Mrs. Gina S. Nelson, M.D.

Hi there,

When considering a patient for TOLAC, trial of labor after C-Section, many factors come into play, from both the mom's side and the baby's. For example, likelihood of a safe delivery depends on the reasons for the first C-Sec and if they are still present in the next case, then it does not look good. For example, I could imagine a mom having her first C-Sec for breech failed version, and the two subsequent babies who presented head down were delivered vaginally without incident. Then, her daughter, once grown up, had a large baby who arrested labor at 6 cm. In the daughter's second pregnancy, the doctor again sees excess maternal weight gain, a larger than average baby, and no descent into the pelvis near term. Those would not be good conditions in which to consider a TOLAC. This is just a hypothetical example, but there are an infinity of others which might cause a doctor to advise her against a TOLAC.

Your daughter is always welcomed to seek a second opinion. We encourage TOLAC in appropriate patients in centers that are equipped to handle it, with 24/7 anesthesia and Ob coverage.

Best of luck !

Constipation is most commonly related to diet and lack of exercise. We also tend not to drink adequate water. Do HIT (high intensity interval training) regularly, and eat a diet rich in fruit and veggies, as well as soluble and insoluble fiber. It really will work. My go-to's are berries, fresh or frozen, oat bran cereal, and brown rice, together with salads, cooked greens, and lately, kombucha and seaweed snacks. Getting backed up in the bowels makes you more prone to urinary tract infections, and impairs your ability to engage your abs well during workouts. It also makes you more likely to get hemorrhoids. The sooner you fix this, the better.

I have many patients with RA who have had successful pregnancies. As a rule, autoimmune disorders such as yours wane in pregnancy, so that is good. While MTX is not safe, steroids are. You should plan a consultation with a perinatologist (high-risk Ob) and your rheumatologist about how your care would go, and meanwhile, get as healthy as you can.

Dietary measures should be first. Drink 2-3 L water per day, eat oat bran cereal with berries for breakfast, eat salads with protein for lunch, and have a little brown rice with dinner. Make sure there are fruits and vegetables with every meal. Avoid hard cheeses. You may use Colace 100 mg 2-3 times per day. Regular exercise in pregnancy barring any contraindications, also helps, even yoga.