Jenni Rutter
My experience with obstetric cholestasis has a very positive outcome. I am now a very proud Mum to healthy 8 week old twin boys, Toby and Joshua.
I should perhaps have been more wary of what might be around the corner during the third trimester of my pregnancy, when my consultant began saying at the end of each appointment in a slightly surprised tone: “you really are doing rather well”. My pregnancy was indeed straightforward right up until 33 weeks. Apart from anaemia (standard with twins) and finding out I was RH negative, my pregnancy had followed the text book.
By 32 weeks I was becoming increasingly jittery about not knowing whether I would be having a natural delivery or a c-section, and when. But I tried to remind myself that all the uncertainties of delivery were just a necessary step in relinquishing the usual control I had enjoyed exercising over my life as a 35 year old professional career woman.
It was a very warm weekend in late August when my bump began itching. My best friend was visiting from Germany with her 3 month old so I was slightly distracted. I was 33 weeks pregnant and my belly was enormous. When I look back now at photos we took that weekend I find it impossible to believe that I could have been so big. I look like I have a bowling ball stuffed up my top and my bump is so perfectly round that it looks like I am faking a pregnancy, Hollywood-style.
I had read the “What to Expect” bible’s section on itching and noted that it was something to look out for. But it didn’t seem to apply to me. My hands and feet weren’t itchy - only my bump and to a lesser degree my upper chest. It seemed so logical that my bump would be itching given the incredible stretching it was doing. I reclined on the couch that weekend like a huge whale, door to the garden wide open and naked to the waist, with a wet muslin spread across my tummy and chest. It took a real effort of will not to scratch myself. The intensity of the itching should have warned me something was not quite right, but I simply made a mental note to mention it to my consultant at my next appointment.
It was lucky that I did. When I saw him the following Wednesday and told him about the itching he immediately sent me for a blood test. On Friday his assistant rang to say they suspected obstetric cholestasis and I should make my way to the hospital (St Thomas’s) for a chat and to check on the babies. I put the phone down and burst into tears – I couldn’t believe something was actually going wrong. My husband very sensibly pointed out that stressing was far worse for the babies than anything else, and I had to remain calm. With his help, I did.
I was told it would take a week for my bile acid results to come back and for OC to be confirmed. In the meantime, my ALTs were high and I went to hospital to have the twins’ heart-rates monitored and for another blood test. The heart-rate monitoring was a bit hit and miss – the midwife didn’t manage to get a good connection and left us alone in a room for 10 minutes with a loud alarm going off indicating no heart rate. We weren’t too worried – but the noise was well and truly winding us up by the time she returned. The following day we received another call – to say that my ALTs had gone up further and I should come back to hospital on Sunday for further monitoring. On Sunday morning I had a 3rd blood test and more monitoring. The twins seemed to be doing fine, but my ALTs were soaring and at midday I was given a steroid injection to help the twins’ lungs develop in case I needed to be delivered early. I was 34 weeks and 4 days pregnant and my consultant said the babies were “still better off in than out”.
That afternoon my consultant decided to check me into hospital for the night to keep an eye on me. My husband was duly sent home for a suitcase. Thank goodness I had begun packing it a week earlier – just in case. I still felt physically fine, the itching wasn’t as bad and I was no more uncomfortable than usual. However, overnight I developed protein in my urine and my blood pressure (which had been low and stable throughout my pregnancy) started to creep up. Photos taken that day show me very red in the face and a little puffy. By Monday lunchtime my consultant was concerned that I was also developing pre-eclampsia. At 3pm, after another blood test showed a further rapid hike in my ALTs, he told us he wanted to deliver me that night by c-section. Suddenly the birth of our twins was upon us, with only 5 hours to get used to the idea! I was 34 weeks and 5 days pregnant. The special care baby unit was put on notice of possible new arrivals, while my husband and I tried to relax and at the same time brace ourselves for what was to come.
The c-section was straightforward and our twin boys were born at 9.44 p.m. and 9.45 p.m. on 3 September. They were in perfect health. Toby weighed 5 lb and Josh weighed 5¾ lb. They needed no special care, and were moved with me to the High Dependency Unit for the night. Spending a night on this ward was not a pleasant experience – I had a tight blood pressure band on my arm which took a reading by squeezing all life out of my arm every 10 minutes or so, and I was of course catheterised and paralysed from the lower chest down. But as I lay there watching the sun rise over the Thames and light up the Houses of Parliament and the London Eye, I reflected on the sheer beauty and perfection of my baby boys and the fact that my consultant had quite possibly saved their lives by acting so quickly to identify and deal with my condition.
Weeks later, my consultant confirmed that my bile acids had been 17.2 (below 6 was a safe reading) and at one point my ALTs had been 200 (at St Thomas’s less than 24 was considered safe during pregnancy). His main concern had been how fast my condition deteriorated. As I write this 8 weeks later, I am not aware of any lasting side effects.
Obstetric cholestasis gave me premature twins, and an interesting story to tell my boys when they are old enough, but has had no other effect on me. I know how lucky I am to have had such excellent care, and such healthy babies. What scares me more is that I hadn’t taken the itching seriously, and things could have been so different. Although OC is more common with multiple pregnancies, I still feel there should be greater awareness of this quiet but potentially very serious condition.
© Jenni Rutter 2007
