emergency CS in the middle of the night the bowel surgeon may not be there to assist. So that’s one thing to consider. If you want lots of kids it is probably worth trying for vaginal delivery because that will mean most likely more vaginal deliveries, and less repeated surgical risks over time.
Sorry a bit of a ramble, hope it’s helpful in some way!

@Immaback Sorry to hear you had a bad natural birth. That's the worry that if there was any tearing I don't know if I would be able to keep any continence control. It's lovely to hear some positive c-section stories and it is making me feel a whole lot better so thanks!

@Givemeabreak45 oh really that quick! I would like to be home asap as I take immune suppressants so unusually pick up some kind of bug in hospital and with covid it's not ideal. So glad your on the mend.

@TenThousandSpoons0 When it comes to giving birth I just want whatever is best for both baby and me. I am just trying to weigh up the risk of incontinence from a natural birth against the risk of cutting the bowel in a c-section. This is my first baby and I would only ever see myself having one more. My Crohn's consultant has said that the first sign of 'trouble' i would need to be rushed for an emergency c-section to try and protect the muscles. I have an anterior but not low lying placenta but baby is in good position, baby was measuring bit but is now averaging out, I have slightly low BMI but I struggle to keep weight after having my large bowel removed. I feel like a section would be the best option it's just the risk of cutting the bowel has me petrified but I was never told how high or low that risk was. I think a planned section is better than emergency as you say having the bowel surgeon there and not rushed. I have contacted my surgeon who done my previous operations (he has moved hospital trusts) hopefully he comes back to me with some advice. Thank you very much though talking it through with you lot is making me feel better and process things more rather than just worrying away!

@TenThousandSpoons0 can I ask what you decided to do in the end? I’m in a similar situation and I’m 36 weeks pregnant. I had bowel cancer 11 years ago and had whole large bowel removed but didn’t have a bag.

I now can’t decide if an elective would be best. Doctors seems to say I can try for vaginal but would be a low threshold as can’t risk it being a big emergency due to not knowing what scar tissue they will find.

But they arnt pushing me either way and I need help to make the decision I really would love 2 more children after this so also worried about too much surgery.
Help! Xxx

Hi! I'm in a very similar situation. I have crohns as well and in the past I had an ileostomy that was reversed. I asked for a c section because of the incontinence risk and because I also have rectal inflammation when in a flare. My consultant has not mentioned the risk of perforating the bowel and getting an ileostomy again as significant. And in any cas, it's a reversible ostomy (my first ostomy was caused by a perforation of the bowel in the first place, although a natural one, not a surgical one. So even messier! I had almost my whole ileum removed). I'd much rather have a bag - I know what great quality of life I can have with one, reversible or even permanent! - than dealing with faecal incontinence or with any kind of rectal damage. This is my point of view though.

Hey, thought I’d share my experience although I’m in a different situation as I have a permanent ileostomy due to crohns. I had to have a c section as my baby was breech. We set a date on a day my consultant said there were specialist staff around the hospital if they were needed (randomly had to be tues to Thurs). However my ds had other ideas and came early, so ended up with an emergency one and on a friday 🙈. It went fine, no issues around my scar (I had open surgery, so it’s straight up the middle). In fact he commented on how good in looked in there after my previous surgery. Hopefully this gives you some confidence that a c section can go smoothly x

I've got ulcerative colitis, and I've never considered a vaginal birth. My section is booked for Monday. The thought of a tear fills me with absolute terror.