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09-16-2010, 11:39 AM   #1
Lydia
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C-section?

My husband and I are trying to get pregnant. I have a history of fistlating crohn's disease. I am on remicade and have been since March. With the last flare I had a couple fistulas and they closed up 4 days after I started the remicade. I know they recommend c-sections, but I do not want to another c-section. I did not enjoy my birth experience, and I had a hard time bonding with my child as a result.

Since I am on remicade, and it healed my fistulas and I dont have any sign of active disease, why cant I give birth? I could understand if I was flaring while pregnant....but if I am not I want to try a natural childbirth. This disease has robbed me of so much, I just see it as one more thing it will take away from me.

Does anyone have any stats on women in remission at the time of birth or did they just lump all crohnies together in regards to this fistula thing? I can not find any stats either way, just recommendations. It would be nice to have some numbers so I can make an informed choice. If the risk is low, I am willing to chance it.
09-16-2010, 11:44 AM   #2
Manzyb
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Hey there!

I don't have any numbers or anything like that, however, I am pregnant and just saw my OB for the first time. He actually suggests doing a vaginal delivery unless for some reason later on in pregnancy it is indicated otherwise. He said with a C-section you have a risk for fistulating around the incision with it also.

For right now, he wants me to have a vaginal birth, I guess we will talk about it later if he thinks it would be necessary for a c-section.

I think it just depends on the doctor really.
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09-16-2010, 11:58 AM   #3
Lisa
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When I was pregnant I discussed natural vs. c-section with my Drs....I had active fistulas at the time - recto-vaginal and peri-anal, so it was decided that the best course for me was to have a c-section....I was NOT on remicade at the time.

If I had NOT had the fistula complications, I would have gone for a natural birth.....

Something else I would look at is scar tissue or thin tissue due to the past fistulas - I would think that the OBGYN should be able to give you some insight on how he/she feels you would fare with a vaginal birth? You don't want to risk tearing too much.....

It sounds like it is still a recommendation for you to have a c-section - ultimately it is up to you - and you know your body best.....there always is the option of going to a c-section if things are not progressing etc - although that is not as good as starting off that way.....

No matter what - congratulations!!!!!
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30 plus years and counting with UC/Crohn's!
on remicade since 11/05

While my experiences may not be what everyone has had- I feel it is worthwhile to share any and all experiences that may be beneficial to others.
09-16-2010, 02:30 PM   #4
My Butt Hurts
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I don't have any statistics, but I can tell you of my own experience. I had a perianal fistula as well as a rectovaginal fistula at the time of delivery for my second child. (Diagnosed after the birth of my first child, so it doesn't apply there.) Both my gyno and my colorectal surgeon said that it shouldn't be a problem to deliver vaginally, and everything turned out okay for me. I thought for sure that little whole would rip open to a big hole, but it didn't.
Good luck with your decision, and super good luck getting pregnant!!
MBH
09-16-2010, 04:22 PM   #5
Lydia
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Thanks ladies. With this disease, the fact is I have a risk of a recto-vaginal fistula no matter what. I dont have to deliver a baby to get one, it can just happen. I really think I am going to deliver naturally, if I am still in remission when the time comes. My husband is so nervous, but I KNOW in my heart I can do it. Your replies gave me some food for thought, and I thank you. I just need to find a midwife that will support me. They are in high demand so its best to be on a waiting list before I even get pregnant.
09-16-2010, 04:41 PM   #6
Manzyb
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Good luck to you Lydia!!

I, honestly, am scared of delivering either way!! This whole thing is so new to me (being pregnant). It's crazy, but I guess either way it goes will be for the best for me and baby.

How long have you been trying for?
09-16-2010, 11:43 PM   #7
Bosmom1008
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Hi,

I'm new to the site but am also actively trying to conceive but it's just not happening. I'm mom to a healthy and very energetic six year old but I was also 27 when he was conceived. Now at 35, I'm not sure if it's mostly my age, the fact that I've had CD for 13 + yrs or just a combination of both.

My first pregnancy wasn't planned and I wasn't in remission when I conceived. My symptoms got better in the beginning of the pregnancy but I had two hospital stints for low potassium.

My son was born at 36 weeks and 5 days and I delivered vaginally. I have what I refer to as my tag along (an outer hemorrhoid) as a result of delivery.

If we get pregnant again, I would opt to do it the same way.

Good luck to all -those who are currently pregnant and those trying to become so.
09-17-2010, 12:36 PM   #8
Lydia
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I have been trying for a year now, with 3 very early losses. It sucks. I am going to ask them to test me Lupus Anticoagulant Antibody. Its common in autoimmune people and it can cause pregnancy loss.
09-17-2010, 02:21 PM   #9
Bosmom1008
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Lydia,

I'm sorry for your losses. I actually want to be tested just to be sure I'm still ovulating. I've tried the tests from the drugstore but I've never had one tell me I was ovulating. I did recently buy a book that explains in great detail a woman's cycle. It's straight forward but I'm still taking notes. As much as we want a second child, we won't go the route of any type of hormonal help. I'm of the school that if it's meant to be it will be.
11-30-2010, 04:11 PM   #10
insert_name_here
 
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Hi Everyone!

I don't post very often, so I want to introduce myself. I'm 30 y.o, was diagnosed with Crohn's 18 years ago, on Remicade and have an open perinanal fistula with 2 setons. I've had about 10 surgeries in the past 2 years to get things to settle down. The setons currently manage the issue well, although I do tend to have cycles of infections. Somehow, since my pregnancy I haven't required the use of antibiotics. I'm assuming this may be due to pregnancy lowering one's immune system, which is a good thing for those of us with Crohn's since our immune systems are generally in overdrive.

I'm 12 weeks pregnant and have opted for a C-section for my delivery. Why, you ask? Because I don't want to take the risk of having permanent fecal incontinence. It is a REAL RISK for those of us with active fistulas...and for those who have scaring, causing weakened muscles in the anal area. Also, I recently found out I'm having twins! So...for me a C-section is the way to go!

If you have your heart set on a natural delivery, perhaps if this is your 2nd+ vaginal birth your body is more prepared for the stretching needed without taring?

Also, if you are on Remicade, it does cross the placenta barrier. In a recent UCSF study it was recommended that you not have an infusion past 32 weeks. Then, the day after delivery, while in the hospital, you should be given Remicade. Even with these precautions, your baby maybe immuno-comprimized, and you should check with your pediatrician to see if any special care is needed.

I hope this helps! Whatever your decision, C-section or vaginal birth, it should be your choice. It's your body!

Kind Regards
12-02-2010, 05:42 PM   #11
Manzyb
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Hi Everyone!


I'm 12 weeks pregnant and have opted for a C-section for my delivery. Why, you ask? Because I don't want to take the risk of having permanent fecal incontinence. It is a REAL RISK for those of us with active fistulas...and for those who have scaring, causing weakened muscles in the anal area. Also, I recently found out I'm having twins! So...for me a C-section is the way to go!



Kind Regards

Congratulations on the twins!!!!

Are you happy that you did the C-section? My OB doesn't believe in doing them unless absolutely neccessary. However, I've read some nasty stuff that happens to people with Crohn's who do deliver vaginally. I have way too many problems, I don't want things to be all funky down in that area. I've had perianal Crohn's in the past, but that has been a few years ago, I just realy don't want to risk it.

I am pretty sure I would rather have a C-section. It might be selfish of me though since it might not medically be needed.
12-02-2010, 06:15 PM   #12
insert_name_here
 
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Hi Manzyb!

I haven't had a C-section yet, so I'm not sure how it'll be like for or whether I'll be happy about it. Certainly there are risks to C-sections, especially if you're planning to have more than 3 children delivered in this manner (risk of the placenta growing into your C-section scar).

However, from what I understand, "normal" women who deliver vaginally tend to have more incidences of incontinence and prolapse within 10 years of delivery in comparison to those who have C-sections. On the other hand, children born via C-section before 39 weeks tend to have more respiratory issues because their lungs haven't naturally dried out (a part of the natural delivery process).

Since I've been struggling with an open fistula, and the various treatment choices, I've been looking at fecal incontinence support groups/message boards to see what its like to live with this type of issue. From what I read, you wouldn't wish it on your worst enemy. So, the way I reason it, if I become home-bound or if I have to give myself enemas before leaving the home, not eat most of the day, etc...I will not be able to function in the way I would want to as a mother or as a person. This is why I am certain I want a C-section, even if some may regard it as selfish. Butómy doctors certainly don't! Also, I will insist on having my C-section date scheduled for after 39 weeks (although when carrying twins, the reality is I may have to deliver earlier).

A resource I found helpful in understanding C-sections is the Pregtastic Podcast on iTunes, episode 125. They have an OB on the show to discuss the risks and benefits.

Also try talking to your gastro. Perhaps your he will have some research or opinions about your case, and whether a C-section is a reasonable request...and maybe he can speak to your OB to help reinforce your wishes.

Good luck!
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