Oh help me, OB-GYN Kenobi! You’re my only hope!
I can’t believe this is happening again. And so early! That’s right – my body has gone into super crazy overdrive with the unbearable itchiness associated with Intrahepatic Cholestasis of Pregnancy (ICP). As you may or may not know, I’ve dealt with this in every single one of my pregnancies to varying degrees.
The first time around, I had NO idea that the horrifying itchiness was anything to worry about. I’d heard that the skin stretching from a growing baby would cause itchiness, and I didn’t think that there was anything worth mentioning to my doctor. I was living in the UK at the time, and when I did happen to mention it to my midwife, I was kind of embarrassed and made light of it. As a result, she didn’t really consider it as a problem. In fact, despite the agonizing continuation of symptoms, I never mentioned it again. I actually ended up going into preterm labor at 32 weeks, spending several days leading up to the new year in the hospital. I had to have steroids to help the baby’s lungs grow, and it was one of the scariest moments of my life. Lucky for me, they managed to stop the labor from progressing, and I ended up going full term, being induced at exactly 40 weeks. If I knew then what I know now, I’d have made a bigger deal of it, but when it’s your first baby, you feel like you’re overreacting to everything.
In my second pregnancy, I began to itch somewhere around 27 weeks. It literally came out of nowhere, and I was woken up from a deep sleep by a feeling like being crawled on by a million tiny insects. The palms of my hands and soles of my feet were the worst, and no amount of scratching would help. By the next morning, the itching had mostly gone away, and I went about my day with no problems. But that night, I once again was overwhelmed by severe itch. I got out of bed at 2 am to take a cool bath in the hopes of calming down my skin, but it didn’t help at all. But once again, the next morning, I was less itchy, and I ignored the symptoms.
It didn’t help that we were living in a small apartment in Florida at the time, and more than once we’d seen cockroaches roaming our home. I started to think that the itching was psychosomatic and that maybe I was just paranoid. But the itching continued each night until I finally told my doctor what was going on. She was much more perceptive than my previous midwife had been. She immediately organized blood work to be done so they could check my bile acid levels and my liver enzymes. While we were waiting for results, I ended up going into preterm labor.
According to ICPCare.org, preterm labor is very common during Intrahepatic Cholestasis of Pregnancy. The high levels of bile acids make a uterus more sensitive to oxytocin, which is the hormone responsible for stimulating contractions. Because of this, it takes less of it to send you into labor. Preterm delivery actually occurs in about 20-40% of ICP pregnancies! Thankfully for me, they once again were able to stop my labor from progressing, though I had to go on immediate and total bed rest.
When the test results came back, it showed that my levels were mildly elevated, so a plan was put in place to retest in a couple of weeks. At times, it can take a while for the test results to match the symptoms. In the meantime, I was given the drug Ursodyoxicholic Acid (Urso) to help manage my symptoms. A few weeks later, test results showed that my levels were significantly higher, and after being put on monitors in the doctor’s office, they weren’t able to record any fetal movements and very little heartbeat. I was sent to the hospital for a biometric ultrasound. Basically this is a 30 minute test for the baby to ensure he’s okay. It took barely five minutes for him to pass every test except for one – practice breathing. After the full 30 minutes, he still hadn’t done it, and this was a huge cause for alarm. I was sent home with plans to return in two days for a second test.
When the next test was done, once again he failed the breathing portion, and we found that my bile acids had risen yet again. I was immediately booked in for an emergency induction… at 35 weeks!
ICP is a very serious condition, which can lead to many complications for the mother and the baby. The most serious is stillbirth. It can also lead to clotting issues for the mother, which can cause her to lose too much blood. Unfortunately this happened to me. Our son came shooting out of me long before the nurses were ready for him, and as a result my doctor didn’t have a chance to be informed of his imminent arrival. Since nurses are unable to deliver a placenta (even though they delivered the baby!), I lay on the bed for a long time, bleeding copiously before my doctor could arrive to finish things off. I remember shaking uncontrollably and feeling exceptionally weak. Once I’d recovered a bit, I was told that I’d lost too much blood and would need a transfusion. They gave me two pints of blood the next morning, and my OB said that she would suggest a second transfusion, as it hadn’t lifted my iron quite enough. I have no idea why, but I declined a second transfusion and got on with things.
Happily for me, my second experience with ICP ended well, despite the difficulties we went through.
With my last pregnancy, I once again dealt with ICP, starting around 33 weeks. My OB was aware of my history, so as soon as the itching started, even before my levels were checked, she started me on Urso. Believe it or not, ICP was actually the LEAST stressful part of my third pregnancy. I had so many problems that pregnancy that it put me off having any further children (until now, apparently!). But the ICP was actually well managed, and the itching wasn’t nearly as severe as with my second pregnancy. The Urso worked well, and my OB planned for an induction at 37 weeks. The whole thing was fairly uneventful, even though I had some delivery issues – namely the epidural didn’t take, and I had a “cervical lip” which made the process SO much more painful.
But all in all, in my experience, my second bout of ICP was the worst.
For the last few days, I’ve been dealing with itching so bad that I’ve got bloody gouges all over my body from trying to scratch it away. My palms and soles of my feet are once again really uncomfortable, and my entire body feels like ants are crawling over me. My doctor is actually away this week, and although I’ve sent her a message through the internal message center, I don’t know when she’ll get back to me. I’ve never experienced it this early in pregnancy, and it’s kind of scary to me that it could be starting up this soon.
For now, I am dealing with the itch as best as I can and hoping that I can get put on Urso once my doctor is back. Any tips or tricks on how to assuage the itch from anyone who has been in this situation would be greatly appreciated!