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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. 

Cholestasis, a Change of Plans, and a Respectful Induction

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. 

Difficult Pregnancy and Traumatic Birth {Hyperemesis Gravidarum, Gestational Diabetes, Cholestasis And Induction}

Difficult Pregnancy and Traumatic Birth {Hyperemesis Gravidarum, Gestational Diabetes, Cholestasis And Induction}

My pregnancy and birth were by no means ideal or what I had planned. But sometimes its more important to hear about the births that didn’t go to plan than the ones that did. If my experiences can help just one person then my story is worth sharing. – Johanna

Ever since I was a little girl I have been desperate to experience pregnancy and motherhood, seduced by images of glowing women tenderly rubbing their bellies and tiny perfect infants.  I knew early in my teens that pregnancy may never be a reality for me – I suffered from severe endometriosis and lost a fallopian tube to a laparoscopy at the age of 17 and was told my chances of conceiving without intervention could be minimal.

Fast forward eight years and there I was with a positive pregnancy test in my hand. I was cautiously excited – despite the unplanned nature of the pregnancy – knowing my chances of ectopic pregnancy and miscarriage were high. In my mind I had won my battle – I had proved the doctors wrong with my pregnancy and could not imagine that anything but happy days were ahead for me. Sadly, my battles were only just beginning.

By the time I saw my baby’s little heart flickering on the eight week dating scan I was already very ill. I was wracked with debilitating nausea and vomiting and having trouble even keeping down water. I was told all the usual things – have small meals, get fresh air, try ginger, eat crackers – but nothing worked. I had been determined that I would eat healthy and not take any medications at all during my pregnancy and was still dragging myself to work to do ten hour shifts in child care. When I finally broke down due to exhaustion and dehydration and let my partner Mark take me to the doctor to get a prescription of anti-nausea meds I cried all the way home. They did nothing to help and I soon made my first visit to the hospital after vomiting blood. They put me on IV fluids and gave me a medicine called Ondansetron (Zofran). For the first time I was able to drink a small cup of water and keep it down so they sent me home with no medication, no advice and two days off work. As soon as the medicine and fluids wore off I was back to my worst and in desperation and fear for my baby’s life I went to a doctor to beg for a prescription for Ondansetron – she told me she wouldn’t prescribe it for me and it was dangerous for my baby and I left in tears feeling devastated and ashamed.

Two days later I was back at the hospital being admitted and was finally diagnosed with Hyperemesis Gravidarum – I was vomiting blood again after days of bringing up all food and liquids and bile, too dizzy and weak to get out of bed without assistance. Food revolted me, smells revolted me – I couldn’t stand the smell of tap water let alone my partner, I couldn’t stand up long enough to shower and I couldn’t brush my teeth without vomiting. I was losing weight rapidly. I had to tell my work I would not be in for the foreseeable future. Mark was working full time and then coming home to nurse me – as well as running our household by himself – I was utterly helpless and some days could not even make it across the hallway to use the toilet without assistance. My Mum came over on her day off every week to take me to Drs appointments and offer what assistance she could with house work etc.

After my admission to hospital I was given a script for Ondansetron. It gave me a little more control over my vomiting but I still vomited most things. I managed to keep myself hydrated with lemonade ice blocks and frozen coke because they were all I could keep down. I cried bitterly when I was alone, scared that I could not provide my baby with the nutrition necessary for it to grow and convinced that the baby would die…or that both of us would. I was pushed into early testing for gestational diabetes due to my high BMI and when it came back positive I felt even more helpless – the only things I could manage to keep down were the very worst things for GD but I had to eat what I could eat or end up back in hospital.

The strain of going down to one income became too much and when the government wouldn’t help us with any sickness payments, we had to make the painful decision to pack up the little home we had made for ourselves, break our lease and go and live with my parents. My symptoms got very slowly better and I began to get a better hold on my vomiting. I was able to expand my diet to more normal foods and keep down water with the help of my medication – even if the nausea was still very prevalent. The damage to my body had been done though and I was suffering from malnutrition, weak, had lost a huge amount of muscle and was in constant pain due to atrophied muscles in my back as a result of all the months of bed rest.

At my 20 week scan we found out we were expecting a little girl and by about 22 weeks my vomits had decreased to one every few days – unless I exerted myself in any way, got too tired or got upset. I was still unable to contribute to the household in any way and spent my days lying in bed watching TV. I was very grateful that I was seemed to be coming out the other side of the hell I’d been going through with HG and my GD was totally diet controlled (I’m still not convinced the state I was in when the test was done didn’t produce a false positive) – things were looking up!

I was 32 weeks when I again started to feel something was wrong. I had been improving in tiny steps and filling my time writing my birth plan – I was planning a birth totally free of induction or drugs. I became incredibly itchy, to the point that I wanted to rip my skin off and I was crying. I was diagnosed with Cholestasis of pregnancy – a condition involving the liver which meant that my baby was at a much increased risk of stillbirth and would have to be induced before 38 weeks and had to spend the night in hospital for monitoring because my test results were so bad. I couldn’t believe it! Why did these things keep happening to me? I had been through such pain and suffering already and had been focusing my energies on making up for my terrible pregnancy with an amazing, intervention free birth….now that was being ripped away from me too! Around the same time I was informed that the glandular fever I’d had the previous year had not in fact resolved itself as I had been told and had in fact been active and present in my blood throughout my whole pregnancy!!!!

At 34 weeks I was admitted to hospital again – this time I was struck with excruciating pain in my back, so bad that I was screaming and wild. I spent 6 nights in hospital with a massive infection in my gallbladder and on IV antibiotics. The doctors were very concerned by my body’s lack of immune response – despite the seriousness of my infection I never once got a fever which showed that my body was not trying to fight the infection at all.

I made it to my personal goal of 36 weeks, managing to enjoy my baby shower – which we had long feared I would not make it to. Then my liver began to show increased distress despite the 8 tablets a day I was taking to try and keep my body working and my induction was scheduled for November 21st – I would be 37 weeks and 2 days.

The day of my induction I was filled with conflicting thoughts. I was excited to meet my little girl although I would not be having the birth I had planned. But as much as I did not fear the actual process of birth, I had trouble believing that things would go right for us given all the road blocks that had been thrown in our way during the pregnancy.

We arrived at the labour ward at 5pm and Mum, Mark and I settled into the room armed with many bags of things to sustain us through the long night ahead – 12 hours with a foley bulb in if I was dilated enough or perhaps the same amount of time with cervadil. They examined me, ready to try and place the foley bulb and found I was already 3cm dilated! The midwives and Drs were happy and excited saying this never happens for a first time Mum at my gestation. They decided to send me home and have me come back in at 7am rather than break my waters and have me labour through the night. The Dr gave me a stretch and sweep and we went home and tried to relax – it felt like an anti-climax but I was also excited thinking that perhaps I wouldn’t need any interventions. My body could do this! Despite my best efforts that night, I didn’t go into labour and my waters remained intact. When I got up in the morning I had started to lose some of my mucous plug and became excited that perhaps I had dilated even more overnight.

Back at the labour ward and a check revealed I was still only 3cm. I was disappointed but determined. The midwife ruptured my waters with a great deal of effort and to my great disappointment there was meconium in them. This changed the whole birth plan right away – I was no longer allowed to labour without any augmentation – I would have to go straight onto the hormone drip. I asked if they could keep it on a very low level and they agreed. When my contractions began it was 10am and I handled them well, walking around the room and bouncing on the birth ball. I had to consent to monitoring because of the drip but had organized to have to wireless monitor – it was a struggle from the start. It was supposed to make it easier for me to move around but every time I moved it kept cutting out and finally I had to have the wired monitor on as I continued to bounce through contractions on the ball. Every time I stood I was losing amniotic fluid in big gushes but my contractions which were coming every 2 minutes were ‘too short to be effective’ and they turned up the hormone drip. I began laboring on hands and knees on the bed which felt very good but in this position none of the monitoring would work and the Drs came in and told me I had two choices – lie still so the monitoring worked or consent to internal monitoring. I chose to labour on my back to spare my baby from having her head punctured.

Lying still on my back was torture and made the contractions hugely intense. It was now 5pm and I had now been contracting every two minutes for 7 hours but a check showed I was only at 5cm. Having made so little progress made me really disheartened and I was starting to doubt that I could do it. I had clearly stated in my birth plan that the midwives and Drs were not to offer pain relief but Mum and my fiancée Mark could see how exhausted I was getting and urged me to try some gas to take the edge off and I consented around 6pm. The gas relaxed me a lot – made me cheeky and stoned – and helped me focus on the task ahead and regain my confidence. This had an effect on the contractions which started to last longer and every second contraction my body began to push involuntarily which made me feel quite confident that I was making progress. 8pm found me at barely 7cm and the midwife made the decision to turn up the hormone drip making the contractions even more intense. I couldn’t stay still, the gas stopped working, the baby had turned so she was posterior and I couldn’t stop myself pushing during the contractions which was making the lip left on my cervix swell. The Drs came in and told me they were having trouble finding baby’s heartbeat – my student midwife told me later that they were pushing for a C-section at that point – and they convinced me to agree to internal monitoring.

By this stage I had lost control. I had told myself I would be calm and cool but I was screaming my lungs out. Mum and Mark took turns leaving the room for breathers because it was hard for them to see me like that. I was exhausted – I had now been contracting every two minutes on a high level of hormone for 12 hours – and, desperate not to have to have an epidural I consented to pethadine. I really regret this because it was useless, making me sleepy between contractions but doing nothing to help with my pain. Before the pethadine kicked in the midwife convinced me to try the shower, hoping I could stand up in there and get things moving but my legs would not support me, the pain was too intense.

At 12am I was checked again and was 8cm, still thick. The midwife told me that based on my progress so far she would estimate that it would take me three or four more hours to dilate fully. After 14 hours of contracting every two minutes I had a decision to make. I could see my Mum and fiancée having worried discussions over in the corner, I had no more energy, and I had screamed so much my throat was raw. I felt broken and helpless and I knew that I didn’t have another 3-4 hours in me. Mark and I started talking and he told me that he supported any decision I made, that it wasn’t failing, that I had endured so much and fought hard – especially considering my lack of stamina from all those months of bed rest. I felt like a fool, like I had failed. In my head I could see my birth plan with every second line crossed out. An epidural was always something I had been insistent I would never do but at this point I truly felt that even if I made it to 10cm without one I would have no energy to push and would end up with a C-section anyway.

At 1am, after 15 hours I got an epidural and cried the entire time. When the epidural kicked in the room visibly relaxed. I was no longer screaming and Mark and Mum were visibly relieved to see me not suffering any more. With the pain gone my midwife was able to help me maneuver into some different positions and I was able to get a couple of hours sleep while they raised the hormone drip to its maximum. At 3am they brought in an ultrasound to check where baby was and found that she had moved out of the posterior position and was ready to go and a check showed I was fully dilated. I dozed for a while longer and then asked for the epidural to be dialed back so that I could feel the contractions enough to push. At 4am I was ready to push with a mirror in front of me.

At 4.43am after almost 19 hours of active labour, Ella Quinn was born into her Daddy’s hands.

newborn birthed into daddy's hands

newborn with mom

The relief and joy was overwhelming. I held her on my chest and cried hysterically. Mark began to cry too which was something I had never seen before and I have never been more in love with him than I was in that moment.

newborn bonding

newborn with mom and dad

mom and dad newborn hospital birth

hospital birth

I began to shake and shiver violently. Ella had some problems initially – she had trouble breathing, then low blood sugars, an infection and jaundice – and spent her first five days in the special care nursery but is now home, a beautiful girl with a mop of black hair who is growing bigger on Mummy’s milk and adored by all around her.

I have my good days and bad days. I have my days where I think, why me? Why did I have the horrible pregnancy, the difficult birth? I have days where I wonder what I could have done differently during my labour to avoid all the interventions I ended up having. I have days when I feel like the huge debacle that was my pregnancy is only eclipsed by the failure that was my birth experience. But then I remember that no matter how I feel about them, my pregnancy and labour resulted in an amazing daughter who is not going to care if I hated being pregnant or if I had an epidural. She is only going to care about how much I love her – and that is something I’m positive I will be successful at.

Birthing My Beautiful Twin Girls {Premature Cesarean Birth}

Birthing My Beautiful Twin Girls {Premature Cesarean Birth}

My name is Katherine and this is my story of birthing my beautiful twin girls.

I was only 18 a month before I fell pregnant with them. From 2 weeks on I was horrendously sick, right up until I was roughly 24 weeks.

When I was 28 weeks pregnant with them, I was diagnosed with Cholostasis. They put me on the Urso (a medication) but the itching was horrible. Then when I went in for my 30 week scan I was told pretty much then and there that my little Sophie was breech and she was at the bottom and unless they changed I wouldn’t have a hope in having a natural. That same day I was told neither of them were growing… in fact, losing weight.

I was to go in for an appointment the week after. That appointment was the start of my horrendous last few weeks of pregnancy.

I was admitted to hospital with pre eclampsia and anemia. While anemia is pretty common, I was getting pretty sick with the pre eclampsia. I just wanted to go home. I stayed in for roughly five days when they finally let me go home.

I was home one night… when the next morning I woke up with horrendous back pain and pain across my tummy… I thought I was in labour! So back to the hospital I went. I was readmitted and put on iron tablets, a higher dose of Urso and about 3 different blood pressure medications. I was told I would be in hospital until I gave birth.

As I was having twins and they were quite small, I was told they would be in Neonatal care for a little bit. About a week and a half after being readmitted, I proceeded to have my tour of the neonatal ward. Half way there I collapsed.

I don’t really remember much until I was down in the delivery ward… where they decided they were going to prep me for surgery. They put me on magnesium sulphate through an old drip which was excruciating, some of the worst pain I’ve felt in my life, so they literally had to rip it out and start all over again. They wanted to put a catheter in. I’ve never sobbed so much in my life, at the thought of getting one. Anyone would have thought that I was in natural labour!

Right up until this stage I was alone, all alone. A bit after that, my partners mum walked into the room… I was so terrified. I was so scared of surgery, so scared of anaesthetic … and so, so scared… of finally being a mother.

When all my drips were in, my fluids were up and my catheter inserted they wheeled me down to theatre with my mother in law and father in law.

They attempted to give me an epidural… they missed 8 times and on the ninth, as much as I wanted to be awake, I gave in. My body couldn’t cope… I was a mess… When finally they said, we are going to put you under, I broke down. What if I could feel the surgery? What if something happened? What if I didn’t wake up? As my mother in law was walked in, she and I both in tears as I was laid on the operating table, my arms literally pinned down. I fought the anaesthetic as much as I could. I could feel the burning sensation from the toes up.

I woke up in Intensive Care.

mother after general anesthetic cesarean

It was the scariest thing I’d experienced. All I wanted was to see my babies, but I wasn’t allowed too… I saw photos of my partner’s parent’s phone and even then I vaguely remember them as I was so out of it.

The next day, around lunch time… one of the neonatal nurses brought down four photos of my babies, two of each. My little Sophie and my little Clarabelle.

premmie twin

premmie twin

It was so, so hard, because all I had were pictures. I couldn’t hold them. Later on that night, about 8pm, I was finally being told I was going back to my room in maternity. But I didn’t want that, I WANTED to see my children.

So after much argument that I was way too sick, they wheeled my bed into the Neonatal care centre and brought my tiny babies that were born at 33 weeks and 4 days out to me in their humidity cribs. I was only just barley allowed to touch them. I just wanted to hold them. It hurt so much to yearn for something I wasn’t allowed.

meeting daughter for the first time

mother meets twin daughter

twin cesarean birth

Later on that night, a nurse came into me and told me that if I woke up during the night, buzz them and they would help me hand express. I woke around 3, so I called. The nurse mentioned if I could get out of bed she would take me to them. I was so determined… as much pain as I was in. I was wheeled to them and I finally got to hold them, my little Sophie Anastasia and Clarabelle Maree.

Although they were in hospital for another 23 days, the day I brought them home was the best day of my life…

I hated the way I gave birth… But I’d do it again for my children. Even though it brings tears to my eyes even typing this.

twin girls at hope

Planned Induced Birth turns to Fast Natural Birth {Cholestasis}

Planned Induced Birth turns to Fast Natural Birth {Cholestasis}

I’ve recently had my second daughter – she is now 6.5 months old and after a very traumatic birth with my first daughter, I was terrified of giving birth this time around. But you know what, it was THE most amazing thing I have ever experienced. Ever!

I cant really remember the birth of my first daughter, it was a bit of a blur (in a bad way). I was a week overdue, induced, full on contractions for 27 hours, pethidine, vacuum, episiotomy and eventually an epidural because she was posterior and they wouldnt let me push. I was devestated and felt like a failure. When they were giving me the episiotomy, they went through 5 pairs of scissors because the doctor kept saying “These are too blunt, I can’t cut through!” I felt like a roast chicken they were hacking up 🙁 Then when they were stitching me up the doctor was panicking and said “I can’t see what I’m doing, there is too much blood everywhere, someone help me!” In the end, he stitched me up badly and I was unable to urinate without pain for nearly 9 months.

This time around I just assumed that things would go the same way. I thought that my body just didnt know how to give birth. I was terrified.

However, before the birth, there was the pregnancy – and what a pregnancy it was! I have a feeling my body really doesn’t like being pregnant and it told me in more ways than one!

Apart from the usual morning sickness, I developed something called Cholestasis, which affects the liver. The long and short of it is bile is produced in the liver and normally flows down the bile ducts and into the intestines where it helps with the digestion of food. However, in my case, the flow of bile into the intestines was reduced and so the bile salts built up in my blood. These toxins could overflow and spill into my bloodstream and therefore through the placenta to the baby.

Anyway, this meant being in and out of hospital for testing and monitoring from about 34 weeks onwards. Cholestasis made me extremely exhausted – to the point where having a shower would make me feel as if I had run a marathon! I was nauseated, tired, weak, had no appetite whatsoever and I also had episodes of intense itching. My liver function results kept coming back worse than the time before and because of all the complications I was to be induced at 38 weeks. This was something that I had wanted to avoid at all costs after what had happened with my previous induction. However, all the doctors assured me that this time it would be different.

The day before my induction was just like any other. I didn’t have any pains, contractions or any signs that this baby was ready to come out! I wasn’t looking forward to my induction; however I was becoming pretty fed up with this pregnancy and wanted her out!

Early Wednesday morning at around 3:30am, I needed to go to the toilet (which was a rather common occurrence during this pregnancy!). However, as soon as a stood up out of bed, my waters broke all over the floor. This was all a bit new to me, as nothing like this had happened in my first pregnancy. We rang the hospital and I told them that I was booked in for an induction at 7:30am that morning; however they told me to come in straight away as they had to monitor the baby because of my Cholestasis. They did tell us to take our time because it was super busy and they were rushed off their feet.

As soon as I got into the car, my contractions started coming thick and fast. I decided to time them (with a handy little program on my iPhone) and found that, despite being in “early labour” they were lasting around 30 seconds with a 3 minute break in between. Labouring in the car is so uncomfortable! I remember having to lift myself off the seat for each contraction while breathing through it. Finding a comfortable spot was a tad hard!

We arrived at the hospital at around 4:15am and we waited in the waiting room for around 15 minutes. My contractions were still the same, I was breathing through them; however, Abraham could tell my breathing was becoming more laboured as each contraction passed.

After being settled in one of the rooms, the midwife examined me at mentioned that it was early days and I was 2cm dilated. We had decided that I was to have an early epidural when I got to 3cm as I was still very traumatised by my first birth where it took me nearly 15 hours to get to 3cm! Although I was only 2cm, the midwife said she would talk to the doctors and get them to give me one as soon as possible. They prepped me by putting the drip in my arm and getting all the things ready on a tray for the anaesthetist when he arrived. They then left me to labour in peace.

It was at this stage that I was struggling to breathe through the contractions and began to vocalize through them instead. I did this for around an hour, just leaning on Abraham for support (while deafening him in the process!). I swear the whole birthing suite could hear me – I felt like I was roaring and yelling at the same time. I felt as if I was losing control and not coping with these “mild” contractions anymore. If I was at 2cm – I was glad an epidural was coming!

At around 6:00am, 3 hours after my water broke, I told Abraham to go and get the midwife because I felt like I wanted to push. I don’t think he took me very seriously – I’m known for exaggerating at times! The midwife came in and told me to calm down so she could examine me and see where we were at. I shouted, “Please get me my epidural!!” and the midwife exclaimed, “Sorry honey, its too late for that, your baby’s head is right here!”

Then I completely lost the plot! This wasn’t how things were supposed to turn out – I needed my epidural! I had never pushed out a baby without pain relief (I had an epidural with Bella after 24 hours because she was posterior and they wouldn’t let me push!) The midwife was trying to get me to lay down on the bed and get ready to push, however I kept clamping my legs closed – in denial that this was actually happening!

At 6:10am, I pushed through my first contraction. I screamed the whole way through it and didn’t push effectively at all. The midwife looked at me and said, “Right, Naomi. When the next contraction comes I don’t want to hear a sound come out of your mouth! Push instead of screaming!” Was a bit of a slap in the face, but it was exactly what I needed to hear.

I pushed through the next contraction and her head came out. The midwife asked me if I’d like to feel her – it was the most amazing experience! As the next contraction came I pushed for the third time and Mayah Hope Schultink entered the world. The first thing I said was “I did it! I just did it all by myself!” Apparently you couldn’t wipe the smile off my face!

cholestasis pregnancy

So I went from facing an induction, to going into labour naturally and delivering my baby girl drug free in less than 3 hours! Who would have thought?! I cannot begin to explain how empowering it all was – I felt like a woman, a powerful, capable, maternal woman. I Birthed Without Fear! {Naomi}

cholestasis baby

Watching an Induction Turn to a Cesarean

Watching an Induction Turn to a Cesarean

Mom seeing her beautiful girl for the first time after a scary c-section. The birth story that follows is from the perspective of the photographer.

This was my first time attending a birth as a birth photographer. It was Mom’s first baby and she was being induced 3 weeks early due to a condition called cholestasis and her plan was to have a natural, vaginal birth.

We all arrived at the hospital bright and early on a Monday morning. After being checked into a room and getting situated a nurse came in, introduced herself, and immediately started asking questions like, “when was the last time you ate?” and “have you ever had abdomial surgery before?” Once she had the answers she was looking for she quickly left the room.

This line of questioning struck me as odd and immediately raised red flags in my own head. I have two small children of my own so I know a little about the birthing process and what is involved. So why would the nurse ask those types questions if Mom was coming in for a “routine” induction where the goal was to have a vaginal birth? These sounded like questions one would ask a mom who was coming in for a “routine” cesarean birth. I was expecting to hear talk of pitocin and dilation and a plan of action. But, what do I know about inductions? I’m a photographer not a physician.

Within 5 minutes the nurse was back and informed the parents that she had spoken over the phone to the attending physican who had read Mom’s chart and was guessing that this was going to be a big baby. Therefore, she was ordering an ultrasound to get an “accurate reading”. Again, bells were going off. How on earth would the attending physician know that this was going to be a large baby when she hadn’t even laid hands on Mom? Besides, how large can a baby who is 3 weeks early really be? But what do I know?

So Mom and Dad head down stairs to radiation and within 30 minutes are holding a piece of paper that said the baby is 9lbs, 7oz, (+/- 27oz.) To say they had a look of shock on their faces would be an understatement. I am personally thinking that this is the most ridiculous thing I had ever seen. EVER. Again, the baby is 3 weeks early and to me, Mom doesn’t look like she’s packing a 9 pounder. She doesn’t even look close. But, what do I know?

Within minutes of being back in their room, the nurse comes in with a phone in her hand. She said the doctor was on the line and she wanted to speak with Mom. They have a conversation for a few minutes and the look on Mom’s face turned from shock to disappointment. The last thing she said to the doctor was, “well, if you think that’s what’s best, then that’s what we’ll do.” A C-section was scheduled for 5 o’clock that evening.

My own births were vaginal. I had an epidural with my first and an unmedicated birth with my second. I’ve learned a few things from my own births, as well as other vaginal births I had attended over the years. I know that every birth is different. They can be messy and unpredicatable and they can long. I had never been a part of a cesarian birth before so this was going to be a new experience for me.

At precisely 5:15, Dad and I walked into the operating room and were instructed to stand over by Mom’s head. She was already on the operating table, feeling comfortably numb, and all the surgeons were ready to begin. The atmosphere was happy and calm and the room was filled with excitement as we awaited the arrival of a brand new baby. At 5:44pm the doctor lifted a screaming, beautiful, 7 pound baby girl over the curtain for her first debut.

The pediatrician told Dad and I that we could walk around the operating table over to the incubator to get a better look and snap a few pictures of Baby Girl. As a photographer, I have a natural curiosity of all things new and interesting and since I had never been awake in an operating room before I was curious as to what I would see on the other side of the curtain. I had prepared myself to see intestines, a bladder and possibly a uterus outside of Mom’s body along with a whole mess of blood. But it was nothing like that. It wasn’t even close. The area was clean and sterile and the only blood to be seen was on pieces of gauze that were in some kind of a numbered, hanging, system that looked like the shoe organizer in my closet. I was amazed.

Suddenly, the day’s turn of events made perfect sense to me. Why on earth would a doctor want to participate in an unpredictable, uncomfortable. induction that could literally take days when they could just perform a cesarian and be home by dinner time? No muss, no fuss. But, what do I know

Told by Ginessa with Little Wonders Photography
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