Hi Everyone! 

It's been a while. Got my j-pouch in 2008, and it is still going strong, just pouchitis a couple times a year (or maybe it is sometimes bad IBS... we often aren't sure). 

My husband and I went to consult with a high-risk specialist before we begin trying for a baby (I'm in my late 30s, and the pouch allowed me to qualify for a specialist.) 

To our surprise, right off the bat, my doctor said I should think about having a vaginal birth. She said I would have to have an epidural to limit any strong pushing, and they would have to watch me every step of the way during birth, but that it is easier on the body than another surgery, entirely possible, and should be ok, if no immediate complications arise. She seemed really sure of opting for the v-birth if no immediate complications arise. 

Okay.... this is the first time in ten years I have EVER heard that. I ALWAYS heard that it is c-section or nothing. This v-birth thing makes me feel nervous. I spent SO long wrapping my head around the benefits of a c-section and got really used to the idea.

Now, here's the other part. A few years ago I had a hemorrhoidectomy. I'm not gonna lie, I had the biggest dang hemorrhoid anyone ever saw, and it made doctors nervous. It was positively awful and the surgery to remove it was a bit of a risk. Thank goodness, it turned out ok and the darn thing is gone now. HOWEVER... that makes me more nervous about a v-birth. 

I know an ostomy bag works well for some people, but it just wasn't good for me. I never want to go back to an external bag again. In fact, that fear made me delay pregnancy for a long time, although having a child had been a very dear dream of mine, and if anything would be worth a risk, it would be a child. BUT I still don't want to go back to the bag if I can help it. I LOVE my j-pouch, and I don't want to ever face that bag again.

What do you all think? Should I just skip the worry and go for a c-section? 

What did you choose, and how did it turn out?

Thank you for sharing!

Original Post

Hi, how exciting thinking about having a baby!!  I had my J pouch done in 2003. I like you am in my mid to late 30’s. I got pregnant when I was 33 and delivered via c-section right before I turned 34 (2 weeks). I never saw a high risk doctor. My obgyn was very great and capable, she totally understand that with my history I was more comfortable with a c-section and she never tried to push a v birth on me. I think you may need to get a second opinion and find a dr who is going to listen to your concerts and be open to what you also feel is best and more comfortable with. Good luck!!! I hope this helped

Congrats with this next adventure. After I had my J pouch 20+ years ago,  I too was informed by the surgeon, that yes the pouch wouldn't prevent me from future pregnancy's, but he felt that with the J-pouch, I would have to consider a C section. But again.. my J pouch was done more then 20 years ago, so I'm sure they have made many positive advances with this procedure.

Putting your question out there at this site, is going to be a great resource for you with connecting to other's who went through pregnancy's and deliveries after  J-Pouch surgery.  

Back when I had my surgery there was no site like this to connect with others. While in the hospital waiting for my surgery, my doctor gave me a list of over 300 J- pouch patients and informed me that he wanted me to make calls and connect with some of his former patients. He felt the importance of direct contact with patients who had gone through the procedure and with answering any of my questions and concerns. I do remember it was very uncomfortable for me to make those personal calls, but those who answered were wonderful. Many years after my surgery, I too was the receiver of many calls from new patients with many questions.

This has been a wonderful site that circles the wagons for it's members for J-Pouch questions & answers.    

Good Luck!  Claudia  

I had my Jpouch surgeries in 2013 and then csections 2014 and 2016. I remember my GI surgeon warning  of incontinence should my sphincter tear during a vaginal delivery so he strongly advised csections. I figured after all that work to finally have control over my bowels I wouldn’t risk it.

My csections went very well but I was relatively young (27-29) and healthy and my doctors also noted I don’t seem to scar badly which can cause a lot of issues (internally specifically). 

That being said, I had little babies and I always kind of wondered if I had been able to do vaginal birth... I really appreciate your doctor’s attitude and confidence. In your case it could be less risky to do a vaginal birth since csections certainly have risks as well. 

Congratulations and keep us updated!

How exciting!

My babies are already 6 and 9 years old, so I agree that doctors may feel differently  now, but I had 2 c-sections for my babies.  All went great!  My colo-rectal surgeon didn't even want me to go into labor so I had scheduled c-sections in week 38.  I never went into labor and all went according the plan.   My babies were healthy and strong then, and likewise now! 

I will note that my colo-rectal surgeon said he sees women ("normal" women without pouches) who have incontinence issues post delivery.  He is only able to help 1 in 3.  That made my mind up for the c-section.  I had r/v fistulas and many issues that meant there was nothing left to sew back together if I had any issues from delivery.

Yes, c-sections come with their own risks- it is surgery!- but I have no regrets.

Best wishes!!

Laura

Just chiming in here to say that I had a baby a year ago, my first, and it was a vaginal delivery. There are good reasons to choose either option, but I was with a doctor and hospital that aim to avoid unnecessary c-sections, and we agreed that my best chance at reducing complications was to try for a vaginal delivery. It was luckily not affected by and did not affect my pouch, and I hope to have more vaginal deliveries in the future. 

Good luck as you consider your options!

My doctor told me that it would be a vaginal delivery unless I needed an emergency surgery. After consulting the literature I was quite comfortable moving forward with a vaginal delivery. They took precautions to make sure I wouldn’t tear into my anal muscles by having her be delivered in a slow and controlled way. It was an amazing experience and an easy recovery 

Thank you everyone! 

@little greeny and @susbo I was wondering what precautions they take to avoid impacting the anal muscles. Were you able to feel calm and confident throughout the process? Did you go into a normal labor process? My doctor mentioned that an epidural is a must, and the goal is just to let the baby "slide out" as slowly as possible. Was that how it was for you? 

It still makes me a little nervous! But, time has a way of working these things out.

Thanks for your stories and your help, ladies!

That's interesting about the epidural! I never heard anything about that during my care-- it was just up to me whether or not I wanted one (which I did). To reduce the risk of tearing my doula prepared warm compresses for my perineum during the pushing stage (to help the tissue stretch). I do think having a doula was integral to helping me feel comfortable attempting a vaginal delivery. She was not only well-versed in what happens in a "normal" labor and delivery, but she also knew my whole story and could help make sure that everyone was keeping that in mind in making decisions about my care. 

Also, I'm sure this would be a controversial choice, but the doctors had decided ahead of time that if the need for an episiotomy arose (and I was at a hospital with very low episiotomy rates overall), they would make the incision horizontally instead of vertically, like it normally is. They explained that although this isn't usually the preferred method because it has a longer/more difficult recovery, they wanted to try to direct any major tearing away from my rectum. Luckily, I didn't need one. I did have a second degree tear, so it was confined to my vagina and has healed well. 

As for my labor, I ended up being induced at 40w4d because the amniotic fluid was low. Since my body was clearly not ready to be in labor, it took about 48 hours until I was ready to push. I pushed for 3.5 hours. It was absolutely exhausting, but absolutely worth it! 

The comment above me said it perfectly, it was necessary for me to have an epidural so that the baby would “slide out”. They said that in unmedicated births, moms push too hard and delivery too quickly to avoid tearing. They had me get an epidural at 8cm (which was a welcome relief at that point) and then she came an hour later. They had also discussed doing an emergency transverse episiotomy if there was any evidence of tearing . That being said, that wasn’t necessary as with the counter pressure and the slow delivery I didn’t tear at all. I didn’t even need pain medication in my recovery. I’m interested to know (if you are open to sharing) where you delivered. I delivered in Toronto and plan on delivering all future children there 

I delivered a breech baby vaginally, with epidural, induced (because of Liver cholestasis) and all went well! I really wanted to avoid surgery and adding more scar tissue to my abdomen if I could. (jpouch 2002, more emergency surgeries / resection 2004, and many SBOs). I did have to fight to do this. I had one of the 2 doctors left in LA who still do vaginal breech deliveries. i did a ton of research on breech delivery. I told him to invite any student in that wanted to see it and learn how to do it. Was great. 

You all are giving me hope. I’m now on my second run of IUI and I’m in the two-week wait. I’ve been starting to feel hopeless about it all, because I’m not sure ivf is in the realm of what we could afford. Here’s hoping I can join you in a successful birth story- because it sure sounds nice not to have to have another surgery... that is, if there’s no tearing! 😳

I had this page set to follow when I was attempting to get pregnant/ deciding on delivery last year so the new posts reminded me to come back and provide my experience for anyone who may be searching in the future like I was. 

I was underweight after my final surgery and that most likely kept me from ovulating when we were trying. If your surgery was relatively recent don’t be discouraged, your body may just need a little more time to reboot.

 Prior to UC, I had two healthy pregnancies and uncomplicated vaginal delivery of two big babies. I then went on to have two miscarriages which we now believe were most likely caused by my undiagnosed UC. After being diagnosed and starting a biological I had another miscarriage but it was chromosomal and random, unrelated to my autoimmune conditions. The hormones from my third miscarriage sent my body into a tail spin and my colon came out about a month later. I had extensive internal bleeding from that surgery and a pretty extensive emergency surgery that same night. Despite that, I was able to stay on schedule with my second and third surgery. I completed my take down in Nov of 2017 and we began attempting to get pregnant in March of 2018 with clomid and trigger shot. The hormones were too much for me (crazy respect for you ladies who go through the ivf type drugs!) and we resigned ourselves to being done after month two. Beginning of July 2018 I got a positive test and was both overjoyed and terrified. 

I went back and forth on delivery a LOT and with my OBs recommendation I landed on a controlled vaginal delivery (induction with epidural to let baby “slide” out as others have said). However, I then saw my colon surgeon for pouch irritation near the end and asked him off hand what he thought of delivery method. He initially said he thought attempting a vaginal delivery seemed reasonable but that he would do some research (I was his first pregnant pouch patient). He called my OB and myself a week later and basically said after researching and speaking with colleagues he recommended a c-section. My OB said now that he was involved we basically had to go with his recommendation as my OB would be liable for disregarding his recommendation if a vaginal delivery went south. That was honestly A-OK with me. I was relieved to essentially have the decision made for me and to go with whatever my surgeon thought was best. My OB was great but I think everyone knows how attached you can be to a cautious and caring colon doc so what he thought simply carried my weight with me.

My csection went great. The surgery aspect is nothing compared to the open pouch surgeries I had. They do not cut the abs, they simply slide them up a bit. It was a little more extensive recovery than my vaginal deliveries but we had prepared for the worst case recovery (had help lined up,etc) and it was so much better than that. 

I knew this baby would be my last so had I planned on more I would have factored that into my decision of section vs vaginal.

I’m getting notifications on this post too, so just to provide my own update: I had a second uncomplicated vaginal delivery in February of this year. Big factors for me were the fact that my colectomy and j-pouch surgeries were about 15 years ago and I haven’t had any real issues (besides pouchitis) since, and I plan to have more babies, so c-sections could get riskier. Both of my pregnancies have resulted from IVF due to my tubes/ovaries being in the wrong places after my colon surgeries. We’re lucky that IVF has been a relatively smooth process for us (only had to do 1 egg retrieval and now have embryos stored for any future transfers). 

I had both a vaginal birth and a c section prior to my jpouch surgery.  Here's my take on both.  I had to have a csection due to my oldest being too big for my body.  (Couldn't fit through the vaginal canal)  Baby measured normal and was 8 6 1/2 oz,  Average is considered 7 1/2 pounds.  So I was over a 1lb bigger and still measuring within reference.  Second baby was induced in order to have a vaginal birth (I had already had my jpouch surgery scheduled and would have had to postpone it for a month or so with csection).  Again, baby measuring average and 10 days early she came at 7 lbs 15 oz.  So again, bigger than normal.  The tears I had were extensive and while I deal with some leakage now I know if I wouldn't have had tears like that I would have more control.  

 

I personally wouldn't risk being incontinent with a vaginal birth.  I healed so quickly from the csection and truthfully it was not that bad.  I was a mess down below for over a month with the vaginal birth and things have never been the same.  

 

Yes you risk more adhesions but I'd rather deal with an adhesion than loss of control forever.  

 

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