Giving birth with Crohn's - how to decide how to deliver?

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killerzoey
Regular Member


Date Joined Jul 2007
Total Posts : 161
   Posted 11/8/2008 10:05 PM (GMT -7)   
Hi

It's been a while since I've been on here.

I have Crohn's and it's active in my rectum and perhaps stomach/duodenum and a few spots in my colon. Hasn't been too bad during pregnancy.

I am 36 weeks pregnant and early on I tentatively scheduled myself for a c-section on Dec. 1st, at 39 weeks.

But now I'm reviewing all the info and trying to decide if I really need to go this route.

My incentive for opting for a c-section was wanting to avoid any avoidable horribleness that can be caused by vag. delivery.

The first time I gave birth I had what I thought were terrible hemorrhoids. Walnut-sized, one thrombosed. Maybe they really were hemorrhoids. I don't know because I didn't know I had Crohn's then and I didn't really have them analyzed, lol. So at the very least I can probably expect that to happen again. They were so painful I required Vicodin for a week or so (after having delivered drug-free at home, lol).

So anyway, I have read the studies that say that in a certain segment of Crohnies, c-sections are recommended. And that whether or not you are in that segment has to do with if you have "active perianal disease". I saw a colorectal surgeon last week and he took a look and said that he could definitely tell I was pregnant due to the tissue being softened, and some hemorrhoid tissue as well. But he didn't see anything that screamed "Crohn's" or "don't let this woman deliver vaginally!" He did, however, stop short of advising me on how to deliver.

I understand that regardless of my current condition (and even regardless of if a woman hase Crohn's) that a bad tear can lead to a recto-vaginal fistula. I have discussed attemtping to get an accurate read on baby's size and he said not really possible in 3rd trimester. Can be off by a pound or more and even head circumference isn't reliably measured. He just wants me to do a c-section and says why bother tearing things up down there...but then he says that if he were a woman he'd opt for one regardless.

I just don't want to be cut open if it's not necessary.

Any thoughts or experience anyone can share with me to help me make up my darned mind? The time is drawing near...

Thanks in advance!
36 year old wife, and mother of a fabulous toddler. Diagnosed with Crohn's Disease July '07. Meds: Asacol 1600 mg, Low Dose Naltrexone 4.5 mg, Sertraline (Zoloft) 50 mg.


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20576
   Posted 11/8/2008 10:20 PM (GMT -7)   

You probably had/have what I have which is perianal crohn's skin tags (mine were mistaken for hemmies too), check out this link...the first set of pics are actual hemmies, the pics under the hemmie pics are those of perianal crohn's skin tags (aka; elephant ears)....

http://www.emedmag.com/html/pre/fea/features/011504.asp

 

I had these skin tags with my first baby only I had no other CD syptoms what so ever and every doc that saw my sin tags told me they were hemmies...I delivered that baby naturally, I had problems with the skin tags and internal crohn's about a yr and a half AFTER my baby was born which is when I got DX with crohn's...

 

Then I had my second baby with full active CD (including flaring skin tags because they did a hemerhoidecotmy on those tags just before my CD attacked me internally because as I stated above that's what I was told they were)...anyways getting to the point, my first baby was huge at 8lbs, 15oz and I had her naturally with the tags there and flaring, I had my second baby naturally even though I knew by then that those tags were not hemmies and I had full blown active CD I was told it would be better if I had a C-section but I opted to have another vaginal birth because I had already stretch down there once before, second baby was 8lbs, 3oz and all was fine (because of the previous stretching from aprox a little over 2 yrs earlier.

The only thing I have to add is if you are a fistulizing crohnie then a C-section might for sure be the way to go, you take your chances with the skin tags, make sure that if you start to tear while the baby is comming that the doc uses a knife to lead the tear away from the anal skin tags.  You don't want them to be cut into or off because they may never heal leaving you with an open wound and lots of infections given the area they are in.

 

:)


My bum is broken....there's a big crack down the middle of it! LOL :)


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20576
   Posted 11/8/2008 10:27 PM (GMT -7)   
Oh and I did tear with my first baby but my doc lead the tear away from my anal tags and I only tore a little and she only cut a tiny bit and I never ended up with a recto-vaginal fistula because thankfully even after 17 yr straight of having CD with no full remission I've never had a fistula, so it does not mean that just because you have CD and natural child birth that a bad tear will lead to a recto-vaginal fistula either. Go with your gut instinct, that's what I did, just be sure your doc know to lead any tearning AWAY from the anal tags.

:)
My bum is broken....there's a big crack down the middle of it! LOL :)


Kaycie
Regular Member


Date Joined Jan 2006
Total Posts : 449
   Posted 11/8/2008 10:53 PM (GMT -7)   
I opted for a c-section, but had to deliver via emergency c-section regardless because my Twin A was breech and her pegged foot (she was missing a foot from her anomaly) tore through my cervix. (All that was pain med free by the way - I didn't get any relief until the spinal for the emergency c-section.

I, too, could not get my colon surgeon to give the OB an ok to do a c-section. He, too, stopped short of recommending delivery, basically stating it wasn't his call. He was just protecting himself, but when I explained how I felt it might be better and if he thought that was true, he DID agree with me.

I'm a fistulaizing Crohnie. I have 3 fistulas, 2 around my vagina that connect to my rectum, and a third on my perinium (sp?). In addition, I have a skin tag, 2 fissures, and I've had an abscess before as well...same region. So, I did NOT want to do any more damage down there. It was a wise decision on my part, but I require the c-section regardless.

That said, my RE (Reproductive Endocrinologist) did recommend the c-section based on my history, but he too stopped short of giving the recommendation to the OB. Luckily, I have an AWESOME OB/Peri who agreed before the emergency section that we would do a section regardless.

I will say one negative thing about the c-section. It did take 5 days for my bowels to kick in. I took 2 doses of Miralax throughout pregnancy to even go (I ended up in the ER 3 times for compactions while pregnant - mostly due in part to Zofran), I continued taht until i was semi-regular. But, one thing I have noticed, is with my most recent flare, my pain levels are a NEW intensity. And, I fear I have some scar tissue around my small intestines from the section which causes me to feel more pain with a flare then before.

But, I think it was a minor trade off to doing irreversible damage to my rectum. My muscles have already weakened considerably... I know whenever I end up with surgery, my rectum will likely be gone..

Hope this helps somewhat... Message or Email me if you want to talk more... happy to share!
Kaycie - Age: 26
Crohn's - Dx Nov 05
Failed Remicade, moving onto a Clinical Trial called ABT-874 - Tentative start date - 10/2/08 - 10/16/08  - Infusion, every 4 weeks.
IVF #1 (In-Vitro Fertilization) - Failed
IVF #2 - IVIg, Heparin, Baby Aspirin - TWIN GIRLS!!!
Reagan Dawn - 8/2/07 - Lived 1 hour 27 minutes due to Cloaca, NOT affiliated with my Crohn's
Addison Maria - 8/2/07 - 13 months old


gachrons
Veteran Member


Date Joined Mar 2007
Total Posts : 4527
   Posted 11/9/2008 11:07 AM (GMT -7)   
Hi Since you have the rectum area in a problem zone as it were might make sense to go C- section but I have never had S- section. lol gail
Hallarious woman over 50 ,CD ,IBS 27 years--resection,fistula's,obstructions,hemmies,and still alive.lol gail


MMMNAVY
Veteran Member


Date Joined Jul 2006
Total Posts : 6927
   Posted 11/9/2008 12:33 PM (GMT -7)   
I don't know. But I was thinking a c-section might be the way I would go if I am going to give birth.
Forum Co-moderator - Crohn's Disease
...I will find a way, or make one. -Philip Sidney 1554-1586
Make sure your suffering has meaning...
All suggestions/options/opinions are caveated with please consult with your local health care provider...


daniellenikole
Regular Member


Date Joined Jul 2006
Total Posts : 77
   Posted 11/9/2008 10:02 PM (GMT -7)   
I had to make the same desicion when I had my son..I had a normal vag birth with my daughter pre-sickness..but with my son I had lots of rectal involvement as well as a fistula near my anus and significant disaease through out my colon. I was very agaist having a section at first but found after speaking with my doctors enough times it was probably best..they were saying basically the tissue in your rectum and vagina can become damaged during birth and can lead to recto-vaginal fistula formation as well as other rectal problem like prolaspse etc... in my case my rectal disease is quite severe i was very worried about making it worse or giving myself more fistulas so I opted for the c-section. And i'll tell ya- it wasnt half bad..i mean, birth is a breeze!! i had a natural med-free birth with my daughter and the c-section was a walk in the park compared. The recovery was hard the first few days..but as long as you know you make it past the 3rd day or so it gets sooo much better:) hope this helps a little..good luck.

Danielle
25 years old..Just had my second baby(a son)born Feb. 26th..using 75mgs of Imuran...He is perfect in everyway: ).Been on the BIGGEST Crohns "rollercoaster"..been down to 88lbs (5'7) about 2yrs ago..very sick..Been on Pred, Pentasa, Entocort, Cortifoam enemas, Imuran, and flagyl and cipro for anal fistula. Currently only taking Remicade and PREDNISONE: (..and it has been my miracle* drug!..(That was short lived: (
 
 
 


RedAdmin
Veteran Member


Date Joined Aug 2003
Total Posts : 1017
   Posted 11/10/2008 8:41 AM (GMT -7)   
I know that my daughter was considered small - 6lbs, but I did not have a c-section and I delivered 6 weeks early. My doc never even discussed that option and I have been with him somewhere aroun 15 years, so he knows my history. As a matter of fact he recommened the doc I do see for my CD.

My best advice is to follow your heart - shut up (mentally) and get out of your own way and you will know what to do.

Many blessings on this happy event in your life.
Red (Lee Ann)
    'Be who you are and say what you feel...
     Because those that matter...don't mind...
     and those that mind...don't matter.'

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