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Discussion Starter · #1 ·
During my last pregnancy I developed cholestasis. The odds are that I'll get it again and since we're likely only have one baby this time, he/she will go full-term unlike our 37w5d twins went. The odds of stillbirth caused by cholestasis go up dramatically after 38 weeks. Should I get care from a midwife during pregnancy because of this? WWYD?
 

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I dont know this disease...is it something that you can test for and if it's neg, not worry? or does it need constant monitoring, like it shows up at variable times?

well I was just googling it. http://www.americanpregnancy.org/pre...pregnancy.html

you get it typically late in pregnancy? if it were me...I'd stay unassisted the first few months at least...but get a midwife later to keep an eye on it, if you DO develop it. that site I linked says they dont know if the second pred increases chance, but some say you're 90% likely. this is one thing that I feel getting outside prental care is the point of, to keep you + the baby safe.
 

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i think that in this case, i would get midwifery care to watch for this, and then UC if you feel comfortable or utilize the midwife if you feel more comfortable with that. the midwife will also help you develop a birth plan for the hospital too--in case that is necessary.

so, i think that your situation requires a bit more planning than others--but i'm sure you'll get the kind of birth experience that you want!
 

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I've worked with a mom who had cholestasis with her first pregnancy. She worked really hard her whole pregnancy to keep her liver healthy by taking Blessed Thistle, Dandilion and eventually Sam-e (per some amazing studies out of europe about using same-e to treat serious liver conditions, after no small amount of study and discussion)

Could you find a naturopath who would be willing to work with you on this?
 

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just had a gal with this and so it is fresh on my mind--
you could start now when not pregnant and see if anything makes a difference- it could be that twins made it worse.
in any case something like lecithin and high dose b vitamins for gall bladder- sometimes people don't have stones they have thickened sludge- and it still causes problems- so I would say do this before pregnancy and go for increasing greens and other veggies in your diet and decreasing deep fried foods -- you could also use some milk-thistle and dandelion for support.
in pregnancy the gallbladder like everything else reacts to hormones of pregnancy and softens and moves more slowly/sluggishly--
guar gum has been shown to decrease the bile salts up to 40% in some women so I would say use it along with the other herbs and vitamins and the sam-e supplement. for our gal nothing worked completely and her skin stayed itching the whole end of pregnancy.
now to address what the problem(s) are-
#1- bile salts if they get too high in the 40's for some and for others problem are at about 3x the normal levels. the bile salts start settling out into the placenta enough to create a compromise/ diminish placental function
additional consideration when the bile salts are high is that it causes the baby's gallbladder to shut down- feed back mechanism so can't say it isn't working properly because the body is responding right but causes problems in utilization of fat soluble vitamins
#2 - fat soluble vitamins are not being properly absorbed when mom has cholestasis this means potentially low vitamin K/clotting factors in mom and baby ( some infants have problems during the birth process- with brain hemorrhage because of this)

so if you can get serial labs on liver function - most importantly bile salts to be sure that they are not building up to too high of levels.

how itchy did you get ? did you break out all over or just upper body? when did it start?
M. Moore the herbalist doesn't name this problem in pregnancy but does have some interesting stuff to say about similar problem in a non-pregnant person- and he recommends of red root-- for headaches or itching associated with sluggish gall bladder ( he also says if taken in pregnancy use lower doses).

oops forgot to add that I would recommend that a baby get a vitamin K shot in this case because of the depressed function of the gall bladder- makes for absorbing oral nearly impossible even for baby..
 

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Discussion Starter · #6 ·
Thank you for the information everyone. I am already pregnant and starting to get itchy. I don't remember when exactly I got it last time but it was around the beginning of the 2nd trimester. Earlier than most cases. I am currently only 7-8 weeks. I was on 15+ capsules of dandelion last time and it didn't seem to do much for me. I ended up with needle-like pains and numbness by the end that I thought was pregnancy carpal tunnel but have read it could have been a sign that the cholestasis became severe. I'm not sure.

Also, my daughter had clots behind her placenta and my son had jaundice for 2 months after birth. Are these also signs of Cholestasis?

I'm going to speak with my previous midwives before me move away. They can get me on the right herbs and things until I can find a midwife out East where we're moving to. I am going to try to get blood work done before we go also, but there may not be time left. What tests should I request?

Thank you for all your help!
 

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Encapsulated herbs are notoriously non-helpful.

Try tinctures (liquids) they will blow you away as far as effectiveness goes if hte only kinds of herbs you have ever taken are dried and encapsulated.

You can ask a care provider to order a Liver Panel and it will have all the appropriate tests on it.
 

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the jaundice for 2 months yes-- sounds like it got pretty bad-- the guar gum will help keep the levels down- have a liver panel with bile salts- knowing how far out of range the bile salts get is a crucial point for safety-
get the milk thistle- also eat artichokes (same family with similar qualities)
eat raw and steamed veggies- and fruit try to not eat butter fat as it goes straight into the blood stream.
 

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Discussion Starter · #9 ·
Quote:

Originally Posted by midwifetx
Try tinctures (liquids) they will blow you away as far as effectiveness goes if hte only kinds of herbs you have ever taken are dried and encapsulated.
I started off on some powder form added to water/liquid of some kind and I just couldn't take it. They put the powder in the capsules for me.

I'll ask about the tinctures available for me. Thanks!
 

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Discussion Starter · #10 ·
Quote:

Originally Posted by mwherbs
the jaundice for 2 months yes-- sounds like it got pretty bad-- the guar gum will help keep the levels down- have a liver panel with bile salts- knowing how far out of range the bile salts get is a crucial point for safety-
get the milk thistle- also eat artichokes (same family with similar qualities)
eat raw and steamed veggies- and fruit try to not eat butter fat as it goes straight into the blood stream.
Two months was how long it took to get completely gone including his eyes, which took forever to clear. About 5 weeks in his skin.

I am taking dandelion and mixed capsules for Liver and Gullbladder function that include milk thistle. About how many of each (including just milk thistle) would you recommend this early on in pregnancy? Thanks!

I am already eating a ton of raw vegetables and fruits because of crazy cravings for them. If I even look at anything fried or greasy I get nauseous. It's the only time I feel it also. My body must be telling me something.
 

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Discussion Starter · #11 ·
Quote:

Originally Posted by mwherbs
the jaundice for 2 months yes-- sounds like it got pretty bad-- the guar gum will help keep the levels down- have a liver panel with bile salts- knowing how far out of range the bile salts get is a crucial point for safety-
get the milk thistle- also eat artichokes (same family with similar qualities)
eat raw and steamed veggies- and fruit try to not eat butter fat as it goes straight into the blood stream.
Two months was how long it took to get completely gone including his eyes, which took forever to clear. About 5 weeks in his skin.

I am taking dandelion and mixed capsules for Liver and Gullbladder function that include milk thistle. About how many of each (including just milk thistle) would you recommend this early on in pregnancy?

I am already eating a ton of vegetables and fruit because of crazy cravings for them. I've never experienced this in other pregnancies. If I even look at anything fried or greasy I get nauseous. It's the only time I feel nauseous also. My body must be telling me something.
 

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Quote:

Originally Posted by MyCalling

I am taking dandelion and mixed capsules for Liver and Gullbladder function that include milk thistle. About how many of each (including just milk thistle) would you recommend this early on in pregnancy? Thanks!

I think the point is that we *wouldn't* recommend capsules of dried herb....it is simply NOT potent enough...get a TINCTURE. You said you were going to ask, so that's great...

I'm sorry, i know they SUCK, but it's the only way to get the strength you need.....

I too had cholestasis with my last pregnancy, so i hear you!! I about itched myself raw....my midwife helped me with herbs/remedies (mostly what has been mentioned here, and also LOTS of water) It started later than yours...i don't remember exactly...maybe 32 weeks or so...and i AGONIZED over whether we should induce, etc...but luckily, after a few weeks on the tinctures and stuff, it gradually went away.....I ended up delivering at 40W 1D, with no symptoms of cholestasis.....I also get several chiro adjustments, which, while they were for other problems i was having with my pubis, i believe also helped my body be able to function better on a holistic level, you know?

Of course, the best thing would have been for you to have done a complete liver cleanse before you got preggo, but clearly that's not an option...are you on ANY medications? If so, and they can be reduced/removed at all, you should, to take strain off of your liver. I know this is partly what helped me..i take meds for diabetes, and stopped...took a HUGE strain off my liver! At that point, for me, after an entire pregnancy of well-controlled diabetes, the risk of being slightly uncontrolled for a few weeks, in return for taking the strain off my liver, was worth it.

I too would check bile salts as well, especially if the symptoms flare up....
If i were extra worried, i might consider getting something like 5-W formula...but instead of starting it at 35 weeks, start at maybe 32-33 weeks...so you can hopefully deliver by week 37-38.......Now, before a bunch of you who have never been faced with a 50%+ chance of stillbirth from going past 38 weeks start to chime in and flame me for suggesting this, all I'm gonna say is : I KNOW the risks of being premature...being DEAD is worse.

*IF* I felt the issue was really getting out of hand and my baby's health was in danger, I would do an indiction or C/section....depending on how far along in the pregnancy, what the situation was, etc.....I had my first UC, and plan to have further babies that way, if possible, so I do not say that lightly...but dead is dead...I'd do what i had to!
 

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Quote:

Originally Posted by MyCalling
During my last pregnancy I developed cholestasis. The odds are that I'll get it again and since we're likely only have one baby this time, he/she will go full-term unlike our 37w5d twins went. The odds of stillbirth caused by cholestasis go up dramatically after 38 weeks. Should I get care from a midwife during pregnancy because of this? WWYD?
Um, yes.
 

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I too had ICP with my last pg. Not with my first. And so far, not with my third. But I'm on the look out for any of the symptoms.

I am currently doing an UP, but not by choice. I plan on contacting a midwife as soon as we are back stateside (for a homebirth). But should there be any hint of the itch, I'd fly out to a Korean dr as fast as I could to get tested and monitored.

B/c of a drs idiocy, I was not notified of my ICP until I was already 38 weeks. I also agonized over what to do (as far as inducting). Lots of sex, membrane stripping, and a variety of tinctures had my in labor within days (and just hours before a scheduled induction). If my ICP returns, I'll start trying to get things moving at 37 weeks. I won't go a day past 38 weeks.

I hate to say it, but it sounds like you are getting it already (you poor thing, I am sooooo sorry). I'd contact a midwife, just to have peace of mind. Even with the ICP, I think you could still do an UC. I just wouldn't do a UP.

Good luck.
 

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Haven't had time to read all responses, please forgive if repeating...

The gentlebirth.org archives have a great article written by the woman who was a doula at my recent FB. She's had OC 4 times and managed it with diet. She supports hb/fb for mamas with OC.


NAK...
 

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Your friend has some interesting advice and most of it we have tried- do you know if she stopped itching or if that stayed with her even if she got the numbers to drop? her quote in 1/4 of babies having problems seems a bit high.. but maybe that is regional.
 

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Quote:

Originally Posted by DreamerMama
I cannot believe this is even a question. Please, for the sake of your unborn child, contact a midwife.
I can believe this is "even a question." There are many reasons UP may be a safer option, even under these circumstances. Please don't imply that this mama cares any less for her baby than anyone else. To do so is unsupportive, inconsiderate, and unhelpful.

Treatments such as those suggested (herbal tinctures and supplements) combined with monitoring of maternal symptoms and baby's physiology (movements and heartbeat) will not be made automatically more effective just because a midwife administers them. We as individuals also have much more time and motivation to inform ourselves specifically on our particular conditions and to find recent research on treatments than our practitioners, with their multiple patients, have at their disposal.

By the way, vitamin K is avalable OTC to be taken orally. Oral administration results in slower assimilation, but has also not been associated with elevated risk of leukemia, and is just as effective in assisting clotting as the injected form.
 

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I agree someone should take care of themselves first even if they are going to a provider.
but now I will say that this condition blocks/prevents the absorption of oral vitamin K and is one of the causes of oral vitamin K "failures" in studies on oral vitamin K in newborns. but there should be someway to get vitamin K injectable simply
 

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Quote:

Originally Posted by kaylee18
I can believe this is "even a question." There are many reasons UP may be a safer option, even under these circumstances. Please don't imply that this mama cares any less for her baby than anyone else. To do so is unsupportive, inconsiderate, and unhelpful.
I totally agree. I was diagnosed with cholestasis with my first (and only, so far) pregnancy. Symptomatically, I didn't have it very badly. But it was diagnosed and it came a hair's breadth away from ruining my home birth. I had a backup obstetrician and a midwife. The hospital that my OB is associated with put huge pressure on my OB to see that I was delivered in the hospital. My OB therefore put huge pressure on my midwife, telling her that they would both be in very hot water if I gave birth at home and anything went wrong, because the hospital big-wigs were watching my case very carefully. My midwife therefore backed out on me when I was 38w4d pregnant and told me that she felt a hospital birth (induced) was best for me.

Long story short, I managed to find out about all this political crap, changed OBs so that my midwife didn't feel so scared that she was risking her license and gave birth at home at 39w1d.

In my experience with mild cholestasis, the doctors are NOT the best people to treat cholestasis. My doctor simply wanted to put me on the Urso and induce me at 36 weeks. He had no natural alternatives to suggest. My midwife knew nothing about the condition. I managed to keep my cholestasis mild, I believe, by going on an extremely strict diet (only fruit, veggies, whole grains and eggs -- absolutely no sugar or white flour) and also taking an herbal 'anti-itch' tincture. Doing these things brought my bile acid numbers back down into the normal range, although my liver enzymes did stay elevated. I did have mild itching until the very end of my pregnancy, and it disappeared the moment I delivered.

I am considering getting pregnant again in a few months and I saw the comment from a PP about doing a liver cleanse beforehand. What does that involve?

I realize that your cholestasis sounds considerably more severe than mine was, but I think it's reasonable to surmise that the same general approach could be helpful.
 
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