From MIDWIFERY MATTERS, Issue No.106, Autumn 2005
IT WAS ANOTHER DAY into a textbook pregnancy at week 33 when I found out that
my liver was poisoning my baby.
I'd been to Tesco looking for some cream to put on my itchy hands and feet.
They'd been like that for a couple of weeks but I'd put it down to yet another
pregnancy-related ailment, as if swollen limbs and five trips a night to the
toilet weren't enough to be going on with. It was only later that afternoon
at a routine ante-natal appointment that I realised it would take more than
a moisturiser to stop the intense heat emanating from the palms of my hands
and the soles of my feet.
Five minutes later I was having a blood test; five hours after that I was sitting
on a hospital bed surrounded by a team of doctors and getting a steroid injected
into both my legs to strengthen my baby's lungs.
"What's the worst-case scenario?" asked my husband.
"Death," replied the midwife quite matter of factly. Had the illness
been missed, my son could have been stillborn.
It was a night we will never forget. Just a week earlier I had been at Cardiff's
Llandough Hospital for a tour of the maternity unit. Now my husband and I were
sitting in the same ward trying to comprehend what we were being told. I had
obstetric cholestasis, a liver condition that is thought to affect around 1%
of women during pregnancy. There is no cure except early delivery of the baby.
All I could understand that night was that my body was poisoning my baby.
I was put on medication in an attempt to stop poisonous toxins from passing
through the placenta to my baby. From then on it was a question of getting through
each day until the baby was mature enough to survive outside the womb.
The staff at Llandough knew their stuff and for this we will always be grateful.
I was diagnosed immediately and received excellent care with daily heart traces
and the support of a super-confident and able consultant who had handled many
similar cases before. But had I lived in a rural area outside of the city where
not so many cases are seen I can't help feeling it may have been a different
story.
The medication I was prescribed appeared to start working after three days and
my husband and I breathed many sighs of relief. The itching wasn't as bad, and
for two nights I didn't feel the need to walk barefoot on the cold stone tiles
in the kitchen in the middle of December. But the relief was short-lived. The
following week the itching got worse and I knew deep down that the levels had
started rising again.
Twice-weekly blood tests confirmed that the levels were on an upward trend.
The doctors didn't know why and could not tell me what was causing my liver
to malfunction.
One theory is that the liver can't cope with the high levels of hormones in
pregnancy and this leads to a reduction in the flow of bile which helps get
rid of waste products. The build up of too many bile salts in the blood causes
the itching and in some cases jaundice in the mother.
Knowing my baby could die at any moment inside my womb and being powerless to
do anything about it made me feel desperate. I only felt safe for the half an
hour each day I was hooked up to the heart monitor which confirmed that yes,
he had come through another night.
But as I left the hospital each morning I would close my eyes and walk slowly
to the car, thinking of cunning ways I could stay at the hospital so they could
keep checking he was still breathing. Each day I had no idea how I would spend
the 23 hours that loomed until I could come to the hospital next. At home I
was told to feel for movement every hour. I woke several times during the night
poking my tummy to get a reaction. It was torture.
Every day I would ask the hospital midwife if it was possible to deliver him
yet. I just wanted him out, where I could see him and touch him, regardless
of the consequences. If he had to go to the Special Care unit I didn't care;
we could get him better if he was on the outside. It was a gut feeling that
strengthened as week 34 and week 35 passed. Doctors were treading the thin line
between the risk of stillbirth and damage to the baby if born too early, insisting
every day that we had to wait.
Ten days before Christmas I was admitted to hospital but there was nothing the
doctors could do except watch and wait. It was still too early for him to be
born. In the middle of the night I called the midwife several times to put icepacks
on my feet and I slept fitfully with my arms around my huge tummy.
I knew my baby would have to be delivered by week 37 - the risk of stillbirth
increases dramatically after this time. Again doctors don't know why. But when
the poison in my blood increased once again, three days before Christmas, the
consultant was willing to take no more chances and booked me in for a Caesarean
section the following day. I knew I could not have gone through another week
wondering if my baby would survive Christmas.
Tom Waters was born a healthy seven pounds despite being nearly a month early
at 12.36pm on December 23rd. I kept asking if everything was OK. I was sure
there would have been something wrong, but apart from being a bit cold and difficult
to heat up, our baby was fine. I held my little sparrow as I had nicknamed him,
all night in my hospital bed. I was the only one on the ward on the 25th December
and we spent our first Christmas Day together as a family.
We were lucky. Many women fail to mention signs of itching, believing, like
I did, that it is just another annoying side effect of pregnancy, and it is
only after a stillbirth that they remember having suffered it earlier. Apart
from the risk of stillbirth obstetric cholestasis does not seem to cause any
other complications for the baby, and women who get it go on to recover completely
with no damage to their liver. Unfortunately however there is a very high chance
that it will strike again in subsequent pregnancies and earlier in the term.
While pre-eclampsia and other serious pregnancy-related illnesses are given
extensive coverage, obstetric cholestasis is not. It is clear that more research
needs to be done. Mothers-to-be as well as the medical profession certainly
need to be made more aware of the dangers.
My first pregnancy is over and the OC is gone, but its legacy lives on. I'll
never be free of it. I know that if I ever want Tom to have a little brother
or sister I run the risk, a high risk, of obstetric cholestasis returning. It's
a risk I am not looking forward to taking again.
Felicity Waters is an experienced freelance journalist having
worked in both print and broadcast media. Whilst working as health correspondent
at the Western Mail, the National Newspaper of Wales, she won an award for her
investigative journalism.
copyright Felicity Waters
Updated LW January 17, 2007