I posted this question at the end of a previous post, but got no responses. Thought maybe I'd try again with a new post...

What I am wondering is what exactly is it about a vaginal delivery that makes it dangerous for a j-poucher? Is it the pushing? Is it the risk of tearing? What is it?

I'm concerned because I have two children born via vaginal delivery pre j-pouch and frankly, I don't want to have a c-section. I don't want another abdominal surgery if it is not absolutely necessary.

Also, my OB doc is a regular OB doc and has no experience with j-pouches that I am aware of. Should this really be a concern? Do I really need to go through the whole process of selecting another OB?

Can anyone shed some light on this?

Thanks!
Alex

Alex,

The issue with vaginal deliveries has to do with the eventual loosening of the sphincter muscles that happens to ALL women who deliver vaginally. The more vaginal deliveries you have the more stretched the muscles become and the more potential for you to lose some or all control of them as you age (it is not something that is an immediate concern, but one over time). For women without a pouch, this loosening or deterioration isn't usually a big deal, but for obvious reasons it can be a real issue for pouchers.

Cleveland CLinic has great information about why c-sections are recommended for pouchers; check out their site, or search here for "c-section" as this question comes up a LOT. Jan, have I portrayed this correctly? When you search this topic, look for Jan Dollar's responses as she has addressed this question not only from the perspective of a nurse, but as a women who had vaginal deliveries pre-pouch.

I understand not wanting another abdominal surgery, and only you know what the right choice is for you, however, the c-section is nothing like the abdominal surgeries for j-pouch. I was out of bed from my c-section as soon as my epidural wore off, took only Tylenol as a pain killer and was off that in a week. IN many cases, a bikini incision can be done for the c-section and it is much easier to heal from than the midline incision.

Out of all the surgeries, C-section was the easiest!

Let's put it this way: each and every vaginal delivery you have will serve to potentially weaken your sphincters when you are aged (not now, but 20-30-40 years down the road). Not much of an issue for those with a colon, but when you tend toward loose or liquid stools, it can be a big deal. And, the larger the baby, the greater the risk of damage.

So, it is totally up to you. You cannot undo the past, but you do have control over what transpires in the future. If you are happy with your OB, I don't see any reason to change. I've have both vaginal and c-section deliveries and they are pretty comparable as far as recovery goes.

Jan

I just wanted to concur that the recovery time for the c-section is a cake walk compared to J-pouch surgery. I was pretty worried, esp. given that after a c-section I'd also be required to care for a new person! But seriously, I had my daughter via c-section on a Friday, went home on Sunday, and was on my own w/ the baby by Wednesday. If you're worried about scars, what's one more? I can't even see my bikini scar anymore. Good luck with whatever you decide!

Everything that has been said about sphincter control/ tone is true and reason enough for me to want a c-section but my colorectal surgeon also insists that I have one because we now know that I have a severe amount of adhesions in my abdomen and pelvis. He said the problem that he sees with a vaginal delivery is that if some thing goes wrong and a c section becomes needed he doesn't want it to be an emergent situation where Dr.s are cutting quickly and he might not be there. I'm about to start IVF and if I get pregnant we will have a planned c section with my colorectal doc there just in case. It's just something else to think about, there is no way to know how much scar tissue you have from your surgeries unless some one has been in to look.

LisaJo, that is an excellent point. Interestingly enough, I have heard from some here that their OB/GYN docs wanted to insist on vaginal specifically because of the possibility of problematic adhesions. Of course, that is assuming that this is a perfect world and obstetric reasons for c-section do not occur! My first was born c-section because of a breech presentation that was not discovered until after 12 hours of induced labor. It wasn't an emergency section, but it sure was not planned... Thankfully, this was long before my j-pouch surgery.

Jan

Thanks so much for all of your input! Because of my age and some blood pressure issues, my OB has referred me to a High Risk OB for genetic counseling, testing and a BP eval and treatment. While I'm there, I will discuss the whole j-pouch/vaginal/c-section issue and see what he says.

Thanks again!
Alex