Last Tuesday, Billy and I attended our 21-week ultrasound at North Shore University Hospital. We were happy to discover that the baby is still in fact a girl. More importantly, her health is perfect. She passed all of the genetic testing with flying colors and all of the measurements at this mid-pregnancy ultrasound were right on point. Actually, she was measuring three days ahead of her due date! Because I have ulcerative colitis, they would like me to return at 28 weeks to make sure she is still gaining weight and growing as she should. Unfortunately, mothers who suffer from CD and UC have preterm births and underweight babies more often than the general population. I assume this is due to malnutrition and poor nutrient absorption. Which brings me to my dietary approach to my pregnancy…
As I've stated time and again, there is very little information available for pregnant J-Pouchers, especially regarding this issue. I have seen three different OB/GYNs since my surgeries and all three have offered me different advice and conflicting points of view. It's difficult, to say the least, to know how to approach pregnancy in the safest and healthiest way possible. But, as my baby is measuring three days ahead of schedule, I assume I am having some success in this regard and would like to share my methods. I have done a lot of research on the most important foods to eat during pregnancy: spinach, Pacific salmon, eggs, figs, orange juice, yogurt and sweet potatoes seem to top these lists. As a J-Poucher, I have a difficult time absorbing a lot of these healthy fares, especially raw fruits and vegetables. In fact, I am fairly certain my body does not absorb the nutrients from these foods at all. SO, prenatal vitamins have become an absolute MUST. Plus, I try to focus on the foods that my body is good at absorbing, especially ones that may create bulk. Sweet potatoes, salmon, eggs and yogurt have all been added to my diet on a very frequent basis. I still eat spinach (almost always cooked) and other fruits and vegetables, but I try to limit them and I also make an effort to cook them (although it is important to keep in mind that this does alter the nutritional value of these foods). Because these food groups (fruits and vegetables) almost ALWAYS create extremely frequent trips to the bathroom and a loss of fluid that is not a very good thing for a pregnant woman or a J-Poucher, I think it is important to be careful with them and monitor how they are affecting your fluid absorption and frequency and cut back accordingly.
On a similar note, the word on the street (and in the doctor's office) is that pregnant women should increase their caloric intake by 300-350 calories per day in the second and third trimesters. I have increased mine by around 500-600 calories per day. My weight gain is on track (although it's a little scary to think that I now weigh 40 pounds more now than I did 1 year ago coming out of my surgeries). I was able to gain almost 25 pounds back before I became pregnant and have gained about 16 pounds in my first 22 weeks of pregnancy. My feeling is if I gain five pounds more than I am supposed to, that is OK as I feel more comfortable knowing that my girl is getting the nutrition she needs.
Now to the C-Section issue. As mentioned briefly above, I saw three different OBs in the past year and all three had differing opinions on this issue. The first, while a very accomplished OB at NYU, had never heard of J-Pouch surgery and assumed that we should "avoid a C-Section at all costs" as to avoid another surgery on my abdomen. The second believed that I could choose between a C-Section and a vaginal birth (she, too, had never heard of J-Pouch surgery). At this point, I consulted with my surgeon and he referred me to an OB who has dealt with several other J-Pouchers in the past and he has opted for C-Section in almost all cases. My surgeon was ADAMANT about my having a C-Section. During labor and birth, there is a risk of damage to your anal muscles, as well as risk of fistula and need for episiotomy. If anything happens to my (or any other J-Poucher's) anal muscles, our J-Pouch is no longer viable. Yup, you know what that means. Permanent ileostomy. Now, while these risks are very real and frightening, it does not mean these complications will necessarily happen and some J-Pouchers do opt for vaginal deliveries. Personally, I do not want to risk my pouch and, hence, my quality of life. So, C-Section it is.
As the pregnancy progresses, my J-Pouch, blood clotting disorder and abdominal scars are having more of an impact and I therefore have much more to say about issues surrounding pregnancy after total colectomy and J-Pouch surgery. Stay tuned for more on these subjects as I continue to explore this frontier.
Oh, and here is a quick shot of my five-month belly!