I did not have a jpouch with my births but I did have two c sections and two surgeries for my jpouch after my kids were born and I am fine with no scar tissue other than at my anastomosis connection which had nothing to do with prior c sections.
I was very worried also about normal delivery and the pressure on my rectum as I had active Uc during the last several months during both my pregnancies. Your obgyn is smart in scheduling you ahead as mine did too for the same concerns. If they watch you closely it is unlikely you will go into labor and even if so, it is likely you will have time to get to the hospital even if for an emergency c section.

If it is possible, I would request your colorectal surgeon be present at your c section surgery in the event there is any type of colorectal issue. I know this may not be feasible but when I had my jpouch surgery I insisted a gynecological surgeon be present as I have an enlarged uterus with a polyp and wanted him present in the event a hysterectomy was needed at the same time to create my jpouch. I used a highly qualified specialist who my colorectal surgeon recommended who operated out of the same hospital as my colorectal surgeon did. I know this may be harder for you if your colorectal surgeon is not affiliated with the hospital you will give birth at.

As far as the pressure goes, I bet that is common with the increased size of your uterus and probably nothing to get that worried about. I am sure others who have been pregnant with a jpouch can better ease your concerns. Congratulations also!!!

what sort of delivery did you have with your daughter? if you had a vaginal delivery that went well (minimal tearing, small to average size baby, not very long pushing), you could consider that instead of a c-section. i had my daughter naturally pre-pouch and had a very easy delivery with my son post-pouch. however, if you had a c-section already, that will likely be your preferred route this time.

also, yes, as you are in the 3rd timester, increased pressure is very common. it's difficult at this point to know if it's just extra pressure or pouchitis. pouchitis is common during pregnancy. you can discuss with your GI if he/she suspects and you can take a course of either flagyl or augmentin to help clear it up.

Thank you for the in-site. I had a C-Section with my first daughter due to a weak heart and my surgeon not wanting to risk any tearing to the anus or rectum for my future J-Pouch. I switched my OB today after finding out my Surgeon does not practice at any of the hospitals she goes to and having him in on the surgery is the biggest thing. I mean anyone can do a c-section but fixing a knicked or damaged pouch is up to my colorectal surgeon. Has anyone every had to go back to the Ileostomy after having a pouch? Was it worse the 2nd go round?