Wish I could give you a name. But I can ice you information on my experience. My cousin is a high risk ob but no longer sees patients just does ultrasounds he was my best resource. I have had 6 surgeries and was weary of doing a c section but alas currently that's what I'm scheduled for on march 3rd. It's my first pregnancy. I spoke with multiple doctors and the reason I am going c section route is the risk of tears or damage to bowel during vaginal delivery. Since it's unknown but the risk is there and could mean I would end up with a bag which was already brought to my attention before pregnancy due to pouchitis complications over the years I agree with this approach. You can certainly try vaginal if you are comfortable with the risks as that is really the only concern for going with that birth plan. there isn't much research or experience out there for anyone to really know the probability of bowel perforations from a vaginal delivery. 

Good luck

-Arpi

Thanks for sharing your thoughts! I think it is a hard choice, I guess I am just trying to sort through the risks associated with each path. I'm excited for you and your wee person and I hope your birth goes beautifully!

Warmest, Elizabeth

I'm not pregnant but I've thought a lot about getting pregnant while TTC and I spoke with my GI surgeon prior to TTC. My husband is also a physician and helped deliver many babies during med school. If I can get pregnant I'm DEFINITELY asking for a c section. Your post brought two thoughts to mind for me.

1) There is definitely a risk of vaginal and GI tearing during delivery. If I remember correctly, my surgeon mentioned 2-5% chance of significant damage to the pouch such that a permanent ostomy would be necessary. So... not too big of a chance but that's never a chance I'm going to take. I've had great luck given a difficult medical history, but I'm not special and I could easily be part of that small percentage. Also, I feel like the damage that happens during delivery is not necessarily within the control of your doctor - they are there to help facilitate the process and to ensure things go okay while nature takes its course. To me, a routine and scheduled c section to be safe is well worth it compared to a potential emergency surgery that leaves me with a bag as well as a much longer and more stressful recovery. I think it depends on your situation. My ostomy and I didn't get along at all and my pouch has been great - obviously there are others on this forum who feel the opposite. I'm not doing anything to compromise my pouch, especially adding a child to care of to the mix.

2) I think you can definitely find very good, humble and open physicians - and it's VERY important that you find one that you can trust. I do want to point out, though, that I doubt you're going to find any surgeon or OB who will argue for you to have a vaginal delivery. It isn't a question of western approach or a physician being overly confident in his or her knowledge or way of doing things. As an engineer working in the endoscopy medical device space, I don't find this to really be a medical question... it's more of a mechanical reality The tissue wall in the lower GI tract is thin compared to others in the body and anyone with a pouch has anastomoses holding that wall together - those are points of weakness that are fragile. A c section helps you bypass of those weaknesses; a regular vaginal birth puts stress on them. A c section is predictable while a regular vaginal delivery is not (even for someone without our issues!). Honestly, I think you just need to find an OB (high risk or not) who you're confident can carry you physically and emotionally through a potentially difficult and unpredictable time.

Unfortunately, I'm in Boston so I can't recommend anyone  My GI surgeon had a baby fairly recently and she referred me to her OB.

Best of luck!!

Thank you for your thoughts. Yes, I agree that no OB is going to be able to promise me protection in a vaginal birth. I think that for me, the humble part includes acknowledging that they cannot promise me protection with a cesarean either. Both come with significant risks and I just don't want to gloss over the risks of a cesarean because the doctor feels they are "predictable."

The list of risks of potential surgical complication is significant and apply to me just as much as the risks to my pouch in a vaginal delivery. I know that there are OB's who recommend trying vaginal and others who recommend elective cesarean and I just want to talk with doctors who can be real with me about the potential up-sides and down-sides of both options. That is what helps me to trust doctors, so if any of you out there have an MD who was able to articulate this stuff well, I would love to know them!

I personally take comfort in the literature and data to make medical decisions (always have). If you have experience in the medical field it may be valuable for your doctor to provide you with the journal articles/ research that is backing these decisions. I've found a systematic review but unfortunately I have not been able to access it due to ongoing challenges with my database subscription. I plan on asking my OB to access it. At this time I am leaning more towards a c section as I already have slight incontinance with my pouch and the doctor has told me that the risks of an emergency C section are far greater than one planned collaboratively with all the right staff present. 

"The Effect of Restorative Proctocolectomy on Sexual Function, Urinary Function, Fertility, Pregnancy and Delivery: A Systematic Review"

Please keep me updated during your research. I am very open minded and this conversation is at the top of my mind right now

I'm psyched that you found a meta-analysis, I have been looking! I am scheduled to talk to several MD's, so I will certainly let you know what I find. 

Cheer, Elizabeht

I thought this one was interesting too. Basically, it seems like the different specialists have different views, so patients end up with multiple opinions that don't necessarily line up. That is what I am experiencing for sure. 

"Significant variation in recommendation of care for women of reproductive age with ulcerative colitis postileal pouch-anal anastomosis. Dig Dis Sci. 2014 Jun;59(6):1115-20. doi: 10.1007/s10620-014-3043-4. Epub 2014 Feb 19.

Let me know what you find as well. 

Cheers Again, Elizabeth

I have a consult with a very well known local OB in a couple of weeks so I am hoping to get more information from her (hopefully in the form of articles). I'll keep you posted!

I am currently due Feb 17 and planning to try for a vaginal delivery. I met with several ob's and surgeons, and the ones who will be overseeing my care all agree that a c-section carries more risks than a vaginal delivery. I'm definitely nervous about the possibility of tearing severely, but I believe the risk of a third or fourth degree tear is very low and I will be doing everything I can to minimize it-- my doctor has said that he would not use forceps or a vacuum, and I will be working with a doula who will be using warm compresses and recommending pushing positions that reduce tearing risk. My doctors are concerned that a c-section could cause more scar tissue and complicate things further in my abdomen. It's also worth noting that I hope to have more children in the future, and we know that c-sections get riskier the more you have.

Just thought I'd share my perspective! It definitely seems like c-section is the more popular choice on here, but I think for me it's worth at least trying vaginally and seeing how everything progresses. 

Susbo please update us on how it goes! I'm excited for you I haven't been able to get any doctor to approve my desire for vaginal delivery. Which is interesting because in the beginning there were conflicting opinions and a few felt vaginal held less risks but eventually all turned to c section as the safest. Which I don't know if I believe. 

-Arpi

Susbo how far along are you now? Are you delivering in a bigger hospital or a smaller one?

I'll be 37 weeks on Friday- hard to believe it's getting so close!

Re: hospitals, I live in a medium-sized city (Richmond, VA) with one large, academic hospital and several private community hospitals. I was previously being seen at one of the community ones, and the doctors there (I saw an OB and a GI dr) recommended a planned c-section, basically in order to "control" as many factors as possible. I sought opinions at the academic hospital, and my regular OB, high-risk OB, and general surgeon (who consulted with a colorectal surgeon) all agreed that the safest/best outcome would be an uncomplicated vaginal delivery. Obviously, we won't know if it's going to be complicated or not until it happens, but I'm comfortable proceeding with this option as long as no other factors come up (anything that would tip the safety balance in favor of c-section). I think that if my labor hits any snags they'd be quicker to opt for the c-section than they would a "normal" patient, which I'd probably be fine with as well. So we'll just have to see! Keeping my fingers crossed that the pregnancy continues to progress smoothly and labor goes well. I'll definitely keep you posted, and good luck to everyone else on this tough decision!

Ahhh, you are so close! That is super exciting. Your going to have a wee person so soon! I am 19 weeks now, so still have a long way to go, but things are going well so far. The biggest challenge really has been my anxiety around this decision. I appreciate everyone's thoughtful replies and hope to hear that all went smoothly for you on the flip side! Sending the very best energy possible!

Hi all- I just thought I'd post a quick update to let you know how everything went. We welcomed our baby boy last Thursday! I was able to have a vaginal delivery and everything seems to be in working order on the pouch front. I did end up with a small 2nd degree tear, but it's inside my vagina, so nowhere near the pouch.

Labor was certainly not super smooth, but luckily everyone was committed to trying to avoid a c-section if at all possible. I had to be induced at 40w4d due to low amniotic fluid, so when I was admitted to the hospital I was only 1 cm dilated and 0% effaced. Labor lasted 2 full days and I had just about every intervention thrown my way to get it going and progressing. Thankfully it didn't come to this, but the doctors had decided that should I have trouble pushing, they would preemptively cut a mediolateral episiotomy. I wasn't thrilled about this, but they felt that if it looked like I was going to tear significantly, it would be best to encourage it to happen off to the side instead of through my perineum. My hospital has a 0.2% episiotomy rate, so I trusted that this would only be used if absolutely necessary.

I'm happy to chat with anyone else facing this decision. It was an agonizing one and I was so worried about whether or not I was making the right choice, so I'm happy to help in any way that I can!

Hey !! Congrats on the baby boy, I'm super happy for you!! I'm heading to a special pregnancy clinic in Toronto next week to discuss recommendations so this comes at a perfect time! As I get closer to delivery I'm starting to waver on a C section, largely because I want to be a serogate to my cousin which means I'll likely have more than three pregnancies. That being said my pregnancy has been rough. I have been really struggling with incontiance which I think is playing into my dehydration/cramping/ trouble gaining weight (for me not for baby). I was diagnosed with GD yesterday as well (I'm suprised because I am super thin, active and healthy but also have a huge family history of it). Oh and I've been taken off work for a shortened cervix which is being monitored closely. My thoughts are that if this baby is premature than a vaginal delivery would probably be easier (I'm obviously not hoping for a preemie at all).

Good luck at your clinic appointment! I'm sorry to hear your pregnancy has been so difficult. Yeah, I would say that the number of pregnancies I hope to have was definitely a factor. Early on my doctor said that if this were going to be my only one he'd be more inclined to schedule a c-section, but since we're thinking 3, it would be much less risky to have vaginal deliveries if I could safely do so pouch-wise. 

I don't know what the cause of your incontinence is, but I know one of the big things my doctors emphasized was that my sphincter muscles seem to be pretty strong and I had good "perineal integrity" to begin with. If this weren't the case I'm not sure how the recommendation would have changed.

Aahhh! Congratulations!!! I am sorry to hear about the long rough labor, but that is SO amazing that you have a new wee person in your family! I hope you are getting to enjoy him A LOT as you recover!!!

I too have been actively thinking about this whole crazy question. Basically both of the Maternal Fetal Medicine docs I ended up talking to said that there is really no clear answer or easy way to avoid risk. We just have to pick our poison. (It's so good that your pouch made it through!!!)

I think one of the MD's I spoke with would lean towards a cesarean and one towards a trial labor to see if we can get the baby out that way. Both gave me about a 70% chance of being able to do it and both said I could choose either way with the caveat that they would like me to be at a hospital where they can get a GYN-Oncologist there for a cesarean birth, should I need it.  They both said these folks are very good surgeons for dealing with our particular little mix of GYN and gut stuff, plus they see abdomens that have been cut into a bunch all the time. (Yay!?)

The easiest place for us to have these docs on standby is Stanford, its a further drive for us, but so be it. That MD seemed more comfortable with letting me try to labor and they have a big team of MDs who have the GYN-ONC specialty. Good grief, I knew this was going to be complicated but wow! Plus of course, I have a fancy little collection of other issues  (I'm 40, my umbilical cord is connected into the side of the placenta rather than the center, etc etc). Luckily I am super healthy, the pregnancy has been pretty mellow for me so far (25weeks now!) and I never had any anal involvement before, so that is hopeful. Anyhow, we are going to try and then of course roll with the punches.

Congratulations again and I would love to hear from everyone as things unfold. C

Cheers! Ellie G

Congrats ��! It's really amazing to hear success with vaginal delivery for a poucher. None of the doctors I consulted with would allow me to even try vaginal. I'm happy for you and what a birth story .. sorry it was so rough.  My c section is scheduled for Friday morning .... a bit nervous for that but I guess it will be fine. Enjoy the new baby and your new life as a mom!!