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My Experience with Obstetric Cholestasis in Pregnancy

by Robyn (@l_i_t_t_l_e__a)

Robyn had an anxiety fuelled, high-risk pregnancy following recurrent miscarriage. She suffered with Hyperemesis Gravidarum (HG) and was then diagnosed with Obstetric Cholestasis, a pregnancy complication that affects the liver. All this, during an isolating pandemic which meant each hospital visit was faced alone. In this piece, she shares her Obstetric Cholestasis story in the hope that it might help to raise awareness of this little known condition and make other mums feel less alone. Robyn is the founder of Little A & Co, a mother-daughter duo small business hand making gorgeous (and very effective) terry towelling dribble bibs.

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Obstetric Cholestasis story
Obstetric Cholestasis story | Credit: @robyn_a_cb

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It was December 2019 and we had recently returned from almost a month away in Australia. A trip that saved us, in so many ways, after multiple miscarriages and the emotional drain that struggling for a baby can bring. Little did we know, it had also brought us a new pregnancy and a whole heap of hope.  

Our previous losses isn’t what this story is about, but I feel it gives some insight and perspective into how anxious I already felt to be pregnant again. I also feel a compelling need, desire and responsibility to talk about it. When we had a missed miscarriage the year before, I felt so alone.

By January 2020, a month into this new pregnancy,  I was suffering with Hyperemesis Gravidarum (HG); severe nausea and sickness in pregnancy. This condition is so debilitating and isolating. Something that intensified greatly just a few months later when suddenly the whole country was plunged into its first national lockdown.

I work in healthcare but before my pregnancy I had never even heard of Obstetric Cholestasis. I had a friend who was about 18 weeks ahead of me in her own pregnancy and she had just been diagnosed with OC, so I became aware of the condition and its symptoms too. As the name suggests, Obstetric Cholestasis is a condition specific to pregnancy and resolves once the baby is delivered. It causes the mothers liver to leak bile acids into the bloodstream, that in a normally functioning liver would otherwise have been broken down.

For the mother, the risk and impact is low. It doesn’t cause much damage but results in intense itching (usually, however less so in my case) of the palms of the hands and soles of the feet. However, for the unborn baby the high concentration of acid in the mothers blood can cross the placenta and increase the risk of stillbirth. Thus, managing and monitoring the condition is essential.

I hadn’t experienced the usual Obstetric Cholestasis symptom of itchy palms and soles of the feet, but I had been experiencing itchy arms and lower legs, particularly at night. Initially I put this down to the spring heat wave. However, due to my friends’ diagnosis, I mentioned it to a community midwife. She was quickly dismissive, saying it really is specifically the palms and soles of the feet, but then added to keep an eye on it too. Something just didn’t feel right. At a visit to the day assessment unit  (DAU) at 30 weeks (hello anterior placenta, severe anxiety and doubt over foetal movements) I mentioned the itching again to a different midwife who promptly requested a blood test.  

Credit: @robyn_a_cb

The first set of bloods showed my bile acid levels were borderline for the condition, I was to return in a week for repeat bloods. 5 days later, I went back to the DAU because the itching had moved and increased in intensity; now it was severe and on my palms and the soles of my feet. Looking back, it’s quite hard to explain the intensity of the itching. I would be woken by it  in the middle of the night, getting out of bed to frantically rub my feet back and forth on the carpet. I didn’t even care about carpet burns in comparison to the itching.

This time, my bile acid levels had increased quite significantly and the blood test confirmed I had Obstetric Cholestasis. My pregnancy was immediately labelled as ‘high risk’ and my care was transferred from the community midwives to a consultant. 

I started on medications, though they’re known to not be entirely effective. I had weekly blood tests and bi-weekly scans and I spent multiple nights in triage hooked up to the CTG machine for increasingly frequent reduced movements. My husband patiently waited alone outside in the car thanks to pandemic protocols. The anxiety and fear, and then being forced to face this all alone, was crippling. 

To cut a long story short, the frequency of my blood tests was increased until one showed sky high levels of bile acid (the consultant told me it was the highest she’d seen, which was not particularly helpful to hear!) It was decided that an induction at 37 weeks was the safest course of action. I wasn’t worried about the induction itself but the thought of having to go through it alone, at least at the start, terrified me.

This story has a happy ending: my baby boy was born, healthy, in summer 2020 with my husband present and I’m so grateful for this outcome. I’m still processing the trauma that I felt from my Obstetric Cholestasis story, from experiencing a high risk pregnancy during a pandemic, and from my missed miscarriage.

If you too are experiencing or having experienced Obstetric Cholestasis or a high risk, anxiety-heavy pregnancy, please know you are not alone. Please do ask for help. And, finally, if you experience itching of your palms, soles of your feet or even on your arms and legs, during pregnancy, please, please tell your midwife and ask about Obstetric Cholestasis.

Support:

ICP Support Charity (intrahepatic cholestasis of pregnancy)

READ NEXT: How to Have a Positive Birth Experience, Even When Your Pregnancy is High Risk