I'm currently 20 weeks pregnant and unsure about my birthing plan. I had my colon removed in 2007 and had a second surgery about 3 months later and now have a j pouch. My surgeon at the time told me when I had children I would need to have a c-section because of the risk of tearing the pouch, damaging anal muscles, and risk of future problems, incontinence. My ob/gyn says that a vaginal delivery will be safer and I will have more risks with a c-section, because they do not know how much scar tissue I have from my previous surgeries. Any advice, opinions, or knowledge would be greatly appreciated!! I am very nervous/scared and I do not want to have a vaginal delivery but I feel like my dr is making that my only option.

I would recommend getting the two doctors to talk to each other.

thanks for your advice. My surgeon is no longer in the area that I live in, he went to another hospital in another state, I am going to see a high risk specialist to get her opinion and I plan to try to cntact my former surgeon if I have to.

OK, realistically, your OB needs to accept the possibility that a c-section might be necessary. Look at the c-section rates for people who don't even plan for one. Obviously, if you wind up with a breech presentation, transverse, failure to progress, abruptio placentia, etc., a c-section would be pretty much mandatory. So, he should be ready to deal with your issues, adhesions and all.

Lots to consider when opting for a vaginal. First, would this be your first vaginal delivery? If so, that adds some risk to the pile. If you had delivered vaginally before and it went well, that could go in favor of repeating it. Size of the baby matters too. What if the baby is 9 pounds or more? There are women here who did fine with their vaginal deliveries, one who even opted for a home birth!! But, that was their choice and they were willing to deal with the unknown future risks. We don't KNOW that future continence will be compromised, but many don't want to take that risk.

A high risk OB makes all kinds of sense to me, especially one who will discuss ALL the pros and cons and help you make decisions that are individual to YOU! Good luck and congrats on the healthy pregnancy!

Jan

this is my first pregnancy. I have read alot of posts on here about delivery, I am most comfortable with a c-section having a colorectal surgeon present also. Hopefully I'll get some good advice from the high risk ob/gyn, my ob/gyn is in a small town and hasn't dealt with this type of situation before.

You need to do what you feel is best for you and your baby. I had two c-sections post-pouch, by two different doctors, neither of which had issues getting through adhesions/scarring. How much scarring may also depend on how you had your surgeries (mine was laparoscopic). I'm sure your worries will be put to rest after you speak to another physician.

Congrats and best of luck!

Colleen

You probably have read some of my posts since you are thinking of having a colorectal surgeon along for the ride if you have a C, and that's an approach I wholeheartedly encourage and support. It gave both me and my OB (who was a maternal/fetal medicine specialist, who in my mind you should be seeing if you are a poucher as we are a special case) peace of mind in the operating room.

I did not wish to be wearing adult diapers and changing my own diapers along with my sons. I felt it was important to do the best thing for both me and my baby and in my case, that was having the C. I have no regrets and it was a very smooth, quick and routine C.

thank you! That's exactly how I feel I want to do what's best for my baby and myself, I want to be healthy so I can be the best mother I can be. There are no high risk ob/gyns in my area but I'm going to cincinnati tomorrow to meet with a high risk specialist. So hopefully I can get some good advice from her and she will understand my concerns.

It's definitely worth going to see the MFM. I really liked my regular OB but the MFM is just so much more prepared for unexpected eventualities and complications, I felt more confident being under his care during my pregnancy and having him handle my C.

Everyone has a birth plan, but it's just that, a plan. When it comes to delivering a baby, so many factors can come into play. It's a great idea to have hopes for how you would like everything to happen since it is such an amazing experience.

My plan was either natural or c-section (options open) depending on how things looked near the end. Assuming the baby stayed small (based on ultrasound), I had hoped to go early and deliver with no intervention. At 38 weeks the baby hadn't come yet, and was a nice size (smallish like my daughter), and I was 3 cm dilated. Since I had already had a baby with a very easy delivery, an induction at 39 weeks was scheduled. If he came before then great, otherwise, we would get him out at 39 weeks before he got too big, which would increase the risk of tearing. We did an induction just before 39 weeks. After several hours the Pitocin didn't do anything, but as soon as they broke my water, I went from 3-8cm in an hour (got a quick epidural) and then was pushing shortly after that. Pushing was under a half hour. I had minimal pain after the baby was born and was able to get away with just a couple days of ibuprofin and nothing else. This was a huge benefit as I didn't have to take any drugs that slowed my bowels down. The epidural slowed things down a tiny bit, but since I didn't have it very long, that was probably also a good thing for my digestion. Thus I never had any gas pains and I was able to go to the bathroom with pouch function in tact a few hours after the baby was born.

As a first time mom with a pouch, you have a little more risk going natural as you don't know what to expect. But like I said, my first delivery pre-pouch was very easy and I had minimal pushing. With my history, all my docs (OB, GI, surgeon) were on board with my plan. I am so thankful that I did not have to undergo another surgery. Recovery was very easy for me as I only had a small tear (same as with my daughter). But, you have to consider your pouch and if you are willing to risk anal muscles being comprimised down the road. So far, no problem here, but I guess we'll just have to wait and see 10 years from now!

I saw the specialist today and I am switching to her. I need to be seeing a high risk dr and there are none in my area but it's only about a 40 minute drive. She is familiar with j pouches and is trained in that type of surgery. nas of now the plan is c-section at 39 weeks with a colorectal surgeon present also. She recommended a c section, there are risks with both but she said less risk with a c section. I feel very relieved!

You won't believe how much easier it is to recover from the csection vs pouch surgery. Even though they are cutting in, they aren't manipulating everything inside, just getting baby out. With my second csection I was in the hospital alone a lot as my hubby was caring for our 2 1/2 year old and I was getting out of bed by myself to get the baby and feed her. I had a high risk OB and felt it made a huge difference in how everything progressed. Good luck!

I asked my colorectal surgeon about any recomendations for baby doctors and he gave me two. I will be going with them mainly because he said that he can be in the OR when I deliver so he can check everything out before they sew me up. And I like that idea! Good luck

My surgeons have always said that when it comes time for a baby, I need to have a c-section, end of report. That could also be because I'm very petite and also have crohn's disease. But, I think a c-section is what I would opt for even if I weren't in the situation I am in! Erin

quote:

Obviously, if you wind up with a breech presentation, transverse, failure to progress, abruptio placentia, etc., a c-section would be pretty much mandatory.

Sorry, but wrong.

OBs are surgeons, and most of their training is in surgical means of birth. Combine this with the fact that there is less liability (and more money) in a c-section, and everything that goes "wrong", which included not dilating at least a centimeter an hour (so...onset of labor to being ready to push in 10 hours, max), and you're getting Pitocin, if not a c-section right away. Pit increases the chance of a c-section to over 50% because the body can not handle it well.

Placenta issues, like pre via, does mean a c-section is necessary to save life, same with transverse. Failure to progress is defined as less than a centimeter an hour. Breech babies are born just fine with a practitioner who has been trained in how to deliver breech babies.

Have you heard of sunnyside-up babies who were coming at an angle with their CHINS first? Well I hadn't until I went into labor and that's how my daughter was coming. In a hospital, that would have been a mandatory c-section. Thank the gods I had a midwife at home who was trained in delivering babies in positions other than posterior crown-down. After 14 hours of labor (which would be considered "failure" to progress) I was ready to push, and five and a half hours of pushing later (yup), my daughter was born. I didn't even have a single tear. Yet according to hospitals, that would have been a mandatory c-section.

The c-section rate in hospitals is 33% not because one out of every three births would likely result in death (is that many women died, our species would have died out), but because of liability issues, impatience, doctors wanting to get a baby delivered before the end of a shift (whoever actually delivers the baby gets the money, so what doctor will want to let the next doctor get the money if he's been waiting for 8 hours for the baby to arrive?), etc.. For all of the c-sections in America, we have one of the highest rates of maternal and infant deaths in all of the developed world.

If you haven't already, I urge you to watch Business of Being Born. I spent months and months researching all of this, and then saw that documentary and everything I had already found on my own was neatly summed up in that documentary. Since I had done the research on my own prior to seeing it, I know the doc itself didn't influence my views. Since then, summer of 2009, I have continued to research. The #1 reason to section someone like us is for liability. The chance of a problem with a vaginal delivery is very slim, about as low as for anyone else (which is low enough that there's no justification for the section rate) but if something goes wrong, everyone always asks why a c-section wasn't done. When someone dies as the result of a c-section, no one ever asks if it was really necessary and instead everyone says that it just couldn't be prevented because "everything was done."

The OB/GYN I had told me it was a sure-thing that I would die with a vaginal birth. My body screamed at me otherwise, my gut instinct telling me it was wrong and that I could do it! In my sixth month I found a midwife whose been midwifing since the 1970s. Going with a midwife was the BEST decision I could have possibly made! My husband was terrified out of his wits I would die, but he knew better than to question me when my mind was made up, and my mind was so firmly made up because my body told me I could delivery the baby vaginally and I knew hospitals weren't going to give me the chance. She was born in our bedroom, and you know what? I can't wait to do it again!

What does YOUR BODY say? Does your body, not your head, but your body, your gut, tell you that you can deliver this baby vaginally? Or is your body telling you that there will be a problem? Even when we try killing ourselves our bodies try to live. Your body won't tell you it can do something it can't. Your body wants to live even more than your head. When my daughter ended up in that position, before it was discovered, I suddenly knew something wasn't "right," and I was right about that. I listened to my body. LISTEN to YOUR BODY.