I had my 32 week appointment today with my OB as well as antenatal testing.
I found out that Kaiser doesn’t mess around when it comes to intrahepatic cholestasis in pregnancy. I’m being induced on 9/13, when I will be only 36 weeks and 2 days. I sort of expected my OB to say “This isn’t really a big deal, but as a precaution I guess we’ll induce you at 38 weeks.” Nope. They want this baby out before 37 weeks. At 37+ weeks, apparently, my bile acids could spike dangerously high at any given time and harm or even kill the baby. Scary.
While I feel relieved to not be worrying that my baby will die in utero, I’m fighting some fears today that she will be little. Really little (Josh was 6 pounds 13 oz at 39 weeks). And that maybe she might not nurse so hot right off the bat. That she might have some respiratory complications. Of course, there are many 36 weekers out there that eat and breathe like champs and act like grown up term babies. I’m praying that our little girl will be one of them!
The NST went really well and baby passed with flying colors. She had good movement and good heart rate. I have an anterior placenta so her movement is muffled a bit — I have to be paying attention most times to notice her movements. Baby was already in vertex cephalic position, which was awesome! (Now please stay that way, little girl!) The ultrasound showed excellent fluid levels and lots of fluid around her umbilical cord. The nurse was great and she felt like an old friend by the time I left. Another nurse came in and wanted to discuss my ultra-hot feet at night time and came up with 3 or 4 solutions for me to keep them cool. They took good care of me, and I’m grateful for that! I’m going to be spending lots of time with them before this baby comes.
The nurse then gave me a TdAp and I didn’t even feel it. Not even a pinch – nothing (I admit to looking for an injection site). I’m so thankful for this vaccine which will protect my baby from pertussis until her 2 month vaccines– given that she’ll be little and it will be the winter months by the time she gets her first round of vaccines.
In the exam room, my OB answered a lot of my questions today (I brought in a long list). Information she passed along to me:
- The medicine I’m on (Ursodiol) may or may not help decrease bile acid levels, but it should decrease the amount of itching I have.
- She will not be checking my bile acid levels again unless I have a major change of symptoms (i.e. I become jaundiced, etc). Since baby is being delivered early I am fine with that. Currently my liver enzymes are normal and the bile acids are just slightly elevated.
- She said that diet changes won’t help– but that it would be a different story if I had gall stones (which I don’t).
- They don’t know what causes Cholestasis in pregnancy, but they do know that there is a genetic component and that it’s related to hormones. Patient with twins and triplets are more likely to get it, as well as patients who went through IVF (increase in hormones = higher risk of cholestasis). Since no one else in my family has had this, I’m guessing that the IVF/embryo transfer is the culprit in our case.
I can’t believe our baby will be here in a month. I’m not even to that really uncomfortable pregnancy stage yet or feeling like it’s time for this baby to come out. As I process her early inducement date, I’m definitely feeling a mix of excitement and fear. I will be praying much over this next month for our little girl’s safety. Please pray with me!
Now off to get this toddler of mine to sleep for his nap. Teething has ruined his happy napping schedule!