When I fell pregnant with Finn, now almost five years ago (feels like forever!) I wasn’t in the best health. I was pretty anaemic and the doctors were trying to figure out what could be wrong but when we realised I was pregnant they stopped further tests and my iron levels returned to normal throughout the pregnancy. After those initial weeks of getting my levels back up and a course of antibiotics for an infection, my pregnancy seemed to be going perfectly. I didn’t have any morning sickness, I had no problem with sugar levels or anything else for that matter. My bump was cute and small so I wasn’t struggling with the weight. It felt like I was born to be pregnant at that stage! That was up until 32 weeks when one night my feet started itching, terribly.
Have you ever had an itch so bad that no amount of scratching relieved it? An itch so bad that you spent hours in the middle of the night just scraping your skin to get some relief. This is what cholestasis is like. I knew something wasn’t right when it continued the following night and I started to get distressed. I turned to Dr Google, searching for some answers when I came across obstetric cholestasis. At the time, cholestasis was quite a rare pregnancy condition and not a lot was known about it. The numbers of mothers who are diagnosed with cholestasis have increased significantly since then and there is now more awareness of it as well as more doctors who know what it actually is.
I immediately went in to hospital to be tested for it, but my doctor said that it was probably just dermatitis. She wasn’t even going to test me for it!! but after some serious pushing from me, she took my bloods. Sure enough it came back showing my levels had gone up and I did in fact have cholestasis (mama’s instinct, right?!).
Now to explain levels and how they work can be a bit confusing. To explain cholestasis in layman terms (because even I struggle to understand it) is a condition of the liver, where there is a reduction or impairment in the flow of bile to the liver. Eventually the build up of bile salts in the liver leads to bile entering the blood stream which then leads to the itching. There are two blood tests that are usually monitored with cholestasis and this is your liver function and your bile salts. When they go out of range, this is usually evident of cholestasis and when they jump up really high it becomes quite a worry. The medication they use to try and help reduce the itchiness and level of bile salts is called ursodiol. I tried taking it with Finn and it didn’t work so I stopped taking it and just used calamine lotion on my feet for some relief, but really nothing helped.
For me and many others, it is only isolated to pregnancy and usually in the third trimester when there is a build up of hormones. There are no known causes of cholestasis yet, apart from some theories that say it is genetic or a high sensitivity to the build up of pregnancy hormones. After pregnancy, the itching usually stops and everything returns to normal as it did with me. I also had my liver tested to see if anything else might have been wrong but everything came back clear, which proved for me that it was only pregnancy related.
So once I was diagnosed with cholesasis, I became a high risk pregnancy and was monitored every week on the CTG to make sure baby was OK. Cholestasis does not have a lot of impact on the mother (apart from the awful itching) but for the baby it can be quite traumatic and the risk of stillbirth becomes higher, which is why I think nearly all cases of cholestasis in pregnancy are induced earlier.
With Finn, after weeks of monitoring and trying to maintain levels we booked in for an induction at 37 weeks. I think they usually am to induce from 37-38 weeks because bubs is considered full-term then. After going through a pretty hectic labour, Finn was born in to the world weighing 2.9kg and within 10 minutes his apgar score was 9. He
was a very healthy, happy little baby and I was so thankful after weeks of anxiety and stressing about him, that he was OK.
Now with cholestasis, unfortunately their is a high chance of getting it in subsequent pregnancies so when I became pregnant with Leo I was prepared for the outcome yet hoping it wouldn’t show up. Now four years later since I had Finn, the knowledge of cholestasis had definitely increased and my obstetrician had a good insight in to what it was and what our plan would be if it came back. My pregnancy with Leo was much different to Finn. Aside from the horrible morning sickness, I was a lot healthier this time around. I didn’t have to take anything during my pregnancy except for one panadol for a headache and my diet was better (aside from the odd cream donut craving! ha).
When I hit the third trimester I was looking for that itch every night and when I slept through the night without waking, I was so bloody happy! I remember having a bit of an itchy belly and thinking oh no it’s back, but it would go away again and I would be fine. Because I was so focused on it, every little itch became exaggerated even though most were due to the heat. My obstetrician took my levels in the third trimester just to make sure it hadn’t returned and they came back fine. By week 34 and with still no sign of it, I started to get excited. Maybe it wasn’t coming back?!
Just as I hit 36 weeks, I woke up in the middle of the night with an itch and my heart sunk. It was back. I went in the next day and my levels had jumped up so high that we had to book an induction for the following week at 37 weeks on the dot (that is how quickly it can happen!). I cried. A lot. I guess I had made it so far that I thought it wasn’t coming and the thought of having bubs in a week gave me a shock. I also had no chance of having the water birth that I longed for. However, I wanted bubs out safely and I knew if they tried to push it out any further I would just be anxious the whole time. It was best to induce at 37 weeks and get him out and I was grateful I had made it so far without the itch. I didn’t take anything this time around to relieve the itch as even though I had the itch at 36 weeks, the week leading up to my induction I didn’t itch hardly at all. It was so weird comparing it to when I had Finn as I itched every night on my feet without fail from 32 weeks until 37 weeks so I was definitely blessed this time around. It just goes to show though that even just one night of an itch can mean it has flared up again!
After another full on, possibly more traumatic induction, my little Leo was born in to the world weighing a very healthy 3.2kg! For 37 weeks that was an awesome weight and he was placed on my chest immediately. He didn’t need any assistance and was as healthy as can be. As soon as he was born, my levels went back to normal again and the itch was gone.
Since going through this journey I have met a few other mums who have had cholestasis and also joined groups online where there are so many others going through it! It seems the condition is not so rare after all but I would guess that the rate of safe and healthy births has increased dramatically as more knowledge of the condition has come out.
So my note to all pregnant mums out there is don’t ignore the itch and don’t let someone tell you “It’s nothing”. Yes itching can be a symptom of pregnancy and many mothers get dermatitis or itchy skin from stretching and heat. But, this is not always the case and it is always better to be safe than sorry and get on to it as soon as possible. Trust your instincts. I had to demand the doctor to test me but if I hadn’t and it had gone unnoticed, I don’t know what would have happened.
Lastly, if you do have cholestasis, as much as it can be a anxious time for you, it will be OK. The itching is horrible, and I really can’t give you some sort of relief for it because I didn’t find any myself but try to keep your feet and hands cold before getting in to bed as heat will make the itch worse. The most important thing is that you know what to expect, that your monitored and that you can have a healthy, happy baby. Here is my proof of two of them below!
I feel so lucky to have two beautiful healthy boys despite having cholestasis and both of them being induced at 37 weeks. For anyone going through pregnancy with cholestasis, please reach out if you need any support or just want to ask me anything. I will answer all your questions as best I can. You are not alone!
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