My Birth Story: Intraheptic Cholestasis of Pregnancy – ICP

I adored being pregnant. I adored embracing the changes in my body, celebrating what it was doing and watching my baby bump grow. I adored reading those little updates on my phone, the ones that tell you when your baby is the size of a pea or an avocado. I adored all of the planning and the deciding, from the nursery to the name, the way I’d dress him and the way we’d feed and sleep. I actually quite liked all of the anticipation and the excitement, and spent hours imagining my perfect birth.

Unfortunately, due to a potentially life threatening allergy to general anaesthetic running in my family, my birth was labelled as ‘high risk’ which ruled out the midwife led unit water birth I was so desperate for. My birth plan still reflected my wishes though and I planned for an active, positive birth.

My pregnancy was relatively normal, and I had a pretty easy time. I felt nauseous a lot but only ever threw up once so I was really lucky. I worked 60 hour weeks throughout and the only thing I really suffered with was tiredness. I drove a lot as part of my job and would actually have to pull over and take a nap because I was so exhausted just from growing this little human.

Just over a month before I was due we got the keys to our new house. It needed some work so we were staying with my parents while we finished the decorating. I was fairly relaxed about the situation as I was convinced I would end up going overdue any way, so we were in no rush. I was actually worried that I would get 42 weeks and have to be induced, which was my biggest fear.

Intraheptic Cholestasis of Pregnancy (ICP)

At around 35 weeks pregnant I read about a condition known as Obstetric Cholestasis (OC) or now more commonly known as Intrahepatic Cholestasis of Pregnancy (ICP). A lady on my BabyCentre Birth Board had discovered she had it, and had been booked in for an induction. Her symptoms included being incredibly itchy and scratching constantly, especially on her hands and feet. ICP is potentially a very serious liver disorder that develops in approximately 1 in every 140 pregnant women. A healthy liver allows bile acids to flow to your gut to help you digest food, but ICP means the bile acids don’t flow properly and instead build up inside your body. The condition is usually manageable and should resolve after pregnancy, but it does carry a risk of stillbirth.

Of course, immediately after reading about her itching, I began to scratch. Feeling itchy is like that isn’t it? Even writing this now I have started feeling it a little. I was convinced it was in my head, that I’d just become paranoid because of what I had read. It was only once my boyfriend pointed out that my feet were bleeding from all of the scratching that I realised I should mention it to my midwife.

At my next appointment I was around 37 weeks pregnant and I brought up the itching. She agreed that it was most likely nothing and told me not to worry at all. As a precautionary measure she sent me off for a bloody test, but assured me that it would be fine.

Early on Wednesday morning, at 38+2, my phone rang. It was a midwife, who told me that my blood test results had come back and she’d like me to come in to discuss them. Thankfully I was a few days into my maternity leave by this point so didn’t have to worry about getting to work. I asked her where I should be going.

“Delivery suite, and bring a bag.”

Those words sent me into sheer panic. My hospital bag was half packed, probably missing loads of essentials and I’d left it at the new house which we hadn’t moved in to yet. The nursery was half finished, the cot barely built and I hadn’t even bought cot sheets. I couldn’t calm myself down and by the time we got to the hospital my blood pressure was sky high. A kind midwife reassured me, and I tried to keep my panic under control.

We were informed then that my test results showed I had Intraheptic Cholestasis of Pregnancy, and they recommended an induction – immediately. Usually mothers with ICP are induced at around 37-38 weeks pregnant and I was already passed that. I knew nothing about the condition aside from what I had briefly read on the birth board, and I felt completely overwhelmed. I’m someone who likes to have thoroughly researched every outcome, to determine what the best course of action should be. But we had to make the decision there and then, whether to allow them to proceed with the induction or not. Eventually I consented to the induction and I was admitted straight away.

By that point it was around 5 pm. I was taken to a ward and given something to help the itching while a midwife explained the induction process. I knew inductions weren’t quick, and I fully expected to be waiting on the ward for several days. We didn’t tell anyone I had been admitted, not even my parents, because I didn’t want to face all of the “is the baby here yet?” messages. The first pessary went in at 6 pm and I felt slightly more positive as the midwife said she could feel that I was favourable.

I must’ve done 100 flights of stairs that evening, desperate to get things moving, and almost immediately I began to feel strong period cramps. We headed down to the canteen but I couldn’t eat anything. Back on the ward they put me on the monitor and confirmed contractions had started, but they appeared small. They didn’t feel small, and soon I was throwing up from the pain. A midwife chuckled, and said if I was struggling now it was going to get a lot worse. My boyfriend had to leave, and he headed to our new home to do all the things we hadn’t got around to doing yet.

12 Hours Into Induction

Very early the next morning I was still experiencing strong period cramp type pains. As a midwife prepared to examine me I felt a popping sensation and knew that my waters had gone. My phone had 1% battery and I sent emergency texts to my boyfriend and my sister telling them to come right away. The midwife ushered me into the shower but I just sat on the floor shaking. Minutes later a different midwife was banging on the door, telling me I had to get to the delivery suite straight away. They wheeled me down the hall in just a towel, I hadn’t even been able to pack up my things, nothing was the way I had imagined.

Thankfully my boyfriend arrived quickly and my poor sister, who had only just got into London (100 miles away) when she got my text, wasn’t too far behind.

The next 12 hours are a total blur to me and I only remember parts of the day. Still naked from the attempt to shower, my sister helped me put on a bra and knickers, which I immediately took back off. I couldn’t stand the feeling of my knickers touching me. By this point I hadn’t eaten for nearly 24 hours, but I was told they couldn’t bring me anything because they was a possibility I would end up in theatre. I learned that baby was back to back which was making my contractions more painful.

Because of the induction and the ICP they wanted the baby to be monitored throughout my labour, which meant me being strapped down on a bed on my back. It felt so counter productive to me. I wanted to be able to move freely, stay active and use gravity to help get this baby out. My sister, who has 8 children of her own and studied to be a midwife for three years, helped convince them to use a clip on the babies head to monitor him instead, so I could get up and walk around.

While I laboured doctors were in and out of the room, checking on my progress. It seemed like there was a lot of clock watching, and I felt like my body was under pressure to progress at the pace they wanted it to. Several times I was told they wanted to put me on the hormone drop, which is the next stage of induction, but I refused as I felt that I was progressing well on my own. I was given gas and air which really helped me to concentrate on my breathing, and used a TENs machine from very early on which I found beneficial.

Anterior Cervical Lip

As I started to feel like I needed to push my midwife checked again and told me that it wasn’t time yet. The pain I had felt up to that moment was nothing compared to the feeling of trying to fight the strong urge to push that was surging through my body. I began throwing up as I fought against my body and all of my instincts. I can’t really describe the feeling, but I had to use every single ounce of my energy to ignore the need to start pushing. Later on I read an article likening telling a labouring mother not to push with telling someone not to blink, and that’s exactly how it felt. This was by far the worst part of my labour both physically and mentally.

As the shifts changed I had a new midwife called Cheryl, who could see my visible distress. She examined me again and told me there was an anterior cervical lip preventing my cervix from being fully dilated. She was able to push the lip over the babies head with her hand and finally I was encouraged to follow my own instincts and push. I still hadn’t been allowed anything to eat, and I was exhausted from fighting my body but I was ready to meet my baby.

I honestly don’t remember much pain from then, although the sting as the baby’s head crowns is quite something. I remember Cheryl telling me I was nearly there, and then feeling incredibly cross with her when he wasn’t out on my next push. I think that things finally started to feel real for me at this point, I really was about to be responsible for another human and I suddenly panicked that I wasn’t ready. I remember blurting out “but what if I can’t breastfeed?”, which is the first time in the whole 9 months that I’d even considered that.

“Oh my god he’s huge”

I finally gave birth to Dilan Henry Ilker (who actually remained nameless for well over a week..) at 5:57 pm on November 21st 2013, almost exactly 24 hours after my induction had started. I think you’re supposed to say something loving and memorable as they place your newborn on your chest, but I specifically remember exclaiming “oh my god, he’s huge”. Cheryl followed my birth plan wishes and we were able to delay cord clamping and have plenty of skin to skin before his Dad cut the cord and he was taken to be checked over and weighed. At 7 lb 3 oz he was a perfect little bundle, with big dark eyes that were already opened wide and staring back at me.

I enjoyed the typical delivery suite Breakfast of Champions – tea and toast with jam, and we got to enjoy our little boy for a few hours in our own room before moving back to a ward. The days that followed were tough, much tougher that I ever thought they would be, as we struggled to establish breastfeeding in a hospital environment.

Three days later we were discharged, and Dil and I were able to enjoy our very first night together in our new home.

My birth was so far from what I had imagined, or what I wanted. I’m so grateful to my birth partners for advocating for me when I wasn’t in a position to do it for myself and I’ve tried not to spend to long dwelling on how I wish it had been different. Now that I’ve suffered from ICP once there is a strong chance I will develop it next time, which will mean another high risk pregnancy. I would love to have a more natural birth, and the ultimate goal for me is a home birth with my next baby but I am very aware that I will have to take whatever comes. Whatever happens though I know I can plan a positive birth, especially now that I have more time to research and prepare.

For anyone who has suffered or suspects they may be suffering from ICP take a look at ICP Support, a great charity supporting women and investing in important research around the disorder.

1 Comment

  1. 2nd June 2017 / 8:04 am

    I had cholestasis in both of my pregnancies and was gutted to be induced at 38 weeks both times. I really wanted to experience the baby coming naturally, just once! But obviously it’s whats safest. Lovely post, I love hearing cholestasis talked about more and I love reading peoples birth stories too. x
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