The following is the post I was writing from hospital on the Sunday morning before I went into labour. I figured I would share it with you just for kicks and because it explains a bit more about the condition I had developed. When writing this I was quite frustrated about being cooped up in hospital for potentially another 8 days (till I hit full term at 37 weeks) and had grand plans to persuade the doctors to allow me to be released and treated as an outpatient. Little did I know that the doctors were conspiring against me (and planned to induce me on Sunday) or that the alien had its own plans for a great escape that day. All I can say is that I am pretty glad I was in hospital in the end!
So it seems that itchiness all over without any rash is a bit more serious than I thought. At the consultants’ appointment on Friday, I told them about it and the obstetric consultant ordered a blood test to check my liver function. When I asked him if it was likely to be something else, he was pretty confident that the test would come back positive for some kind of liver malfunction. So from being super bored with me from when I started at the clinic to now, when really I was an interesting haematology case but not very exciting from an obstetrics point of view, suddenly it was all over to him, the haematologist could sit back and relax.
The expected diagnosis was obstetric cholestasis, a liver disorder that affects 0.7% of pregnant women in the UK. There seems to be little understanding of what causes it, the main culprits believed to be our old friend oestrogen or genetics, as the Royal College of Obstetricians and Gynaecologists report, the rate for Chilean women is more like 2.4% and in the UK those of Indian or Pakistani origin have a greater likelihood of getting it at 1.2-1.5%. So even less likely amongst those of British caucasian origin – lucky old me. The risks associated with the condition are generally deemed to be for the baby, with an expectation of a greater risk of premature labour [Elly: how right they are!], stillbirth and meconium passage during birth (the baby pooing during delivery is generally viewed as a sign of fetal distress and can cause breathing issues if said poo is inhaled). However, the evidence on whether there really is a difference for expectant mothers with Obstetric Cholestasis relative to the general population is scant, because the general practice now is to induce or do a c-section once past 37 weeks, so it’s hard to tell what differences are due to OC vs forcing early birth, and equally there is no way of knowing what would have happened and the birth been left to take its course.
So coming out of the appointment I was quite upset – all my plans for the next five weeks being rather annihilated by the expectation that I would be induced within a fortnight and that unless I spontaneously decided to go into labour, then I would have to be induced (none of these things would be in my birth plan!).
So imagine my joy, when a few hours later the obstetrician rang me and told me my results were back and my liver function was indeed abnormal, but not in the way they would expect for OC. My bile salts had come back moderately elevated, but it was my liver enzymes (ALT levels) that were extremely high and that indicated liver damage and, to make matters more complicated, was not a normal presentation for OC (as those in the know call it). He asked me to come into hospital that afternoon to be monitored over the weekend – I asked if I should pack my hospital bag as if for delivery, he said “that would be advisable”.
Cue a certain level of panic. I didn’t have a hospital bag packed – I wasn’t due for another five weeks, I shouldn’t need to have a hospital bag packed! So I rang Fred and told him to get home pdq, and then sought out Cath’s post about the hospital bag to work out what I needed!
Once in hospital we were ushered into the delivery suite and specifically to a nice corner room specially kitted out for twin deliveries (did they know something I didn’t?). It was pretty frightening – why was I in a delivery suite when I had no plans to deliver? Doctors came round and took copious amounts of blood. The lowdown seemed to be that if my ALT levels had deteriorated further then they wanted to induce me that night. Luckily they hadn’t, but the same principle was held overnight – so I slept on the delivery ward with Fred sleeping in the rocking chair. My ALT levels were steady the next morning as well. The obstetric consultant on duty explained that they would move me to the antenatal ward but would continue to monitor me. They didn’t know exactly what was wrong (OC being diagnosed by ruling out all other possibilities, including very serious conditions like Acute Fatty Liver) and were weighing up whether the baby was better off out than in. When asked how they were doing that, she said (paraphrasing slightly): “We’ll make the decision pretty much on gut instinct – obstetrics as a line of medicine is not well developed, we are only one step away from witchcraft”. And although this shocked the midwives and doctors trailing after her on the round, I recognised the sentiment from the research done for this blog: because of the ethical implications when involving babies, the usual scientific studies with controls (e.g. those given placebos) are not as widespread (you don’t want a baby go die because you gave its mother a placebo) and using just the data on those who naturally experience something that you want to study, the number of factors that could be influencing why that woman is having that experience are difficult to tease out.
So I was moved to the antenatal ward on Saturday. And not much happened. In the morning I would have a blood test, then three times a day I would be put on a monitor (where interestingly there were spikes on the Toco which I couldn’t feel so the midwives assumed these were Braxton Hicks). And nothing else. I was very bored and looking out onto HM Prison Wormwood Scrubs did not help the feeling of being trapped. I occasionally was allowed to escape to the canteen (where we ordered the car seat online) and I snuck out with Fred for a walk around Wormwood Scrubs Park, which was a nice park with a variety of wide open spaces and copses and I was glad to get out into the fresh air.
I was going stir crazy. I felt fine and I was stuck in hospital mostly doing nothing. And all I could see was more of the same stretching out before me for at least eight days.
Sunday morning I was going to make my case for escape – they could treat me like an outpatient, I could come in for these tests, come in if anything changed. I’d do anything not to sit there bored out of my mind for any more days!
And then my waters broke… and my perspective changed rather.