Hopeful thinking.

[MountainMamaGC]

Now I am not pregnant with my second yet, but I have been thinking about giving birth naturally. My first DD was delivered by c-section. It was recommended because I have a history of fistulating crohns disease. Basically they told me if I tear I could develop a recto vaginal fistula and it could be impossible to heal.

I had a bad flare recently and I a developed some fistulas, one almost tunneled through to my vagina. I went on remicade and the fistulas closed up in 4 days and I went into remission. That was back in March. So I am healed up and in remission now. The remicade is very good for healing and preventing fistulas and I am on this drug indefinitely. I plan on taking it while pregnant and breastfeeding.

So if I am in remission and I am on a drug that healed my fistulas, why cant I have a vaginal birth? I KNOW I can do it. I have big hips, and a high pain tolerance. If my crohns has taught me anything its how to breathe through extreme pain. I want to have a natural birth at the same time I am afraid they will bully me into another c-section. Now with them giving antibiotics 100% of the time I really dont want one at all.

Does anybody know anything about this? Have midwives or doulas on here helped someone in a similar situation. I would love to give birth, I have even had dreams about it.

[CherryBomb]

Big hips (from the outside) have nothing to do with the shape of your pelvis internally. There are plenty of women with wide hips who have narrow pelvises.

It doesn't sound to me like you were told that you can't *physically* give birth, but that it's not recommended because of the possibility of it creating a permanent fistula. I don't think with your history you'd find an OB or hospital based midwife who would be willing to take you as a vbac, but you might be able to find a homebirth midwife who would.

[MsBlack]

I agree with Cherry Bomb--it might be best to seek homebirth care for a variety of reasons given your crohn's disease. You might do best to start thinking about this option, and researching the mws in your area, now--while there is time to give it full consideration, gather info, etc.

But I do think there is every reason to believe you can give birth vaginally/naturally. Cherry Bomb is right, that the external measurements of the pelvis do not always say anything about the internal measurements. Still--the vast majority of women CAN birth vaginally, and I think it's safe to assume that you will be able to, as well

[MountainMamaGC]

I would have to give birth in the city. Midwives are covered by government healthcare and they are allowed to deliver at the hospital there. Would that make a difference in getting a VBAC? I live a long way from any midwives or the city so I would go stay with my mom from 38 weeks until whenever the baby decided to show up.

If I did a homebirth it would have to be in my mothers home.

[MountainMamaGC]

I can also develop a fistula in the incision area of a c-section. So the risk of the fistula is there either way. Just the area would be different. I have never developed a fistula from a surgery. I have had 2 crohns related surgeries with out getting a fistula and my c-section also healed wonderfully. I think if I did tear, that I would heal nicely. I really think the risk is low, so long as I am in remission at the time of birth.

It occured to me to go this route because I was talking about giving my DD to someone for the 1st week or so after my c-section. The thought of that made me cry. I dont want to exclude her when the next baby comes, but the recovery is so lousy that I cant imagine taking care of my first child and the newborn in that first week after a c-section. If a birthed naturally I would recover faster and feel better.

I emailed a midwife in the city, I hope she has good news for me.

Sorry to think out loud, just going through the pros and cons and maybe trying to get more incite.

[aimeem]

My concern with this would be that I don't think you can use remicade while pregnant. It's a very strong drug, as I'm sure you know. I haven't researched this, but I would be very cautious and discuss it with your gastro. If I'm right and you have to go off remicade when pregnant, I would worry about the possibility of fistula.

[forumyonly1]

my sister in law has chrones disease and has had two vaginal births and is planning her 3rd right now.. from what i understand there is risk both routes.. but it is your body and youre choice.. i would highly suggest going with a midwife as she would be the most understanding for you desire to have a vbac and would most likely be the most successful choice for you! as for your medication i *think* my sister in law is using that medication and it's controversial to take while pregnant.. but she has with all three pregnancies.. however he doc advised her not to breastfeed with it... so she never has.. but yeah.. any way. i hope you get your VBAC when the time comes!! GL!

[MountainMamaGC]

Hales says the medication does not pass into breastmilk as the molecules is too big and even if it did it would be digested because its a protein. Thats why you have to get it by IV and you can not eat it. All of the literature states that remicade can not be detected in breastmilk. For me breastfeeding is too important to not do it, because research shows it can prevent inflammatory bowel diseases like crohns and colitis.

My GP and GI specialist have approved me to use remicade while pregnant and breastfeeding. Thanks for the concern. Remicade is pregnancy class B. Its safer to be on that than have active crohns while pregnant. Active crohns can cause miscarriages and birth defects, especially if its active in the first trimester.

So that being said, I dont have to stop taking my medication when pregnant. I am starting to get optimistic for a VBAC. Now if I could only get pregnant.

[aimeem]

Sounds like you know a lot better than I do. My partner has crohn's and is on remicade, but he's a guy, so I didn't know either way.
I don't really have any other advice, just wanted to say how great it is that you're so knowledgeable and proactive about your health. I can barely get my partner to stop eating super-spicy foods.

[MegBoz]

Wow, that's tough. I'm not familiar with chrones or anything, so I have nothing to add there.
Just wanted to comment on this:

Originally Posted by Lydiah

I was talking about giving my DD to someone for the 1st week or so after my c-section. The thought of that made me cry. I dont want to exclude her when the next baby comes, but the recovery is so lousy that I cant imagine taking care of my first child and the newborn in that first week after a c-section. If a birthed naturally I would recover faster and feel better.

My DS is 2 & I'm 12W along now. I've been so sick this 1st trimester, I'm unable to care for him. Thankfully, I've had enough help between DH, Mom, MIL, sister, etc. But I realize I may also not have the energy to chase around a nearly 3-year old PP either. Especially if I tear again, I'm going to want to try to spend as much time lying & being still as I can. (A little fact my MWs failed to mention to me the first time! )

Yes, it's true that generally a vaginal birth is a quicker & easier recovery than CS, but that doesn't mean you'll be A-OK to care for a toddler & newborn simultaneously. I think having help in caring for a toddler PP is a good idea in either case.

[MountainMamaGC]

Originally Posted by aimeem

Sounds like you know a lot better than I do. My partner has crohn's and is on remicade, but he's a guy, so I didn't know either way.
I don't really have any other advice, just wanted to say how great it is that you're so knowledgeable and proactive about your health. I can barely get my partner to stop eating super-spicy foods.

Its hard to acknowledge you have a problem. Also its a life long problem, so you start getting the mentality that there is no point in taking care of yourself, because you will still have crohns no matter what.

I realized thats not true when I had a 4 year long medication free remission. I ate whole foods and took really good care of myself and I got the longest remission in my life. Having a chronic illness is a very individual jouney. He may come around someday.