Conception and pregnancy with a stoma

If you have a stoma and want to have a baby, it is important to talk with people who can advise you – your doctor, your gynaecologist, and your Stomal Therapy Nurse.

Contraception

The effectiveness of birth control may change, depending on your surgery and the type of stoma you have.

Diaphrams or caps may not always be suitable for women who have a stoma because the anatomy of the vagina and uterus may be altered making insertion and retention difficult. Nevertheless, they are suitable for some women.

The contraceptive pill may not be suitable for some women with an ileostomy, depending upon how much intestine is remaining. A higher than average dose may be necessary if absorption in the intestine is not very good. In some individuals with Crohn's disease, absorption is so unreliable as to make the pill unsuitable as a form of contraception.

For women with an ileostomy, a three monthly depot injection of progesterone may be a suitable method of contraception.

The intrauterine device or coil is not advisable for women who have not had children and may never be suitable for some with stomas. If there is a history of damage to the fallopian tubes or infection, the coil should not be used. If the uterus is fixed in an unusual position following surgery, it can be very difficult for a coil to be fitted.

Condoms provide an effective alternative for those where other methods are unsuitable and are very reliable, provided they are consistently used.

Contraception should be discussed with your surgeon, gynaecologist, gastroenterologist and Stomal Therapy Nurse.

Getting Pregnant

Generally, if there are no other problems, there is no reason why you cannot have a baby. Having a stoma does not prevent you from becoming pregnant and giving birth normally. Many doctors recommend a waiting period of approximately one to two years after surgery before conception so that everything inside you can settle down.

It is not uncommon for women to need help in achieving a successful conception and certainly not all of these women have a stoma. So if you do want children, but seem to be having difficulties in conceiving, don't automatically put this down to the fact that you have a stoma.

If you are experiencing difficulties with conceiving, discuss this with your GP.

The Ante-Natal Period

Ileostomy and Colostomy

Occasionally during pregnancy some women with an ileostomy or colostomy get episodes of intestinal obstruction when the enlarging uterus causes a hold up in the passage of intestinal contents. The stoma stops flowing into the pouch and the abdomen may come distended and colicky pain is felt. Restricting the diet to fluids only and resting may solve the problem, but on rare occasions hospital admission and an intravenous drip will be needed to 'rest' the intestine.

Urostomies

Women with a urostomy may be more prone to kidney infections during pregnancy, so ensuring you stay hydrated is important. Although your urine will be tested at every ante-natal visit, if you think you have a urinary infection you should see your doctor straight away. Your doctor may want to do further tests and will decide if an antibiotic is appropriate for your condition.

Labour and Childbirth

If the rectum has been removed and there is scar tissue in the perineum (the area between the vagina and the original site of the anus) it may be necessary to do an episiotomy (a small 'cut' to enlarge the vaginal entrance) in order to make the birth easier and prevent a tear.

However, episiotomies are also common in women who have rectums. Sometimes a delivery by Caesarean section in necessary, but 10 % of all women have a Caesarean anyway and there is no reason why it should be any more difficult for you. If your specialist thinks you will need a Caesarean section then it will be discussed with you in advance.

If you have an epidural you will remain conscious throughout the birth of your baby and enjoy a relatively pain-free delivery. Some women need a forceps delivery, but there is no greater likelihood of you needing this than for any other women having their first baby.

Whatever type of delivery you have, your pouch will obviously need changing after the birth because of the physical exertion and change of shape. Before you get too far on in labour or before a Caesarean delivery, make up a little package with everything you need.

Your abdomen will be quite sore for a couple of days after a Caesarean, if possible, ask one of the theatre staff to change the pouch for you before you regain consciousness or full sensation.

Having a baby or deciding to have a baby is a very personal choice. You are advised to consult with an appropriate healthcare professional early so you are able to get the most appropriate advice for your situation.