Cesarean Section After Anal Fistula Surgery: Risks & Considerations

Question
About 8 or 9 years ago I had emergency surgery for an anal fistual. It had come back twice and the last time I was septic with a fever of 106 when I arrived at the ER. The surgery went well and I have not had any problems since. My doctor feels that the risk of it reopening calls for a cesarian. I am concerned about that as well, since I almost died from it, but I think I am more concerned about the risks of the cesarian for me and the baby. I am also concerned about the drugs interacting with the baby and being passed on in breast milk.

I had accepted that I would be doing the cesarian, but I very much want to go through natural birth because it seems healthier for the baby and less recovery time for me (an almost necessity since I am alone).

Your input would be appreciated.

Thank you,
Lisa

Answer
If the anal fistula was repaired 9 years ago, it is, most likely, completely healed by now and I doubt that you will need to avoid a vaginal delivery in order to avoid "re-opening" of the repair.  However, a vaginal delivery may cause injury to your rectum and you can possibly have a stormy course such as you did with the fistula.  A cesarean section really poses no risk to the fetus or to you. It is performed thousands of times daily and is a safe procedure. The drugs used for anesthesia are the same used for a vaginal delivery as well. They have no effect on breast milk or nursing. The recovery time is less for a vaginal delivery but there really is no reason for concern. If there is any doubt as to damage to your rectal mucosa, go for the cesarean sectoin.