An ostomy is a surgical opening that connects an internal organ, such as the intestine or urinary tract, to the outside of the body, creating a stoma on the abdomen to divert waste into an external pouch. For women with an ostomy, the question of whether pregnancy is possible is a common one. The answer is yes; women with an ostomy can experience healthy pregnancies and deliveries. While the stoma itself does not interfere with conception or gestation, the journey requires careful preparation and coordination with a specialized healthcare team.
Impact on Fertility and Ability to Conceive
The ostomy itself, which is a physical alteration on the abdominal wall, does not reduce a woman’s ability to conceive. However, the medical condition that led to the ostomy, such as Crohn’s disease or ulcerative colitis, or the extent of the surgery required, may influence fertility. For instance, extensive pelvic surgery like a proctocolectomy can sometimes lead to the formation of scar tissue or adhesions near the fallopian tubes, which could potentially make conception more difficult.
It is recommended that any woman with an ostomy planning to conceive seek pre-conception counseling with a multidisciplinary team. This team should include a gastroenterologist, an obstetrician-gynecologist, and a stoma care nurse. This allows doctors to ensure the underlying condition is well-managed and in remission, which generally leads to better pregnancy outcomes.
A review of current medications is also necessary during this planning phase to confirm that all treatments are safe for both conception and the developing fetus. Waiting six to eighteen months after the ostomy surgery to allow for complete abdominal healing is often advised before attempting to conceive. This preparation ensures the body is in the best possible state to support a full-term pregnancy.
Adjusting Stoma Care During the Nine Months
As the uterus expands during pregnancy, the physical changes to the abdomen necessitate adjustments in daily ostomy care. The growing pressure from the uterus can cause the stoma to change in appearance, potentially increasing in size, protruding slightly, or even retracting. Because of this, it is necessary to measure the stoma frequently to ensure the opening of the skin barrier is correctly sized, preventing skin irritation and leakage.
The pregnant abdomen changes shape and contour, which often requires modifying the pouching system to maintain a reliable seal. A stoma nurse may suggest switching from a flat barrier to a convex one, or they may recommend using an ostomy support belt to provide stability and support as the body stretches.
Women with an ileostomy should be mindful of the increased risk of intestinal obstruction, where the enlarging uterus compresses the bowel, potentially blocking the passage of output. Symptoms like severe cramping, abdominal distension, or a significant decrease in output require immediate medical attention.
Hydration is a major concern, particularly for those with an ileostomy, as they are already prone to fluid and electrolyte imbalances. Morning sickness, which involves vomiting, can rapidly lead to dehydration, making it important to proactively maintain fluid intake. Regular communication with the stoma nurse is important to address any skin irritation, which can become more common due to hormonal changes and mechanical stress on the peristomal skin.
Delivery Methods and Immediate Postpartum Recovery
Having an ostomy does not automatically determine the method of delivery, and a vaginal delivery is often possible if there are no obstetric reasons preventing it. When a Cesarean section is planned or becomes necessary, the surgical team must carefully consider the location of the stoma and any existing abdominal scars when making the incision. Informing the delivery team about the stoma’s precise location is important for planning the procedure and avoiding accidental injury during the birth.
Immediately following delivery, the abdomen will rapidly deflate, causing a significant change to the body’s contour and the stoma’s appearance. The stoma will typically begin to shrink back toward its pre-pregnancy size, a process that requires a rapid adjustment to the pouching system. The stoma nurse should be consulted quickly to select a smaller, appropriate barrier size to prevent leakage and protect the skin.
The immediate postpartum period involves monitoring the stoma for any swelling, bruising, or signs of injury that may have occurred during the delivery process. As the abdominal muscles recover, the risk of developing a parastomal hernia remains, and new mothers are generally advised to avoid heavy lifting for several weeks. Focusing on rest and proper stoma care is necessary for a smooth recovery and adjustment to life with a newborn.