Cholestasis… pronounced kō-lə-ˈstā-səs. It just SOUNDS awful. And it is. The itching …. oh the ITCHING! And it’s worse on the palms of your hands and the bottoms of your feet. You see, you itch because of your blood, not your skin, so no amount of itching will relieve it. Oatmeal baths, lotions, and even anti-itching medications — useless and the medication can even be harmful so don’t do it. If you’ve ever experienced it you know I could go on and on about it and STILL not do it justice.
For me, it reared its ugly head about 38 weeks and hit like a freight train. I remember so vividly being up at 2 am, itching, crying, and Googling and more crying. And the more I Googled the more it seemed likely that I had this scary-sounding condition called Intrahepatic Cholestasis of Pregnancy. And sure enough, my liver levels were tested and it was confirmed.
While Cholestasis is rare, I still run into people now and then that have had it. They say 1 or 2 out of 1,000 pregnancies will be diagnosed. Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder and the term “cholestasis” refers to any condition that impairs the flow of bile, which is a digestive fluid, from the liver. While it can be seen as early as 8 weeks of pregnancy, it is much more common to appear in the third trimester. This is due to hormone concentrations being higher. From the site itchymoms.com it says:
Women carrying multiples, women who have had IVF treatment also appear to have a higher risk and those who have had previous liver damage or issues may be more likely to develop. The incidence of ICP also shows a striking geographical pattern, with a higher prevalence in Scandinavia and South America specifically Chile where the reported prevalence is as high as 15.6%. Mothers and sisters of patients are also at higher risk of developing the condition, proving that there is a definite genetic predisposition.
Standard protocol is to do an induction or scheduled cesarean at 36 or 37 weeks. This was a far cry from the homebirth I was planning at the time. I had also had a low-lying placenta that was completely covering my cervix until about 35/36 weeks and was on bedrest for 8 weeks during this pregnancy to boot.
Instead of automatically transferring my care, my amazing midwives recommended an herbal regimen. I started taking milk thistle and dandelion leaf religiously. I am not, by nature, a super-consistent person (just look at my pattern of when I publish blog posts) but you better bet I was meticulous with these simple herbs. I got the milk thistle in a tincture form and we bought some straight-up organic dandelion leaves at the health food store.
I couldn’t stand the taste of the leaves themselves… the more I ate the more bitter and awful they became. So we would chop up and prepare two separate smoothies for me about every other day for weeks so that I could take the tinctures with regularity, and without gagging them down.
We tested my liver levels a week later. My midwives said that if we could at least keep the levels the same and they didn’t rise, that we could continue with plans for a homebirth. Otherwise we would be transferring care and doing a medical induction at the hospital. Undesirable, but I wouldn’t have hesitated should it be necessary.
As high as 15% of pregnancies with Cholestasis that go untreated result in a stillbirth. It is a fairly irritating condition for the mother, but can be fatal to the baby. And I was well aware of that. This is not something to mess around with or treat lightly.
It also gave me a rush of terror and gratitude since I was fairly certain I had this condition when I was pregnant with my first, but the itching wasn’t as bad and I never thought to tell my OB that I was “really itchy.” I just chalked it up to being pregnant in a dry climate in the winter time. But I would itch my feet so bad in my sleep that I would bleed. I had perpetual scabs on the tops of my feet and thought I would have permanent scarring from them it was so bad. I even got to the point I was wearing socks on my hands at night to prevent me from itching. My doctor had no idea, though because in the U.S. you see your OB for only an average of 6 minutes for a prenatal. Hardly enough time for them to pick up on and ask about something like severe itching, that’s usually worse at night.
So back to waiting for the results… they came back and not only did they not increase, they went DOWN into “normal” levels!! It was a miracle!! We kept a really close eye on everything and I stayed extremely consistent with the herbal regimen that my midwives had me on and just continued with the original plan of staying pregnant until the baby decides to come.
With my first, I went to 42 weeks and 2 days so we knew it was a strong possibility that I would go past 42 weeks. In Colorado, where I gave birth to my first 3 children, you can have a homebirth after 42 weeks if you have an OBs “green light” as I like to call it. I saw the amazing Dr. Johnny Johnson. He said I was very healthy overall and he had no problem with me having a homebirth. I did have my membranes stripped at that appointment and had the same thing done at 42 weeks with my first son.
The woman who did the ultrasound told me that the machine didn’t measure above 9 lbs 6 oz and she was confident that my son was larger than that, but couldn’t tell how much larger. She offered for us to be induced at the hospital in case I wanted helped with that. She was very respectful and polite, and I replied that I could push out a 10 lb baby at home and that I would be just fine. They were all very supportive and sent me on my way with my stamp of approval.
I went into labor that night and gave birth that night at about 2:30 in the morning after three and a half hours labor that was virtually pain-free and what I would call perfection. Intense and powerful, but perfection nonetheless. I was 42 weeks and 3 days when I delivered and he was 9 lbs 15 oz of absolute perfection. I called the doctor’s office the next day to tell the ultrasound tech how big he was and that I did it! His birth story and video montage make me cry every time I watch it. He is just so amazing to me.
But my journey of Cholestasis didn’t end with that one pregnancy. It is very common and expected to repeat with subsequent pregnancies and I was pregnant again just 8 months after giving birth. I was, of course, highly concerned that the itching would crop up again and I would have to go through the entire process all over again. Just because it worked out one time doesn’t mean that this next time it wouldn’t have been more severe of a case.
So I started taking the milk thistle right from the first trimester. Then in the third trimester I jumped the dose and also added the dandelion leaf, both in capsule form this time. I was taking about 4-6 capsules spread out over the day, every day, in the first trimester and then about 12 per day in the third. And like before, I was highly consistent with my dosing and had a wonderful midwife again that was a hospital based CNM that monitored my progress and condition. At the different times we checked my liver levels I was normal and never was diagnosed with Cholestasis with that pregnancy. I have high-risk pregnancies due to the Cholestasis, but there is very little that is a direct risk to the labor and birth process from it, especially with my levels being in the normal range both times. This time I even went to 43 weeks at 4 days and had him at home, unassisted. His birth story is so tender to me and I’m so glad I wrote it up right away.
Please note: Do NOT attempt to self-treat or diagnosis this condition. As I said earlier, it can be very serious and may not be obvious how serious it is until it is too late. I am not one to motivate by fear, in fact I do all I can to not do anything out of fear, but I want to be very clear that this is a serious medication condition and requires care by a physician or qualified midwife to handle it.
I plan to always watch things with every pregnancy I have in the future as well but have also been trying to love and support my liver in between pregnancies. I also have come to know that Cholestasis is a condition that highly involves the gallbladder and ties in with this post of a gallbladder attack I had just last year.
What has YOUR experience been with Cholestasis? I would love to hear about it!