C-section or not?

Hi,

I've had Crohn's disease for over 15 years and I'm currently 32 weeks pregnant with my second baby. I've been really lucky and have had a great pregnancy so far, just as with my my first.

With my first, I had a c-section. It came highly recommended by my OB due to some scarring from an old perianal abscess. She said that if I tore I most likely wouldn't heal and I agreed. Nobody wants an open wound down there.

The c-section has come recommended again. But this time I've done a bit of research and I'm not so convinced it's the right thing to do.

I've been well for about 4 years now, which makes me feel invincible. But in the past I've had 2 resections and 1 reversed ileostomy. Right before I discovered Remicade, I was even considering having my rectum removed... which was not a fun road to be on.

So, as you can see, I'm not sure what to do. Will be seeing my GP tomorrow for some advice, but I was hoping someone on here might might have some experience that could help.

Thanks in advance (and sorry for the long post!).

-S.

My OB strongly suggests it. Will have to confirm with my GI but last time around I remember him saying he didn't think a c-section was necessary. The abscess has been healed for quite a few years, but I'm no expert... which is why I'm confused.

Crohn's is so different for everyone, which is why I figured I'd ask here for real life experiences.

Thanks for your reply!

Good advice, thanks. I've emailed my GI and asked for his opinion. I'll see what he says and then take it from there.

I don't really have a colorectal surgeon, the surgery was done in the emergency room. But I'm sure my GI could refer me if needed.

Thanks again:)

In prep for trying to conceive, I went to a high-risk conception consult and the maternal-fetal medicine docs spent some time going over my history and making a plan. They said a c-section might be necessary due to my history of surgery and perianal CD. They said that the decision should be made in conjunction with the CR Surg who did my surgery. They asked my surgeon and she called me to say that unless some other aspect of the pregnancy warranted c-section, I should be fine with vaginal birth. I had multiple fistulas before my surgery but they have been healed for about 4 years now. Additionally, this would be my first child, so VBAC is not a consideration for me as it would be for you.

My thought process on this would be to minimize interventions for both you and baby. If your old wounds have been healed for a long time, I wouldn't worry about them. It would be interesting to hear what the colorectal surgeon will say, but my guess is that he won't have much to add.

What is your treatment plan for your Crohn's during the next two months? I assume you're taking your last remicade dose in the next week or so to prepare for the birth - are you planning to schedule an induction if you don't have a C-section?

If you do have the C-section, you will undoubtedly be given antibiotics. That fact, in combination with the risk of a post-partum flare, would be a nonstarter for me. But I had unmedicated vaginal births for both of my deliveries so I'm clearly biased in favor of that approach.