I never forgot about this blog, but I did get pretty side tracked by life. I just published a blog post about preparing for Reyna's birth that I wrote long ago. Well, Reyna is now almost two and I am set to deliver my second baby in the next few weeks!
That said, my second pregnancy has gotten complicated in the third trimester. I am writing a guest post on my experience for another blog, but figured I would share the more detailed post here as well. Hopefully I will find some time to go back and fill in the gaps, and post some new content and recipes soon.
That said, my second pregnancy has gotten complicated in the third trimester. I am writing a guest post on my experience for another blog, but figured I would share the more detailed post here as well. Hopefully I will find some time to go back and fill in the gaps, and post some new content and recipes soon.
Nutrition, Healthcare, and Intrahepatic Cholestatis of Pregnancy (ICP)
Amanda is a holistic nutritionist. her blog can be found at amandabrowningnutrition.weebly.com/blog
I am currently 37 weeks pregnant with my second baby. Almost five weeks ago I was diagnosed with a liver disorder called intrahepatic cholestasis of pregnancy (ICP), which essentially means that my liver is not removing toxins properly, causing them to build up in my blood and skin.
I woke up one night with intense itching and burning on the palms of my hands and soles of my feet. I tried everything I could think of to stop it, but nothing worked and I lay awake for hours thinking I might go insane. I googled my symptoms and texted Amanda at 1am saying “I think I have ICP and I am freaking out”.
I read a bunch of online information about ICP and called my midwife who sent me to the hospital for testing. Though I believe much of the confusion and fear I experienced through this ordeal has been due to the uninformed resident I dealt with in the birthing unit that first day, I was sent home with the clear message that there was nothing I could do to change my condition. The baby should be fine, but the toxins in my blood would continue to build, my symptoms would worsen until I delivered the placenta, probably by a medical induction as early as 36 weeks. Any liver damage I would sustain would be “reversible”, and as long as the baby was delivered before the risks of still birth increased he would be healthy. There was medication I would take which may or may not help my symptoms which the doctor told me to “try or not, up to you”, and my care would be transferred from midwife to O.B. I would be closely monitored and come back for weekly tests at the hospital.
Now, I fall somewhere in the middle of the spectrum between “granola” mom, and what I will call “convenience” mom. I am practical, but of course I want the best for my family, and am willing to make certain sacrifices (like time) to make things from scratch, or do things the hard way. When it comes to health care, I take as few drugs as possible, and believe in getting a second or third opinion on any medical advice (especially after this experience with ICP!). After getting over the initial shock of my diagnosis and the disappointing implication that I would probably not get to experience another natural unmedicated midwife-assisted birth like I had with my first baby (and would suffer insane itching every night for the next 5 weeks), I became suspicious of the conclusion that there was just nothing I could do to help my condition.
This is where Amanda comes in. I figured I would try the medication I had been prescribed, but when I went to the pharmacy I found that it cost $450, and I would need two refills. My husband and I don’t have insurance and while we could afford it (and had tons of offers for help), I decided to try and deal with my symptoms another way before spending that kind of money on a drug the doctor wasn’t sure would work, and could potentially further stress out my liver.
Amanda went straight to work researching and consulting other holistic practitioners for me. She vehemently disagreed that my lifestyle and nutrition choices had no impact on my liver health, and gave me advice on immediate changes I could make to decrease the amount of toxins I was ingesting, and detox my liver. These included:
Cutting out sugar, flour, processed foods, caffeine, animal fats, canned food, and dairy.
Switching to natural products for laundry, deodorant, moisturizer etc. Eating smaller meals more often.
Taking dandelion chamomile tea four times a day, and drinking tons of water with lemon.
She also suggested using positive affirmations about my body, and daily yoga/stretching.
I will admit that at first glance the list sounded daunting. And most people I told about the plan wrote it off as impossible, though some did acknowledge that “you gotta do what’s best for you and the baby”. Having done a sugar detox before I knew it would be possible, though perhaps not fun. So I did it.
At first it was easy, because obviously my future health (ability to have more kids, avoid future liver problems) and the health of my unborn child are extremely motivating. I ate tons of beans, veggies, and chicken, and I didn’t touch anything on the bad food list.
At this point my midwife had received my initial test results and was confused as to why I was confirmed as having ICP, since my bile salt tests (a “hard” marker for the disorder) were not yet back, and beyond having mild symptoms my liver enzyme tests showed only slightly elevated, but not dangerous levels of urate. My symptoms had also begun to ease. I slept through the night because I was exhausted, but itchiness on my hands and feet sometimes lingered during the day, and started in the early evening, especially if I got to hot. My itching stopped completely about three days after it had started, though I noticed a few other symptoms such as orange urine and light colored stool.
The next week I had a second round of tests. I felt awful that day and had to leave work because I was dizzy and tired. I had caught a bad cold and had fever, chills, and a very sore back. The hospital did a urine test to rule out kidney infection, and monitored to me to make sure I wasn’t in early labour. They found that I was very dehydrated, and that my urate levels had slightly increased over the last week. The doctor told me I needed to eat more sugar and suggested I drink ginger ale and juice instead of water.
As horrible as all that sounds, I was slightly relived, though ever more confused. I still had no idea if the changes I was making had any effect, and the doctor wasn’t very helpful at answering my questions (because though my midwives had decided that I was now under O.B. care, but the hospital disagreed, so the doctor didn’t think she should make recommendations since I wasn’t technically her patient. Communication was very bad), but my urate levels were still well below the danger zone, so even if I kept increasing each week, I stood a good chance of not being too toxic when it came time to give birth.
When I got home and did even more research, I found that dehydration can cause skewed liver enzyme tests! I kept up my diet plan, but relaxed it a little. Obviously I disregarded the doctor’s advice to add sugary drinks to my diet, but I had been finding it tough to know what to eat, so I had just been avoiding eating. My cold had killed by appetite, and I had lost about three pounds. It was also holiday season so there was constant temptation. I started focusing on hydration, added in a vegan sugar free electrolyte drink once a day, and was basically drinking at least 15 cups of water. I also let myself eat more fruit and stress less about following every rule all the time. For example, I ate a piece of cake at our Christmas lunch at work. I had some gravy on my Christmas turkey. I guiltlessly added a teaspoon of jam to my oatmeal. I enjoyed the rare decaf latte with soy milk. Put cheese on my cauliflower-crust pizza.
At my week three tests I got some good news. I felt had been feeling great since getting over my cold and was completely symptom free for about four days. My bile salt test results were finally back and they showed that my levels were only slightly high. The put it in context, 6 is normal, 40 is really high, and I was at 7. Barely toxic! I meant I still had a positive diagnosis, but that there were more options for my care, and the O.B. might be more flexible on my induction date. Also, my urate levels had dropped below what they were at my initial test two weeks prior.
I left the hospital feeling great and encouraged to continue with my diet changes. After meeting with my midwife again, I have been told that as long as I remain symptom free (and I have so far), my care will continue on with the midwife as normal. Hospital testing is done, and hopefully I will go into labour normally. The O.B. does not recommend letting me go back my due date, but pretty much my baby is going to be allowed to go to full term and come when he is ready! I still have not received any additional bile salt test results to compare with the first week.
Reading over what I have just written and considering my personal circumstances, one might write off my results as luck, or say that I never should have been worried in the first place. I myself have thought this on many occasions and still personally question whether I have this disorder or not. However, what I have learned without a doubt it that my nutrition absolutely plays a role in how I feel. I am 37 weeks along and feeling amazing. Besides being constantly kicked in the ribs and not being able to bend over, I have zero nasty pregnancy symptoms. I feel empowered and in control of my own health care and my own body. I have confidence in my ability to give birth and to advocate for myself and my baby. At this point I don’t know how the birth will go and of course there is always the chance of complication, but I feel very content and excited about the pending arrival of my son and ready for any challenges that come with that!
I am currently 37 weeks pregnant with my second baby. Almost five weeks ago I was diagnosed with a liver disorder called intrahepatic cholestasis of pregnancy (ICP), which essentially means that my liver is not removing toxins properly, causing them to build up in my blood and skin.
I woke up one night with intense itching and burning on the palms of my hands and soles of my feet. I tried everything I could think of to stop it, but nothing worked and I lay awake for hours thinking I might go insane. I googled my symptoms and texted Amanda at 1am saying “I think I have ICP and I am freaking out”.
I read a bunch of online information about ICP and called my midwife who sent me to the hospital for testing. Though I believe much of the confusion and fear I experienced through this ordeal has been due to the uninformed resident I dealt with in the birthing unit that first day, I was sent home with the clear message that there was nothing I could do to change my condition. The baby should be fine, but the toxins in my blood would continue to build, my symptoms would worsen until I delivered the placenta, probably by a medical induction as early as 36 weeks. Any liver damage I would sustain would be “reversible”, and as long as the baby was delivered before the risks of still birth increased he would be healthy. There was medication I would take which may or may not help my symptoms which the doctor told me to “try or not, up to you”, and my care would be transferred from midwife to O.B. I would be closely monitored and come back for weekly tests at the hospital.
Now, I fall somewhere in the middle of the spectrum between “granola” mom, and what I will call “convenience” mom. I am practical, but of course I want the best for my family, and am willing to make certain sacrifices (like time) to make things from scratch, or do things the hard way. When it comes to health care, I take as few drugs as possible, and believe in getting a second or third opinion on any medical advice (especially after this experience with ICP!). After getting over the initial shock of my diagnosis and the disappointing implication that I would probably not get to experience another natural unmedicated midwife-assisted birth like I had with my first baby (and would suffer insane itching every night for the next 5 weeks), I became suspicious of the conclusion that there was just nothing I could do to help my condition.
This is where Amanda comes in. I figured I would try the medication I had been prescribed, but when I went to the pharmacy I found that it cost $450, and I would need two refills. My husband and I don’t have insurance and while we could afford it (and had tons of offers for help), I decided to try and deal with my symptoms another way before spending that kind of money on a drug the doctor wasn’t sure would work, and could potentially further stress out my liver.
Amanda went straight to work researching and consulting other holistic practitioners for me. She vehemently disagreed that my lifestyle and nutrition choices had no impact on my liver health, and gave me advice on immediate changes I could make to decrease the amount of toxins I was ingesting, and detox my liver. These included:
Cutting out sugar, flour, processed foods, caffeine, animal fats, canned food, and dairy.
Switching to natural products for laundry, deodorant, moisturizer etc. Eating smaller meals more often.
Taking dandelion chamomile tea four times a day, and drinking tons of water with lemon.
She also suggested using positive affirmations about my body, and daily yoga/stretching.
I will admit that at first glance the list sounded daunting. And most people I told about the plan wrote it off as impossible, though some did acknowledge that “you gotta do what’s best for you and the baby”. Having done a sugar detox before I knew it would be possible, though perhaps not fun. So I did it.
At first it was easy, because obviously my future health (ability to have more kids, avoid future liver problems) and the health of my unborn child are extremely motivating. I ate tons of beans, veggies, and chicken, and I didn’t touch anything on the bad food list.
At this point my midwife had received my initial test results and was confused as to why I was confirmed as having ICP, since my bile salt tests (a “hard” marker for the disorder) were not yet back, and beyond having mild symptoms my liver enzyme tests showed only slightly elevated, but not dangerous levels of urate. My symptoms had also begun to ease. I slept through the night because I was exhausted, but itchiness on my hands and feet sometimes lingered during the day, and started in the early evening, especially if I got to hot. My itching stopped completely about three days after it had started, though I noticed a few other symptoms such as orange urine and light colored stool.
The next week I had a second round of tests. I felt awful that day and had to leave work because I was dizzy and tired. I had caught a bad cold and had fever, chills, and a very sore back. The hospital did a urine test to rule out kidney infection, and monitored to me to make sure I wasn’t in early labour. They found that I was very dehydrated, and that my urate levels had slightly increased over the last week. The doctor told me I needed to eat more sugar and suggested I drink ginger ale and juice instead of water.
As horrible as all that sounds, I was slightly relived, though ever more confused. I still had no idea if the changes I was making had any effect, and the doctor wasn’t very helpful at answering my questions (because though my midwives had decided that I was now under O.B. care, but the hospital disagreed, so the doctor didn’t think she should make recommendations since I wasn’t technically her patient. Communication was very bad), but my urate levels were still well below the danger zone, so even if I kept increasing each week, I stood a good chance of not being too toxic when it came time to give birth.
When I got home and did even more research, I found that dehydration can cause skewed liver enzyme tests! I kept up my diet plan, but relaxed it a little. Obviously I disregarded the doctor’s advice to add sugary drinks to my diet, but I had been finding it tough to know what to eat, so I had just been avoiding eating. My cold had killed by appetite, and I had lost about three pounds. It was also holiday season so there was constant temptation. I started focusing on hydration, added in a vegan sugar free electrolyte drink once a day, and was basically drinking at least 15 cups of water. I also let myself eat more fruit and stress less about following every rule all the time. For example, I ate a piece of cake at our Christmas lunch at work. I had some gravy on my Christmas turkey. I guiltlessly added a teaspoon of jam to my oatmeal. I enjoyed the rare decaf latte with soy milk. Put cheese on my cauliflower-crust pizza.
At my week three tests I got some good news. I felt had been feeling great since getting over my cold and was completely symptom free for about four days. My bile salt test results were finally back and they showed that my levels were only slightly high. The put it in context, 6 is normal, 40 is really high, and I was at 7. Barely toxic! I meant I still had a positive diagnosis, but that there were more options for my care, and the O.B. might be more flexible on my induction date. Also, my urate levels had dropped below what they were at my initial test two weeks prior.
I left the hospital feeling great and encouraged to continue with my diet changes. After meeting with my midwife again, I have been told that as long as I remain symptom free (and I have so far), my care will continue on with the midwife as normal. Hospital testing is done, and hopefully I will go into labour normally. The O.B. does not recommend letting me go back my due date, but pretty much my baby is going to be allowed to go to full term and come when he is ready! I still have not received any additional bile salt test results to compare with the first week.
Reading over what I have just written and considering my personal circumstances, one might write off my results as luck, or say that I never should have been worried in the first place. I myself have thought this on many occasions and still personally question whether I have this disorder or not. However, what I have learned without a doubt it that my nutrition absolutely plays a role in how I feel. I am 37 weeks along and feeling amazing. Besides being constantly kicked in the ribs and not being able to bend over, I have zero nasty pregnancy symptoms. I feel empowered and in control of my own health care and my own body. I have confidence in my ability to give birth and to advocate for myself and my baby. At this point I don’t know how the birth will go and of course there is always the chance of complication, but I feel very content and excited about the pending arrival of my son and ready for any challenges that come with that!