A "mother to be" has to overcome numerous difficulties: carefully-chosen dietary, bloated figure, ugly stretch marks, nausea, insomnia, great pain in delivery etc. 

On top of these, what if the mother has a stoma on her stomach due to a partial bowel resection after diagnosed with the Inflammatory Bowel Disease (IBD)?

What a great amount of courage and love it takes for her to choose to become a mother?

37-year-old LI Hong is the mother-to-be in this story. Twenty years ago, she was diagnosed with Crohn's Disease, a kind of chronic inflammatory bowel disease with no cure at present. Since then, LI started her odyssey to pursue healthcare where at some point she met Prof. CHEN Yan, the Vice Chair of SAHZU Gastroenterology.

A Life-Changing Hangzhou Trip

To attend a volunteer medical consultation organized by Prof. CHEN, LI came to Hangzhou. In the consultation, LI was advised to have a bowel resection, or colectomy, and a stoma surgery to clear the bowel obstruction and relieve her constant abdominal pain. It was an extremely tough decision for a young woman like LI, not only because she would still need to use the feeding tube some time in case of unstable condition even postoperatively, also because she would have to rely on an "artificial anus", or a stoma, on her abdomen for the bowel and annual functions for the rest of her life. However, LI Hong was finally moved by doctor's candid words and strong determination. She chose the surgical option.

The surgeries turned out to be very good. LI Hong recovered quickly. To help more patients with Crohn's Disease, LI joined the IBD Foundation run by Prof. CHEN.

New life began in Hangzhou for LI Hong, so did her love life. LI found her loved one the year after she moved to Hangzhou and got married in 2021 when she turned 36 years old. LI was soon pregnant. With all the happiness, the couple was worried. 

Another Important Decision for Her

LI's condition has been very stable, but pregnancy confronted her with brand new challenges.

Are oral medicines she's been taking safe for the baby? Will they cause deformity?

Will she be safe when in delivery?

With these questions in mind, LI consulted SAHZU Chair of Obstetrics Prof. WANG Liquan, who then had a thorough discussion with Prof. CHEN Yan. Both doctors believed that LI Hong was capable of child bearing. They made a promise to LI to take care of her together. Hearing that, LI was much relieved.

With routine check-ups at Prof. CHEN and Prof. WANG's clinics, LI Hong entered the 38th week of her pregnancy smoothly. Her lab tests were all normal, so was her baby's.

For a mother-to-be with a such special condition, the 38th week is a right timing to terminate the pregnancy. Doctors decided to perform a Cesarean section (C-section) for LI.

C-Section as Well as a High-Risk Surgery

However, the history of multiple times' incomplete intestinal obstructions and the bowel section and stoma surgery may have caused extensive adhesions in LI Hong's pelvic and abdominal cavity, which greatly increased the risks of the C-section.

In addition, the C-section scar could be easily contaminated and infected by the nearby stoma on her abdomen. The postoperative incision healing could also be affected by her serum albumin level that is only 26.4g/L on admission, much lower than what a normal pregnant woman would have.

Therefore, a team of obstetricians, gastroenterologists, colorectal surgeons, wound therapist, anesthesiologists, nutritionists, and nurses was quickly established and a detailed surgical and postpartum care plan was schemed in order to ensure LI Hong's safety in delivery. 

The Baby was Born!

When everything and everyone is ready, the C-section was carried out by Prof. WANG Liquan and Associate Chief Physician Prof. SUN Xiwen on February 21, 2022. A healthy baby girl was delivered during the operation with a birth weight of 3,650 grams and a birth score of 10 (10 as the full score).

When baby's loud cry was echoing in the operating room, all the doctors and nurses and LI Hong were so relived. After the operation, the postpartum management was conducted as planned. LI Hong had a quick and full recovery!

LI Hong's case shows that women with IBD can also have a smooth delivery if they have a multidisciplinary assessment, preparation and management before and during pregnancy, said Dr. WANG and Dr. CHEN. For young female patients with IBD who want to have children, they are suggested for a multidisciplinary consultation to assess their physical conditions before pregnancy. Joint efforts of regular check-ups and multidisciplinary management during pregnancy would enlighten hope to give birth to a healthy baby.