Cholestasis, a Change of Plans, and a Respectful Induction

I’d planned a natural birth in a birth center from the second I found out I was pregnant with my third child. I’d had a dehumanizing induction with my oldest; my second baby’s birth was far better than my first but still not exactly what I wanted so I made huge changes during my third pregnancy in order to finally have the experience I desired. My pregnancy was wonderful and healthy and everything was perfect every step of the way, I received care from a wonderful practice of naturally-minded obstetricians and midwives and truly enjoyed every prenatal visit. Everything was going great and my husband and I were happily anticipating our impending daughter’s birth.

When I hit 37 weeks I started noticing that my skin was very itchy. I used a lot of lotion and didn’t think much of it at first but I quickly realized it was getting worse by the day. I was soon so miserable I was even willing to try anti-histamines despite being reluctant to take any medications while pregnant. Unfortunately neither anti-histamines or any lotion or cream helped at all. After six days it was so horrible I was becoming concerned, this just didn’t feel normal. I called my doctor’s office on a Sunday morning and asked for advice. The midwife I spoke to thought it would be a good idea to come into labor and delivery and have blood drawn to be tested for obstetric cholestasis. After examining me she was hopeful that it was just a miserable case of PUPPPS but felt that the tests were a good idea.

Unfortunately the tests took about a week to come back so we wouldn’t know for sure anytime soon.

The next day I noticed baby was moving a bit less than normal. By that evening movement was significantly less but I was still feeling her enough that I wasn’t panicking. I was up all night trying everything I could think of to get her to resume normal movement but had no luck. I got up in the morning, took our big kids to school and called my doctor’s office. They had me come in immediately for a non-stress test. After a few minutes on the monitors baby wasn’t moving so they brought me apple juice… and more apple juice… and cups of ice water. Attempts to buzz my stomach yielded no results. Baby’s heart rate was perfect but for some reason she was clearly not moving.

A few minutes later one of the doctors came to talk to me. My hands and feet were where the itching was the worst, he examined them carefully and found there was no rash or apparent cause to the itching and said that this was concerning. The timeline of my symptoms and the appearance of my skin were textbook signs of cholestasis, a condition where a build up of bile acids in the blood stream cause intense itching. Still birth is a potential risk of cholestasis and given my baby’s major decrease in movement he felt it would be best to induce labor. He could tell I was extremely upset and was willing to support me even if I disagreed with his recommendation. He told me to call my husband and discuss it with him but that if we decided it would be best to induce labor that he was going to schedule my induction immediately. It didn’t take my husband and I long to agree that this was the best option. Several months before I had attended a Birth Without Fear Meet Up where January described the birth of “Beard Baby”. Prior to her birth she had had decreased movement and January described this as feeling that her baby had “nudged” her. I had a brief moment of peace realizing that my baby was nudging me as well and that this was all a sign that it was time for her to be born.

My mother picked up our children, we packed our bags and in what seemed like seconds we were at the hospital starting the induction. I had a very hard time processing what was happening to me and barely spoke a word for hours. I couldn’t believe that in such a short time my plans for this birth were completely shattered. How could a pregnancy go from complication-free to this in a matter of minutes? I was three centimeters dilated and 50% effaced but I truly did not feel my body or baby were ready to be in labor and I was absolutely terrified to start down this road of interventions.

After getting settled into our hospital room, the midwife from my practice who was there that evening came in to talk. She had a student midwife with her and they were both extremely compassionate and willing to do whatever they could to try to give me as much of the birth center experience as they could. The induction plan was to use Pitocin very slowly and to bring in a portable birth pool for me to labor and birth in. After talking to them I felt a million times better, this wasn’t exactly the birth I wanted but it was going to be okay.

Pitocin was started and I quickly began having regular contractions. I tried to rest through the night but the itching was worse than ever and prevented me from resting at all. One thing I’d found that helped the tiniest bit was Earth Mama Angel Baby nipple cream and luckily the hospital used this brand. My midwife’s student brought me tons of packets of it and I passed the night applying nipple cream to my entire body. By morning I’d had little progress and was feeling discouraged. I felt sick to my stomach I was so worried that this was going to turn out badly. As the morning went by however, things finally started to pick up a bit and contractions became much more intense. I began having to actually breathe through them and was only comfortable standing up, rocking through them. My midwife Missy and her student Lila Rose thought it would be a good idea to check me and see if they could break my water. They thought that since this was my third baby that if they broke my water things would progress very quickly but I was absolutely convinced there was no way that would work. Regardless I agreed that it was worth a shot. They checked my cervix and found that I was five centimeters. They broke my water and left the room for a bit to be with another patient.

In a matter of minutes my contractions intensified. They went from very uncomfortable to actually painful and I continued standing up, rocking and swaying through them. I suddenly realized I’d been too upset to eat anything for almost twenty hours and became very worried that this would effect my ability to get through labor. My husband offered me several healthy snack options but the only thing that sounded good was a Kit Kat bar that he helped me eat in between contractions. I don’t remember Missy and Lila Rose coming back in the room but when they saw me they realized I was getting close. I didn’t realize this myself though and still truly felt that I was half a day away from giving birth.

I was in a lot of pain at this point and asked to get in the tub. Lila Rose got it ready for me and helped me get in. The warm water was an immediate relief in between contractions but during contractions I was in extreme pain. I remained sure that I was no where near giving birth and this began to alter my state of mind. I was so sure I was going to be in labor for hours upon hours and didn’t know if I could handle this pain for the rest of the day. Lila Rose helped me breathe and focus more during contractions, despite my being a total wreck her words of encouragement were extremely helpful. She was using a Doppler to check baby’s heartbeat frequently and realized her heart rate was going up and staying up and she asked me to get out of the tub. She and my husband helped me get out. As soon as I stepped out I felt like I needed to go to the bathroom. Lila Rose told me that that was just the baby and I didn’t really need to use the bathroom. I remember thinking “I’m not an idiot! I know that feeling like you need to use the bathroom is actually the baby when you’re close to giving birth but I am NOT even close to giving birth so I must actually have to go.”

I labored on the toilet for a minute and Lila Rose draped a warm blanket over me. Baby’s heart rate was still high so Missy asked me to try to get on my hands and needs on the bed. I moved into this position pretty easily and the contractions suddenly became absolutely unbearable. Contractions were maybe 20 seconds apart so I wasn’t getting a break between them at all. I started saying there was no way I could do this and that I needed an epidural. Missy tried to calm me down and reminded me that I didn’t want an epidural and that I would most likely regret it. She and Lila Rose tried to get me to focus more on what my body was doing and how each contraction was getting me closer to meeting my baby. I was still sure that I wasn’t actually close to meeting my baby though and asked again for an epidural. They explained that this baby was going to be born before they would even have a chance to request an epidural and I was perplexed. I didn’t understand why they were so sure that I was very close to having a baby when I was beyond certain that I wasn’t close.

Suddenly I felt the urge to push. I slid down on my side and started pushing and instantly my entire mood and mindset changed. I could feel my baby descending and the urge to push made me realize that I really was very close to giving birth. The urge to push was such an immense relief compared to the contractions that I’d been feeling that they actually almost felt good. I could tell each push was extremely productive and she was coming fast. My midwives started telling me that they could see her hair. I could feel intense burning and felt like I was pushing too hard and too fast and I tried to slow down and breathe her out but my body was on auto pilot and I didn’t feel lik&e I had much control over pushing. Before I knew it I could feel her body sliding out and I reached down to touch her, suddenly she was on my chest, screaming, and I was in disbelief. I immediately asked my husband what time it was and found that it had only been about 40 minutes since my water broke.

I birthed the placenta painlessly but my midwives said there were still a lot of large clots in my uterus and working them out was extremely painful. I was bleeding more than they liked though and they wanted to make sure everything was okay. Once they were sure, they checked me for tears and found two very small tears and asked if I would like them to stitch them. They thought they would probably be fine either way but that they would heal a little faster if they were stitched and I agreed. As soon as they were finished they covered my naked baby and I with warm blankets, dimmed the lights and left my husband and I to bond with our baby girl. We were left completely alone for hours and it was absolutely wonderful. No one bothered us or tried to bathe our baby or mess with her at all. A pediatrician stopped in just as I was actually feeling ready to try to get up and use the bathroom and clean myself up a bit anyway so the timing worked out perfectly.

I felt immense relief knowing that our baby girl was earth side, safe and healthy. I had salvaged a pretty awesome birth out of a situation that terrified me. I had been induced with my first baby and had absolutely no control. Every decision was made for me, without me. Not only was I never consulted but I was so disconnected from how birth should be that I didn’t even realize that I had a right to be consulted. I remember feeling as though I was in the way during my own birth. I remember thinking everyone would have an easier time delivering this baby if I wasn’t there. This induction was a completely different and wonderful experience. My health and the health of my baby were the priorities of my doctor but they were not used against me. My choices were respected every step of the way. I received guidance from my health care providers and was allowed to make my own choices. This wasn’t the birth I had planned but it was exactly the birth my baby needed.

Submitted by Kate S.