I had a dreamy nine months of pregnancy with my first daughter. The tenth — that sneaky last month that you don’t realize is included in the 40-week count — was a game-changer.
Around 36 weeks, I noticed itching on my hands and feet, then my belly. I turned to my trusty BFF, Google, who assured me it was my skin stretching or something called PUPPP. I self-diagnosed myself, bought anti-itch lotions and headed off to one of my standard doctor visits.
My doctor was not a worrier, which was my favorite thing about her. Her calm, “I’ve seen it all” nature complemented my own, “OMG IS THIS NORMAL WTF IS GOING ON” perfectly. As usual, she talked me off the ledge. “You don’t have a PUPPP rash. You’re fine. Here’s some hydrocortisone cream.”
I coated myself in cream. The itching got worse. It crept up my chest and down my legs. Then my arms and head began to itch as well. It wasn’t soothed by any remedy and scratching made it worse, but was unavoidable. I looked crazy, constantly trying to relieve this sensation and in turn aggravating it more. I itched from the inside out.
I Googled again — and discovered intrahepatic cholestasis of pregnancy (more commonly known as cholestasis or ICP). Posts from women online perfectly described what I was feeling. I called my doctor and shared my newest self-diagnosis. In her trademark blasé voice, she assured me again I was fine. She told me to stop going online.
I showed up for my 38-week appointment armed with the symptom information I’d read — yes — online, and itchy, red, swollen skin.
My skeptical doctor agreed to draw bloods to test for cholestasis if I wanted. (Yes, please.) The results took one week to process. Those days were bad and nights unbearable. The itches would jump from one body part to another constantly all night long. It was pure torture.
Until my doctor called to inform me that I did have cholestasis: “Actually, your levels are high enough that I don’t want to wait until I am on call. Why don’t you come in tonight for an induction?”
My husband dabbed hydrocortisone cream on my legs in the hospital bed (above) as they turned on the pitocin, still attempting to relieve my symptoms, to no avail.
Thankfully, all turned out to be fine. Despite finding meconium in my water once they broke it — a sign of fetal distress — there were no complications with my daughter’s birth and the itching went away as soon as she was out. At 39 weeks, I delivered a healthy, 8 lb. 8 oz. baby girl.
Then? I decided to have another baby. For some reason, I stayed with the same doctor. I had seen her for regular checkups in the four years since my prior birth, and time had dulled the whirlwind of frustration I felt last time.
I hadn’t looked into the condition more last time, given my doctor’s lack of concern. Now, I read cholestasis can come back, or not. It can be worse, or not. Time had dulled my memory of it as well, so I threw caution to the wind — which blew it right back in my face. The itching appeared earlier and angrier. At the first tingle I knew it had returned and raised the flag at my 30-week visit. My doctor remained her calm self, drew blood, and diagnosed me one week later.
I armed myself with ICP facts and statistics. I was grateful I hadn’t done so last time, because I had delivered beyond the last recommended timeframe of 37 weeks. As the site said, untreated ICP has a risk of stillbirth as high as 15%.
My doctor was shocked at the numbers I threw out at her, told me I had nothing to worry about, and promised to seek counsel from the heads of the department. She was trying to calm me down, but her lack of knowledge on this particular condition put me into a tailspin.
My plan: Be hyper-vigilant, monitor blood levels weekly (knowing the test still takes one week to come back), have as many non-stress tests as possible.
Her plan: a low dose of a medicine that sometimes relieves the itch and sometimes doesn’t, but which reduces the effects of ICP on the baby. We would induce at the end of the recommended 37th week, with some weekly non-stress test beginning at 34. We didn’t need any more blood tests since I was diagnosed already.
I sought the second opinion of a maternal fetal medicine specialist who agreed with my plan of action. She doubled my dose of the medication which as of yet had provided no relief, and advised me to be an avid kick-counter. Any lack of baby movement should send me right to the hospital for monitoring.
I felt validated, which did wonders to calm me down. With the higher medicine dose, the itching lessened. Two non-stress tests each week became my norm. My regular doctor agreed to blood tests whenever I wanted. I almost became … relaxed.
I requested a blood draw at my 35-week visit and a week later got the same call as last time: “Let’s not wait till next week. Come in the next time I’m on call to be induced.” I was induced at 36 weeks and 5 days, and gave birth the day I turned 37 weeks. Thankfully, again, all went well — a healthy 7 lb. 11 oz. baby girl.
I delivered two healthy babies, because of my own actions. I can see why doctors might detest when patients self-diagnose on the internet. But in my case? There’s a 15% chance I saved my daughters’ lives.