Crohn's and C-Section?

[elanorh]

Mom mentioned the other day that a family friend's wife, due with their first child, is going to be given a c-section (already scheduled) a couple weeks before the due date.

The doctors have told her that with her Crohn's disease, they are concerned about the pressure that the growing baby will be putting on her intestinal system, etc., and that with all her Crohn's issues, it would be best to c-sec.

I don't know enough about Crohn's to know whether there's any validity in what they're saying, and thought I'd see what folks think here (pure curiousity, I don't think anything is changing in care strategies for the mom and don't know her well enough to pick her out of a lineup even, it's her dh that I grew up with) ....

I did tell mom to make sure to let the expecting mom know that she's available to help with any bf questions the mom has, since bf is shown to reduce the risk of Crohn's and that's certainly something the mom has to be hoping to do for her child (no LLL or LCs anywhere near the area, it's very rural).

[Tummy]

:

Definantly going to this thread

[hellyaellen]

i have colitis wich is very similar as far as symptoms go but differrent as to causes ( i think thats the differrence anyway ) and have never been told anything like that. but it could be one of the differrences in the two diseases.

[Hayes]

My little sister's best friend has Crohns. She has delivered two little boys, both vaginally. One was a bit early ,but that was due to a heart defect the babe had. He is now 2.5 and doing perfectly fine. Second babe came about 2 weeks before EDD and has had no problems. As long as mom is watching her diet, I don't know of a medical reason to section.

[egoldber]

I am also curious about this. My SIL has Crohn's and she is expecting her first baby in January (after 2 years TTC, 6 rouns of IUI and 3 IVF attempts). So far she hasn't had any flare ups during the pregnancy which I know was a concern. I don't think they have said that a C-section will be required, but I know that she wants one after seeing my last traumatic birth experience.

[lolar2]

I have ulcerative colitis and belong to a Crohn's and Colitis support group. Also last year I went to a CCFA patient education conference, and a female GI spoke on women's issues and I took careful notes. So here's the scoop:

With Crohn's patients, it all depends on where the disease is located. A woman with perianal disease such as inflammation or abcesses around the anus should not have a vaginal delivery, because that is basically guaranteeing a recto-vaginal fistula. The skin just won't hold up. Also a Crohn's patient with an existing recto-vaginal fistula, or recto-perineal fistula, should not have a vaginal delivery because it would make the fistula worse. Likewise, there are some types of adhesions (either from disease process or from prior intestinal surgery) which make it difficult for the uterus to contract properly. OTOH, a Crohn's patient with, say, esophageal and small bowel inflammation but no perianal involvement and no adhesions of the wrong kind can easily have a normal vaginal delivery (though sometimes they don't know they are in labor, being used to pain and pressure).

Ulcerative colitis patients can pretty much always have normal vaginal deliveries. Unlike Crohn's, UC does not increase miscarriage risk by much, so is not automatically considered a high-risk pregnancy the way Crohn's is.

Finally, with both ulcerative colitis and Crohn's patients, there can be a mechanical problem which would inhibit vaginal delivery. If there is damage to the rectal muscles, or if the rectum has been surgically removed, pushing can be pretty much impossible. I do know one woman who birthed vaginally who had an ileostomy and her colon and rectum had been removed, but she couldn't push. It required big-time forceps and vacuum. So people with no rectums or with rectal muscle damage usually prefer C-sections.

No one with inflammatory bowel disease should have an episiotomy because even ulcerative colitis increases the risk of episiotomies' becoming recto-vaginal fistulae (though unlike Crohn's disease, UC does not cause spontaneous r-v fistulae without childbirth).

[lolar2]

As far as breastfeeding, probably the best thing you can do for your friend's wife is to find out what meds she will be taking post-partum and get accurate information on whether they are safe for breastfeeding. Especially in rural, less up-to-date areas, some doctors recommend against breastfeeding on meds which have been shown to be safe!

The other thing you can do is make sure she has plenty of support lined up postpartum. Inflammatory bowel disease of either kind commonly flares strongly immediately postpartum, and breastfeeding during the resulting malnutrition and dehydration and blood loss is already hard enough. If she has to do housework as well, she may end up giving up on breastfeeding altogether because it would be too much for her.

[Full Heart]

A friend with crohns had 2 emergency sections because her health got so bad. With her last she almost died . She showed up at my moms house and was grey. My mom sent her to the hospital and instead she went home (she said later she didn't know what she was thinking), by the time she got to the hospital it was an emergency. With her first pg she didn't know she had crohns (but she developed a fever that wouldn't go away, babe was born early I think 34 or 35 weeks can't remember this is 5 years ago). But both pg were planned vaginal births even the 2nd. Her health was just terrible though. When shes not pg she does much better so it probably depends on how the body responds to the pg.

[elanorh]

Thanks!

I'm glad that it sounds like it would be a necessary csection -- it'd stink to go through that and the recovery time unnecessarily.

I forwarded the information you all shared to my mom -- she hasn't talked with the mom about bf yet (I think she's deferring a bit to the woman's mother who is coming over from England) -- but hopefully she'll be able to print off some of the information and stop by to visit with the expecting mom to let her know that she can support her/answer questions, and encourage her. I know the g'ma is planning to be here for a month or so, so maybe housework etc. won't be as much of an issue (although whether g'ma is OK with her dd bf, might be another story).

Mom really worries about being a Nosy Nelly, so I don't know how much she'll extend herself on this .... She's great with people and absolutely non-threatening in every way (a nurse) and I think she'd make a great doula (I've even suggested it to her ) -- so hopefully she'll find a way to bring it up. Maybe I should tell her that she can even blame it on me suggesting it. The dh knows me well enough to not take offense I think.