Tuesday, September 29, 2015

My Journey with Cholestasis of Pregnancy

*I promised I would update you all on baby B's birth and how it all came about but while I was trying to figure out how to get it all out of my head and into writing, I realized I couldn't share that story without sharing this one first. It is the basis of why he came early and I couldn't just leave that out. Plus, its something that I know people are curious about. Its rare but it can have potentially devastating effects and I feel like its important for others to hear about. 

When I hit about 30 weeks in my pregnancy, I started to itch. Having had a PUPPP rash for the last 3 pregnancies, I was used to my belly itching uncontrollably, but this was a totally different beast. It started as a mild itch that really only affected me at night. It was like a weird tickly sensation all over my body. The odd thing about this itch is that it never showed any signs on my skin. No rash, no redness, no hives of any kind and it was all encompassing. Every part of my body itched. At first, I figured it was dry skin and slathered myself with a thick lotion every night before I went to bed with hopes it would help. When it didn't, I tried benedryl. When that didn't help, I mostly just whined to Michael who I'm fairly sure thought I was just losing my mind.

At 34 weeks when nothing else was helping and my family got tired of scratching the various parts of me I couldn't reach (you try scratching your feet when you can't even reach them to put shoes on!), I finally sent an email to my midwife telling her what was going on and asking if there was anything she could recommend to make the insanity stop. Within an hour, one of the nurses called me back and started asking questions.

Was it worse at night? Was it on my palms and soles of my feet? Was I jaundiced at all? 

I answered all her crazy sounding questions and then she explained her reasoning. There was something called Cholestasis of Pregnancy that met most of my symptoms and it could be really bad for the baby. The only thing was, I had no gallbladder so she didn't think that could be it. She suggested a warm oatmeal bath and more lotion. 

I hung up and consulted Dr. Google about the Cholestasis and she was right, it met all of my symptoms to a T. Right down to the depression and exhaustion I had been struggling with but attributed elsewhere. The scary part was when it started getting into how it was harmless to the mother outside the insane itch but had a high instance of still birth if the pregnancy continued too long. Basically, because of the pregnancy hormone changes, my liver was leaking bile acid into my blood stream. It just made me itchy but it could slowly poison my unborn son. 

About the time I started to get really worried, the nurse called me back. She said that she had consulted with the OB in the office and it turned out she was wrong, the gallbladder being gone had no bearing on the possibility of Cholestasis. She made and appointment with me to meet with them in the office on Monday because it was almost closing time but told me if I was too worried to wait to go to the labor and delivery triage and have them test me. 

After I got off the phone with her, I went to see Michael at work and tell him what they had said. I tried to gently explain the risks but all he heard was that B might die. He was rightly as freaked out as I was and we decided to go on into the L&D triage to get checked out.

Once we got there, they hooked me up to the monitors and ordered blood work for a liver function test to check my liver enzymes and a test to check my bile acid levels. The nurses didn't have much knowledge to share with me on the Cholestasis thing. In fact, they had never heard of it and had to look up what it was to even really know why I was so worried about it. 

After about an hour, my midwife came in and told me that the liver test came back normal but it would take probably a week to get the bile acid tests back to confirm the Cholestasis. She went ahead and prescribed the meds for Cholestasis and told me to go home and try to rest. She also told me she wanted to start me on twice weekly monitoring and biophysical profiles until we got the results. I was already seeing a perinatologist and she said she would call them first thing Monday and get us scheduled with them too. We were so glad that they were being proactive and treating this like it was as serious as we knew by now it could be. 

Long story short, it took about 10 (long, tense) days to get the bile acid results in and they were only slightly elevated but still not normal. The perinatologist made the executive decision that because of the symptoms and the fact the meds were helping the itch a little, to go ahead and schedule the induction to be moved up to 37 weeks instead of 39 to reduce the possibility of still birth. It was a relief but still nerve wracking because having a baby that early can come with its own set of challenges.

They continued monitoring me closely for the rest of my pregnancy which I'll admit became a little bit of a chore. Going back and forth to both the perinatologist and midwife's office twice a week was stressful but I knew it was for the best and I held my breath every time they fired up the ultrasound machine hoping to see that little heart beating away first thing. Every appointment, he seemed to be dealing with it well. He had one episode of high heart rate and a couple episodes of weird decels but nothing the doctors were overly alarmed about. Until I hit 36 weeks and change.

I noticed over the weekend that he seemed to have slowed down in his movements. He was still in there and still wiggling but no where near what he had been doing. I drank extra water and told myself he was just running out of room. We were almost there. 

On Tuesday (36 weeks and 4 days), I went in to the perinatologist for my BPP and they asked all the normal questions about his movements and how I was faring. I told them about the decreased movement and the tech took it more seriously than I expected which immediately set me on edge even though I had already seen his heartbeat. She went on with the BPP and told me my water was borderline low and she could tell he wasn't as wiggly during the ultrasound as he usually was. Then she left to get the Doctor. 

I sent Michael a text message really quick and he asked what that meant and I told him I had no clue but she seemed worried. After a few minutes, the Doctor came in and we went over everything the tech had said and what I told her. He checked my fluid levels again and just kind of watched him for a few minutes. That is when he said, "We are gonna need to go ahead and move up your induction. To today.".

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