Pregnancy + perianal scaring = c-section?

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Regular Member

Date Joined Jan 2005
Total Posts : 140
   Posted 10/27/2011 1:12 AM (GMT -7)   
I'm having a baby within the next 3 weeks! :)

Everything has gone very well, it's the delivery that's got me worried. I have some perianal scaring from a couple of abscesses I had 2 years ago. My obgyn is recommending a c-section because she's afraid if I tear in that area it won't heal. My GI believes a c-section is not necessary.

I'm being followed by a high-risk ob with 35 years experience so I have a lot of respect for her opinion. But I know that a vaginal birth is best and keep thinking back to what my GI said.

There have been times when my perianal disease was so bad I had to basically wear a diaper - the thought of permanently losing control of my rectum scares me. For the most part, Remicade is helping keep that under control.

I keep writing this post and then not posting it since I know I should listen to my obgyn. But part of me wants to go ahead with a 'normal' delivery.

Any advice would be greatly appreciated.

Veteran Member

Date Joined May 2010
Total Posts : 8384
   Posted 10/27/2011 9:37 AM (GMT -7)   
Minou, congrats on your upcoming birth!

If you feel comfortable doing this, I might suggest you visit with another OB/Gyn for a 2nd opinion. High-risk OB/Gyns are culturally attuned to a patient who needs a lot of interventions. If your pregnancy has been normal and your baby is presenting normally (not breach, not "sunny-side up") then it seems reasonable that you should expect a vaginal birth. Maybe getting a 2nd opinion from a regular OB/Gyn will give you a different perspective. I did not use a high-risk OB for either of my pregnancies, even though I knew I had IBD during the 2nd one. But i have not had abscesses or other complications of Crohn's like you describe.

Is this your first child? Has the OB examined your perineum to see how the scarring looks?

Are you planning to have a doula present during the birth? There are ways to push a baby out that will minimize the chance of tearing. What kinds of preparation or training have you done for the birth? In normal tissue, a tear heals much faster than an episiotomy - you should have a conversation with your OB/Gyn about that, too.

In the birth of my first child, my OB/Gyn cut my perineum after I'd been pushing for a while. In my 2nd birth, he didn't and I tore, but both times I healed just fine.
I should mention that I fired the OB/Gyn who cared for me during my first pregnancy at 34 weeks because he could not accomodate my birth plan.  He was not a high-risk OB and had a 60% c-section rate.  I went to another OB for the remainder of my pregnancy and had a perfectly normal vaginal delivery.  You can change OBs even this late in the game if you want to.  Really.
49 yrs old, IBD diagnosis in spring '01. Proctitis, gastritis, ileitis.
Currently taking Pentasa (3g/day), Sulfazine (1.5 g/day), Prevacid, folic acid, vit. D (2K iu), flax seed oil (2 tsp/day), mesalamine enema as needed. Gluten free as of 5/30/11.

Regular Member

Date Joined Jan 2005
Total Posts : 140
   Posted 10/27/2011 6:42 PM (GMT -7)   
Hey Kazbern,

I spoke to my GI today and he agrees with the obgyn's concerns. He suggested I might try to deliver naturally and take it from there.

This is my first baby, yes. The ob has examined the scar tissue and that's why she's concerned. I went though a bad flare just over a year ago and I almost had my rectum removed... scary stuff.

I think it might be one of those things where you just don't know until you get there. Next week I'll have a lot of questions for my ob.

Thanks for your reply.

Veteran Member

Date Joined Nov 2003
Total Posts : 7314
   Posted 10/27/2011 8:49 PM (GMT -7)   
Minou congratulations. I sure hope that whichever way you decide to go, it is a quick and easy process for you and baby.
I lost an ovary to a cyst months before I got married and unbeknownst to us, I slammed straight into menopause. I did actually spend a few years trying to get pregnant and had often considered the question you have now. To risk a tear and anal damage or accept the risks and longer recovery time of a C section. I don't even know if I've got scar tissue but I do know that even thinking about diarrhea can pop a fissure. Ooops there goes one now! LOL
I really doubt that you're alone in this boat especially since I had thought long and hard about while I was just trying to get pregnant. I'm sure some of the other Moms will be able to share their stories. And remember, Kazbern is right. You can get a second opinion or even change Obs at ANY TIME.
Best Wishes for you and baby.
Keah, who still does not have Crohn's!!!
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