IBD Delivery Options

What to know about delivery with IBD

Determining a mode of delivery is an important step in your pregnancy journey. Whether you’ve been diagnosed with Crohn’s disease or ulcerative colitis, we’re here to help you understand your IBD delivery options.

While we’ve provided some helpful information below as you prepare for delivery, talking with a doctor who specializes in IBD and pregnancy is the best way to ensure the most successful delivery for you and your child.

Vaginal delivery vs. C-section

Vaginal deliveries are common in women with IBD and are the preferred mode of delivery if safe from the perspective of your individual disease course. However, there are certain instances in which a cesarean section (C-section) is recommended. In women with Crohn’s Disease with active perianal or recto-vaginal fistula(s), a C-section is often considered the safest mode of delivery to avoid deep tearing that could affect the anal sphincter (the muscle that allows you to hold in stool/avoid accidents). Most women who have vaginal deliveries will have a low grade tear (Grade 1 or Grade 2), especially with their first pregnancy. Low grade tears do not involve the anal sphincter and usually heal without complication. Higher degree tears (Grade 3 and Grade 4) involve the anal sphincter and may be more difficult to heal, especially in women with perianal disease who often have injury to their sphincters at baseline. The biggest concern is that impaired healing of a high degree tear could result in long term injury to the sphincter muscle and impair your ability to hold in stool (maintain continence). That being said, a history of perianal disease does not necessarily prevent you from having a vaginal delivery; if your fistula(s) has healed, you can discuss the option for a vaginal delivery with your GI doctor and OBGYN.

A C-section may also be recommended in women who have an ileoanal pouch (IPAA), also called a J-pouch. This is an effort to protect the anal sphincter from tearing, as an injury to this muscle can cause issues with the pouch functioning properly. However, a J-pouch doesn’t completely exclude the possibility of a vaginal delivery. Some women with J-pouches opt to attempt a vaginal delivery with a low threshold to convert to a C-section if they have risk factors for more severe tears (baby is measuring large, delivery is taking a very long time, need for episiotomy or use of instruments like forceps during delivery). Make sure you talk with your doctor about what’s right for you and your baby.

Mode of delivery has been evaluated and shows no impact on the mother’s IBD. In fact, one study found there was no difference in IBD-related surgery, need for hospitalization or escalation in medical therapy among women with either mode of delivery. Additionally, research has shown that women who take biologic therapy during pregnancy (through the third trimester and shortly after delivery) are not at increased risk of postpartum wound infections.

Furthermore, there is no increased risk of development of new perianal fistulas among women with Crohn’s disease after vaginal delivery compared to C-section. Women with a history of IPAA may have increased nighttime bowel movements and incontinence, but these reported symptoms did not differ based on mode of delivery. Baseline pouch function was also restored after pregnancy among women with either vaginal delivery or C-section.

More studies are still needed to evaluate the long-term effects of pregnancy and mode of delivery in patients with IBD. As always, it’s best to talk with your gastroenterologist, obstetrician and colorectal surgeon to discuss what mode of delivery is right for you.