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Vaginal Delivery with Perianal Disease

Hello there IBD Mamas!

I am seeking advice based on your wisdom, especially if you have had a vaginal birth with a history of perianal disease.

I am 21 weeks pregnant with my first child, and even though I was in a fabulous state of remission at conception, I have never been entirely free of nearly constant anal fissures and occasional/seemingly random vaginal fissures. I get the feeling at times that my perianal tissue is permanently degraded/compromised. I also have a history of painful rectal and anal disease when not in remission. However, I have never experienced abscesses or fistulas.

Based on my history, my Maternal Fetal Medicine specialist has talked about the possibility of C-section even from our preconception appointment. Early in my pregnancy, I was resolute in my need/desire for a C-section. Now, as everything becomes "more real", I find myself questioning that original preference. At my last appointment when I was not yet questioning a C-section, my MFM was very affirming of C-section, even saying that was what she would do if she were in my shoes.

I have read every study I can find about perianal disease and vaginal birth outcomes and I know that active perianal disease indicates a significant increase in the occurrence of severe vaginal laceration. And I have been told that severe vaginal laceration will put me at risk for further perianal complications such as abscesses and fistulas. This risk really scares me, as I am already impacted daily by the pain and discomfort of perianal disease and do NOT want to experience more of it!

So having done considerable research, I am now interested in personal stories. Has anyone delivered vaginally with active perianal disease at the level of anal and vaginal fissures and had a successful outcome?

By the time baby arrives, either by C-section or vaginal delivery, I just want to feel 100% sure that I made the best choice I possibly could with all of the information available to me.

Right now I have a strong desire to pursue a vaginal birth and I'm questioning myself a little - am I simply grieving my ability to have a vaginal birth, or is a vaginal birth actually possible and I need to push a little for it?

Would love to hear your thoughts, thank you so much in advance! :heart::heart::heart:


Staff member
New York, USA
When I became pregnant, I had active perianal disease, but in the form of fistulas....my OBGYN talked to me about the risks/benefits of vaginal delivery, and recommended a C-section, wich I had and don't regret at all!!!

Something to seriously think about, and you already touched on it - if you have active disease/fissures etc...having a vaginal birth puts you in danger of damaging yourself even further, with no guarantee that you may have to change plans mid-birth and go for a c-section. Especially if you want to have more children, any damage caused by a first birth may impact the possibility of complications further down the road.

Another thing to consider is sex itself - what consequences may occur if you end up tearing even more, will your body be able to heal itself, will intercourse end up being painful etc dur to damage, scarring etc....

I'm NOT trying to sound alarmist, just trying to give you as mich information as possible.....

Whatever you do decide, I wish you the best of luck with everything!!!!! It's good you are researching before you are down to the end so you have time to talk things over, read up on everything etc.
I totally agree with all that Lisa responded. I had nearly the same condition when I had my baby and opted for the c-section per my doctor’s advice. The possible complications from vaginal birth in this case seem too dire to me. I was never sorry for the choice I made. By the way, Humira has now put me in remission. Good luck!
Big thanks to both of you for reading my post and sharing your experiences. I indeed was grieving that Crohn's was dictating yet another thing in my life - this time, how I'll give birth - and your responses helped ground me in my decision to go with the C-section. Thank you for helping me come to a place of greater acceptance. I truly appreciate it! I will be giving birth to my son via C-section in the first week or so of August. He and I are both doing so well so far and I'm so grateful even to be having him after all of my health struggles! It doesn't matter how he gets here. C-section is the safest for us and that is okay!