[ozmidwifery] Re: on the subject of induction/cholestasis

[G Lemay]

Hi Amy,  Here are two articles you should read about Cholestasis.  One is off this list and the other is from http://www.birthlove.com Gloria in Canada           What Is Obstetric Cholestasis?                      -by Natalie Forbes Dash                       Homebirth Access Sydney                       Blue Mountains Homebirth Support                       CHOLESTASIS is a liver condition that involves pruritis (itching) and increased bile acid levels in the last                       trimester of pregnancy. Approximately 1% of pregnant women have this condition, which continues until                       delivery. Babies have an increased chance of meconium stained amniotic fluid, foetal distress, spontaneous                       preterm delivery and a 1 in 4 chance of being stillborn. Subsequent pregnancies are usually affected, getting                       worse with each. Quite often symptoms go unrecognised in first pregnancies, increasing babies risks.                       Cholestasis is caused by a blockage. When the liver has little capacity for absorption or excretion of bile,                       some of the normally excreted bile acids cause partial destruction of the liver cell membrane, allowing the                       toxins to enter the blood.                       Little is known, but there is evidence to show that oestrogen plays a large role. Patients with increased                       oestrogen levels, such as those carrying twins, have an increased incidence of the disease.There is also a                       chance that cholestasis could be hereditary.                       Symptoms may be difficult to diagnose until the patient is very sick., but if women and caregivers are aware                       of cholestasis it can be controlled. Pruritis (itching) usually starts on the soles of the feet and the palms,                       extending to the rest of the body. In some severe cases it can involve the face, ears, mouth and head.                       Itching is at its worst throughout the night, leading to sleep deprivation, exhaustion and physical and                       mental fatigue. Mild jaundice is shown in about 20% of patients and some babies are born jaundiced.                       Nausea and vomiting can be present throughout pregnancy, and 50% of mothers get urinary tract                       infections at the onset. In severe cases a cough may come on in the earlier stages before itching begins.                       Approximately 80% of patients show rises in liver levels after 30 weeks gestation. More severe cases come                       on earlier, last longer and have extreme symptoms, i.e. prickles, stinging, pain in the head and an increased                       chance of fatty liver disease, putting mother at risk.                       Although the outcome is mostly good for mum, this disease frequently leads to malabsorption of vitamins,                       worsening maternal nutrition status. Cholestasis has about a 20% risk of postpartum haemorrhage and the                       tendency towards bleeding may be caused by inadequate absorption of vitamin K, which is needed for the                       blood to clot.                       So far the treatments available to us are undesirable. We are only offered ways of suppressing the                       symptoms and the treatments only work if diagnosed early enough, or if it's a mild case and still side effects                       are not known. I was offered antihistamines and tranquillisers to supposedly help with pruritis, steroids to                       mature my baby's lungs and an induction or caesarean after establishment of foetal lung maturity at 34 wks.                       Unknown are the effects of these drugs on our livers. It's possible that they could be actually making the                       problem worse for baby or subsequent pregnancies for the mother. I took this disease very seriously, but                       was unable to accept these options. After researching cholestasis this is how I decided to manage my                       condition.                       Firstly I did the obvious and took out all fats from my diet, eating only fresh fruit and vegetables, preferably                       organic and drank 10 litres of purified water a day (the recommended amount of water is 2/3 litres per day) to                       flush the toxins out of my liver. I also drank fresh beetroot juice and vegetable soups. I took herbs to                       support my liver throughout my pregnancy and had a mix made up from my naturopath after cholestasis                       was confirmed, including Dandelion, St Mary's Thistle, Globe artichoke and Psyllium husks. I also did yoga                       and had Reiki to support my mind and body. Acupuncture was performed throughout my pregnancy for                       liver function, but more for use of induction in the final days before delivery. I had blood tests performed                       monthly until 20 weeks, every week from 30 weeks and every day from 32 weeks until birth. I also agreed to                       daily monitoring of baby's heartbeat. At 32 weeks I became aware of my liver cells dying and my levels                       indicated I was on my way to fatty liver disease, giving me a 20% chance of maternal mortality.                       I knew I had to take full responsibility for myself and my baby and putting drugs into our bodies would                       only of done us more harm. Unfortunately there is not much information about this disease and many                       doctors and midwives are unaware of the symptoms, making it very difficult to diagnose.                       Since my last baby was born, almost 3 yrs ago, I have continued to research this condition. There has been                       very little progress in the treatment offered from the medicos. Ursofalk acid is used in most cased, this                       relieves the itching by binding the bile acids in the blood. It's advisable NOT to stay on this medication                       longer than 2 or 3 wks as long term effects are unknown. Induction, or alternatively Caesarean is then                       advised once off the drug, so steroids are used to mature baby's lungs.                       I have recently been back in touch with the Professor from my last pregnancy who sees approx 4 women per                       month with Cholestasis. He tells me that I'm still the only woman that he knows of that has actually                       decreased elevated liver results as high as mine were. He now suggests to all his clients to start drinking                       minimum 2 litres of water per day, along with dietary changes. Unfortunately most don't though.                       All GP's, Midwives and GYN/OB's need to be made aware of how serious Cholestasis is, and how to reduce                       the risks after a diagnosis has been made. Preferably starting with natural alternatives.                       Please feel free to pass on this information, or my details to any women who have in the past, or are now                       suffering. As well as any health professionals that come into contact with pregnant women.                       Natalie Forbes Dash                       Homebirth Access Sydney                       Blue Mountains Homebirth Support Cholestasis (from a Canadian Herbalist) Three things I would address with a client suffering from Obstetric Cholestasis     1. Help the liver function better directly and by helping general digestion     2. Relieve the symptoms (itching)     3. Ensure that the mother and baby still receives the nutrients that are normally dependent on proper liver/gall bladder function. My tools may include any of the following:     Milk Thistle, Dandelion Root, Yellow Dock tinctures - 2 ml of each three times a day: helps liver function     Nervine herbs like Passiflora, Skullcap, Lemon Balm, Catnip, and Chamomile: calms the nervous system and thus addresses the itching     Emulsified Vit A and E supplements: a weak liver may cause an inability to absorb these nutrients     'Greens' powder and alfalfa tablets: to boost vitamin K intake, and help liver function     Floradix iron (or other liquid iron): easier iron for the liver to process     GLA supplement like Evening Primrose or Borage - 2000mg day     Probiotics (acidophilus): to help the digestive system     Digestive enzymes: Papain/Bromelain for vegetarians, Pancreatic enzymes otherwise     Fresh vegetable juices such as beet, carrot, and celery     Sulfur containing foods such as organic eggs, garlic, onions, legumes     Plenty of water. Using the nervine herbs to make teas helps increase intake as well.     Avoid all known toxins- pesticides, household cleaners, air pollution etc: avoid over-taxing the liver     Avoid fatty foods. After birth I would put the mother on additional supplements such as lipotropic factors and NAG. After the first year of breastfeeding I would also put her on a cleanse/fast, and continue to help her address her liver's health, particularly if she was planning another pregnancy. -- " We must be the change we wish to see in the world"    Mahatma Gandhi ---------------------------------------------------------- Stacelynn Caughlan, Cl.N., C.H., R.N.C.P. Clinical Nutritionist, Certified Herbalist Prenatal and Pediatric Care Vancouver, B.C. http://www.motherandchildhealth.com adamnamy wrote: Just seeking some advice from midwives out there-I know I will most likely forget to ask all of these when I go to the antenatal clinic or have my next midwife visit   I am 35+something weeks and have started to show signs of cholestasis over the past few weeks.  Blood results are fluctuating a bit they go high and the next one is about normal and then high again.  I am preparing for the eventuality of an induced hospital birth (though still hoping to go into labor at home in the 36th week) Some part of me wants to be induced now so I don’t have to deal with the stress of that stillbirth stat.  anyway…   Can someone tell me?   1) Is it the syntocin in the IV that poses the greatest threat to me/we in terms of “uterine hyper stimulation” and fetal distress or can the prostaglandin gel and ARM cause that too?   2) Is the “failed induction-requiring C/s” rate really around 50%?  Is there anything that I can do to minimize that risk if I am induced? Like staying up, walking around, asking to be left alone, requesting minimal monitoring –that sort of stuff.  And will they let me do that at a large teaching hosp? (I have the dream of asking to be left alone and sneaking off to the bathroom and giving birth in the water quietly without any interference--don’t like my chances!)   How much negotiating power do women really have in this circumstance? My view is that ultimately it’s my body, my baby, and my birth but I don’t want to make it hard for us all by being hard line at a time when I need to go inside and give birth (I can see that back-firing on me).  It’s just hard to work out what the important stuff is-it all seems so important!   Amy     -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006