Sawyer’s birth story: cholestasis causes early induction

It’s Birth Story week. If you’re new here, my third baby Sawyer was born in 2011. Whereas Holden’s birth was a highly scientific 44-hour ordeal and Milo’s was a quick and easy four-hour walk in the park, Sawyer split the difference at 24 hours and a new kind of medical drama.

The pregnancy had new challenges for me — advanced maternal age, extended diabetes test, half marathon, a cough that lasted my entire party trimester – but I entered my final month of pregnancy healthy and radiant. People were so nice to me. At 34 weeks, I had this awesome series of pictures taken by photographer Brian Smith at the BlogHer conference in my favorite blue dress.

The itching starts
Monday after the conference, I was exhausted. I also noticed that my skin was feeling itchy and my hands were red and puffy. I assumed it was from the extra heat, walking, and flying. I called in a lovely at-home mama masseuse who gave me a chamomile massage and suggested that I drink tea and take it easy.

Soon after drinking the tea, my skin became even more itchy especially my hands and feet. The itching subsided after a few days.

On Friday night, we were on a double date with friends. I remember it was a special night because Karen and Ross told us they were expecting their first baby, so we all headed to a tea shop after dinner for our after-dinner drinks. Again I ordered the chamomile because I thought it was the most mild/gentle tea available. Again, the itchy hands and feet came back. This time, I wondered if there was a connection between the tea and my extremely itchy extremities. It did not subside.

My whole body was itchy but my hands and feet were the worst. I looked like a crazy monkey. On heroine. At night, the feeling was more intense. I wished I had a metal brush to scratch at my palms and soles of my feet.

I had heard that itchy skin was common toward the end of pregnancy but this felt different.

By 35-weeks pregnant, after fervent googling and trolling the babycenter boards, I discovered a condition and asked my doctors to test me for it: obstetric cholestasis.

It takes about a week to get results for the bile acid test. My own favorite OB was on vacation so I met with others in the same practice. The dr. who confirmed my suspicions made it sound very grave while the next dr. I saw made it seem like no big deal. My bile acid levels were tested at 41 (and they said anything over 20 is cause for concern).

Cholestasis is a liver condition that happens to 1 out of 1000 pregnant women. Basically my liver couldn’t breakdown bile acids so they end up in my blood stream causing me to itch all over endlessly 24 hours a day. It has the potential to put the baby at high risk too. Very high risk. Like still birth high risk.

I was given a prescription for Urso and asked to come in for biweekly non-stress tests (fetal monitoring for 30 minutes laying flat on my back) in addition to my weekly appointments around 37 weeks. I took the Urso medication which didn’t seem to help; stopped eating all food with fat in it (which is everything!); and purchased this special anti-itch Sarna lotion. The lotion made my skin feel better, but I couldn’t shake the image that everything I was eating was attacking my baby. Time seemed to be the enemy.

After freaking out on the babycenter birth club boards I learned that bile acid levels over 40 are a strong indication to deliver early. These levels can double overnight and do not seem to be helped by standard anti-stress testing or fetal monitoring.

On some level, I had hoped that I was overreacting. Once my doctor came back from her vacation, she said that we needed to get the baby out before 38 weeks or risk stillbirth. My liver enzymes were attacking the fetus and birth was the only remedy. We chose 37.5 weeks for the induction.

I kept it pretty quiet on the internets and among my real-life friends too but the night before my scheduled induction, I sent out a fleet of “pray for me” emails to the many people in my life who I would want to know if the worst happened.

My induction was scheduled for Holden’s second day of 1st grade while Milo’s preschool was closed for the week. Luckily, my mother was able to come in on short notice. Her main job would be juggling my two boys and keeping them happy and fed.

The morning of the induction.
I was dropped off alone at the hospital to start the process and Alec joined me (by bike) once the morning logistics were sorted.

It was weird being at the hospital but not in labor. I checked in on foursquare. I read my depressing book on the iPad. I was bored. Worried for the baby, but bored.

Alec and I hung out while we waited for labor to begin. He remembers me taking a pill to kick off contractions; I was also hooked up to an IV drip of something. We watched I love you, Man on the iPad. I ate a ton of red Jello and slurped chicken broth. We debated baby names, we were down to two names that we both liked. We walked the halls together with me clutching my IV stand on wheels.

I heard shrieks and screams from down the hall. The woman had run out of time for her epidural. F that.

Every time a new doctor came on shift, I repeated my fervent interest in having an epidural: Blah blah, third baby, last one came fast. “Oh yes,” the nurses would definitely keep that in mind.

Around midnight, after taking induction meds all day, the doctor told me I wasn’t even in labor and I should be eating real food. What the hell? Seriously, what had I been doing if this wasn’t even labor? I was not pleased. But I did have dinner.

Ultimately, I spent about 12 to 15 hours hooked up to the IV drip of pitocin before anything resembling labor started happening. Contractions and labor pain began in earnest around 3am the next day. I got the epidural in time. I pushed for around 20 minutes. Sawyer was born healthy and strong at 8:18am on Thursday.

We texted our loved ones the details: Baby boy!! 21″ 8#5oz no name yet.

What a big boy! I had feared that he would be tiny or his lungs would be immature because he was coming so early. Neither of those fears came to pass. Instead, he was so swollen from IV fluid that he didn’t regain to his birth weight for abut 4 weeks.

Can you see how puffed out all his little skin is? So many rolls.

My recovery was all about the swelling. The sheer size of my feet, ankles, calves, and all the way up past my knees due to pregnancy water retention capped off with IV fluids from my birth had me convinced I was in kidney failure. I nearly checked myself into the ER. Cankles past my knees, people!!

I never found out if drinking the chamomile tea had anything to do with my liver problems but I haven’t touched it in over a year.

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RookieMoms co-founder & mom to 3 boys in Berkeley, CA. Bossy big sister and project manager turned blogger helping moms enjoy their first years of motherhood. Find me on my other site on 510families.com or hiding in my minivan eating dark chocolate.

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