Pregnancy and IBD Part 5 - Delivery and Breastfeeding

If you have Inflammatory Bowel Disease (IBD) and are thinking of having a baby, you may be concerned about how your condition might affect your pregnancy. You may also be worrying about whether having a baby could affect your IBD. The good news is that the great majority of women with Ulcerative Colitis (UC) or Crohn’s Disease (the two most common forms of IBD) can expect a normal pregnancy and a healthy baby.



What sort of delivery should I have?

In most cases, a normal vaginal delivery should be perfectly all right. However, a caesarean section may be recommended by your medical team if you have severe or perianal Crohn’s Disease. You may also be advised to have a caesarean if you have an ileo-anal pouch. 

This is because there is some evidence that a vaginal delivery may lead to an increased risk of faecal incontinence, although other studies suggest this risk may be lower than previously thought. A recent survey among women with IBD who did not have a pouch also found that about one in 10 reported problems with faecal incontinence following a vaginal delivery. On the other hand it may be worth considering that a vaginal delivery avoids surgery and its possible risks.


If you do opt for a vaginal delivery but also have scar tissue around your anus, your doctor may advise an episiotomy (a cut at the opening of the vagina) to prevent tearing. Talk to your gastroenterologist or obstetrician about your own preferences and about any worries you may have.


What about my ileostomy?

Many women with ileostomies have a normal pregnancy and delivery. Your stoma may change shape and become larger as your abdomen expands. It will usually return to normal after the delivery. Occasionally the enlarging uterus can temporarily block the stoma. A change of diet may help – your stoma nurse should be able to advise you on this. You may also find there is an increase in output from your stoma during the third trimester of pregnancy. This too should resolve itself after the birth. Most women with a stoma should be able to have a vaginal birth, but sometimes a caesarean section may be necessary. 

I want to breastfeed. Will my medicines do any harm to the baby?

Breastfeeding is important for the development of a healthy immune system, and is generally recommended. There is no evidence that many of the drugs used to treat IBD are harmful to a breastfed baby, although very few are actually licensed for use while breastfeeding. This may be because little is known about the drug’s long term effect, or because the drug companies are cautious about conducting trials with breastfeeding mothers. So, they prefer to advise against any use of their medications while breastfeeding. If you would like to breastfeed, talk to your doctor and your IBD team about any possible problems from your medication.

• Based on past experience, the 5-ASA drugs such as mesalazine and sulphasalazine are considered by doctors to be safe while breastfeeding. Research has shown that they are transferred into the breast milk, but in very low concentrations.
• Steroids such as prednisolone also appear in low concentrations in breast milk. Again they are generally considered safe, although if you are taking large doses of steroids (over 40mg a day) breastfeeding is not recommended. You can reduce the effects of steroids by waiting for 4 hours after taking a dose before starting to breastfeed.
• Some doctors would not advise breastfeeding by mothers on azathioprine or mercaptopurine, but very little of the active drug is secreted into breast milk. Also, there is no evidence of harm in children of mothers who have breastfed while on thesedrugs. Thus the benefits of breastfeeding may outweigh any small potential risk.
• Recent studies have suggested that infliximab does not pass into breast milk and that it may be safe to  breastfeed while taking this drug. 
• Evidence about adalimumab’s safety is still very limited. The long term effects of these drugs on a child’s developing immune system are also still unknown. Most doctors still recommend that you do not breastfeed during treatment with these medicines or for six months after your last dose.
• Breastfeeding is not advisable if you are taking ciclosporin, methotrexate, mycophenolate mofetil, or tacrolimus. It is also better not to breastfeed while you are on antibiotics such as ciproflaxacin or metronidazole, or the anti-diarrhoeals, loperamide and diphenoxylate.

Our booklet Drugs used in IBD and our specific drug treatment leaflets have more information about all these drugs. 

For all the information contained in this series of articles and more please read our information leaflet Pregnancy and IBD.