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.".

Eight

D,

This morning when I went to wake you up, you were already awake and after I sang happy birthday to you , you gave me the biggest grin and said "I'm eight now". You are so excited to grow up and be a big kid. I want to stall time and let you be a little boy for just a little bit longer. Mostly only for selfish reasons though. You have always had an old soul in a kid body. I just want you to stay that little snuggly mama's boy forever. Maybe you'll just be a big mama's boy instead? You do still love to snuggle.

You are growing to be such a little man lately. You are more confident than ever and more assertive with people who would otherwise take advantage of your sweet personality. Its been good for my heart to see you thriving socially and making new friends all the time. You've always been so much more shy than your little brother but you are coming out of your shell more and more, showing off your fun, caring side to more people.

Second grade is treating you well so far. You are enjoying the little bits of extra freedom your personality grants you especially. You are the kid that teachers trust to run errands for them. Even last year you were the kid that your teacher trusted to take other kids places like the nurse or office to check out. You are trustworthy and its good that your teachers are seeing it. Academically, you are thriving too. Math is not your thing but you make it happen. You get it honest kid, sorry.

Baseball is still your thing. You have grown a lot on the field in the last year too. Its crazy how much skill and determination you show on the field. You want to be the best and want to learn. Your coaches have all said how impressed with your drive and how well you take direction. Its shows in your playing too. You are quite the slugger and have settled into the pitcher/ second base rotation with more experienced kids and are showing them a thing or two. To say I'm proud is and understatement. Of course all that baseball and your second favorite pastime, swimming, means you are built like a rock. Tall and slim but literally all muscle.

Of course you also welcomed your little brother Bae with an open heart this year too. I knew you would. You've always had this ease about you when it comes to babies. They always just adore you and he is no exception. You get a little rough with him some times without meaning too but as he gets bigger, I'm sure he will make an excellent wrestling buddy just like Kai. You were so excited to see him for the first time. I will never forget the way your face lit up when you walked into the hospital room and saw him laying there on the bed with me. It was like excitement and a sense of peace all rolled into one. It was as healing to you as it was Michael and me. Like a puzzle piece just clicked int place in your heart.

I am so proud of you D. You are strong in ways beyond your years, you are kind to every one you meet, and you are so very smart. I can't wait to see what the next few years bring you. They will be a period of immense growth, and while I don't think I am ready for it, I know you will handle it with the same grace you handle everything else with. I will always be right here behind you, in awe, if you need me my love.

Love always,
Mama

Monster 6.0

My Sweet Monster,

Today you turn six. Six hurts my heart more than five did or some reason. You are just so excited about it though and its infectious. You have been giving us the countdown for weeks on how many days until your birthday and I have been impressed at how well you have kept track. Then you woke up this morning all excited because its finally here! You opened most of your presents yesterday and you loved the toys you got but your face when you opened the Skylanders game is one I won't soon forget. Pure joy! You get to do show and tell at kindergarten all week for your birthday week and I can already tell you are going to run out of days before you run out of things you want to take.

This past year seems like such a blur. You have grown physically by leaps and bounds. Getting taller and stronger by the day it seems. You have officially outgrown your big brother in the weight department and are getting close to doing the same in the height department as well. I still hold to my stance that you will eventually outgrow us all. You will be a big, strong boy when you grow up, just like you are now.

You've grown in the sports department too. I used to say you were going to be my math-lete instead of my athlete because of your clumsy but you've actually (finally) started getting more control over your own feet. You played t-ball again last fall and spring but you still hated it so we skipped it this fall. You will like coach pitched ball so much better, I am sure of it. For now though, you have been excelling at swimming. We started you in swim classes early this summer and you've taken to it extremely well! You keep moving up levels and out swimming kids much bigger than you. Michael thinks you might be a swim team kid if you put your mind to it and I agree. You are strong and fearless and love a good competition.

You still have that huge personality too. The kind that draws people to you like a carnival ride they weren't sure they wanted to ride but convinced them to anyway. You love to entertain and love to play but mostly you love to talk. Also, be in charge. We're working on that last one but sometimes its impressive how good you are at it. Even with much bigger children. They all listen to you and do their part. Maybe you'll be a politician.

You got a new baby brother this year too and you have absolutely been over the moon. Your little brother, even at a few weeks old, just adores you. He will be fussy and wiggly but when placed in your arms, or you start to talk to him, he gets still and pays attention to you. Even when nothing else works. ITs really pretty amazing to watch. I'm glad for you. You were so excited about im. Especially after Gage, you needed a take home baby as much as any of us. If anyone asks, you always tell them you have 3 brothers and it makes my heart leap every time because you remember. You loved and you love and I love you.

Baby, I'm so proud of you. I love your crazy. I love your heart and incredible mind. You are an amazing little mama's boy and I am excited to see just how far your drive and personality takes you. It will be far.

I love you my monster,
Mama

One Month Old

My little man is a month old today. Let me just tell you, it is insane how fast it has gone. Of course, he is just an amazing baby so that has made everything very easy. He sleeps like a rock, nurses like a champ, and is growing like a weed. As of today, he is up 2.4lbs and 3.5 inches! We spend most of our time just snuggling or running after the big boys. It won't be long before he is running with them.