What is Cholestasis and how to manage it
Cholestasis of pregnancy (also called obstetric cholestasis in the UK) is a liver condition that can happen during pregnancy, usually in the third trimester (after 28 weeks), but for some it may show up earlier. It affects the flow of bile-a fluid your liver makes to help digest fats.
Normally, bile flows from your liver into your gut. But in cholestasis, that flow slows down or gets blocked, which causes bile acids to build up in your body and that can cause symptoms, particularly itchy skin.
My experience of Cholestasis and how I managed it
When you find out you are pregnant, you normally self-refer yourself to your local or chosen hospital, this is so you can begin the prenatal appointments and have a designated midwife/team.
Shortly after finding out I was pregnant, I referred myself and began receiving appointment letters for scans and midwife appointments. These usually start at 12 weeks of pregnancy. I had been assigned a midwife who would be at the majority of my midwife appointments (these are normally formality chats in which they check on the mum/parents, answer the many questions you may have as a first-time parent, be observant of any wellbeing issues or any further referrals that can be recommended).
At the appointments I continued having every few weeks, my midwife had mentioned the basics of when to contact them or if I was concerned about anything regarding the pregnancy. One thing she always added was to look out for itching in the hands and under the feet.
I was 31 weeks pregnant, sitting with my family, and, all of a sudden the palms of my hands began to itch. I told my husband and we called triage (sort of like a&e but for pregnant/post-natal women. They told me to go in right away. I did a blood test and 3 days later was told my bile acid level was 16, and the normal level was below 14. They said it was not a major concern at this point, however, extra monitoring is required. I went on to have weekly blood tests at the hospital.
The bile acid levels ranged from 16 (at 31 weeks to 107 (at 36 weeks). Once it got to 107, I was admitted into hospital for induction at 36+2 weeks pregnant.
The risk of cholestasis on the baby can include: a pre-term birth (earlier than 37 weeks), fetal distress, meconium (first poop) in amniotic fluid as a result of stress, and rarely – stillbirth.
It is important for the mother and baby to be diagnosed, monitored, and managed properly from the moment the first symptoms arise (other symptoms can include jaundice, dark urine, pale stools, loss of appetite or abdominal pain). Although I did meet another lady who had cholestasis but did not know she had it until she got to around 39 weeks, as there was no itching for her (subclinical cholestasis). The only way to know for sure is to have a bile acid blood test done.
If you have had cholestasis previously, you have a higher chance of it developing again in future pregnancies. After my experience, I know how best to manage my symptoms (husband + aloe vera) and to not be so worried as long as I am being monitored, I would take it easy, chill out as much as possible and try to manage my symptoms whilst trying to go about daily life. I would also stay on top of my blood tests, log in to your hospitals online health record system so you can see the results of your tests. I saw my bile acid levels rise to 107 in the last blood test I did and ended up being the one to inform the hospital. The NHS is underfunded and sometimes your results won’t be seen as quickly as they become available (especially if your blood testing for bile acid is sent to another hospital, mine was sent to St Georges so always waited 2-3 days).