The first sign of trouble was my glucose test, which I failed quite impressively. They want your glucose to be under about 130 for the one-hour test...mine was 208. So I had to take another test, a three-hour. No biggie; my midwives tell me that only 30 percent who fail the first test fail the second, and I don't have a history of large babies or diabetes, nor am I overweight. Lucky for me, I'm in the top 30 percent, and I did even more poorly on this fasting test. Not only was my blood glucose too high on the fasting portion, but instead of being below 140 for the first hour, I was 283. !WOW! That's a bad score. In fact, they tested me again, just to make sure there wasn't some kind of malfunction. The good news was I didn't have to stick around for the next two hours. The bad news was I got to leave with a diagnosis of gestational diabetes. Lucky me.
That was Tuesday. On Tuesday, I felt like a big fat failure who was also a little sad about having to completely give up the Dr. Pepper (again). Wednesday I met with the nutritionist and left feeling empowered and ready to take on the challenge. I dutifully picked up my blood glucose meter and started pricking my finger. (This is now a family affair because to a three-year-old and a four-year-old, there is apparently nothing more exciting than watching Mommy poke her finger and "put the blood on a stick.") I was doing great.
Thursday, I started itching.
Now, when I say I started itching, I don't mean to say that I had a benign, generalized itch, or that I was experiencing the typical belly and hips itching that women experience as their skin stretches over their burgeoning bodies. I don't even mean that I was itching in a way similar to having a particularly bad reaction to poison ivy, or a bee sting, or developing hives. Oh, no, friend. This was a sudden, intense, positively consuming itch that over took every inch of skin I had. I itched inside my ears. Even my eyelids itched. Having vaguely remembered reading something about calling one's doctor if this happened, I told Rob, "I think this is SOMEthing...I think I better call."So even though it was late and it had only been going on a short while, the intensity drove me to call my midwives. Now, if you know me well, you know I have a tendency towards hypochondria, and I fully expected my midwives to tell me to take some Benadryl and that I'd be like new in the morning. Unfortunately, she told me to take some benadryl in the hopes that it would knock me out (it did not), and to get myself into their office as soon as it opened in the morning for some blood work.
That night I barely slept for all the itching--waking every 45 minutes or so to soak in ice water--, and in the morning, I had a pretty awful talk with my midwife. They felt pretty confident that, given the itching with a total lack of rash, as well as a couple less conversational symptoms, that my blood work would come back showing elevated liver enzymes and elevated bile acids, both diagnostic of something called Intrahepatic Cholestasis of Pregnancy, or ICP.
Now, let me insert here that having a conversation with your midwives that includes things like "amniocentesis," "35 week induction," and "fetal demise" is pretty much the best way possible to cause a meltdown in a pregnant woman. Nevertheless, I held it together until I talked to my mom on the phone, and again when I got to speak to Rob.
We had to wait until Monday to get the results, and in the meantime, I found out that my cousin had also had ICP (it has a strong genetic component), and she gave me some great resources. I read all I could on the subject to prepare myself, and on Monday, I had lots of questions to ask. When my midwife called on Monday, she let me know that the results showed I did have elevated bile acids, and that meant ICP was another diagnosis in the same week as my gestational diabetes. Both disorders have a very high likelihood of returning in any future pregnancies. Like I said, this little man is apparently working hard to be the baby of the family! :)
The midwives and one of the doctors in the practice met that day to discuss how to manage my care, and thankfully, came to conclusions that I was hoping for.
ICP is a fairly rare condition (one source said 1 to 2 cases in 1000 pregnancies) caused by hormones in pregnancy creating a malfunction of the common bile duct, which creates a build up of bile acids in the blood. It is only resolved by birthing the baby. While ICP doesn't carry any serious risks for me--simply this insanity-inducing itchiness--it does carry some serious risks for baby, including stillbirth. Other risks are early spontaneous labor (in as many as 60% of women), fetal distress, meconium passage in utero and aspiration, and hemorrhaging. Fortunately, with the use of medication, fetal monitoring, and early induction, the risk of stillbirth in ICP babies can be brought down to about the same level as in typical pregnancies.
So, from here on out, I will be seeing my midwives weekly for blood testing, non-stress tests (or NSTs), and medication adjustments, if needed. They won't be letting me get past my 37th week, and if I am extremely symptomatic, or the meds don't work to bring down my bile acid levels, we may need to do an amnio and deliver even earlier than that. So far, I've been on the medication about 3 days, and I think I am just starting to experience a lessening of this dreadful itch. That is a good sign, and hopefully we can make it to 37 weeks.
This whole ordeal is, admittedly, kind of scary. In spite of the medication and early induction, I do sometimes have those "freak out moments" where I worry about what I would need to do if the baby doesn't make it. And I've also had to adjust my idea of an "ideal birth" this time around. Of course, I'd like to have another natural childbirth, but really, I don't care how baby gets here, just that he does so safely. I'm so grateful right now that baby has always been so active and that I know he is still kicking around in there. I'm grateful for priesthood blessings and the comfort of the Holy Ghost, and I am so grateful for the prayers and thoughts of my friends and family over the past week!
In a way, I am excited we'll be getting to meet this little man a month sooner than we thought; I just wish it were under better circumstances! All in all, I know that we are getting good care and I feel safe in the hands of my midwives. I'm also blessed to know a couple of people who have been through this and have beautiful, healthy babies to show for it. I will be so happy to add my little guy to that list!
So, that's the whole scoop on me and baby. Prayers and thoughts are so appreciated!
And, since no post is really complete without a photo, here is a quick photo of me with my round belly, just a few days before all this craziness!
For more information on Intrahepatic Cholestasis of Pregnancy, please check out this great website, full of information, treatment plans, and medical journal entries: ICPcare.org
