Ep 305: Trust Your Body — Ashley’s Story of Intrahepatic Cholestasis of Pregnancy

Speaker 2 (00:00.288)

In today's episode, Ashley shares her powerful story of navigating intrahepatic coli stasis of pregnancy, not once, but twice, from unexpected early labor to a lightning fast birth with no time for pain meds. Ashley's experience is a vivid reminder of how important it is to listen to your body. She's now an advocate for ICP awareness and her journey is one every expecting parent needs to hear.

Speaker 2 (00:33.324)

the Birth with Power podcast where knowledge is power and power transforms birth. I'm Dr. Nicole Callaway-Rankins, mom of two and practicing board certified OB-GYN with over 20 years of experience and nearly 2000 births attended. I've seen firsthand how the hospital system can leave women feeling unheard and uncertain, but that doesn't have to be your story. Here, you'll get the knowledge, support and strategies to take charge of your birth experience.

so you can walk into the hospital feeling calm, confident, and empowered. Note, this podcast is for educational purposes only, and it's not a substitute for medical advice. See the full disclaimer at drnaclomeragans.com forward slash disclaimer. Now let's get to it. Hello there, welcome to another episode of the podcast. This is episode number 305.

Whether this is your first time listening or you've been here before, I'm so glad you're spending some time with me today. In this episode, you'll hear from Ashley. Ashley had intrahepatic coli stasis of pregnancy or ICP with both of her pregnancies. ICP is a liver condition where bile acids build up in the body during pregnancy. And if it's not caught early, it can increase the risk of complications like stillbirth.

In her first pregnancy, Ashley ended up delivering at just 35 weeks and went through, well, a lot, including shoulder dystocia and episiotomy without pain medication, a vacuum assisted birth and a post-fartum hemorrhage that led to a blood transfusion. She's sharing her story to raise awareness about ICP and help other families feel informed and empowered.

Ashley has since become the lead ambassador for ICP Care, an organization that supports women and families affected by this condition. Now, I don't share stories like this to scare you, but birth is unpredictable and hearing real experiences like Ashley's isn't about creating fear, it's about helping you know what's possible so you can feel prepared and confident. Because when you know more, you can better advocate for yourself.

Speaker 2 (02:44.622)

Ashley's story is really a powerful reminder to listen to your body, trust your instincts and lean on your support system. So whether you're dealing with a high risk pregnancy or just want to be ready for whatever birth brings, this episode is full of honesty, hope and heart. I know you're going to love it. Let's get into it.

Speaker 2 (03:15.47)

Thank you so much, Ashley, for agreeing to come on to the podcast. I'm excited to have you share your story.

Thank you for having me. I'm excited to be here.

So why don't you start off by telling us a bit about yourself and your family.

Sure. My husband and I have two small children. So as people like to say, we are in the thick of it. We have a two-year-old daughter and a son who is almost seven.

Okay, all right. So you're definitely in the thick of it. Yeah. All right. So you have two children. We're talking about your first birth in particular, and we're talking about how you just to give some of it away, how you had coldly stasis, but we'll get to that. In order to understand what happened with the birth and how things transpired, let's back it up first and talk a bit about how your pregnancy and prenatal care went.

Speaker 1 (04:08.088)

Sure. so I actually switched OBGYN several years prior to, even conceiving, because I knew I wanted to deliver at the hospital where we delivered. I'd heard a lot of good things from friends and family and was just really wanting to make sure that I was able to be set up, to have the best care possible when that time came. so my prenatal care, would say was, it was great. My doctor.

Okay.

Speaker 1 (04:37.964)

was very attentive. There were no issues. I was diagnosed, and so this is like part of the cholestasis story. I was diagnosed with gestational diabetes at 28 weeks when they do the testing as usual. And so I managed my diet from that point on much more closely than I had been prior. But otherwise I would say it was very standard quality care.

So I don't feel like anything was missed or you know, I didn't have any other issues really up until you know, my symptoms started to show.

Gotcha, gotcha. Now wait, back up for a second because how long before you got pregnant did you change doctor?

Probably like two two years or so. Okay, just so I could make sure that I had established care and was in the city. I am a planner. Definitely a planner. Got it.

I'm really planning ahead. Okay. Got it. Okay. And apparently it paid off because you were happy with the care you got. Okay. All right. So I don't even know because you ended up delivering a little earlier and we'll get to that, but what did you do to prepare for your birth considering as you're a planner, maybe you had already started.

Speaker 1 (05:41.101)

Yes.

Speaker 1 (05:57.546)

Yeah, so I had several books and I will not say that I read them. I will say that I skimmed them, you know, reading some chapters, reading things that sort of stood out. For work, I had been at that time working for a breast pump company. So that was something that was really important to me thinking about breastfeeding and planning what I would do sort of after baby came. But for the birth, I will say that I had a feeling that things

Gotcha.

Speaker 1 (06:27.118)

may not go as planned or it may not be perfect. Not necessarily in a bad way, but just that I had heard enough stories from friends and family where it's like, you think you're going to do X, Y, Z and you get there and everything kind of shifts. So I did not take the time to make a playlist for my birth, which I think is great. when people do that and they're able to use it, I love that idea. I actually did not do that though.

I would say that the biggest thing we did was we took a class. So it was sort of what to expect in the hospital and also some like baby care and things like that afterwards at the hospital where we were delivering. And one of the things that I was, I would say most concerned about was having to make the decision about whether or not to get an epidural. I was very worried about the pain.

obviously something that I hadn't experienced before. but I was also worried about some of the, side effects that happened afterwards or things that can go wrong. And again, enough kind of experienced, acquaintances and friends and things like that sharing stories. So I had heard about a walking epidural, which I ended up asking about in that class and, come to find out that hospital did not do walking epidurals. And I think they stated,

most hospitals in the US don't actually do walking epidurals because of safety and insurance issues. So that was a learning moment for me. And so I figured, okay, well, when it comes down to it, I'll make the choice. I ended up not being able to make a choice. Yeah, the one thing that was like really sort of concerning or worrisome for me ended up not being in my hands anyways.

Gotcha, gotcha. So was there anything that you wanted for your birth in particular?

Speaker 1 (08:26.584)

I would say the most important thing to me when thinking about the birth experience was just the quality of care. I had a friend who was a doula at the time. And so I did sort of lean on her with some questions and that sort of thing. I didn't end up hiring a doula or a midwife and the hospital system actually does have a midwife group, which I didn't know about at the time, but I think that's.

pretty cool that they offer that as an option. But it was really just the quality of care. That was number one for me.

Okay, okay, okay, that makes sense. And then was there anything that you were afraid of about giving birth?

the I would say the pain.

Yeah, yeah, yeah, okay. All righty. So then you were going along in your pregnancy and then talk us through what happened because some things changed.

Speaker 1 (09:23.342)

Sure, yes. So the majority of my pregnancy was, again, pretty standard, pretty normal, no complications. I was diagnosed, again, with gestational diabetes at 28 weeks. Even then, managing my diet and really paying attention to what I was eating and doing the blood sugar checks and checking in with my doctor and things like that, even the nutritionist was super helpful at the hospital.

All of that was pretty normal. So 28 weeks gestational diabetes, then fast forward about two weeks later, I started to feel itching when I was traveling on a work trip. And when I say itching, it was like on my feet, like on the bottom of my feet and a little bit on my hands. Now the first thing I am thinking is I'm traveling, I'm in a hotel, like, my gosh.

Yeah, that was it.

Immediately, so I'm ripping the sheets back, pulling, you know, the pillows off and checking. And I don't actually know if you can see bed bugs. I've heard that they're microscopic, Yes, so I did not see anything. The itching actually subsided a little bit towards the end of that trip. It was only a couple of days long. In the time where I had experienced the itching while I was traveling, I did look up the symptom.

Yes, may we never know.

Speaker 2 (10:34.561)

Okay.

Speaker 1 (10:46.058)

and discovered colostasis of pregnancy. At that point, since it had subsided and I was really trying not to get myself worked up or, know, to, to worried about something that may not be the case. I ended up letting it go. Now probably not the right thing. And this is why I'm here, you know, advocating for, you know, paying attention to your body and symptoms and things like that.

I mean, but I hope that you don't beat yourself. I mean, because if it got better, you know, yeah.

I don't. And it had subsided, it truly had subsided. But then it was like three weeks later. So around 33 weeks or so is when it came back. And that time, since it came back, I immediately sent a message to my doctor. the hospital system that I'm part of uses Epic. I don't know if I should be using brand names, but they use Epic. So it's the MyChart portal.

that you can send your doctor messages, which I think is just fantastic and it makes things so convenient. However, instead of responding to my message in the portal, they call back immediately. it's interesting because it does say when you send your messages, if it's urgent, you call 911 because it could take 24 hours or 48 hours or whatever the timing is.

Okay.

Speaker 1 (12:09.918)

I will say they were very honest. So whoever read that message, let the doctor know right away. And I got a phone call saying, in. We need to do some testing. So I did. I went in. While I was there getting the testing, they let me know that there's only a couple of labs in the United States. And I'm not entirely sure if it's the same case now, since this is almost seven years ago.

But there were only a couple labs that actually tested for intrahepatic colostasis of pregnancy in the way that they needed to determine. So it was going to take a few days to get the results was the what I was told. Yes. Yeah. In the time that it took to get those results, I ended up going into labor. So about 33 weeks and two, three days, I was out to lunch with my mom and sitting there and kind of

It still takes a couple days.

Speaker 1 (13:03.432)

know, when saying I was cramping is what I was saying. And she was paying, I think, more attention than I was at that point to how frequent I was when saying. And I was like, it's probably Braxton Hicks because it's so early. And then she made me time it. So thank goodness for moms. And it was pretty close together. The cramping that I was experiencing was actually contractions. And it ended up being like seven, five minutes.

Yeah.

Speaker 1 (13:33.546)

So I did end up going into the hospital then. At that point, they were able to stop the labor, thank goodness, because it was still so early. Right. It's like a small, small amount. do not remember how much, but it was a very small amount. He was head down and trying to get out. They did stop it.

Were you dilated at all?

Speaker 2 (13:55.465)

Gotcha

Speaker 2 (13:59.764)

Okay, okay.

It was while I was at the hospital that the diagnosis for ICP and tripadical stasis of pregnancy actually came in. So I'm laying in the hospital bed and the doctor that was taking care of me that was on call came in and let me know that that's what it was.

Okay, okay. So, do you remember getting steroids at that time?

I did so steroids and surfactant

Okay. And so the labs just happened to come back and it all sort of happened together.

Speaker 1 (14:31.466)

It did. Yeah. Yeah. So I was there. They were able to, since I was there, talk to me in person about what ICP or cold stasis of pregnancy meant and that I would be coming in for testing more frequently. was technically put on bed rest. Now part of my birth story that's like a little bit crazy is that my husband and I were planning to get married a month, like close to a month prior to delivering.

Okay.

Speaker 1 (14:58.189)

So I was in the hospital, I was released, I think it was on Thursday, and I had to ask, you know, can we still even do this? And they said, so bed rest was, you know, making sure that you're sitting or laying. So they said for the time that you were going to be at the wedding, you're allowed to walk down the aisle and you can get up to use the restroom, basically. Otherwise you're sitting, which I did, but they me the approval to go ahead.

So I did end up getting married like three days after being released from the hospital, which was crazy. And I will say everybody was very attentive and very concerned, but I followed doctor's orders and I stayed sitting.

Okay, okay, all right. And hopefully the wedding will.

It did. mean, I sort of want a little bit of like a do over or at least some sort of, you know, party or celebration where I can actually participate. But it was fun. Everybody else had fun. But we were able to go ahead and make that happen. So that was, it was nice. And then it was nine days after that, that I did go into labor again. So I, he held off for, for a little while.

Yeah.

Speaker 2 (16:00.14)

Okay.

Speaker 2 (16:11.169)

Okay.

Speaker 1 (16:18.144)

I will say, I don't know if my pain tolerance is super high or what, but at that point, when I went into labor, I think it was 35 and two or three days, when I went into labor, I woke up in the morning, I think just totally ready to deliver. I didn't realize that, but it was a constant pain, so I wasn't feeling the same.

pulsating, cramping.

Were you in the hospital? Were you at home? was at Okay.

I had, you know, I'd switched to work from home at the point where I was put on bed rest. after the wedding, I was home on the couch for those nine days. Gotcha. And so I was home and woke up. I had been uncomfortable overnight, but I woke up and it was just, there were no contractions. It was no pauses between.

Okay, so you just woke up and you were just.

Speaker 1 (17:14.475)

And I was like, something, you know, the pain is really sharp. And I was explaining to my husband, it's really sharp. had not to be too graphic, but I had been constipated for several days because he was head down for the first time, you know, since the first time I went into labor. So probably two, two weeks. And I was like, something must be wrong. And, you know, there's an issue with the fact that I'm constipated and some calling the doctor and they're like, well, you can try this or you can try that. And I'm my husband to the store and.

And that time, we're talking like seven o'clock in the morning at this point, there was a little bit of blood that I saw in the toilet and I thought it was probably the mucus blood. Again, like I'm picturing something much more horrific than this little thing that I saw. So even that didn't register. But when I did call the doctor back and said I saw blood, they're like, okay, you need to come in immediately.

Okay. Okay.

Speaker 1 (18:11.2)

And it's like still not registering that this is labrum, like something else. Learned a lot in this first birth experience.

Great.

Speaker 1 (18:20.83)

So we get to the hospital, my husband parks in front of the front door. You know, we kind of run in and they get me into a room right away and check me out. And the doctor tells me so that it was a different doctor than the one I'd seen like normally. I will say I'm gonna hit pause. They did a really great job of having me see all of the doctors in the practice at least once throughout my pregnancy. So I wasn't unfamiliar with this person, just because I'm a regular doctor.

Gotcha. So we get in, she's checking me out and tells me, you're complete. I have no idea what this means. Right. So exactly. are you talking about? What does that mean? And she says, you are fully dilated. Right. Which I was. So.

Like what are you?

Speaker 2 (19:05.23)

Okay, what time was that?

We're talking probably eight o'clock now by the time we're

Okay. And what time did you wake up? Okay. So from six 45 and you said you slept during the night. You were fine. It wasn't anything. You woke up and wake up and then it's like, okay, it's something. Go to the store. Get to get to the hospital at night. And she's like, you're completely dilated. Oh my goodness. Yeah. So what, mean, what

645.

Speaker 1 (19:20.59)

It's often turned a little bit.

Speaker 1 (19:33.3)

At this point now, that decision that I thought I would get to make about whether or not I drugs. There was no decision because I'm here, they're saying I'm gonna have to deliver now. And I said, okay, this hurts a lot, I do want the drugs. Well, not enough time, you don't get the drugs. Because they flipped the room, they're in the hospital, that's sort of how they do it, the rooms are all in one. So they're flipping the room to get ready to deliver my son.

If there's.

Speaker 1 (20:02.648)

like in that very moment.

So, okay, did anything ever register as contractions or?

It didn't. The first time I went into labor it did because there was that pause between. There was no pause. I woke up, I think, fully.

Okay, so then when it hit you like, okay, now this is like happening. From what time, like that they said you were complete to what time was...

Speaker 1 (20:40.366)

And it probably only took that long because his shoulder was stuck. So they ended up having to give me an episiotomy, again, with no drugs, in that 15 minutes.

okay. So, my goodness. Okay. So they're getting the room ready and then they're like, okay, go ahead and push. You push and then you didn't push that long, obviously. And then, so did they say it was, so they said like, it's a shoulder dystocia. We need to like, what happened?

Yeah, they let me know his shoulder was stuck. Yeah, he was five pounds, five ounces. So at 35 weeks, he was still close to to normal size. But yeah, I mean, he's he's he's a stubborn kid. So I'm not surprised. But yes, his shoulder was stuck. They they had to give me an episiotomy and they also used vacuum to help get him out because they noticed that his heart rate started to increase. He was in distress again.

at 35 weeks.

Speaker 1 (21:39.68)

As we kind of get into it, a lot of these things that I'm speaking to tie back to the fact that I had colostasis. that he didn't aspirate meconium, but he had, I don't know why I'm losing this right now.

Sure.

Speaker 2 (21:53.132)

And they amnionic. Okay. This is just a lot. Okay. So, okay. So did they say like, we have to cut an episiotomy in order to get, And it hurt. I'm sure. Yeah. Because you're being, you're being cut with no anesthesia. And then, so all the, and then they're saying, and we're going to use the vacuum. All of this just all at the same time.

You let me know. Then it

Speaker 1 (22:20.694)

And it was fast because they did not want to risk anything happening to the baby. they got him out quickly. Like I mentioned, he did have meconium. He did not aspirate. They got him out quickly enough. They did have oxygen there for him.

Okay, he-

Speaker 2 (22:37.174)

Okay.

Speaker 1 (22:41.154)

They said he took one puff, but he was fine. started crying. were no issues. His lungs were developed enough, I think again, because of the surfactant. And the fact that I did go into labor previously ended up, I think, being a blessing because they were able to do the steroid and the surfactant, which helped him, I think, in the long

We don't really do that routinely. Interesting. Okay, so he was fine, came out, and then you had to get stitched up.

I did, yes. So they did a local for that. So I did get at least a local before I started to get stitched up. They did let me know that he was going to be in observation in the nursery for eight hours because of how early he was. And at that point, my heart is already breaking because I'm eight hours in the nursery where I'm not going to get to spend time with him. Well, that ended up becoming a moot point because right after they stitched me up and they were, I was laying.

still on the hospital bed and they were cleaning things up a little bit, I started to feel something wet between my legs. So. And it was blood. It was. It was not. It was not anything else. I was like, me. I, you know, I feel because they were sort of cleaning up the room and I was OK at that point. So they came over and checked it. They started weighing the pads and then realized I'm hemorrhaging. So the doctor came back immediately.

and checked and I did end up having retained placenta. So I had delivered the placenta and that whole process is something that I feel like doesn't get talked about enough having to deliver that after the baby, which was uncomfortable and painful. But then she's back in there checking and I did have retained placenta that she was unable to get with any of the tools in that room. So then I was told

Speaker 2 (24:35.732)

Okay.

Speaker 2 (24:39.83)

I was like, did you have any pain medicine at that point? Okay, because it was just.

I don't even remember. Yeah, I don't think that they had administered anything aside from the local at that point.

Okay, okay, so I'm assuming she's reaching and trying to feel the plus and it's very uncomfortable Painful even

It is an uncomfortable experience. Yes. I did feel all of that. And so that's when they let me know that I would have to be taken to the operating room to have a DNC to remove the rest of the placenta. And I was unaware of how severe it was. My husband was unaware of how severe it was. I think they actually did a really good job of

Okay.

Speaker 1 (25:24.642)

giving us enough facts at the time so that neither one of us was too concerned. But I did end up hemorrhaging most of my blood. I think there were four five bags or I can't remember, but it was a lot. And so I did have to get a transfusion. And that time they did the DNC and it was after all was said and done with the surgery and the transfusion that they're bringing me out to recovery.

letting my husband know I'm completely out of it. And those eight hours flew by, so.

Okay, I guess there's...

Yeah, so I didn't experience missing him in those first few hours in the same way, I think, if I hadn't had my own issues, but it was still quite traumatic.

Yes. Okay. So how did you, how did you feel? Like, I mean, once you like had a chance to kind of get yourself together, I were you like exhausted? Were you like just overwhelmed?

Speaker 1 (26:32.75)

Completely, completely exhausted and overwhelmed. was not so much the pain afterwards, but my whole body felt just like it had gone through something traumatic. And I had the balloon in afterwards to help with the feelings. So that was interesting. felt like a balloon and a catheter. I really had a tough postpartum experience in the hospital. The nurses that took care of me were...

amazing and you know this is part of when I tell my story and even with my daughter because we delivered at the same hospital the care that I received was outstanding. They were compassionate, they were helpful. I was disappointed because again I was so gung-ho about wanting to breastfeed and knew the importance of you know the first couple hours and getting baby latched and that just went out the window.

And so they had given him formula while I was in surgery and all of that sort of just fell apart, but I didn't let that deter me. So I still made sure that I was attempting nursing and they were helping with the different holds and brought in the hospital pump that I could use to also help with production. there were a lot of things postpartum. All of it was exhausting.

I did have really, really good care during that time. So I feel like that helped kind of get me through. Right, right.

And how long were you in the hospital for?

Speaker 1 (28:09.026)

So this is the, I think, interesting part when you think about insurance. So I was there, I delivered on a Tuesday morning. I was there until Thursday night, pretty late on Thursday night. And I still felt like I had a lot of recovery to do. But in terms of medical care, they let me know that there wasn't anything aside from just letting me rest and checking on me that they...

could do or were doing for me and insurance only covers two nights for vaginal delivery. And so they were not in any way unkind about it, but it was kind of like, if you're not out of here by midnight, you're gonna be charged for a third night and it's not going to be covered because there's nothing that we can say. I was there.

Tuesday, Wednesday, Thursday, so three days, two nights, my two night, three day vacation. And pushed it until almost, you know, the last hour just because it felt like it was hard. It was the third day where I finally got up and took a shower. I hadn't had the ability or the energy to do that sort of thing. So it was on the third day when I finally like cleaned up and I went home that night.

Okay, okay. And then once you got home, how are things?

They weren't bad. I was lucky and I know that a lot of people like the hemorrhaging and, you know, with preeclampsia and things like that, a lot of things can happen once you get home. I was lucky that I didn't have any of that. It all happened in the hospital. So I was very fortunate in that regard. It was tough for me to try to sit and rest as much as I needed to given everything that I had gone through.

Speaker 1 (30:05.514)

Right. But we were lucky we had help. My husband was home for a period of time and my mother and his parents were both close by so they were able to come by and help but it was really just trying to stay still and rest. That was tricky.

Okay.

Speaker 2 (30:24.268)

And then what did you see? Or like, how soon did you see your doctor afterwards? Was it not for six weeks?

wasn't

understand why we do that when people have, I mean, we're getting better about it. And that was a while ago, but like, I mean, you had, you had almost everything. you know, like, okay. At what point, okay, was, did this experience affect your decision to try to have another baby?

It did. So this experience made me a little apprehensive about more about the delivery and the risks. So after I had my son, I spent much more time digging in. I had found ICP care, which is an awareness organization, the couple of weeks after I had been diagnosed. But I don't think that I fully dived in enough to

Comprehend the risks like in that period of time or so early delivery is is a recommendation for ICP Especially if you have really high bile acids, which I did mine were 107 So the the recommendations have changed I think it's now between 34 and 36 weeks depending on how high and I probably would have fallen in that category He still came

Speaker 2 (31:41.451)

Okay.

Speaker 1 (31:53.174)

early on his own. So that ended up not being, again, a decision that I need to make. See, everything just, you I didn't have to make any decisions. So he, his risk of being born stillborn was significantly higher with the higher bile acids than it is with lower and not being able to predict or know.

What would happen the next time knowing that ICP happens? It's somewhere between 60 and 90 percent chance of recurring in You subsequent pregnant pregnancies. So mm-hmm that was a that was a definite concern the pregnancy itself Was okay, and I felt okay for the most part during my pregnant and that wasn't the deterrent It's the the point that you get to where all of a sudden it can like a flip the switch and then it's not okay

See you

Speaker 2 (32:47.598)

Okay.

I did also have, and I will not belabor, no pun intended, this topic, but I did end up having some heart issues. So I had recurrent pericarditis, which is inflammation of the heart after my son. And I was never truly diagnosed with any specific autoimmune disorder, but my markers would be higher when I was having flare ups. And there are connections to autoimmune disorders with ICP. I don't have an official diagnosis and can't.

speak to anything more than just the fact that that happened and that was when he was around two. So we had initially talked about if we're going to have a second it would probably be within that two-year window. That ended up being put off because of the heart issues and then even still after that sort of cleared up and we got things under control it was still a little bit of a concern. Ultimately

Okay.

Speaker 1 (33:46.102)

My cardiologist, my rheumatologist and my OB-GYN all said, I'm cleared. You're healthy. Things are okay. If you want to go ahead and try for a second, then you should go ahead and do that. So we did. I do think that perhaps my body had been through a lot. don't know hormonally, but, I did end up needing to take Clomid to kind of boost things a little bit for the second time. we determined that if it took more than that,

Okay.

Speaker 1 (34:15.821)

we wouldn't pursue anything more just because it felt like just so much to go through after the first pregnancy and delivery. Yeah, so we lucked out, I would say.

Okay. Okay. Okay. Okay. And then was your second delivery anything like? Okay.

It wasn't.

I lucked out. So when I went in for my confirmation, it was with one of the doctors with the practice that I'd seen previously. And he had mentioned he felt very comfortable managing a pregnancy with ICP. So I ended up sticking with a singular doctor for my whole second pregnancy. There had been

Got it?

Speaker 1 (35:02.38)

Discussion prior that I may want to switch to the MFM the maternal fetal medicine or the high-risk group that's part of the hospital system and Since he felt so confident that he could help manage and then call them in or have me transfer if I needed to That was the route we took and I felt very comfortable with it. There was a lot of monitoring Very attentive very responsive if I had questions or concerns, right? So went ahead and then

Okay.

Speaker 1 (35:32.418)

This one was a lot easier so I can speak to it, think a little bit more quickly in that I ended up getting COVID when I was 36 weeks. And at that point I did not test for gestational diabetes. I hadn't had any itching. So I got sick when I was recovering from COVID is when the itching started. So I think that potentially just getting sick triggered something. And so as soon as we found out that's what it was.

Okay.

Speaker 2 (35:54.625)

Okay.

Speaker 1 (36:02.478)

I'm trying to remember. think my bile acids were 21 or 22. So much lower than the 107 that I with my son. So then we decided to go ahead and schedule an induction just to make sure that she was delivered early enough that there were no issues. I think it was 37 and three or something like that. 37 and a half weeks that we ended up scheduling her for.

Okay.

Speaker 1 (36:31.478)

And that whole process of being induced, it was much longer, but everything went much more smoothly. the process that, you know, we, took it to go through the induction and the delivery, everything went so smoothly. did end up getting an epidural. I did not, I did not brave the pain again, especially just with the length of time that I was in there and experiencing contractions. So I did end up.

getting an epidural for that delivery. But it went very smoothly. had, you know, during the whole pregnancy, you know, so many tests and I did see the MFM team for consultations and we had for the 20 week, the scan, big body scan at 20 weeks. They also had a prenatal cardiologist check just to really cover all bases. were really on top of it.

Okay.

And so she came easily and without pain, relatively.

And no shoulder dystocia this time. how much does she weigh?

Speaker 1 (37:37.455)

She was six pounds, five ounces.

Okay, all right, all right, okay. Wow, you went through a lot. Looking back, how do you feel about everything?

I still get emotional talking about my pregnancy, or not my pregnancy, but more so the delivery and the birth of my son. And I still am sort of feeling like I was robbed from those first few hours. I do also volunteer with March of Dimes and I have friends and family that have had babies in NICU for 80 days, 60 days. So when I start to feel robbed of those few hours,

I do try to put it in perspective because I did luck out. I truly, I do think I lucked out. I do think I also was very fortunate. I live in an area that has really high quality healthcare available to me. I made the plan to deliver at a hospital that I knew was a reputable, really good hospital. So there was a lot, I think, that contributed to the fact that we ended up being okay. But it's...

Also one of those things where it's like, had any of those components been different, had I lived somewhere else or delivered somewhere else or had a doctor or a team of doctors who wasn't familiar with cholestasis and dismissed it because itching is common when your skin is stretching and you're pregnant. So I just feel really fortunate and grateful.

Speaker 2 (39:07.79)

Good, good. And I forgot to ask, how bad was the itching between when it was diagnosed and when you delayed?

it was horrendous. The pictures of me when I delivered, have like raked my skin and you can see just even with the medication.

Yeah, I think that's the thing that people don't understand. It's not just like, I'm a little itchy. It's awful.

It was worse, the higher the bile acids, I will say that. I, with my daughter, it was uncomfortable, but I wasn't miserable. I was miserable with my son.

Okay, so then as we wrap up, what would you say is your favorite piece of advice that you would give to someone who's having

Speaker 1 (39:50.318)

Having a baby. My favorite piece of advice is you cannot plan everything, right? So when you're thinking about the birth and planning what you want for your birth, having a plan is great, but I think understanding that that may not happen. But even more importantly, it is pay attention to your body. Pay attention to how you're feeling when something feels wrong or feels off. Definitely let your doctor know. Don't try to dismiss it yourself. Don't try to self-diagnose.

Again, itching is the primary symptom of cholestasis of pregnancy, and it is a very common symptom in pregnancy. So if it's on your hands or your feet or anywhere where you're, you know, aside from your stomach, where you're just, you know, your skin is stretching, definitely let your doctor know. There were even things like upper right quadrant pain is a symptom of cholestasis. And I had what I thought was heartburn that I just could not get under control.

So I had all the different things that I was allowed to have for heartburn while you're pregnant. that ended up, afterwards I realized that that was also a symptom as well. So just pay attention.

Gotcha. pay attention is excellent advice. Excellent advice. And so where can women connect with you? You can say nowhere or if you have any resources.

share. Yes, so I am the lead ambassador for ICP care and we have amazing group on Facebook. There's also Instagram, social media, so you can find me there and ICP care is also on LinkedIn. So anybody professionally who would want to connect that's in the know mother-baby world you know we share a lot there and I am happy to connect with folks there as well.

Speaker 2 (41:34.158)

Well, thank you so much for agreeing to come on and share your story. There's so many things to learn from it, so I really, really appreciate it.

Thank you so much for having me. I really appreciate it as well.

Speaker 2 (41:50.69)

All right, wasn't that a great episode? That was a bit of a wild ride for a birth. And I appreciate Ashley sharing her story. Now, after every episode when I have a guest on, I do something called Dr. Nicole's Notes, which are my top takeaways from the conversation. Here are my Dr. Nicole's Notes from my conversation with Ashley. Number one, that itch can mean more than dry skin. Ashley first.

brushed off her itching as just another pregnancy symptom. And that's a really easy thing to do. But itching on your hands and feet, especially at night, can be a sign of intrahepatic coldly stasis of pregnancy or ICP. It's rare, but it is serious. And the earlier it's diagnosed, the better the outcome. So the moral of the story is if you feel like something is off, say something and then say something again until you feel like you have answers.

You know your body best. Okay, number two, birth does not follow a plan. The baby has the plan and they do not tell us their plans. Ashley's birth moved so fast, there wasn't even time for an epidural. There was a shoulder dystocia, a vacuum and a episiotomy, postpartum hemorrhage all within minutes.

And this is just a reminder that birth truly does take its own path, sometimes a crazy path. You can, however, prepare and plan, and you should, but do know that flexibility and support are key to help you navigate those twists and turns of birth. All right, number three, postpartum recovery absolutely without question needs and deserves more attention.

After her son was born, Ashley experienced that significant bleeding, she needed that surgery, blood transfusion, all of that. That's a lot physically and emotionally, and that can actually sometimes be traumatic. We don't talk about this part enough about dealing with how the unpredictability of birth can sometimes lead to trauma.

Speaker 2 (44:00.824)

but paying attention to the stage matters just as much as the birth itself. The postpartum period is obviously way longer than the birth itself. So make sure that you have help, that you ask questions if you need to, and that you take the time and connect with the resources you need to help you heal and help you get off to the absolute best start to motherhood that you can.

Okay, number four, the second time around, I will say even every birth can be completely different. When Ashley had her second baby, she knew what to look for. She got great medical support. She had a smooth planned birth. Again, plan in air quotes, you know, as much as we can plan birth. But that's the power of knowledge. It can help turn fear into confidence. She had a lot more knowledge about this going into her next birth.

And her story shows that your next birth doesn't have to mirror your first one or your third birth doesn't have to mirror your second one. Truly every birth is going to be. It's different, it's own, it's unique experience and each one can get better with that power of knowledge.

All right, so that is it for this episode. Thank you so much for listening today. If this episode has helped you, share it with a friend, hit subscribe so you don't miss a thing. And if we're not connected yet, come follow me on Instagram. I'm on Instagram at Dr. Nicole Rankins. My DMs are open and I truly love hearing from you. Now, do me one more favor. Come on back next week and remember to trust your power and take charge of your birth.