A common question of the woman with a stoma who is in her childbearing years Is, Can I have children? Our usual response to her question is that having a stoma is not a limitation for pregnancy. Remind her that we all know of women with or without a stoma who have had major or minor problems with pregnancies. Sometimes there may be problems that are unique to the woman with a stoma. However, many women with a stoma have delivered normal healthy babies-even twins!

First of all, if the woman has not experienced a pregnancy before her stoma surgery her fertility has not been prove n. Should there be a problem with fertility, it Is possible that it is due to a preexisting condition. There are conditions such as endometriosis that are not related to the stoma surgery.

There can be a surgically related problem with fertility if there are adhesions that involve the reproductive organs. This can usually be corrected with proper medical-surgical attention.

The pregnant abdomen of the stoma patient is a concern . As the abdomen expands there is the usual stretching of abdominal skin. This same stretching of the surgical scar tissue may cause some discomfort in the form of itching from the loss of elasticity in the scarred area. The itching is easily remedied.

The enlarging abdomen will require refitting of the pouching system especially in the third trimester. The aperture in the stomaplate or flange will need to be enlarged to avoid mucosal trauma.

Some women experience hormonal skin changes (increased oil texture) that Interfere with the seal of the pouch. More frequent changes of equipment are recommended.

Stoma prolapse may occur. If there is no obstruction caused by the prolapse it is of little concern.

Most women with ostomies deliver vaglnally. Those who have perlanal scars also may have loss of elasticity that may require wide episotomies. They may need instrument deliveries due to inability to push. Sometimes a cesarean section is necessary for obstetric reasons. This is often true for those women who have urostomies for congenital defects.

Post-partum stoma concerns are few. The woman with an ostomy will probably have no trouble readjusting her ostomy equipment to conform to her softer, less expansive abdomen. If her abdomen Is tender from cesarean section, she will probably assemble her two-piece system and apply It as a unit until tenderness resolves. She will quickly learn that it is best to have a secure, empty pouch before breast feedIng a squirming infant.