My third pregnancy was vastly different than my first two. Even though I was having a third boy. There were new challenges that I hadn’t experienced before.  First, nausea took over my first two trimesters, and fatigue seemed stronger this time around as I mentioned previously in my first trimester reflections.  And of course, I was taking care of a 4 and 2 year old. For a while, I thought my life in general was the likely cause of being more tired this time around. As I was diagnosed with Cholestasis of pregnancy at the beginning of my third trimester, all of the symptoms started to fit together.

On the plus side, I was more active- I continued to walk and attend my favorite cardio classes about twice a week. My weight was more maintained  than my second pregnancy where it skyrocketed (and never fully went back 🙂 ). I was proud of myself for this part because it’s something I have struggled to do in previous pregnancies, and I thought it would help me have an overall better pregnancy.  And it did, until life had other plans for me. 

As I transitioned into the third trimester, the nausea hadn’t diminished completely but it wasn’t as frequent.  I never fully felt the second trimester wave of energy and to be honest- I started to feel really low.  It’s hard for me to be so tired, constantly sick and raging with all the hormones. I started to worry how it was affecting my household,  myself,  my kids and my marriage.  Which just made me even sadder, but the fatigue was so strong that I could only cry and do the best possible. All of my routines were off and I couldn’t seem to get a handle on any of it. For someone that thrives on routine, it was really hard for me to accept and not feel guilty about. 

The Itching Started

I remember the night I started itching very well. I was 32 and 1/2 weeks pregnant. It was my birthday weekend and my good friends cooked a dinner for me (that was absolutely amazing by the way).  The friend that hosted knew how bad I had been feeling. Being surrounded by friends and feeling understood for all my rollercoaster feelings was definitely something I needed.

Earlier that day, I had been pretty itchy all over.  At first, I thought it was just another “fun” pregnancy symptom.  But then I had to apologize to my friends for constantly reaching into my shirt to scratch my stomach and arms during our conversation. It was nonstop that night and just intensified as the hours passed.

Around 1am I had been in bed for a couple hours, but I hadn’t slept at all. My husband had to help me scratch as I was miserable. The itching was now most intense on my hands and feet. It felt like an army of fire ants was on them.  That is the only way to describe how much more intense it was than just regular pregnancy itching.  It was unbearable.

In my state of insomnia and between scratches, I got on Google. Naturally. I was initially just looking for ways to get some relief. I had already pulled out the cortisone cream and any lotions I could find.

That is when I found out about Cholestasis.  I had never heard of it before but what sent the alarms off in my head was the number one symptom is itching. And not just regular itching- but specifically in your hands and feet. I described it to my husband and we decided to call my doctor.

Right when I told her where the itching was, she told me to come into Triage that day.  Thankfully it was a Sunday, so Jordan stayed home with the kids. I had barely slept so I practically dragged myself there.  

On the way, I texted my mom and sister the page I found on Cholestasis and told them that I was pretty sure I had this.  I’m not the kind of person that diagnoses herself quickly, but it sounded exactly like my experience had been.

The other symptoms were dark colored urine, which I had just mentioned to my doctor at my previous visit. Fatigue, nausea and depression are the other signs.  Hello! I  had all of this! But any of those can come around in pregnancy, the itching is what set it apart.

What is it?

The scariest thing you will find when you look up Cholestasis are the risks.  Fetal distress, preterm birth or stillbirth.  Exactly. The last things you want to hear while pregnant. My mind started spinning and I probably got to a point where I read too much about it and too many real stories.  That is how I work though, I want to know as much as possible about things. But I read the good accounts AND the bad, which to be honest was scary. 

Cholestasis happens when the liver slows down or stops the flow of bile. When bile acids build up, it can spill into the bloodstream. There aren’t concrete causes for it yet, but some general associations. Most women are diagnosed in their third trimester when the pregnancy hormones are elevated the most. So there is a direct correlation with elevated hormones and the onset of the disease.  It also has genetic links and environmental factors that contribute.  

Bile acids in the bloodstream can cause stress on the baby’s liver, which is what makes it so serious.  It also affects their breathing. .

I found it interesting that I never heard of this or that it is not routinely tested for during pregnancy. Why do we get routinely tested for other things that can occur in pregnancy but Cholestasis can go unnoticed and undiagnosed if someone is not familiar with the symptoms?

In Triage

They attached me to the baby monitor immediately. He was active and the heartbeat looked good. Then they did an ultrasound to check the amniotic fluid, which was also where it should be.

Blood tests were then done- as they are the best source at diagnosing Cholestasis. The first one tests your liver enzymes and results are given within the hour.  The second is the most important. It tests your bile acids, but you don’t get the results for a few days.  

One of my liver enzymes was slightly elevated, which wasn’t enough to diagnose me. But purely on my symptoms, they started me on the medication for Cholestasis. Urso maintains your bile acids and helps alleviate the itchiness. There would be no harm in taking it if I didn’t have it. 

Waiting Game

The “normal” range of bile acids in a pregnant woman are 0-10 and anything above that would diagnose me officially with Cholestasis.  A few days passed and I got a 10. Which was annoying. I’d rather it be a 2 and not have it, or above a 10 and have it. Right on the border meant more waiting and more tests. My doctor retested me the following week and my acids had elevated to a 13.  And this was after I had already been on the medication for a week that helps regulate bile acids.  

So after a couple weeks of all this- I was officially diagnosed.  Beyond the medication I was already on, they induce women with Cholestasis early because the most danger to the baby happens in those last weeks.  We scheduled my induction for 37 weeks and it was a whirlwind wrapping my head around the fact that my “deadline” for getting ready for this baby just moved up 3 weeks.  

I had really wanted to go into labor naturally and I worried about my baby coming out earlier than he was supposed to.  But this is what was best for him now.  And that is really all that matters at the end. 

They also prescribed me non-stress tests twice a week in addition to my regular OB visits. They check on the baby’s movement, heart rate and amniotic fluid.  Every SINGLE doctor constantly told me to regularly count kicks and movement. And to make sure I came in if there was any decrease in movement.  Do you know how scary it is to hear that over and over again?  

I became a little obsessive. If he was sleeping, I would freak out and shake my belly to move him and make sure he was still good.  It was stressful, emotional and overwhelming.  Finally, I tuned in to his patterns more and made sure he was moving at his usual times instead of constantly poking my belly around. 

Talking About It

The worry was always in the back of my head. It was hard for me to talk about it all beyond my inner circle. 

I’d casually mention I had to be induced early but probably left many people confused because I wouldn’t really explain why.  When I had to explain what Cholestasis was and the risk it could have for my baby, my eyes would instantly tear.  So I probably appeared flippant in responses, merely because I didn’t want to go into detail and get emotional.

I read so many heartbreaking real stories that I couldn’t confidently announce that this baby was definitely coming on this date etc. Not until he was in my arms. 

Induction

My last OB appointment was at 36 weeks and my cervix was absolutely nowhere near ready for labor.  It was early after all so that made sense.  My doctor moved my induction to the night before I was set to arrive.  These extra hours I was given cervidil to prepare my cervix before I was officially induced in the morning.  

Yes, there were more worries!  I was worried I wouldn’t progress- that it would lead to a 3 day induction or c-section.  I worried about him- that he would need intervention being so early, that maybe he wouldn’t be big enough or developed enough yet to come out. And of course- the biggest worry still loomed over all of that.  That my body was attacking him and this early induction could still end up not being early enough.

1cm is what I came in with Monday night at 7pm and what I still had Tuesday morning when they took out the cervidil at 8am. But my cervix did cooperate and get softer. I was mentally prepared for a marathon though.  Even when everyone confidently said that third babies come quickly.  At this point, it didn’t seem like it would be going that way. 

9:30am they started pitocin.  I was getting contractions but not anything I couldn’t talk through. They put in a foley bulb around 10:15. It is a balloon type thing that would help get me to 3cm.  Around 11:50 it had done it’s job and came out.  They had also slowly risen the amount of pitocin given every 30 minutes to an hour. 

Contractions came every 2 minutes but I could still talk and walk through them.  My husband and I went for a walk in the halls- while dragging the IV drip behind me.  We may have gone too far and gotten in trouble-lol.  Didn’t know I could only walk in the little hallway in front of my room until my nurse came after us that she had lost signal for me.  Whoops.

Then I sat on the birthing ball- bouncing and stretching.  Anything I could think of. I sat on it through my liquid lunch while my husband had real food- still hospital food so I wasn’t too jealous. They kept asking me for pain levels but I was still comfortable. I knew from experience that you are not in active labor until you become uncomfortable. 

My doctor came back around 2pm and said she thought it was time to break my waters and move this along.  She warned me that contractions would probably get a lot stronger and be ready to ask for the epidural if I wanted it.  I wasn’t in pain yet at all so I said okay, but in my mind thought it was going to be a while before it actually happened.

By 2:30pm I was in crazy pain! The contractions were so strong and frequent that we started the process of getting the epidural.  Low and behold, they weren’t available when I requested it so I had a good 45 minutes of super painful contractions before the anesthesiologists came in. 

My doctor kept coming back to check on me. She confidently said we’ll have this baby by midnight.  As she came back to check again at 5pm, she moved the time up even more.  I was actually progressing! Hallelujah! I was 5cm at this point.

He’s Here!

Things moved quickly the next couple of hours.  Around 7:15 she asked me if I was ready to push and in a daze I agreed. She paused for a minute and asked if I was okay. I was a little shell shocked- the worries were still looming.  But I snapped out of it and said let’s do this. 

We’re gearing up for this crazy pushing phase.  Some back story- I pushed for almost an hour with both of my two older boys. The second one hurt like heck so my husband and my mom- who were there for those also- got into position- ready to cheer me on and motivate me through this final phase. 

Guys, I pushed less than 10 minutes.  Maybe 4-6 times and he was out.  The world finally decided that the extreme nausea, Cholestasis and fears for my baby were enough. Hours of pushing would just be overkill.  Thank you!

I burst into tears. He was perfect.  7 pounds, 7 ounces- even at 37 weeks. Who knows what he would have grown to if he cooked longer! The anxiety I was holding in my body finally released into a pool of tears.  He wasn’t tiny or had trouble breathing from being early as I had feared (lungs are one of the last things to develop).

There was a healthy baby boy in my arms. All the feelings of love and relief were incredibly intense. Everyone told me how happy I looked in the pictures we shared after. Letting go weeks of fear created a purely euphoric feeling.

Reflecting Back

In many of the stories I read about Cholestasis, many women were shrugged away about their itching. Told to get some benadryl and they’ll be fine.  Or not prescribed the right medicine. I am so grateful for how my doctors handled my symptoms, and took me seriously enough to prescribe me the medicine right away.  They had a sense of urgency that should be there for something that can have such a fatal result.  The problem seems to be that there isn’t enough knowledge, even among doctors in the field. 

Follow your instincts. With itching or anything else.  This website ICPCare.org was an amazing resource for me. They have accumulated medical research, real stories, and outreach programs about this disease and what is needed for treatment.

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