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Hi everyone,

I am 26 and just recently found out I am pregnant. I had my Jpouch surgery in 2008. I was told by my GI doctor that I would need to be followed by a high risk ob/gyn and from a GI standpoint, he recommends C-section. Although ultimately, he said to listen to what the ob/gyn suggests. I am a travel nurse and away from home until March for work. I have to find an ob/gyn where I'm at (Hawaii) and make an appointment still but was just curious if anyone had any advice or experiences they could share with me. I am very nervous but excited. Thank you!!

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Hi there, Congratulations!! Unfortunately, there doesn't seem to be a consensus among providers as to whether vaginal deliveries or c-sections should be recommended, so it will really depend on where you go. If you have a preference (especially if it's for vaginal), you can seek out a doctor/hospital that is onboard. Evidence either way is extremely limited, but I found a couple studies that were somewhat helpful when I made my decision (linked below).

I'm currently pregnant with my third, and I had my first two vaginally with no impact on my pouch! (I got my pouch in 2004 and have luckily only had pouchitis as a complication.) For me, since I knew that I wanted a few kids (3-4), avoiding a c-section was important because c-sections get riskier the more you have them. My OB even said that if I only wanted one child he might recommend a c-section, but since I don't, it would be better to at least see how labor goes and if we can manage a vaginal delivery. I met with a regular OB, high risk OB, and surgeon at the hospital I was delivering at (which was different from where I had my j-pouch surgeries since I don't live in the same area anymore), and everyone agreed that there was no clinical indication for a c-section. I was ultimately under the care of the normal (not high risk) OBs, and I'm planning to deliver with a hospital-based midwife practice this time around.

The biggest risk is that if you were to experience a third or fourth degree tear, the repair could be trickier because of your surgeries. BUT, there are several evidence-based strategies you can implement to reduce your risk of tearing that severely (I'll link that too). I worked with my doctor and doula to plan for 1) avoiding vacuum/forceps/episiotomy if at all possible, 2) if an episiotomy had been necessary, they would have cut it "mediolaterally" to direct the tear away from my anus, 3) my doula provided warm compresses that were applied to my perineum during pushing. I also looked for a hospital with a lower than average (about 30-something% nationally) rate of c-sections, and episiotomy rates as low as possible. If you are open to working with a doula, she could help you find the right fit for what you're looking for, as well as help you meet any labor/delivery goals that are important to you.

So I think it comes down to what your priorities are and what you're comfortable with. There are lots of j-pouchers who have gone the c-section route and been happy with their results. Just know that you have options, and if you don't like what you're hearing from one provider, don't be afraid to switch!

Happy to answer any questions, and good luck!

Congratulations!! Susbo has a ton of great info above and was one of the sources I used when making my decision. If it brings you comfort, I was told there was no need for a high risk ob/monitoring based on my pouch.

I had two uncomplicated vaginal deliveries before my pouch so I was an excellent candidate for a vaginal delivery. Ultimately, I decided to go the c-section route because we knew it was our last child, I had gotten the experience of a vaginal delivery, etc. Keep in mind that a lot of the research GI's are going off of can be outdated. If you'd like to explore a vaginal delivery (particularly if you'll want more kids as mentioned above) don't be deterred and interview some docs who have dealt with jpouch patients before!!

CONGRATULATIONS!!!! A lot of J-pouchers/ostomates have trouble getting pregnant since we have a 50% reduction rate unfortunately. CONGRATULATIONS!!! I would definitely recommend a C-section, I was told that by more than one surgeon. I do not have kids but if I ever did biologically,  I would definitely do a C-section.

By the way, If you are are able too, I would definitely recommend to breastfeed your baby for at least 2 years or longer. Breastfeeding babies helps reduce the chances of your kids getting IBD. I tested the articles I found and did a survey on here to see if IBD people were breast fed for 2 years or longer, and most of the people on this forum were not shockingly.

Congrats! It’s completely up to you on whether you want to deliver naturally or have a planned c section but my surgeon also suggested a c section for my baby (she’s almost 2 now) simply because we only really get one chance at the j pouch creation. Pushing, she felt, might significantly impact the pouch, cause a prolapse, etc. she didn’t suggest risking it. I didn’t want to be with an ostomy long term so I just went with a planned c section which was a breeze compared to the colectomy and pouch hookup surgery. Plus you get this beautiful baby out of the deal! I was also 39 at the time and high risk so I wanted a bowel surgeon on hand in case there was scar tissue when the c section was performed. That wasn’t really an issue since the bowel is pushed back and the baby sits in the uterus in front of it, but I digress. Chat with your doc and figure out the best plan for you and what makes you comfortable. Congrats and best of luck with this journey!

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