I Had Cholestasis While Pregnant, And This Is What It's Like
In 2013, I was pregnant for the first time. Our pregnancy was a surprise, but one we were happy about. We had just gotten married and found out that we were expecting the day we returned home from our honeymoon.
From that moment forward, it was smooth sailing. I suffered the usual nausea in my first trimester but otherwise, I got off pretty easy. Once my second trimester rolled through, I was feeling fantastic. I had so much energy, I felt like my bump looked cute and loved feeling my daughter’s movements in my belly. Life couldn’t be better.
I had heard from friends that I should enjoy that time, since once you enter the third trimester you start to be uncomfortable, lose sleep, and have to pee all the time. The way I saw it, those rougher times were like baby boot camp, preparing you to lose some sleep. I was optimistic.
I started preparing a birth plan. Water birth, NO DRUGS, birthing playlist. My birth was going to be beautiful! Incredible! NO hospital interventions!! I was a strong woman, after all. Pregnancy was easy. I was eager to bring my daughter into the world my way.
As I entered my third trimester, I still felt good. I was peeing more and I started noticing that my pee looked darker than usual. I didn’t think much of it. I drank more water. No matter how much I drank, it still seemed a bit darker (maybe more orange?) than it used to be.
Around 33 weeks, I began to notice that my feet would start to itch a lot when I’d head up for bed. I figured that my feet were dry, or that maybe the added weight was making the skin on my feet tingly since they weren’t used to it. By that point, I’d gained close to 40 pounds. I bought some nice lotion and started to take better care of my feet.
Pregnancy is weird, I kept telling myself.
I felt like all I was doing was complaining.
Every night, I’d itch again and every night, it was worse. Soon, my palms began to itch at night too. My pee looked like orange gatorade — it frightened me, but I kept it to myself.
Within a week, bedtime would roll around and my hands and feet would begin to itch — so badly that I couldn’t sleep at night. I would rub my feet on my blankets and cry. When that wasn’t enough, I’d move downstairs and scape my feet on our sofa cover. It always felt cold and had little bumps of fabric that really did the trick, at least for a while. This itch was so real that many nights I stood on the cold tile of our kitchen for relief, sobbing, contemplating scratching my feet with a cheese grater.
I called my OBGYN on-call line one night around 3 or 4 a.m. in desperation. The doctor who called me back seemed unfazed when I told her what was happening.
“You’re pregnant,” she said. “You’re supposed to be itchy.”
I cried to her, “THIS ISN’T NORMAL! It’s my hands and feet, not my belly!”
She suggested that I buy this lotion called Sarna that people use for eczema. It didn’t do a damn thing.
My regular OB would be unavailable until closer to my due date. She was on maternity leave until week 36 of my pregnancy. I wished so badly that she were there. I had chosen her as our doctor for a reason — in my and many other’s eyes, she was the best. She would have listened to me — she always humored every issue I ever had with compassion and care.
The following night, the itching continued. My husband became super worried and called the on-call line himself. He hated seeing me suffer. He was firm with the doctor and told her that something was not right.
The on-call doctor took him much more seriously than me (hello, misogyny) and I was able to come in the following day.
Still, nothing. She drew some blood and sent me home.
Week 35, the itching continued. My pee was still orange and now, my poop was white.
I was so freaked out. Every night I applied the Sarna, knowing it wouldn’t work and I had also started bringing ice packs into bed to lay my feet on so that I could sleep.
Every day I dreaded nighttime. Would I be able to sleep at all? Every night I cried. The fear of itching and the itching itself wasn’t doing me any favors. It was affecting my sanity. I felt depressed, afraid and out of control. I worried about my baby. Would all of my suffering and sadness affect her?
Week 36, to the day, my usual OB called me. I was so relieved. Finally, someone who would take me seriously. She had heard from her covering doctor what was going on and she knew what was happening and that it was, in fact, a very big deal. She told me that I had cholestasis of pregnancy and no matter what, DO NOT GOOGLE IT.
I googled it.
Cholestasis of pregnancy, or ICP, affects 1 in 1000 women. It is a condition in which the normal flow of bile is affected by the increased amounts of pregnancy hormones. Aside from making the mother miserable, the condition carries no risk for her and resolves after delivery, but the baby is not safe. After week 37, the risk of stillbirth increases steadily and induction is recommended.
HO. LY. SHIT.
I knew something wasn’t right! I was furious at that other doctor, especially for making me feel stupid, or like I was a whiny baby who couldn’t handle pregnancy.
I went into the office that day and had blood work to check on my liver enzymes and another to check my bile salts. Even without the blood test results, my OB was positive about what was going on. I had all of the classic symptoms — the itching, the orange pee and the white stool — so she took action. I finally felt cared for. I saw a light at the end of the tunnel.
She sent me for an NST (non-stress test) and had me schedule to do them every 2 days. I was sent home with a prescription for a medicine called Ursodiol, which would help me excrete the bile acids and help to reduce the itching. I was sent home, again, with the warning to stay off of google.
I didn’t. I was torturing myself willingly every night. I was so, so afraid. I read so many horror stories about women who lost their babies. Women who had no idea of the severity of their illness until after their babies live’s were lost. Woman, who if only they had found out sooner, could have saved their babies and now were helping to spread what they know now to other women who may be suffering in silence, thinking what they’re going through is normal.
The results took a week to come back. Now, we were entering week 37. I knew that this was the time that my baby could die and that every following day, my bile salt levels would double. I was so afraid. At this point, I don’t know what was worse — the fear, or the itching. Looking back, I think it was the itching. It was making me feel insane, in a very literal way.
That day, I went in for what would be my last NST. My blood tests had returned and she was right, all of my levels were dangerously elevated. With these test results in hand, we were now able to schedule my induction for 2 days later, when my OB would be available to deliver my baby. I would be 37.5 weeks.
I remember laying in the hospital getting ready for my induction to begin, looking at the nurse and crying — asking her if this would help me stop itching. I wasn’t even thinking about my baby at that point. I was barely able to live in my own skin. When I remember this, it makes me so sad. If only someone could have helped me sooner.
Baby Nori was born 24 hours after my induction began. Both she and I developed an infection and had to stay at the hospital longer than expected. My placenta was in terrible shape and broke into a million pieces. To think, I had planned to encapsulate my placenta and eat it. When I asked my doctor if we could still save it, she looked at me like I was bonkers, but also with empathy and told me that would be a terrible idea.
I wouldn’t say that my birth was traumatic, but it definitely wasn’t the all natural, water birth that I had planned. I took all of the drugs and watched Naked and Afraid while I labored — NOT what I had in mind! But, none of that mattered. My baby was safe in my arms.
With my second pregnancy, we anticipated that I would get the condition again and I did. We tested my bile salts every 2 weeks in my 3rd trimester and, at 35 weeks, I began Ursodiol treatment and scheduled my induction. I was itchy, but not crying every night. I knew all the tricks and brought ice packs to my bed from the start.
Mateo was born healthy and neither of us developed an infection.
I don’t want to get pregnant again, solely because of cholestasis — I wouldn’t wish it upon anyone — but the two times I suffered through it were worth it, because now I have my two beautiful children.
If you’re pregnant and have symptoms that don’t seem normal, seek help. If no one listens to you, KEEP BOTHERING THEM! There is good information at Itchy Moms and also ICP Care that you can show your doctor if you think you’ve developed ICP.
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