{The Dreaded Itch}

In my very first blog post I mentioned the dreaded itch, and I thought I would explain it all in a bit more detail and tell my labour stories...

Obstetric cholestasis (OC) is an uncommon liver condition that develops in pregnancy.  The most noticeable symptom is itching (the dreaded itch!!).  Itching in pregnancy is normal, especially around your bump as the skin stretches, however it may be a symptom of OC. The itch in OC is typically more intense on the arms, legs, palms of hands and soles of feet and it tends to be worse at night disturbing sleep. The symptoms should disappear once your baby is born.

I had begun itching in my first pregnancy around 28 weeks and initially thought nothing of it. It persisted however so I called the maternity ward to speak to a midwife about my symptoms and they took me in for some blood tests.  The tests all came back normal, and the trace of my baby was also normal, so I was sent away to be followed up at a later date (I was being monitored more closely anyway because I have Crohn's Disease and continued to take azathioprine during both pregnancies). I saw my obstetrician at 32 weeks and I was continuing to complain of itching but the blood results continued to be normal... At 33 weeks I saw my IBD nurse for a routine check, and she also took blood samples for testing. I went home from work early that day as I was exhausted and my bump was feeling heavy. That afternoon the IBD nurse called to say that my liver function tests (LFTs) were slightly raised but not clinically significant and that it was nothing to be concerned over. That night before I went to bed I thought I had had a show (basically a mucous plug that keeps the cervix closed - a bit grim!). I texted a few of my mum friends but only one of them had had a show and her advice was to call the maternity ward, which I did. As I wasn't bleeding or in pain, the maternity unit didn't need to see me and I was told to rest and get in touch if anything changed. The next morning (33+1) I woke up at 6am having what I thought was a contraction!? I lay in bed and had 3 contractions, 10 minutes apart before going to wake my husband who was sleeping next door in the guest bedroom (my itching all night was driving him mad!). I called the hospital who advised me to take some paracetamol and get back in touch if things progressed any. I was really relaxed at this point and not worried at all.  I lay on the sofa, still in my pyjamas, and watched TV, keeping a note of contractions on a piece of paper. My husband went off to work and I said I'd keep him posted. However, I then got a call from my GP to find out if I could visit the practice for a repeat blood test as my LFTs were abnormal. I told her that I could if she wanted me to, but that I thought I was having contractions and that I'd been in touch with the hospital already. She was concerned that I was told to stay at home given my medical history and said she'd call the hospital and get back to me.... Next thing I get a call from my GP again to say that an ambulance is on it's way to collect me. She also said that if it's preterm labour then it's likely to be quick and to tell my husband not to dilly dally. Panic stations.... I wasn't dressed.... I didn't have a bag packed.... my hubby was an hour away at work! I called hubby who then jumped in the car and headed back to Glasgow. I threw on some leggings and a black maternity dress and then grabbed a bag and started flinging in items. I packed slippers but no pyjamas... I packed my make-up but no toothbrush!?! Next thing there is an ambulance at my house and two paramedics come to the door with a canister of gas & air. I don't know what/who they were expecting but I think they were surprised to see me, with my petite bump... I was escorted to the ambulance (my first trip in an ambulance too!) and was whisked to the hospital. On arrival I was taken to the receiving ward, was strapped up to some monitors and waited for hubby to arrive. Hubby arrived thankfully and a doctor gave me an internal exam (which hurt a bit, but turns out it was painfully because I was having a contraction at the same time!). I wasn't dilating yet, and the midwife kept telling me that I wasn't in labour and I'd probably end up going home that afternoon. I was also taken for a scan to check if my waters had broken, but they hadn't. 

It all started to get a bit more painful and I was trying my best to breathe through the contractions. You've got to remember that at this point I hadn't had any antenatal classes - they were due to start in 2 weeks time! I had however been going to pregnancy yoga so I knew a little bit about labour, what to expect and how to breathe. In addition to this I had a midwife who kept telling me I wasn't in labour!!! I was given some morphine but it made me feel really sick and didn't help with the pain. The next wee while is a bit of a blur, but I remember clinging onto the bed, breathing as best as I could and trying to keep calm. I managed to get hubby to grab the midwife as I was really starting to struggle and I wanted to see the doctor. Finally the doctor arrived and did another internal and I was 8cm dilated. They then piped up that they had better get me to the labour suite and I was given some gas & air. It was all relatively quick after that... the paediatricians joined us in the labour suite and after 30 minutes my son was born weighing 4lbs 14ozs. (The gas & air was mental... it totally distorted my hearing). Thankfully, despite being 7 weeks early, he was fine. I was allowed to have a quick cuddle before he was whisked away to the neonatal ward. I don't think it had sunk in at this point that I'd had a baby!! The midwife then brought me and hubby the best tea & toast ever!!!!! No joke!

5 min after birth!

In the incubator with nasogastric feeding tube

I had repeat blood tests taken during labour and the showed that my LFTs were abnormal. Combined with the itching symptoms and spontaneous preterm labour, I was diagnosed with obstetric cholestasis.

This was then a worry for my second pregnancy - there is a high risk of OC developing again in subsequent pregnancies. My obstetrician was keen for me to reach 28 weeks (onset of itching in pregnancy #1) and had said that as long as I made it to this point then the baby would be fine. Well, I made it to 28 weeks with no symptoms (big relief) and it wasn't until 35 weeks that I started to itch. This time round I was given medication to help reduce my symptoms (it didn't really work unfortunately) and I was seen for frequent traces of the baby's heartbeat. The decision was made to induce me at 37 weeks. Similarly to my first labour experience, I progressed very quickly from 2cm to 10cm (within an hour or so!) and was whisked off in a wheelchair backwards by a midwife down to the labour suite, urging me not to push yet! My daughter, who weighed 6lbs 4ozs, was born inside the amniotic sac, so the midwife didn't break my waters and she popped out in a balloon of fluid! It's meant to be good luck...

On the maternity ward

The OC Support group, for women and families affected by obstetric cholestasis, were a great source of information and advice throughout my second pregnancy and they do a lot of work to raise awareness of the condition and also support research into the causes of OC.