This is a post about pregnancy and birth- from a mom’s perspective. If you’re not down with that, leave now! Quick!
My pregnancy with Pippin was going extremely well. I was planning a home birth with some lovely midwives. I even got a water birth tub from a friend, thinking maybe water wouldn’t make me want to claw my skin off this time around, we’d see. Pregnancy was boring, and normal, and uneventful.
And then it wasn’t. I started itching. Claw my skin off, Benadryl won’t touch it, horrible itching. So, I texted my midwives. “I’m itching. I was itching all night. It won’t stop.” After a few other questions about things like urine, rashes, and poop- my midwife told me I’d need to have my liver tested. I was in the lab a couple hours later having liver function tests drawn. My midwives gave me some dietary changes to make and a juice recipe to drink daily while we waited for results. I kept thinking that the liver test would come back fine and it’d just be another weird pregnancy symptom. (Because, you know, no two pregnancies can be alike. Each kid has to throw in their own twist on things in there.)
My liver function test came back bad. Not horrible, but my AST was at the high end of normal and my ALT was double what would have been considered normal. 33 weeks pregnant, zero history of cholestasis in myself or my family, no multiples, no risk factors at all for this. But, we were testing anyway. They ordered bile acids and I went ahead and set up an appointment with a perinatologist for a biophysical profile, non-stress test, and consult. I took to the interwebz, trying to find out all I could about ICP- treatment, risks, anything I could find. It didn’t take long for me to realize how serious this itching actually was. Not so much for me, for me it was annoying. I’d itch, be tired, maybe some GI pain, but I’d heal once the baby was born. The real risk was to the baby. My baby. The big scary word no mom wants to hear or even contemplate- stillbirth. I was terrified.
I stayed on the diet (no sugar, no caffeine, no fried food, low fat everything, no white flour, nothing processed, lots of greens, lots of water with lemon) and the juice (beet, carrot, apple, grape, grapefruit, lemon, and olive oil). After meeting with the perinatologist, we decided to go ahead and start treatment while waiting on the bile acid results. (Bile acid results take a ridiculously long time to get when you are anxiously awaiting results- about 10 days in my case.) So, I started taking a medication known in short as Urso. And I’d continue weekly biophysical profiles, non-stress tests, and perinatologist consults until we knew I didn’t have it.
I knew from the internet that I was hoping for total bile acids to be less than 10. They finally came back, and they were over 10. 11.9 to be exact. So, a definitive ICP diagnosis, but mild. Second bile acid drawn.
I continued in the care of my home birth midwives and saw the perinatologist weekly for monitoring the baby. My next bile acid result was even higher. Not the news I wanted. It was still mild, but the diet and medication were not exactly lowering the bile acids in my blood. They might have been keeping the ICP mild, I can’t really know.
We knew early delivery would be necessary. An induction would be a possibility. Given that I am a VBAC (though this would be my fourth) and all the other risks associated with ICP, I decided to transfer to a hospital based midwifery group. The transfer, though it was at almost 36 weeks, was seamless, thanks to the back up care provided by the perinatologist. (The hospital based midwifery group works under the perinatologist.) My home birth midwives were supportive of me still trying to have Pippin at home, the perinatologist was comfortable backing me in a home birth, it really came down to my comfort level. And with everything being so up in the air, I just needed one plan for simplicity and on plan that covered all my what-ifs.
At 36 weeks, I started getting nervous. What if my bile acids spike? I wouldn’t know in time to do anything. (Since the blasted test takes 10 days.) So, at my weekly BPP/NST at 36 weeks 3 days, I talked to the perinatologist about my fears. I knew I had a live baby that day, could we say the same in a week? With the risks known to start rising dramatically in week 37, I just didn’t want to risk it. We ended up doing an amniocentesis that day to assess lung maturity. The plan was to begin a low, slow induction the following day in the hospital if his lungs were mature. If the amnio did not come back showing lung maturity, we’d induce at 37 weeks.
Tuesday, the 21st, the amnio results came back showing lung maturity. I went into the hospital that afternoon to begin the slow induction process. I was soft, anterior, not at all dilated. About 50% effaced. And baby at -2. That put my bishop score at about a 6. (Which really isn’t great.) Since I wasn’t dilated at all, we started the induction with cervadil. It states in for 12 hours and gets the cervix ready for the actual induction. About a quarter ’til 5 on Tuesday evening, the Cervadil was inserted and the induction had officially begun.
I kind of expected to have a baby 4 hours after that. I didn’t. I thought, “This is my sixth, it won’t take that long to pop this baby out.” Well, those 4 hours passed, and I decided it was time to sleep. Mentally, I thought it was over. I thought that there was no way this induction would work and I’d have a c-section the next day. Some of you know how traumatic my first c-section was for me and know how hard I fought for my first VBAC. So it will come as a shock when I say that I was okay with the thought of another c-section. I thought, “My baby will be out. And he’ll be alive. And I’ll heal.” I also knew that a c-section would be different this time around. They’d let me hold the baby in the OR. They’d be more respectful. So, that did help, but my main thought was simply that my baby would be alive.
The next morning, the cervadil was removed. I was sure it had done absolutely nothing. The nurse told me they could do it again for another 12 hours if I wasn’t dilated enough to start the next stage of induction. I asked how dilated did I need to be at this point? She said a 2. I was sure I wasn’t that dilated. Surprisingly, I was 3.5cm dilated, more effaced, baby was at 0 station now. On to step 2. After breakfast.
I took a two hour breakfast break. During this time, The Pastor learned that our house caught on fire. The relatively new oven in our kitchen went up in flames. My mother-in-law was with the children and she got them out and called 911. Police, fire trucks, and the Red Cross came to the delight of my boys. Our church family jumped in helping my mother-in-law entertain the kids, feed the kids, and clean up the house. It was just the kitchen. Just one side of the kitchen. But during this break in my induction, The Pastor is on the phone with the landlord, the fire marshall, his mother, and the church lay leader. Poor guy. And he kept all this from me. I didn’t have a clue anything was going on. I knew The Pastor had a head ache, but assumed it was from sleeping on a bench.
9 a.m.- 16 hours into the induction- pitocin is started. When they day low and slow, they mean it. I was still pretty sure none of this would work. I was pretty scared of pitocin, since I have heard plenty of stories about laboring with pit- how painful it is compared to natural birth. I didn’t have an epidural or any pain meds. I figured it’d probably get to that point, but why tie myself to the bed prematurely? Pitocin was started on 1. You read that right. 1. This was definitely going to be slow.
Pitocin a 1. I’d have one contraction every time the piton would drip, which wasn’t often. Pitocin went up to 2. Then 3. Then 4. Then 5. Then 6. It is about this point I really freak out. Here we are, after noon, and this Pitocin isn’t doing a thing! How long am I going to keep at this before someone realizes it just isn’t going to work? I’m freaking out. This is all going to end in me being cut, I just know it. Nothing is happening. Nothing. **I should note that I had friends messaging me telling me things were going well. I also had The Pastor telling me all was well. My freaking out was pretty controlled, but I do think those around me knew where my head was.**
I freak out a little on the midwife. She laughs a little and asks me what I want to do. “I want you to check me! These contractions aren’t even uncomfortable. Clearly nothing is working! My body just isn’t going to work like this.” She checks me. I’m 5cm dilated. She says, “See. It is working.” “It is working far too slow.” is my reply. They bump the pitocin up to 7 and assure me this is normal and usual and my body is working. I’ll admit, while I should have been happy that I was more dilated- I wanted it to be more. 5 was only 2cm more than I was at 9am. This low and slow was never going to actually get the baby out. On the plus side, at least it didn’t hurt.
My doula had stopped in and popped in to say she was stepping out again until things picked up a bit. (I do not like to be watched.) I was starting to feel a bit more uncomfortable, as in, the contractions were starting to get noticeable, but I let her go anyway. Of course, I quickly realized that was a mistake and had The Pastor calling her back a few minutes later. After applying some peppermint essential oil to my lower back because I am pretty sure baby is posterior.
Things went from oh-this-is-noticeable to whoa-this-sucks really quickly. It always does for me and it always takes me by surprise. I knew pretty quickly I was hitting transition. I knew I was just checked less than an hour before and was “only” 5cm. I knew the nurse had just 15 minutes before bumped the pitocin up to 8 because I was clearly not in “active labor” yet. But suddenly, I need my hips squeezed, I need to go to the bathroom, I’m hot, I’m going to puke, I decide I don’t want a sixth baby after all. You know, all those things that happen right before you start to push. Baby had definitely turned around and was ROA and ready.
The nurse wants to check me. I assure her a baby is coming out without her getting involved in my business, if you know what I mean. She keeps asking. I start pushing. My doula is explaining to her that I have a “sound” in my voice when I am complete. The next contraction, the doula says, “That sound.” I push a little. My water breaks all over the nurse. She leaves to change clothes right that second. Surely she’s had amniotic fluid in her socks before. The Pastor and my doula are keeping the cool rags coming, and the peppermint oil and orange oil to help with the nausea.
Less that 20 minutes of pushing (and complaining- I complain a lot while I push) later and we have a baby. I could have sworn he was crowning for half an hour, but that would be impossible given the times. But I swear I thought his head was just never coming out. But unlike the brother before him, his body slid out easily. No pushing past shoulders or hips. Just push out a head and the rest basically fell out. When I first started pushing, the midwife told me he had hair! (As opposed to the brother before him that was born with zero hair and still doesn’t have much to speak of.)
They put him on my chest and I got to smell and cuddle him right away. The Pastor cut the cord after it stopped pulsing. Those that know him will find this part humorous. The midwife asked if he wanted to cut the cord. He said, “As long as I can really cut it and it not be some ceremonial not really cutting it kind of thing.” (Our first baby, the doctor cut the cord, then had him cut it shorter, which kind of irritated him and he is still clearly irritated by it.)
After nursing for about an hour and 20 minutes, they weighed and measured him. 7 lbs. 2 oz. 18.5 inches. They also gave him a vitamin K shot. (This is important for ICP babies. They have increased risk of neonatal hemorrhage.) And then he was diapered and clothed and handed back to me. He stayed with me the entire time we were in the hospital. (You may or may not remember my previous horror stories with postpartum in a hospital, which lead me to home birth in the first place.) He was perfectly healthy. On day 3, his bill levels were borderline, and knowing ICP babies have a higher risk of jaundice, I decided to go ahead and treat him. (The hospital pediatrician left it entirely up to me, which was completely new that a pediatrician thought I was competent.) So, we stayed 12 extra hours in the hospital for him to get some phototherapy. (His levels went from 12 to 7 in those 12 hours.)
I am happy with my choices. I don’t feel bad about “loosing” the home birth plan. Flexibility is a necessary part of the home birth process. Birth is about choosing the best providers and location to fit your needs. When your needs change, plans might change. And that is really okay. My hospital induction, while not being something I would have ever wished for, wasn’t plan B. It was just the plan at that point. I don’t regret that for a second. And I don’t think it was second best. It was what we needed. And all in all, I am glad that the induction worked. It turns out, 7 hours of pitocin isn’t so horrible. It was enough time for my body to adjust. My labor unfolded as my labors usually unfold. I never did feel the need for pain medication or an epidural. The pitocin contractions felt the same to me as natural contractions. I should point out that low and slow on pitocin isn’t very common. So, I do understand that my expectations of pitocin were likely based on people who had much more medication than I did. But if 8 units of Pitocin works, I’ll definitely take it over the body slam that some doctors give.
As for my liver, I couldn’t take meds after Pippin was born. I had Percocet right after he was born, and then Motrin several hours later, and it brought the itching back. So, I opted to not take anything. Instead, I used clary sage and lavender essential oil for the afterbirth pains. It did not make them go away, but it did take the edge off. And I figured I’d rather be cramping than itching like crazy trying to hold and nurse a baby. I’m still taking it easy on the diet, trying to give my liver a chance to heal, and it should be healed over the next several weeks. As to if this will recur, I don’t know. ICP has a very high recurrence rate. But it is usually genetic and mine isn’t. So, we don’t really know. It is possible this was all triggered by my getting rotovirus at 31/32 weeks pregnant. But we’re completely unsure about if it would recur or not.
For more information about ICP, check out this website.