So, I’ve been meaning to write this forever- it’s an answer to everyone’s question of, “So why are you being induced at 37 weeks?” or “What do you have again?” or my favorite, asked by Anissa tonight, “Mommy, why does your whole body itch?”
In all my pregnancies (and I’ve actually written about it briefly before here), I’ve had a condition called Intraheptic Cholestasis of Pregnancy, also known as ICP or Cholestasis. This disease only affects me when I am pregnant, and basically, my liver is creating toxins that can be very harmful to the baby. It’s a scary disease with potentially fatal risks to the baby, however the only true cure for it is delivery, hence why they have to induce at 37weeks (or earlier, depending on the severity of your ICP).
What is it?
According to a great resource, ICP Care, “ICP is a group of liver disorders specific to pregnancy which interfere with the flow of bile. Bile is a substance produced by the cells of the liver to aid in digestion of fats. During normal liver function, the bile which is produced is transported out of the cells and into the bile duct by special pumps. During Intrahepatic Cholestasis of Pregnancy, the cells are unable to transport the bile out of the cells normally, which leads to bile acids building up in the blood. Elevated bile acids in the blood are associated with increased risk to the unborn baby.”
Basically, as the doctors have explained it to me, my body is producing toxins that can be harmful to the baby. At some point, he will reach a threshold at which he cannot take any more of the toxins, which is why I am being so closely monitored.
FOR ME: Well, basically, I itch… A LOT. My body is bruised, raw, red, and completely on fire 95% of the day. I am taking a prescription that lowers the levels of my bile acids and sometimes helps with the itching, but it doesn’t work all the time. I rely a lot on lotions, ice packs, rubbing instead of itching, or just flat out losing my mind and crying. You’d think- oh, itching, that’s not too bad. But oh my goodness, I am here to tell you it will literally drive you mad. And the resulting pain from trying to gain some temporary relief is no joke. Really wish it wasn’t inappropriate to show y’all my bod so you could see all my bruises. It’s pathetic.
FOR BABY: Like I mentioned, ICP can lead to spontaneous stillbirth, usually after 37 weeks. For that reason, it is imperative that mamas with ICP are counting kicks and keeping track of movement. Any decrease in movement could mean baby is reaching their threshold.
My Past Pregnancies
Like I said, I did have Cholestasis with both other kids. However this time, it started a lot earlier and is a lot more severe. With Anissa, I knew I had been itchy for weeks but the doctors didn’t think much of it. They told me to try Benadryl or lotion and stop scratching. Cele basically researched all night and found out about Cholestasis. We begged the doctors to check my Bile Acids and sure enough, they were elevated. By that point, I was already 38weeks, so they induced me right away.
With Tino, I think the doctors had learned more and were more well versed in the disease. This time, they said from the beginning that we would induce at 37weeks regardless of if I had it or not, because the repeat risk was high. I didn’t start itching till 34 weeks, but even then, my Bile Acids weren’t elevated until the day I delivered at 37 weeks. So again, I got off easy.
Ohhhhhh, this time. Baby #3 is really doing me in, y’all! With this baby, my itching started around 23 weeks, so they went ahead and started testing my blood weekly. My first draw showed my Bile Acids at 10 (anything 10+ is considered diagnosable) so I was officially diagnosed then and a plan was put into place, which I’ll outline below. And over the past 10 weeks, holy hell, I have been itching insane amounts. If my ICP had been this bad the other two times, I don’t know if I could have kept going! It is truly miserable!
The Care Plan
Because it started so early and has been so severe, my doctors and midwives have put together a care plan, which includes:
- Weekly blood draws (testing AST, ALT, Bile Acids)
- Bi-weekly NSTs and ultrasounds: Mondays and Thursdays I go in, get hooked up to monitors, they track Baby’s heartbeat and activity for 30 mins-1 hour, followed by an ultrasound to check for fluid levels.
- Max dosage of Ursodiol: medication that helps even out Bile Acids and can reduce itching. This keeps baby safe until delivery.
- Monthly visits with Maternal Fetal Medicine specialists, where they do a more in-depth ultrasound
- Early delivery: this is really the only way to “cure” ICP and guarantee baby’s safety. Set for 37 weeks but if ICP is considered severe, they may consider 35 or 36weeks instead.
Right now, I’m almost 34 weeks and my bile acids have been relatively well-kept with the Ursodiol., ranging between 12 – 24, but not yet reaching the “severe” marker of 40. However, my other levels (AST and ALT) have spiked, so my doctor has said that as long as Bile Acids stay under 40, we can continue on the care plan above. If, however, last week’s results come back over 40, we’ll reconsider and possibly consider an earlier induction.
PHEW! I know, I know, this is a lot to take in and I probably still didn’t do a great job of explaining it, but I hope it helps at least a little bit the next time you see my bruised up arms or I look like a junkie having withdrawals. ICP is a pretty cruel condition, guys, and I BEG anyone that has severe itching to please advocate for yourselves and ask your doctor to check you for ICP!
If you have any more questions, I’m happy to answer them! I’m very passionate about this condition and preventing anything negative from happening to any sweet baby.