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Intrahepatic Cholestasis of Pregnancy (ICP) & My Gentle, Family-Centered Preemie C-section

Intrahepatic Cholestasis of Pregnancy (ICP) & My Gentle, Family-Centered Preemie C-section

I had a typical, healthy pregnancy with my daughter, Priya, until I didn’t. Late in my pregnancy, I became very itchy, my urine was dark in color, I was overly tired and frequently nauseous. I had lamented to friends and family about how I was feeling but was typically met with well-meaning encouragement. I heard things like, “You’re pregnant and chasing a toddler around; of course you are tired!” or, “It’s common to experience itchiness and nausea in your third trimester.” Yet, I could not shake this feeling that something was off.

I started to research my symptoms and came across something called Intrahepatic Cholestasis of Pregnancy (ICP). As I quickly scanned the information, I knew in my heart I had this condition. As I read more, my worry began to increase. The treatment for this condition is to be on a medication that keeps your elevated bile acid levels from harming your baby, accompanied by frequent NST and ultrasounds to monitor the baby, and finally a delivery no later then 38 weeks, my worry grew because I was already over 35 weeks, and when left untreated, the complications can be serious and delivering past 38 weeks has a stillborn rate of 15 percent. Thankfully, I have a provider who excels at really listening to their patients, and when I called with my concerns, they saw me immediately. When I brought this up to him, he ordered the blood test and said they would call with results.

At 35w6d I laid down for bed. Anxious thoughts about receiving my test results the next day filled my head when I realized my baby was quiet. Where the usual kicks and tumbles that kept me up for an hour at bed time every single night, I was met with stillness. I did all the tricks to try and provoke some movement…nothing. Because we were waiting on the results of the blood test, and knowing what complications could arise with this condition, I didn’t want to take any chances, so we headed into Labor & Delivery.

Thankfully, our baby was looking great on the monitors, but right before being discharged by a nurse, my OB caught that the test results had come in. He told me what I had already known in my gut. That my bile acid levels were elevated above 10, which indicated a diagnosis of Cholestasis and that he would need to admit me and deliver her within 12 hours. He said waiting another week when we have had no treatment on board was not safe for her any longer and that she needed out very soon. Thankfully, the whole week I was waiting on my test results I had prepared myself for this scenario and even told my husband on the way to L&D that “I think we are having this baby in the next 24 hours.” So the shock I experienced was minimal.

Because of my previous emergency C-sections, her decreased movements, and the fact that my body had been essentially slowly poisoning her, we opted for a gentle cesarean instead of inducing labor to decrease the amount of stress she would experience during birth.

I have to admit, I mourned the birth I had been preparing and longed for. I had chosen a doula and had put in all the leg work to have my VBAC but sometimes birth plans and birthing your baby safely are not the same thing. Once I knew I would not get my VBAC, I was clear about my desire for a gentle cesarean. My provider explained that a cesarean with a preemie is unpredictable, but as long as she was doing well once she was earthside, my requests would be honored.

My birth plan requested the following:

• I did not want any medication that would make me drowsy for my birth.
• I wanted the radio on to help relax me while in the OR.
• I did not want any drape. I wanted to see my daughter being brought into the world. (This request was met with the exception of needing an air-filled warmer for her on top of us.)
• As long as she was breathing well on her own, I wanted skin to skin immediately in the OR.
• I wanted delayed cord clamping so she could receive her own vital stem cells, red blood cells, iron, and regain her full blood volume.
• I requested that she not be bathed at all but that the vernix should be rubbed in to aide in moisturizing her skin and help protect against infection.
• I wanted my catheter and IVs be removed as soon as possible.
• I requested breastfeeding-safe medication.
• I wanted the support of a lactation team to help me with the learning curve of breastfeeding a preemie and that she would also be evaluated for a lip and tongue tie.

My birth with Priya taught me three important things: First, to always trust your gut. When something feels off to you, listen to your body. Trust your God-given mama instincts. NO ONE knows your body and your baby better then you. Second, find a provider that supports you. Having a birth care provider who listens to you and supports you fully, even during less than ideal birth circumstances like this, makes all the difference in the world. Third, even if you have a less than ideal birth (like my four weeks early, emergent C-section), you can still have a birth that is a healing experience if you feel heard, understood, and your wishes have been respected. Though my story did not look the way I thought it would, I walked away from my less than ideal birth feeling at peace because my providers did everything in their power to give me the birthing experience I desired, and for that I am forever thankful.

If you or someone you know is experiencing itchiness while pregnant, please talk to your provider. Cholestasis of pregnancy, when treated correctly, almost always leads to healthy babies; but when left untreated, it can have devastating consequences. If you feel you are not receiving proper care or support or would like to be informed about this condition, please check this group for the most updated evidence-based research. This is a foundation that brings awareness and proper information to women dealing with this.

Experience and photographs submitted by Emily Russo. 

27 ways to Support Pregnant, Laboring, and/or Postpartum Mama

27 ways to Support Pregnant, Laboring, and/or Postpartum Mama

birth without fear, partner, pregnancy, labor, postpartumThere are so many different ways for a partner to support mama. Some are obvious, some are not. Read on for some ideas on what to ask for from your partner. If you are the partner, here are some examples for you take note of.

  1. “Because he is interested in knowing my birth plan, my wishes and needs, and willing to be my voice in the hospital when I may not be able to communicate well for myself.” -Kimberly D.
  2. “When I wanted a home birth after my first was traumatizing and in a hospital, he supported me 100%. And when I received my GD diagnosis and was heartbroken and afraid of losing my midwife, he helped me make meal plans and get a handle on my diet so that I was able to manage it on my own and did not require insulin. When I was in labour he helped apply counter pressure during contractions, poured water on my back, got coffee and tea for the birth team. Oh and he baked pies for everyone who helped deliver our little girl. Basically, he was my rock and my source of strength.” -Robin K.
  3. “Lots of things, but one that comes to mind was him picking good songs for us to listen to.” -Moriah B.
  4. “Every pain, tear, doubt, decision. He was there. He held me up (literally) when I was too weak to stand. He washed my sore body after 18 hours of labor and an emergency c-section the first time and then held me again after 26 hours of labor and another emergency c-section. When I was too weak to hold our babies after surgery, he held them for me while they nursed. When we got home he showered me until I was strong enough to do it with out pain. He got up every time the baby cried to bring her to me so I didn’t have to get in and out of bed because it hurt so bad. Even though he works 12 hour shifts. He fought the doctors with me when I refused to be induced after I passed my due date. He supported me when the doctors doubted me trying a VBAC. He’s my favorite person.” -Michelle G.
  5. “He supported me whole heartedly to have a water birth at home even though he was scared. He never once left my side during labour and gave me so much strength and courage when I needed it. He was simply amazing!” -Mai W.
  6. “When we were exhausted from a false labor and my hubby bolted from half sleep to tell the doctor I did NOT want pitocin. I was so tired, not dialated, contractions had stopped. My doctor was pushy and seemed upset with me and I’m a bit of a pushover especially when I’m stressed. If it wasn’t for him I would have had a very long, strenuous labor. Baby came safe and easy 2 days later (at a different hospital)” -Kate I.
  7. “Feeding me after the baby was born.” -Kristina M.
  8. “He reminded me that we were so close to meeting our rainbow baby.” -Susanna Y.
  9. “He stayed awake…. 50 hours of labour and that man managed to stay awake with me. Just that in itself was enough. I don’t know how a person does that when you’re not in labour yourself.” -Karen H.
  10. “He worked well with my doula and basically did whatever she said which helped us both a lot. He never left my side. I don’t think he even left me to go pee. He was amazing.” -Cora M.
  11. “Being with me through my entire labor applying counter pressure and wading through the whole gruesome scene, and knowing breastfeeding is very important to me and making sure I was able to do it successfully and without public shame. (Boobs out all the time anytime).” -Tosha M.
  12. “His response when we did non emergent transfer. I was a puddle of useless mess. Totally triggered out from birth trauma from the minute I walked into the hospital. It was awful. I couldn’t get it together. They kept asking me if I wanted pain medication because I was so hysterical and it had nothing to do with pain. He stepped in and knew the answer to every question. He demanded they respect my body. He demanded they respect my midwife. he was there to take me home when they said we were both fine and I didn’t need to stay. He was there when my baby was born, at home as planned, 24 hours later.” -Jessica M.
  13. “He turned his hat backwards when I started pushing–like he was about to work too! Like ‘here WE go’, together.” -Meg M.
  14. “My husband spoon fed me many times while I nursed postpartum which is an incredibly sweet memory for me.” -Melissa H.
  15. “Our girl is our second and I had a rough, rough pregnancy this time around. But on our induction day he had learned all my birth cues. He advocated for me, requested a new nurse when it took her 8 tries on different spots on both arms to hook up my IV, made sure I was given juice on top of my water, bought me 6 boxes of Popsicles, rubbed my back and made sure that, even though transition kicked my ass, I got my med free delivery! I don’t think I would have done so well without him. My daughter was born in 4 minutes, 2 total pushes, no blood and no tearing. He was my rock.” -Eliyana T.
  16. “He helped calm me and relax me during labor and helped me with the birth by reminding me how far we’ve come and how close I was. We both cried during the birth. I had so much love and respect for him in that moment.” -Cassielynn O.
  17. “Foot massages really helped me!” -Chelsea R.
  18. “He read on natural birth and breastfeeding without prompting. And then would rattle off random facts and information. Told me we didn’t need a doula because he was all I needed.” -Ashley M.
  19. “He got all of my craving food and followed directions well during labor and delivery.” -Sarah W.
  20. “Second day home and I was having trouble getting my baby to latch. I was exhausted and in tears. My husband sat by my side and used a bottle of formula to help entice my baby and squeezed my breast just like the nurses in the hospital while I tried to adjust the baby with my hands. Now I’m going on 7 months breastfeeding!” -Jessica M.
  21. “The fact that I was literally in (primal) beast mode, unshowered, broken blood vessels all over my face, straight up demon-screaming, clawing at his hands and arms, and he was looking at me like I was the single most beautiful and amazing thing on this planet.” -Katie S.
  22. “Caring for our toddler after baby was born so I could focus on nursing and resting.” -Imani C.
  23. “My sweet husband just said ‘Whatever mama wants’ during my whole pregnancy.” -Devin S.
  24. “He made a schedule for my recovery so some one was with me at all times.” -Jocilin O.
  25. “My method of coping with labor pains was to “bah” like a sheep. My husband got right in my face and ‘bahed’ with me. It made me feel safe and comfortable and allowed me to let my body open up and baby to come out.” Jodi R.
  26. “He is working many late nights leading up to the birth of our daughter so he can take time off to take care of us postpartum.” -Allegra L.
  27. “My husband sat with me while I labored on the toilet (stalled labor, very intense toilet contractions) and prayed over us while I squeezed the life out of his thigh. During this time my other birth attendants left us alone and I progressed from 6cm-8cm.” Amanda S.

 

I Am Strong – A Premature Birth Story

I Am Strong – A Premature Birth Story

I had my birth completely planned out to the smallest detail: I had a midwife, a birth center, a natural birth plan. Everything was perfect.

At six weeks until my due date I woke up to my water being broken, I had to rush to the nearest hospital without my midwife and with all plans going out the window.  My water was broken, but my body wasn’t going into labor, so I had to be induced. After 14 hours of hard labor I developed an infection and had to be rushed off for an emergency C-section.

My son Benaiah was born at 4:30AM, June 30th. Since he was six weeks early, he was rushed off to the NICU. He was hooked up to a CPAP breathing machine for his underdeveloped lungs, he was living in an incubator, and we didn’t get to be close to each other for the first 24 hours of his life.

premature1

My son spent two weeks in the NICU – growing, getting healthier, with both of us learning how to breastfeed and live life together. Through this whole process I learned how strong I was; for my son I am strong. I am strong enough to watch him struggle and be by his side through it all. I am strong to work with my premature baby on breastfeeding and be patient with him while we both learn. I am strong to smile and laugh with him when all I want to do is cry. My son made me strong and our birth experience bonded us in a way I can’t even explain. He was worth it all.

premature2

Now he is home with my husband and I, he is gaining weight, breastfeeding, healthy, and happy. We are in love with him.

I Am Strong – Enduring 30-Plus Hours of Full Blown Labor

I Am Strong – Enduring 30-Plus Hours of Full Blown Labor

I am strong because when I was in labor, I was in back labor for nine hours and wasn’t progressing so I had to go home.

I am strong because after laboring another 10 hours at home I went to the doctor to get checked and was in full blown labor but only dilated to 3 cm.

I am strong because I did not want an epidural, but more than that, I didn’t want a c-section so I got the epidural to help my body relax and dilate better.

I am strong because I had been up over 24 hours in labor and got the epidural, but because everything was going wrong and they were checking on me every 30 minutes, I never slept.

I am strong because after laboring a full day I wasn’t past 6 cm and had to receive pitocin, which was not in my birth plan.

I am strong because when my temperature spiked, I was given on a nonrebreather face mask to help with my babies decelerations and managed to stay calm.

I am strong because my epidural stopped working when it became time to push at 30+ plus hours, and I had all back labor with the baby posterior.

I am strong because I pushed for three hours to avoid putting my baby through a c-section.

I am strong because I still have sad feelings about getting an epidural and pitocin but look at my healthy baby I know it was all for her.

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Birth and Post-Birth Plans: Drafts to Download, Customize and Use!

Birth and Post-Birth Plans: Drafts to Download, Customize and Use!

Your little one is about to be born. Nothing compares to nesting with your newborn

canada, birth tourism, british columbia, petition e-397

And to get there takes some work. And some planning.

Many women design birth and post-birth plans to clarify – both for themselves and for their care providers – the kind of birth and postpartum care they need. Birth plans are practical, tangible and written; if the mother feels sure that her plan will be read and considered, she feels safer in entering an altered state during labour. They can be helpful for all kinds of births, from elective cesareans to unassisted.

It can be difficult, even scary, to think about what could happen during birth and how you would want it to be handled. But planning for practical eventualities can actually help us to live in the moment: to disconnect from the external reality and go inward, to draw from our inner reserves of strength and have spiritual, ecstatic experiences (yes, it is possible! Yes, you deserve it!). Presenting your care provider with a birth plan ahead of time is also a good way to test the waters: will he/she listen to you during labour? Does he/she share your vision of birth and those precious newborn hours?

Why is this a concern? And what should a birth plan say, anyway? Judith Lothian, a New York-based childbirth educator says, “Tension between health professionals and patients caused by birth plans reflects the larger problems with contemporary maternity care: conflicting beliefs about birth, what constitutes safe, effective care, and ethical issues related to informed consent and informed refusal. The focus of birth plans should be to answer three patient-focused questions: What will I do to stay confident and feel safe? What will I do to find comfort in response to my contractions? Who will support me through labor, and what will I need from them?” (Lothian, 2006)

Big questions. Elizabeth {a BWF mom} shares her birth and post-birth plans. She says, “I got my birth plan from my doula, who got it from a client of hers. My OB/Gyn LOVED it (not to brag or anything) but she said she’s had couples come in with three and four pages of ‘demands.’ My plan was one page for labor and delivery and one page for postpartum.” To download an editable copy of the birth plan, click here. For a copy of the post-birth plan, click here.

Birth Plan
[Parent(s) Name(s)]
Baby [boy/girl/surprise!]: [child’s name]
Estimated Due Date: [guess date]

Hospital/Birthing Center: [location name]
Mother’s Physician: [Doctor/midwife name]
Doula: [name]

We desire a labor & birth that results in a healthy baby and healthy mother.
We would prefer:

  • To have a vaginal delivery over cesarean
  • To have as few medications and other medical interventions as possible
  • To use a hep lock instead of a continuous IV
  • To have as much freedom of movement and position as possible during labor, including during the pushing stage
  • To labor in water as soon as [mama’s name] needs to and Dr. [name] says it’s ok
  • To use intermittent FHM or, if continuous FHM is deemed medically necessary, to use a portable or wireless fetal heart monitor
  • That labor augmentation techniques not be used
  • That the membranes not be ruptured artificially
  • To allow [mama’s name] to push with the urge
  • That pain medication is not offered
    • [Mama’s name] will ask for pain medication if she thinks it’s necessary
  • To risk a tear to the perineum rather than have an episiotomy
  • To have a local anesthetic in the perineal area if [mama’s name] deems it necessary
  • To allow the placenta to deliver naturally

 

Birth Plan
[Parent(s) Name(s)]
Baby [boy/girl/surprise!]: [child’s name]
Estimated Due Date: [guess date]

Hospital/Birthing Center: [location name]
Mother’s Physician: [Doctor/midwife name]
Doula: [name]

If medically possible, we would prefer:

  • To hold and bond with our child immediately after birth
  • To delay cord clamping and cutting until after the cord has stopped pulsating
  • To initiate breastfeeding as soon as possible after birth, including in the recovery room in the case of cesarean delivery
  • To delay newborn procedures and tests until after the initial breastfeeding and bonding
  • For at least one parent to be present for all medical procedures
  • That [baby/baby’s name] room in with us at all times during our hospital stay
  • That no bottles, pacifiers, artificial nipples, formula or water be given to our child at any time during our hospital stay without our consent

For a family centered cesaren birth plan, visit here.

How To Avoid An Unnecessary Cesarean Section

How To Avoid An Unnecessary Cesarean Section

Our BWF Community is a diverse group of women with different birthing experiences. Midwives, doulas, mothers who have birthed only at home, others who have had cesareans, VBAC’s, natural or medicated hospital births. Women have valuable information and support to offer one another.

cesarean birth

I recently asked the BWF Mamas how to avoid a c-section and here are the top answers. Research them more and decide what will help you get the birth that is best for you and your baby!

  • Stay home (number one answer)
  • Avoid an induction
  • No AROM…artificial rupture of membranes
  • Hire a doula
  • Research and know your rights
  • Do not consent unnecessarily to interventions such as pitocin, constant monitoring, and epidural.
  • Take childbirth education classes…Bradley, Hypnobirthing, Birthing From Within, etc
  • Know what you want and do not waiver or compromise (of course unless baby or mom needs help)
  • Be patient
  • Trust yourself, your body, your baby and birth
  • Ask your doctor what their cesarean section rate is. According to WHO it should be lower than 15%
  • Ask your midwife what her transfer rate is and why they were necessary.
  • Find an OB or midwife who supports your choices (can switch at anytime)
  • See a chiropractor who can do Webster Technique to help optimize position of baby. Can find one here.

“Caesarean section without medical indication increases risk of short-term adverse outcomes for mothers. Caesarean section is one of the most commonly performed surgical operations in the world today. However, in a growing number of cases worldwide, caesarean section is being performed without any medical need. The rising number of such deliveries suggests that both health-care workers and their clients perceive the operation to be free from serious risks.” ~World Health Organization

cesarean birth rates
Map created by Jessica Turon, from the Unnecessarean.

{If you find yourself needing a cesarean, read about a gentle cesarean approach here and a family centered cesarean birth plan here}

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