The question came to me in the middle of the night, a few weeks after my surgery. I wasn't ready to ask it out loud yet — but I typed it into my phone under the covers, hoping nobody would see.
Can I still have children?
There's a grief that comes with an ostomy that nobody really prepares you for — and part of it is the fear that your body is no longer capable of the life you had imagined. That the bag means you've lost something irreplaceable. That pregnancy, childbirth, becoming a parent — those things are for people whose bodies didn't go through what yours just did.
I want to speak directly to the version of you searching this at midnight, terrified. Because when I went looking for answers, I found almost nothing — and what I did find was clinical, cold, and written as if the fear underneath the question didn't exist. This article is the one I needed and couldn't find.
The Answer: Yes, Pregnancy Is Possible
Let me say it plainly: most people with ostomies can have healthy pregnancies. The bag itself is not a barrier to conception or childbirth. Your stoma does not disqualify you from becoming a parent. Thousands of ostomates have been pregnant and delivered healthy babies — with colostomies, ileostomies, and urostomies.
That said, the nuance matters. Several factors shape your individual picture:
Type of ostomy
Colostomies, ileostomies, and urostomies each carry slightly different considerations. Ileostomy patients in particular need to be attentive to nutritional absorption and hydration, both of which are more complex during pregnancy.
Why the ostomy was created
If your ostomy was the result of inflammatory bowel disease (IBD), colorectal cancer, or other conditions, the underlying diagnosis — and any ongoing medications — may require planning before conception. Your care team needs to weigh in.
Your overall health
Nutritional status, disease remission, surgical history, and pelvic anatomy all factor into a pre-conception assessment. Getting a check-in with your team before trying to conceive is not optional — it is the most important step you can take.
The bottom line: the bag does not make you infertile. Your path to pregnancy may require more planning, more coordination, and more candid conversations than it would for someone without an ostomy — but the destination is real.
Before You Get Pregnant: Build Your Team First
The most important thing you can do before trying to conceive is assemble a care team that actually understands your situation. Here's who you need in your corner:
An OB/GYN who is familiar with ostomy patients — or willing to learn
Not every OB/GYN has managed an ostomy pregnancy, and that is okay. What matters is finding someone willing to coordinate with your colorectal surgeon and ostomy nurse. Be upfront in your first appointment: "I have an ostomy and I'm planning for pregnancy — have you worked with ostomates before? Are you comfortable consulting with my surgical team?" Their answer tells you everything.
A colorectal surgeon or ostomy nurse for a pre-conception check
Your stoma and the surrounding anatomy should be assessed before you start trying. A WOC nurse can evaluate your pouching system, check stoma health, and give you practical guidance for the months ahead. Your colorectal surgeon can review your surgical history and flag anything that might affect pelvic anatomy or delivery options.
A nutritional status review — especially with an ileostomy
Ileostomy patients are at higher risk for deficiencies in vitamin B12, iron, folate, and magnesium due to reduced absorption in the small bowel. All of these are critically important for a healthy pregnancy — especially folate in the first weeks. Ask for bloodwork before you start trying and address any deficiencies proactively.
A medication review
If you are on medications for IBD, Crohn's, cancer, or other underlying conditions, some of those medications are not safe during pregnancy. Some require a 3-6 month washout period before conception. Do not stop any medication on your own — but do ask your prescriber explicitly: "Is this medication safe if I become pregnant? How far in advance should we discuss switching?"
How Pregnancy Changes Your Ostomy
Your body changes dramatically during pregnancy — and so does your stoma. This is normal. Here's what to expect:
Your stoma position shifts.
As your uterus grows, it pushes against the abdominal wall and changes the landscape around your stoma. The site that was perfectly flat may become creased or uneven. The appliance that fit flawlessly before may start to lift at the edges. This is not a crisis — but it does mean your wafer fit needs more frequent attention.
Output changes — especially in the first trimester.
Hormone shifts, morning sickness, hydration changes, and shifting gut motility can all change your output volume and consistency. Some people find their output increases; others experience more irregularity. Watch for signs of dehydration closely if you have an ileostomy.
Peristomal skin becomes more sensitive.
Pregnancy hormones affect everything — including the skin around your stoma. You may find your usual barriers feel more irritating, or that skin that was previously resilient becomes reactive. Be gentler with skin prep and consider a milder barrier wipe if irritation develops.
Practical tip: Measure your stoma more frequently throughout your pregnancy — not just at your regular change, but any time your appliance feels less secure. Stoma size and shape can change significantly by trimester. Cutting your wafer to the right size is your single most effective tool for maintaining a reliable seal.
Managing Your Ostomy Trimester by Trimester
First Trimester
Nausea is the main challenge. If you're vomiting regularly, hydration is critical — especially with an ileostomy. Small, frequent meals help manage output. This is also when your stoma may start shifting as your uterus begins to grow. Check your seal daily, and don't hesitate to change your appliance early if you notice any lifting at the edges.
Second Trimester
Your belly is growing and so is the pressure on your wafer fit. This is when most ostomates start experimenting with different appliance configurations: low-profile pouches that sit more comfortably on a growing belly, convex wafers to maintain a seal over changing skin folds, and extended-wear barriers that give you more time between changes. Carry extra supplies — your fit may vary more from week to week than you expect.
Third Trimester
Reaching your stoma gets progressively harder as your belly grows. Practical strategies: use a handheld mirror to see what you're doing, ask your partner or a trusted support person to help with changes, position yourself seated or semi-reclined rather than standing. Longer wafer cut-to-fit barriers give you more working room. If you can, schedule a third-trimester appointment with your WOC nurse — they can troubleshoot your system in real time.
Delivery
Both C-section and vaginal birth are possible for ostomates. The decision is made between you and your OB based on your pelvic anatomy, your surgical history, and your individual pregnancy — not simply because you have an ostomy. Be transparent with your OB team about your stoma location and your prior surgeries so they can plan accordingly. Make sure your ostomy supplies are in your hospital bag and that at least one nurse on your care team knows how to help with a bag change.
After Delivery: Your Ostomy Postpartum
Delivering your baby does not mean your ostomy challenges are over — the postpartum period brings its own adjustments. Here is what to expect:
Output will fluctuate.
After delivery, the pressure on your abdominal wall releases and your output may shift — sometimes dramatically in the first days. This normalizes for most people, but give yourself a few weeks before drawing conclusions about what your "new normal" is.
Hormone shifts affect skin and seal.
Postpartum hormone changes — the same ones that affect your skin, hair, and mood — can also affect the skin around your stoma. You may see more sensitivity or reactivity in the first weeks. Be patient, be gentle, and don't hesitate to try a different barrier formulation if your usual one starts feeling irritating.
You will need help.
Bag changes in the early postpartum weeks, when you're sleep-deprived and recovering from delivery, are harder than usual. Have a plan before you deliver: who is your support person for bag changes? Is there a partner, family member, or doula who knows what to do? Brief them in advance. Having that support is not a weakness — it's smart planning.
Breastfeeding and hydration — especially with an ileostomy.
Breastfeeding increases your fluid needs significantly. If you have an ileostomy and are breastfeeding, monitor your hydration closely — your risk for dehydration is higher than for most new moms. Watch for signs: dark urine, fatigue, dizziness, or unusually high output. Keep electrolytes on hand.
“Will My Child Be Okay? Will I Be Okay?”
Ostomy moms exist. They are out there — in the Facebook groups, in the UOAA chapters, in the hospitals volunteering as ostomy visitors — and they are raising healthy, loved children. The bag does not make you a less capable parent. It does not make you less of a mother. It does not mean your child will be burdened or that your family will be defined by it.
What it does mean is that you will be a parent who models resilience. Who shows their child, from the beginning, that bodies do hard things and that we keep going. Who lives fully — not despite the challenges, but with them.
The fear you are carrying right now — "will I be okay?" — is real and valid. And you do not have to resolve it before you can move forward. You can be afraid and still make your pre-conception appointment. You can be uncertain and still ask the question out loud. You can carry the bag and still build the family you imagined.
Your body has already survived something extraordinary. It can do this too.
When I was going through the hardest part of my diagnosis, nobody told me that there was still a full life on the other side. Nobody said plainly: you can still have the things you want. Part of why I built Beyond the Bag was to be the voice I needed and couldn't find — to say out loud the things that everyone was too afraid to say.
So here it is: you can still have children. Your body can carry a pregnancy. You can be an incredible parent with a stoma. The road might look different than you expected — more planning, more coordination, more honest conversations with your care team — but it is your road, and it is still yours to walk.
If you are navigating this and you need someone to think through it with — someone who actually gets what it feels like from the inside — that is exactly what I am here for. Book a consultation. Let's talk through your specific situation.
— Stephanie Crawford, Ostomy Survivor & Founder, Beyond the Bag
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