Obstetric Cholestasis

Well I've really outdone myself this time.

A couple of weeks back I remember remarking to my husband that he was going to have to shave my legs for me (I stopped being able to reach them a few months ago) because they were getting a bit itchy. I thought nothing of it, in fact I did somehow manage to shave them myself.

A few nights later I found myself awake half the night scratching madly at various parts of my body, particularly my wrists and ankles. I was certain I'd been attacked by insects. In fact earlier that day I had declared war on a spider nest and I wondered if I just felt itchy in my head. The next day I woke up and washed the sheets, just to make sure.

However, the itch didn't go away. It hovered incessantly for the rest of the weekend, and I was driven to comment about it on a pregnancy forum where one of the other women remarked that I should talk to my obstetrician. She mentioned something about OC. A quick preliminary search on the internet suggested it was a rare, bothersome condition of the liver in pregnancy but was nothing to worry about.

We were about to head away for a few days, and I was tempted to deal with it when I got back, but something got the better of me and I called my obstetrician first thing Monday morning. He said I needed to come in and I saw him that afternoon. He told me I needed blood tests, which I agreed to go first thing Tuesday morning, just before we left for our holiday. 2 tests were needed, a more immediate liver enzyme test and a bile acid test that takes a week because there are only a few pathology labs in Australia that can process the test.

During the holiday I called for the results of the liver test. He told me my liver enzymes were abnormal. I didn't have proper web access, but I'd been itching and scratching like a crazy person this entire time. The itching had taken over my entire body, particularly at night, attacking the soles of my feet and palms of my hands, causing me agony between my toes, in my ears, nostrils and even my private parts. I was going out of my mind, so at the first available opportunity I decided to do a bit more research into the condition of obstetric cholestasis.

I soon learned that it's not just a bit of an itchy bother, but a dangerous condition of pregnancy leading to a 15% increase chance of stillbirth (increasing steadily after week 37). The normal course of action, therefore, being to induce labour at 37 or 38 weeks, depending on the severity of the condition. Reading this I broke down. I have never cried like that before. It was truly as if the weight of the entire universe crashed down on me. I buried my head on my husband's shoulder and wailed.

As I waited out the rest of the holiday and for the bile acid test results to return, I went through every stage of grief. Grieving for the loss of control over the pregnancy, grieving for the risk to my unborn child, grieving for my inability to provide a safe place for my baby to grow. Denial, anger, depression, bargaining (or fighting in my case), and finally acceptance. Acceptance that I needed to make sure Lilac enters the world safely and nothing else matters.

Finally the next Monday rolled around. I called the obstetrician and he confirmed the bile acids test showed what I already knew, that I had obstetric cholestasis. I went in to see him immediately and I am now under weekly surveillance with more ultrasounds, blood tests and CTG monitoring ahead of me. He said we would induce at 38 weeks unless the condition deteriorates and gave me a prescription for UDCA (ursodeoxycholic acid) the only possible treatment (not cure) for this condition which resolves itself only upon the birth (or death) of the baby.

Having developed pre-eclampsia late in my first pregnancy with Jude, I am a little overwhelmed and even shocked to learn I have this condition. I can not believe it is happening, but it is and I have to deal with it to the best of my ability. Every time Lilac sleeps I sit anxiously waiting for her to wake up and give me a good, reassuring kick. The doctor said 38 weeks, but I am so anxious for her safety it may end up being me who asks for an induction at 37 weeks. This is a big leap from me wanting a natural water birth and having decided early that I would never try to bring on labour, I'd let her sit in there as long as she liked. But with her life on the line, I'm not willing to take a single chance.