These are birthing stories from moms. If you would like to share your birthing story, please click here.
03 March 2017
I woke up in the morning, Set my daughyer Natalia off to school with her dad. I went back to sleep. My helper left for the day at around 9am … I said goodbye and returned to bed.
I woke up again at 12h00 time to fetch my daughter from school… in a hurry I got ready and left.
It was such a a warm day. My daughter and I arrived home but stayed a little longer in the car as we enjoyed the Aircon. I was in such a light hearted and happy mood. Natalia and I watched music videos and laughed and danced away. At home – I just enjoyed my one on one time with her … bathed her, changed her and plaited her – corn row style.
Sumen my husband arrived early from work. He got ready for the evening, as we were invited that evening at my mum in laws home for dinner. I had a shower and got ready. We left home to fetch my son , 1 year 4 months old Josiah – From my mums home in Isipingo.
When we got to my mums house, I noticed my family had all worn clothes the same colour: blue and yellow. We took some photographs together.
At 18h00 I was about to have a seat in my mums living room , when I felt a gush of warm water. “I think my water just broke” I said to my sister Avril. We were all so happy as Alovah’s due date was 01 March 2017 and I didn’t want to be induced in hospital, I wanted as less medical intervention as possible.
I went to the bathroom and cleaned myself up. At my mums home we usually pray at around dinner time… so thats what we did and my sister Avril prayed a special prayer for me to have a safe delivery.
I called my mother in law to tell her that we wouldn’t make it for supper that night. I had supper at my mums place as I had not eaten anything that day and I needed to refuel my body in preparation for a long and difficult labour as told to by my gynaecologist the previous Friday. She advised that my baby was in a posterior position… this got me very concerned.
We left my mums home at about 19h00. I already started to experience contractions that was managable. At 19h20 we are almost home and I remember telling my husband not to rush as I was okay and coping with the labour pain.
Got home. Greeted our gardener with smiles. My husband cheerfully notifies him that the kids are with my mum and that the new baby is on the way.
Hospital bags were packed and ready , I just checked the paper work and a few things and Sumen packed the car , as I removed my jewellery.
To manage the pain at this point I was on my fours and my husband brought me the exercise ball. This helped manage the pain. We also charged the hot water bottle and heated the wheat bag.
My husband then told me to get into the shower and let the hot water run over my stomach and back.
Remember I’m expecting a long and painful labour. My plan was to labour at home for as long as possible before heading to the hospital which is located only 10 minutes away from my home.
So now I’m in the shower and my husband now starts to time my contractions. They were 3 minutes apart and lasting a minute long. I was only in the shower for about 10 minutes when we started to notice that the contractions were getting closer. We then decided to leave for the hospital.
I stepped out of the shower. I’m trying to dry myself with the towel, manage the pain and make my way to the bedroom to get dressed all at the same time.
The pain now has stepped up a notch. I’m on my fours again in my sons bedroom trying to manage the pain while my husband dries my back and helps me slip on a nightie.
Almost there, only for me to put on my underwear and a sanitary pad. My husband gets them for me but it’s the wrong 1. I head over to my bedroom to put on a sanitarypad ….5 steps away.
I leaned against the wall with 1 hand holding my weight as I tried to feel what’s going on with the other hand. It was another small gush of water – amniotic fluid. I shouted out to my husband that we cannot leave to the hospital and that the baby was on her way. The tone of my voice and groans had changed this alone was a big sign to me that it’s all about to happen right there and then in my bedroom.
I could feel the pressure of the baby in my pelvis area. My husband called for the ambulance services , they were in Chatsworth and on their way to us.
I then felt the “ring of fire” , I knew it , her head was crowning. With 1 little push – her head was out. My husband brought towels and cushions. He was so calm which kept me calm and positive.
I went on my fours , as I felt pressure again I gave another little push and Alovah was born. I told my husband to clear her mouth of any fluid she might have swallowed and to make sure she was breathing and then he layed her on my chest.
My beautiful baby girl Alovah was born at home just as I secretively desired in my heart. She was perfect , so warm and so quiet and she just lay in my arms so content.
I kept her at my breast immediately. We were all so happy and so relieved. There was such a presence of peace and calm. This was only God.
The ambulance called and my husband advised them that the baby had been born and both mum and baby were healthy and doing well. They told my husband not to do anything with the cord and that they will come over to deliver the placenta.
At 20h30 the ambulance arrived and they did just that. They were so calm and patient with us. My parents arrived with my kids and we all just enjoyed the 1st few moments with our new baby before we made our way to the hospital.
I’m happy to say that both baby and i were discharged from hospital the next morning with a clean bill of health needing no medical procedures on either of us.
Praise be unto God for this miracle child of mine – Alovah Pandaram
Sumen my husband 35 years old. Technician.
Myself, Navlene 32 years old. I’m a Group Buyer for a chemical company.
1st Born Natalia . 6 years old
2nd born Josiah . 16 months old.
3rd born Alovah ~ miracle baby.
The 4 November 2015, late afternoon I could not believe it for the very first time peeing on a stick and the result was positive. I had in my life peed on a few sticks but always negative. Luckily we had one for the morning as well. Good grief I am pregnant I know nothing about pregnancy; I quickly rushed out to PNA and bought the first book I could find about being pregnant. I followed up with my GP and my blood results confirmed I was in fact going to be a Mommy. The excitement the joy. Oh my life was sweet. Wanting to see my little spec I made an appointment with my current gynaecologist. Sitting waiting for over 3 hours to see her, to go in for 5 minutes being told she guessed I was about 5 weeks and if I experienced any form of bleeding I should contact her rooms immediately. Being pregnant for the first time I was panic stricken did she see something on the scan for her to ramble on about bleeding, which in my mind meant losing my baby. I said to myself she will not be taking my money again. So I moved onto another gynaecologist. Who was pleasant enough but told me he only delivered at the Glynwood Hospital which was not my hospital of choice. I then moved onto my good old faithful gynaecologist who was at the Parklane the hospital I wanted my baby delivered at. I recall a very good friend of mine sharing stories about what she had learnt in her baby classes a few year back and I was so intrigued and interested in them. Having lost my mother in November 2013, I thought I would like to learn about having a baby because I had no clue. I then started attending Sister Hettie’s classes on Tuesday evenings; I fell hopelessly in love with them and could not wait for the following week.
I did not know much, but all I knew was I wanted the best for my baby, I wanted natural birth and I wanted to breast feed and that was it. In my classes everything was confirmed how my birth choice was the best for my baby.
My next gynaecologist appointment I made it very clear I wanted natural birth. Right there that is when my fight my struggle started. The deception and the untruths. My then gynaecologist started trying to brain wash me “you can’t have natural birth your baby is far too big to have natural birth.” If you are determined about natural birth I will send you to the mid wives at Genesis Clinic. My last appointment with him was when he said right next check-up we will book your Caesar bed. I was totally shocked as I thought he understood what I wanted. I took it upon myself to contact the mid wives at Genesis clinic. I was so very mad and thought these doctors do not have my or my baby’s best interests at heart. Who are they to decide my fate I was visiting the mid wives feeling happy and positive about giving natural birth my hospital bed was booked Then came 36 Weeks it is compulsory to see a gynaecologist to secure him as a backup in case of an emergency. I just remember feeling so defeated, he also went on to say how my baby was far too big to deliver naturally. His head was way too big. He listened to how I wanted natural birth then said okay come back at 38 weeks then we can make a final decision. 28 June 38 Weeks he said he will not be the backup doctor for the mid wives if they proceed with a natural delivery my baby is far too big and it’s too risky. My heart was shattered, I was done. I said okay if I have to have a Caesar I want to wait until my full term 40 weeks before he is delivered and I want him on the date his due date 10 July. This doctor tried to convenience me that my baby was too big and needed to be born at 38 weeks that was the breaking point I was so angry I could have spat fire. Taking the news back to the mid wives they were also shocked at his decision. They asked me do you want to see one more doctor. They have one more option. At this stage my husband had, had enough he was petrified at this stage. So I said okay we will do the Caesar then. Something said push on, one more try. Going to see Dr Mia was the most rewarding doctor visit of my life, he said to me there was space, I could deliver naturally my baby was big but not that big. I almost burst into tears. He agreed to be the backup doctor for the mid wives. I had won my battle. He just said please do not go over 41 weeks otherwise there could be complications. I could accept this and trusted him. The endless hours of prayers the endless hours of exhaustion the long travels from Boksburg to Johannesburg. Thank God for my loving, understanding husband who was so patient but I knew was so very scared I was making the wrong decision. So now we waited for me to go into labour. I did ever trick in the book, went for reflexology, and drank cranberry leaf tea. Blew up balloons. Ate pine apple had sex. I was nearing 41 weeks. The mid wives checked me out there was a possibility that I was not ready to even have an induction. My cervix was not right. First check I was not ready. Wasn’t looking good for my natural birth a few days later the mid wives gave me the okay so a decision was made I would have an induction on Thursday 14 July. I accepted that. I think I was booked for 6am the morning of 14 July for my induction. I woke around 4am and had these pains I said to my husband I think I am in labour I kind of knew what it felt like because I had experienced false labour a few weeks earlier. He said no man must be your nerves I said yes you are probably right. I had this major urge to go to the toilet and make a number 2. On arriving at the hospital I told the mid wife what I was experiencing. She said right let’s take a look. So all the checks were made she said Mary-Ann you have gone into spontaneous labour you are 2 cm dilated. I cannot give you and induction we are going to have to let your body do what it needs to do. I was in shock seriously. She said it could take a number of hours why don’t I go home and relax time the contractions, she would be in touch later. We said okay then got into the car and went home. While driving home I felt the pains getting stronger, got home at about 7.30am / 8am man these pains were coming fast and strong I remember not being able to sit or stand it was very sore, I was leaning over the couch trying to breath I said to the hubby I am going to lay down on the bed its very sore. Man oh man they were. I said call the mid wife I am getting scared think we must go back to the hospital. I heard her saying how many minutes are the contractions apart, I said I don’t know I am to sore I have not managed to time them. I had this app I was going to use. I could not really walk to the car. I made it to the front seat with a hot water bottle and I lay down. It was now around 8.45 and traffic was bad, I recall having the urge to push, but I didn’t I knew I must not push I recall my husband driving in the emergency lane to beat the traffic I said please hurry hurry I need to push. (Just like in the movies) I was timing the contractions on the app. They were roughly lasting about 60 seconds and were 2 / 3minutes apart. We got to the hospital my husband frantic to the security guard my wife is in labour we were shown to the front of the hospital door, does she need a wheel chair, I said yes I don’t think I can walk. As we got there so did the mid wife I said I feel like I need to push she said that’s wonderful news. Got to my delivery room which was so lovely having back ache needing to push she examined me and said Mary-Ann you are nearly fully dilated. Let’s get you ready. Listen to your body push when you need to. She explained this could take some time, she said can I break your waters to speed it up. I said okay if you need to. Not too happy because I wanted my body to do everything on my baby’s times as she was walking toward me to break my waters, then there was this massive gush below my waters broke naturally. I was almost crying I could not get over my luck. So here we were pushing in agony I said please can I have some of that gas to help with the pain the mid wife said no it’s going to slow your labour down you can do it push. After what seemed like forever exhausted hot and at my end. I cried out please cut me get him out I can’t push any more I can’t do this anymore. To being told you can and you will. I remembered all that the gynaecologists had said my baby was to big he is going to get stuck. I was in a panic this huge amount of fear, I was crying please my baby is going to get stuck he is too big. They reassured me he was not in distress he was perfect all was going well his head was there my husband said his head is there. So I pushed and pushed then, that split second he was out. My first words were Thank You Jesus. My baby boy, placed on my chest was perfect in every way tears of joy. Feeling the umbilical cord pulsating. Hearing my baby cry. Those first few seconds I believe I had a glimpse of heaven. My husband, the mid wives who admitted they had their doubts looking at me and just praising and acknowledging my fight, my hard work, my miracle. Looking back it honestly seems like a story from the movies.
My son was born at 10h55 14 July 3.6 kg,s 49 cm long and OFC 34cm.
All I heard my entire pregnancy was how big my baby boy was he was going to be over 4kgs. And how massive his head was.
I was not going to accept that I could not have natural birth it was how God intended it. It was the best for my baby. Honestly I was more petrified to have a Caesar than the pain of natural birth. The thought of an unnecessary operation and having a catheter really freaked me out and I was not having it. Why everywhere else in the world you are made to deliver naturally but in South Africa it is a no. I would not accept that my doctor won over what my baby wanted and needed to enter this world. I saw 4 gynaecologists during my pregnancy that I was not happy with and tried to convince me it was not safe. Then I had 1 decent honest doctor and mid wives. After my delivery I stood up walked over rinsed myself off. I was in no pain what so ever, I did not even need any stiches. I was perfectly perfect.
I was in labour for about 6 hours. It angers me that I had to have such a big fight for what should be my choice and my baby’s choice that comes first. Not when its convenient for the doctor so their lives are not disrupted.
I listened to my inner voice who I believe was the lord leading me every step of the way. I have no regrets and I would fight that fight all over again for the end result I hold in my arms every day.
I believe my mom was there with us in the delivery room helping me along
There are words to express how grateful I am that I attended my baby classes and met Sister Hettie. That I educated myself, because if I had not I would have just accepted what was being said.
I have maybe one regret, I was so focused on the delivery I never wrapped my head around afterwards. I wish I had focused more on the breastfeeding, I just thought it was going to be so natural and I would not have any problems with it, but I did. I am still breast feeding now my son is 18 weeks today, but it has not been without a lot of pain, discomfort and agony. My breastfeeding journey has not been easy, but I have managed it and it breaks my heart thinking of ending it in the near future.
All in all I believe I had a difficult road to my birth but I had the most amazing, happy, blessed, positive birth story.
At 41 weeks pregnant awaiting our little baby. But still no sign. Of her arrival. My head set on normal birth but at our second last visit our doctor said “if she doesn’t com by next week we do a c-section. ” after 10 months of preparing my head for normal birth that words broke trough me like knives. The 17th of feb was our last visit to the doctor. No sign of our princess yet. Then the doctor said. “I decided to do induction, please understand that it doesn’t always work but lets try. ” the day of my induction the doctor came in did the exam en said if you would give birth it will be at 4pm and if not we will do an emergency c-section at 6pm.
The nurse came and said. You will not get a c-section today we will have this baby the normal way.
then the pain came. Oh my word it hurt like hell. With each exam it felt like they are twisting and ripping out my spinal cord by my bum…. trying to focus on breathing but with each contraction almost breaking my poor hubbys hand”he must also have pain. “Haha” with almost everything irritating me oh how much pain…..
At 12pm i was only 6 cm dilated and when they came at 2pm nothing has changed. I saw the look on the nurses face. I was worried. They said if in the next hour nothing changes they call the doctor and then comes the c-section.
At 3pm when they came back to the “last” exam her face surprised I was 7 cm dilated and nou its down hill. They called the doctor en at 16:25 Dané was born. By normal birth what an experience.
In the birthing class we saw I video of the birth crawl and we decided that this is what we will do. Directly after they did the exams on Dane they gave her back and we did skin 2 skin. With the nurses watching she did the breast crawl and latched all by herself, this is where our journey started. Unsure of how to do this but we did one day at a time.
There is always something to be thankful for!
Have you ever sat through a moment when you look around yourself and you feel lost? You feel like this isn’t your life. This isn’t your experience. This isn’t how it’s supposed to be. That’s how I feel now. I sit and I stare off into the distance. Somewhere out there is my life how I had imagined it. In a parallel universe I had an easy birth story, we healed, we came home, we bonded.
I didn’t end up in surgery. I didn’t end up in ICU. I didn’t almost die. In another world none of that is part of my story. Except I’m here. In this world. And in this world that is my story. I just went in to have a baby. Those words play over and over in my head. Except instead of just a baby my entire world changed.
The time around the surgeries is a blur. I was so drugged I don’t remember a thing but here’s what happened within days of having my baby.
- On the 4th of September I had a C-section
- On the 8th my second surgery – a laparotomy – to deal with my burst appendix
- On the 10th my third surgery. Which was supposed to be a general rinse but ended up being a serious operation. More serious than the Doctors anticipated. They called me “critically ill.”
- I spent 10 days in ICU
- I spent one of those days on a ventilator in an induced coma
- I spent a total of three weeks in hospital
- Healing. Hurting. While my baby lay in maternity ward. Waiting for his mamma.
- But I just came in to have a baby!!!!
- While I lay healing in ICU, my grandfather died. As if there wasn’t enough going on already. Oh cruel world..
Instead, I nearly died.
One day at a time. That’s how I’ll get through this. How did it happen like this? I’m not sure. Why did it happen to me? I don’t know the answers to those questions now. I cry. I cry a lot. Most nights I can’t sleep. I have the events of the last month playing over on repeat. I’ve thrown grief into things just to keep it spicy.
I guess this is PTSD. I guess I’m even more broken now than I was before. I don’t know why but I do know this; It made me thankful and I know I’ll be okay eventually. Time heals all wounds… isn’t that how the saying goes? I think it’s normal to be sad. To grieve for the time I lost and the experience I had but I won’t miss what this means. I won’t forget that things could have gone very differently. I could have never come home. But I did! I’m so thankful.
What I’m thankful for
I nearly died! BUT I DIDN’T! I could have. I nearly did. But. I DID NOT.
I am thankful that I had amazing surgeons who did not give up and instead found the problem. Besides a burst appendix, I had endometriosis that had punctured my bowel behind my Uterus and wasn’t immediately obvious.
I am thankful that I had incredible nurses who cared for me and nursed me back from the dead. Washing me, making sure I have no pain, Rubbing the wounds on my feet from laying in bed for so long. Turning me, helping me…. all day, all night. I am so grateful to the nurses who watched over me. Adjusted my pain killers, changed my medicine, made sure I didn’t get infections. I am grateful without words to say thank you.
I am thankful for a husband, a mother and a step-father who sat by my side while I spoke through the haze of drugs about rubbish. Blurs of speech about things I imagined. Worrying, waiting, crying. Day in and day out at my bedside. Love like no other. Crying tears in fear – even when I had no idea how serious my own situation was. I don’t know much of anything because I was so out of it for most of it.
I am thankful for a husband who takes care of our son. Most nights on his own so that I can sleep and heal. So that we can be whole. I am thankful that he wakes up when he hears me crying. To make me feel like it’s not the end. I am thankful that he wakes up and makes us breakfast, changes our son and makes his bottle before handing him to me for my first turn after the night shift is over in this merry-go-round of new parenting.
I am thankful for friends who made food and delivered it to my home so that we wouldn’t have to worry about dinner. For a sister-in-law who had a food delivery service arranged too. It’s in these times you learn about the people you have in your life. I am thankful for the ones I have in mine.
I am thankful for family who rushed to be by my side. Who called, who texted, who worried and checked in on me and my progress.
I am thankful for hundreds of messages and calls from friends all over the world. All worried about me.
I am thankful for my son.
Most of all. I am thankful that through all this drama – my baby is perfect. I am thankful that I can get to know him. That I could bring him home. That his cries wake me in the night.
I am thankful that I can watch him grow. I am thankful that I will hear his first words and won’t miss his first day at school or the first steps he will take. I am ever so thankful that I lived to hear him one day call me mamma.
I am thankful that I can watch him become his own person, every day. Fatter, cuter, more aware of the world he’s in. In awe of everything he sees. Crying because he doesn’t yet have the words.
I missed out on the first three weeks of his life. I am thankful that there is so much more for me to experience. I am so grateful that I lived to experience it.
So many people see me and ask me how after everything, I can be smiling. People tell me; I’m strong. The truth is that even in moments like these… there are always things to be thankful for.
Above it all
I am thankful I survived.
So as I sit down and begin putting my absolutely amazing VBAC (vaginal birth after cesarean) story into words I realize what a profound journey it has been!!!
I’d like to start off by saying that I personally don’t believe that any type of birth is “wrong” and believe that whichever way your baby ends up entering into this world is solely part of Gods awesome plan.
I do however believe that many women who desire to birth their babies naturally are being robbed of the opportunity by a system that has become all about the procedures and protocols and nothing about the needs of the mom and her unborn child. A system in which the mothers’ natural instincts are overridden and her voice is silenced… and that saddens me!
I also believe that a VBAC that ends in a C-section can be just as healing as a VBAC that ends in vaginal birth, primarily for the reason that throughout the journey of a VBAC, and a VBAC is truly an extremely personal journey, the mother is heard and the mothers natural instinct takes precedence, above all else!
To give you a true sense of how wonderful and healing my second birth was I need to shed some light on my first labour and birth.
To cut a very long story short, I went into labour naturally at 38 weeks… my labour was 6hrs from first contraction to pushing. Despite my quick labour doctor had ordered the nurses to put up a drip to increase the intensity and frequency of the contractions? (Only he would know why)
After being allowed 10-15mins of push time we were told that the baby is “stuck” and that we need to go for a C-section as baby is in distress. At this point doctor had already cut a routine episiotomy.
Wheeled away to theatre without my husband by my side, while still having contractions, I was afraid to say the very least.
Hubby had to get dressed into his scrubs and made it into the theatre just in time as our precious boy was being lifted over the surgical curtain.
Our baby was absolutely perfect and got 9/10 on his Apgar scores, hardly a baby that was in distress as the doctor had claimed.
Hubby and I both knew immediately that this was in actual fact not an emergency C-section but rather an unnecessary one.
Recovery was hard. I had a C-section cut as well as an episiotomy and a new-born to deal with. Hubby quickly took on his fatherly role and did almost everything for our little boy as I was just physically unable to do so.
Not the ideal birth but our perfect miracle was happy and healthy, and that’s what we stayed focused on.
Fast forward 2yrs and 21days, on December 24th 2015 we find out we are pregnant after only 3 cycles of trying WOW! What a shock! With our first pregnancy we struggled to conceive.
This is where our magical story begins.
As one does I immediately worked out what my due date would be…
4th September 2016.
At this point the birth didn’t even feature in my mind, but soon I realized that I would need to decide if I would settle for a repeat C-section or if I would consider doing a VBAC.
During my first pregnancy I had the privilege of attending antenatal classes with Sr Megan Whiley and she had made us aware of what a VBAC was and what it entailed. I knew that I was a good candidate and that it was a feasible option.
My husband and I both agreed that if I was managed differently in my first labour and birth that we would have had a successful vaginal birth.
We were also well aware that if we got as far as we did in the environment that we were in with the care providers we had, then nothing could stand in our way given the right environment and care providers.
Despite all these convincing points a part of me was still unsure. I knew that if I was going to have a successful VBAC I had to want it more than anything else.
I run my own business and am a super type A personality. There was temptation in the idea of choosing my baby’s birth date and planning maternity leave down to the day. There was a certain sense of excitement in the control I could have if I chose a repeat C-section, and on the other hand I had a great fear of giving up all control, changing to a midwife, giving up the security of my gynea, giving up the many scans and learning to “listen to my own body”. I was not sure I could trust my own body.
I also knew that finding the right care providers to support me with a VBAC could prove challenging and thought that maybe a repeat C-section wasn’t such a bad idea after all.
However the turning point came for me when my gynea announced that we would book my repeat csection for Tuesday the 16th August…. On the 16th of August I would’ve only been 37 weeks… in that moment it became clear to me that due to me going into labour at 38 weeks with my son the gynea was ensuring that he delivered this baby before I had any chance of going into natural labour. Once again it was all about him and his convenience at the blatant disregard of my own desires.
Hubby and I agreed in that pivotal moment that I needed to begin putting my VBAC birthing plan together.
I was extremely lucky to quickly learn of the “VBAC queen” Sue King and her team practicing from Genesis Maternity Clinic.
Sue, Elrika and I with hubby at my side clicked immediately.
We asked all the questions: Is it safe? Is it worth it? Can we do it?
There were still many times both hubby and I doubted our decision. There are many horror stories surrounding birth especially surrounding VBACs. At times it was hard to silence all the negativity and trust we had made the right decision.
Sue guided us like a lighthouse in the dark! Her complete faith in a woman’s body and in the process of birth is contagious.
It was under her tender care that I began to learn to listen to my own body and believe that we are built miraculously to birth. Sue silenced my fears on many occasions when people, even our closest of friends, questioned our decision to VBAC.
We had found the first members of our 3 fold VBAC dream team, our midwives.
At 28 weeks we met our back up gynea. Our gynea, that would support our decision to VBAC. At this point I discovered that, due to insurance implications, gyneas willing to back up VBAC’s are few and far between and that we were lucky to find one!
Last but certainly not least we found our 3rd member of our dream team… our fabulous Doula, Tertia Alkema. People often ask us “what is a doula” and my hubby explains it perfectly, he says a doula is a birth cheerleader. Tertia became my and hubby’s pillar of strength! Our soft place to fall, before, during and most importantly after the birth. Someone to listen, and I mean truly listen. Listen without judgement, listen without any preconceived ideas, just truly listen.
It’s said that “a doula is like a trail guide, familiar with the path, she keeps you hiking through the hard parts, knowing the view at the end is incredible.”
So…. In light of the above we prepared to welcome our second miracle into this world… but this time on our terms in Gods perfect timing.
At my 36 week appointment with Maasdorp I got an all clear to deliver naturally at Genesis under the care of Sue King and Elrika Knoetze as my midwives and Tertia Alkema as my doula. Baby was engaged and in a “perfect birthing position”
The dream of my VBAC was becoming more and more of a reality.
At our 38 week appointment all was perfect and it all became about just waiting for our little missy to make her royal appearance.
At 39 weeks I start having “contractions” during the night but wake up in the morning as though nothing ever happened. (Disappointed)
At our 39 week appointment baby had turned completely posterior (naughty little thing) Backache goes up a notch and “fake” contractions become a normal occurrence… Not to mention the kicks behind my belly button (I’m sure she thought my belly button was the exit 😋)
I booked a reflexology session for Wednesday morning and googled “how to turn a posterior baby”, determined to get everything just right for my perfect VBAC.
This is truly where my birth story actually begins.
Wednesday 31st August 2016 :
07h00 – my toddler wakes up with pink eyes… (Best way to start a day)
08h30 – little ones eyes look better so I decide it’s off to school we go…. Car won’t start (Wow this day just gets better and better)
09h00 – manage to get car push started
10h00 – as we about to start my reflexology session Joshua’s school teacher phones and asks that we please fetch him as his eyes have worsened… I organize for him to be fetched and continue with my reflexology appointment. Very interesting! We book another session and discuss reflex for natural induction.
By this point I’d been having a relatively challenging day (to say the least) and I’m not holding out much hope that I’ll EVER go into labour……. I do however tell hubby that I think missy might have turned back into the right position….
Im tired by this stage and start doubting myself and the process. I decide to pray a prayer of complete surrender.
“I CHOOSE :
God I choose to believe in your perfect timing….
I choose to trust the process….
I choose to find perfect peace in complete surrender….
I choose to allow myself to go in over my head….
In these last days when my strength wavers and my faith falters I pray that you will carry me…
I pray that you will keep my eyes above the waves….
I pray that you will remind me that you’ve never failed and that you won’t start now…”
Fast fwd to 13h30…..
While taking a nap I begin feeling what seems to be contractions… (Keeping in mind I had had false contractions often)
I start timing them… They seem pretty regular but are only about 20-30sec. I mention it to my mom and tell her to not get to excited as they could go away again.
I phone hubby and tell him what’s going on as he is over 170km away.
I also message my doula to keep her in the loop.
We decide I should take 2 panados and a bath and reassess the situation.
Contractions are coming quick now about 5mins apart and lasting 1min and are pretty intense.
The time cuts to 3mins apart… And then 2mins apart in the matter of 40mins 😳 (during which time I’m straightening my hair and stopping to breathe through contractions – for some strange reason I felt I couldn’t labour with a huge bush of curly hair! Hahaha. I also believe at a stage that not all the contractions are as intense so maybe they not all “real”… Toooo funny!! – the things we convince ourselves of in labour!)
Tertia and I agree that I should head out to Genesis and try miss the peak hour traffic.
Hubby arranges for my sister In-law to come fetch me and take me. My toddler stays with ouma at home.
Contractions are now fast and hard and coming quickly… We leave for Genesis at around 16h15.
The car journey is intense but do-able and my sis In-law does her best to console me.
We arrive at Genesis at about 17h00… (Approximately 3hrs 30mins since the first contraction I timed) By this point I just want my hubby!!!! He is about 20mins away.
I’m met by my “dream team.” They are very chilled and I just keep moaning that “these things” are getting really sore now.
They set me up to monitor baby and contractions and all is well…. Hubby arrives and Tertia coaches me through my contractions (a true angel!!)
Elrika sets me up to do an internal…. I’m thinking to myself “Lord please let me be well dilated, I can’t take this pain for the next 12hrs”
She announces that I am 9cm if not fully dilated already. (SAY WHAT?????)
Tertia and Elrika scatter to set up my birthing pool up……
The contractions are hectic at this stage and hubby does a FABULOUS job at cheerleading me through it all (despite me being a little mean at times 😋)
We manage to get me into the bath before I get the intense urge to push…. A desire so so natural and a feeling one can’t really explain!!! 5 contractions later and my perfect VBAC angel was in my arms…. A round and healthy 3.94kgs and 51cm….. I caught my own baby completely instinctually… Hubby cut the cord and the moment was just amazingly magical….
I had trusted my body and trusted the process. Without anyone teaching me anything I had birthed my own baby.
The following day we got a special visit from Sue (despite her having gone for major surgery just the week before) an exceptionally inspirational woman! Our lighthouse in what was a dark journey at times…. never once losing faith in me, in the human body and in the perfect process! I stay eternally grateful!
Without as much as one stitch today, 3 weeks later and I’m still on cloud 9…. So so in love with this little missy!!!
Thank you to my dream team!!! Each and every one of you played a vitally important role in this journey, in my healing, in my hubby’s healing and in the magical birth of our second miracle!
For anyone considering going on this journey I can tell you that with the correct birthing team, in the right environment, with the right mind set and a lot of faith you can’t go wrong!!!! Find the team that wants a natural delivery as much as you do!!! It is an intensely personal journey and wonderfully healing! I am truly forever changed!! I have learnt the peace that comes from complete surrender, I have learnt to trust people again and most importantly to listen to and trust my own body.
As my hubby would say…
“YOU GIRLS WERE BUILT TO DO THIS!!”
There is nothing in this world more natural than natural birth!!!!
I’ve always hoped that my birth story can inspire others. Whether this is your first birthing experience or your second birthing experience after a c-section don’t be afraid to fight for the birth you want and the birth you and your baby deserved!! Stand against the system run by insurance costs, procedures and protocols!! Stand up for yourself and your unborn child!!
An extraordinary creation which amazes every parent, a joyfull journey as you feel the first flutter of butterfly kicks in your tummy till the day you realize this is it, your long awaited baby is making his way into the world, my name is Sherona Sadew and this is my birth story
As a woman I always possessed the motherly instinct and adored babies, I met my husband at the age of 21, and we joined as man and wife, we decided that as responsible adults we was too young to have a baby and I visited my clinic for family planning, as year’s of blissful marriage passed at the age of 25, I felt we was now ready for a baby, sadly after 2 year’s of Still trying it was obvious, we had a problem conceiving, I visited my clinic which referred me to a government hospital, too heartbroken to find the truth I left it in God’s hands, trusting that a miracle would occur, I cried when I wondered what having my own child would feel like and I got a lot of unwanted advice from people around me,I got very involved in a local church and one day at the altar during prayer requests, I asked the Lord to bless my marriage and bless us with a baby, miraculously a month later I realized I was pregnant
I somehow just knew, as the say expectant mother’s do realize, I told my husband to buy a pregnancy test, he sadly said I’m just going to be disappointed and upset once again, I couldn’t wait so I took a taxi to a pharmacy and bought a test, I couldn’t wait to get home, and yes my instincts was correct and I sat on my bed amazed thinking this is really it, two pink lines on the test! I was astonished, I immediately called my husband who excitedly rushed home, he carried me off the floor and said ‘yay! He’s gonna be a father, ‘I replied’ watch the baby you squeezing to tightly ‘
An exciting journey had emerged, I immediately started shopping for baby, researching, collecting every piece of valuable information on baby care from the library, magazines and Internet. I booked at my clinic for monthly check ups, those months was the longest waiting anxiously to meet my baby boy which the doctor had confirmed, my pregnancy was smooth sailing, I was complimented for an amazing baby glow, I hardly had any nausea,and each day was a blessing and enjoyable being pregnant, my husband would warn me not to sit so fast or go up the stairs quickly, I would laugh at him being so cautious.
On my last check up I was referred to a government hospital for the final check up, I awaken extremely early to avoid the long que and tiring waiting times,I had breakfast in the car at 6am and hubby left me at the hospital returning to work, I remember carrying my favourite magazine, living and loving to keep me occupied, finally at 9 am, It was my turn to see the doctor, during the examination he informed me my baby was on his way, I excitedly said finally, I’m so happy, it was 3weeks before the expected due date but it seemed like all was well, I didn’t experience any cramps or symptoms that baby was on his way, doctors was shocked, admitted in hospital, praying all went well, the next morning labour did not progress and I was sent home
Sunday morning, 6am I was awaken by a Wet bed, I immediately woke up my husband, we then realized that my water had broke, this was really it, again bags was re packed and we returned to hospital, I spent the night, around 12 am my contractions had got really painful, in a government hospital, my husband was only allowed to enter the labour ward, he waited anxiously for my phone call, all I wanted was him beside me and I knew it would be ok, nurses were quite rude when I complained of pain and told me to go lie down without medication, I cried but prayed for strength from God
Eventually my husband met me at the labour ward, the nurse who escorted me practically dragged me up to that ward, I knew now I was in safe hands, I then informed the nurse that I needed medication, she gave me a pain injection and then the gas, I was happy with the nurse who was assisting me with the birth and reassured by her caring face and words, 6:10 am, a cloudy Monday morning a smooth sailing natural birth, Josiah Sadew made his way into the world, the power of prayer is evidence in my birth story, a gift from God upon our lives, Josiah has been a joy, I’m loving every day beside him and my marriage and life is now complete, to all the woman who loose faith, don’t, nothing is impossible.
I always wanted to go through normal birth; I hadn’t even thought of having a C-Section. Every time I went to the doctor’s appointment he told me I don’t need to worry I can deliver my baby girl via normal birth.
The last time I went to the doctor’s office at 39 weeks the doctor told me very sad news. I can’t have normal birth due to medical issues.
The next day I went in for my C-Section. I had an amazing experience with my birth, it was not as bad as I thought. My little girl was born perfectly healthy and it was an amazing experience, I’m currently expecting again and baby will be born via C-Section in March and we can’t wait. ♡
Every pregnancy, birth and baby website is cramped with the loveliest natural birth stories and only contain a few C-section birth stories here and there, so I thought I’d share a bit of what my experience was like.
My Journey: Pregnancy, birth and recovery.
The first scan was done at about 16 weeks, everything looked perfect and I felt fine, not even a hint of morning sickness. The next scan was at about 19 weeks –this is when we found out we were having a little princess…
I had a pretty easy pregnancy, experienced a bit of pain around my abdomen at about 20+ weeks and was kept overnight at Vincent Pallotti due to high blood pressure but it turned out to be nothing. My feet and ankles were quite swollen and I had terrible heartburn towards the end but other than that it was a lovely experience, I had a huge appetite and even picked up a total of 20kgs. (This was very unexpected as I have always been very slender and struggled to pick up weight my entire life.)
As the pregnancy progressed our princess developed so wonderfully and gained weight so nicely, only issue was that she wasn’t turning. I ended up having an elective C-section as she was still breech at 36 weeks. Some say the baby can be turned, but I just wasn’t prepared to take that risk after hearing about what could go wrong. I originally prepared for and wanted a natural birth but was happy to go ahead with the c-sec as it didn’t really matter to me how Harper would come into this world as long as she was safe and healthy that was more than good enough for me.
So at my last ultrasound at about 36 weeks little miss still hadn’t turned so we made a booking for the 13th of Jan 2014 – at that stage I would be 38 weeks 5 days.
It was weird knowing exactly when Harper would make her appearance but so exciting as we counted down the days to her arrival.
We woke up at about 05h00 on the 13th, me tired, hungry, excited and so nervous. We left home at about 06h30ish and checked in at the hospital at about 07h00 and then waited for a short time in the reception area for all the documentation to be sorted. We were then taken to the maternity ward and I was shown to my bed, I unpacked some stuff and changed into the hospital gown provided. A nurse then came and strapped on an electronic foetal monitor for a short while.
Allan and I just relaxed and chatted for a bit and were then met by the Anaesthesiologist who popped in to ask me a few questions so as to make sure there would be no problems when he administered the epidural in theatre. Then my Gynaecologist walked in and told us to get ready. Within minutes I was being wheeled up to theatre. Allan quickly changed into his scrubs – he looked so smart.
The Anaesthesiologist put in the drip and then administered the epidural – I am terrified of needles so I was really dreading this part but I was pleasantly surprised because it was so quick and easy. Not really painful just a bit uncomfortable.
Then the catheter was inserted, so glad this was done after the epidural as I’ve heard it’s not enjoyable. The screen was put up and we were told we’d meet our daughter soon.
Allan was sitting next to me on a chair, I can’t remember what we were talking about. I felt no pain, only a bit of tugging and like I couldn’t breathe properly as I was laying on my back with this huge belly, doc assured me that feeling would be gone really soon. A few short minutes later (at 08h45) he held up our daughter over the screen and we laid our eyes on her for the very first time.
She didn’t really cry, just a few little groans. Allan went with her to the other side of the room and watched as the paediatrician cleaned and examined her. He then cut the cord and held her in his arms for the first time. (I watched him pick her up, he just stood there looking into Harper’s eyes, he looked so proud.)
Her weight 3.3kgs and height 52cm.
He brought her to me and gently placed her on my chest, she was so small and perfect.
We had our first family photo taken and were then moved to the recovery room for a short time so that my vitals could be monitored. During this time we tried to latch Harper – not very successfully might I add.
We were then wheeled to our room, as we were pushed out into the corridor, Harper covered and still laying on my chest under a huge duvet, I saw my whole family come out from around the corner – they all looked so happy and were excited to see Harper, they all had a little peak at her as we were wheeled passed.
We reached our room and settled in and were left alone to admire our little girl. A short while later we had a few visitors.
I had a bit to eat and self-administered some pain medication through a pump like device which measures the medication for you and allows you to pump every few minutes. The lower half of my body was still quite numb so it was a bit awkward trying to move in bed and sit up properly.
The next morning the drip and catheter was taken out and I was encouraged to get out of bed. Surprisingly I did so with ease, I was extremely nervous as I’d heard how difficult a c-sec recovery can be. But it really wasn’t that bad.
Harper was latching from time to time but still wasn’t getting enough. One of the nurses suggested we give her a “top-up” formula feed after the breastfeeding just to ensure she gets what she needs – this worked for us.
We were released on Thursday morning, I was quite happy to get home after spending 4 days in hospital. I just wanted to be in my own home.
Harper is a real lady, so sweet and well-behaved. Allan and I are really blessed. I’ve heard how other newborns scream and fuss and we’ve never had that problem with Harper.
I am so thankful that my recovery has gone so smoothly and that Harper is happy and healthy. She is now a beautiful, smart and seriously funny little 6 month old.
We are so in love with her. We have had the best experience thus far, I would not change a thing and I am more than happy to have another elective C-section one day when we decide to have another little one.
On the 8th August, I had my 27 week check up. Every thing seemed fine that morning, I had a healthy pregnancy, no morning sickness, little-to-no stretching pain, no complaints.
I walked into the rooms thinking we will just see how well our angel’s growing like every other check up. The gynecologist did the scan and noticed nothing wrong, we agreed to see each other at my next appointment but as I left I remember clearly standing at the door saying “Doctor, he’s not kicking like he always does.” Thinking back now, I don’t even remember how his kicking was, it must have been by the grace of God that those words came out of my mouth, and a mothers instinct. I was immediately taken to the maternity ward where my little boys heart rate was monitored. The nurse looking after me noticed some drops in heart rate before it would return to normal again. The gynecologist decided I should be monitored longer.
After that everything happened so fast, I barely had time to realize what I was going through or shed a tear. I got an injection to strengthen baby’s lungs and was then told I’m going in for an emergency C-section. As I was lying, waiting I start to feel this weird, sharp pain on the side of my body: the contractions started, all I could think about is this little baby who was only due in 13 weeks.
I was then rushed to another hospital with a bigger NICU. I gave birth at exactly 16:20 to a healthy 740g little boy at 27 weeks, with no complication with me or my son. He stayed in the NICU till he gained enough weight. After 2 months he came home to his parents, and is now stronger than ever…
The cause of the fluctuating heart rate and premature birth, in simple terms that I could understand, was the umbilical cord twisted like a ‘telephone’ cord and he was not receiving nutrients as he should have. I always think to myself: after everything I went through, my son was better off outside my stomach than inside.
I never had the chance to speak about his birth or show how scared I was till now. I had a very supportive husband who stood by me all the way and parents who were there for me every day. Today I cannot thank God enough for a son who shows no signs of his prematurity, who is healthy, strong and a bit too bubbly.
We are now waiting on our princess to arrive. At 30 weeks she’s 1.7kg and she’s decided she wants to spend more time inside her mommy than her brother did, and wait until the perfect time to meet her daddy. (Already daddy’s little girl!)
I had a perfect pregnancy, or so I thought. No morning sickness, no stretch marks, and a small neat bump. My baby was happy, and I felt really connected to her. I spent my pregnancy focusing on the birth itself, certain that I was going to have a 100% natural water birth, using hypnosis and a midwife. I was healthy, did pregnancy yoga, and put a lot of thought and research into every decision I made that could affect my baby.
At 33 weeks I noticed a very mild itch, but ignored it because I had heard that itching in pregnancy is normal. I also noticed my urine was dark but my midwife said I was probably just dehydrated. A week later there was an increase in itching, and I found it odd because it was in areas that I knew my skin was not stretching (such as my wrists and collarbones). Thinking it was dry skin, I poured tissue oil into my bath and smothered myself with cream each night before bed. I slept better when I did this, but I would still wake up in the early hours of the morning itchy, uncomfortable and unable to fall back to sleep. One sleepless night I decided to Google my symptoms and came across a condition called intrahepatic cholestasis of pregnancy (ICP). It sounded like what I had, and the risks associated worried me.
The next morning I called my midwife and asked her if I could be tested for ICP. She immediately referred me to an obstetric gynaecologist (OB/GYN) whose job it was to step-in and take over from the midwife should any complications arise. He agreed with me that it sounded like I might have ICP and that I should be tested.
By then I was 34+4 days. I went for a blood test called a liver function test (LFT), and a gallbladder scan to check for gallstones. The scan came back fine, but my liver enzymes were extremely elevated, so the OB/GYN diagnosed me with ICP. He assured me that my baby would be okay as long as my levels did not increase further and I had non-stress tests twice per week. He also said that we needed to deliver at exactly 37 weeks; the choice of vaginal birth or c-section he left up to me.
I had really wanted my baby to come naturally and in her own time. I decided to go for as natural a birth as possible, hoping that my baby would come of her own accord just before 37 weeks so that I wouldn’t have to go through an induction.
At 36 weeks I noticed a distinct increase in itching. It was disturbing my sleep even more. Four nights before the scheduled induction, on one of my frequent bathroom trips, I noticed something strange. My stomach bulged out in an odd shape that felt very unnatural. It felt as though my baby had moved from her head-down position, where she had been since 28 weeks, to a transverse position. Looking back, I can’t help wondering if that was a sign of fetal distress. Almost immediately the contractions started. They were 2 minutes apart, 40 seconds long. I was in active labour.
The pain was excruciating. My hypnosis techniques flew out of the window and I knew I would not be able to go through with an un-medicated birth. When we got to the hospital, I told my midwife that I needed an epidural, but she convinced me otherwise. She agreed to give me some pethadine to “take the edge off”. I was on the bed and could do nothing but roll onto my side for each contraction. At one point, I even vomited from the pain, but felt somewhat reassured because I had read that this could happen during “transition” (when one is between 7-10cm dilated) so I believed the end was in sight. Then the midwife examined me and told me I was only 3cm. I could not believe it – I had such a long way to go and I was just not coping.
Then the midwife wanted to check my baby’s heartbeat. I was used to her easily finding it, but this time the only heartbeat we could hear was my own. I immediately knew something was wrong. She tried various positions and then went to get another sister to also try. She couldn’t find it either. Then they wheeled in a different machine, and a technician performed a scan. We could physically see my baby’s heart was not beating. I was in so much pain that I didn’t really grasp what was happening; all I could think about was making the pain stop. I was worried about how I was going to cope with the news after the birth, and I was worried about how I was going to handle seeing my baby. But for that moment I needed the physical pain to stop.
I told my midwife that I wanted a c-section, but she advised against one because she said recovery from a c-section and mourning the loss of the baby at the same time would be even more difficult. I eventually agreed, but insisted on getting an epidural: it never arrived. Three hours later, when we were about to move to a cooler room, I decided to make one last trip to the toilet. As I sat down, I had the overwhelming urge to push. My midwife told my husband not to let me, and to get me back on the bed as quickly as possible. When she examined me, she got quite a surprise because I was already 10cm – I had gone from 3-10cm in three-and-a-half hours, and I was certain that was why I was in so much pain. It felt like my body was reacting to the emergency that was going on inside me and trying to get my baby out as quickly as possible. I had my husband come and stand by my side and asked him not to watch the actual birth, as I was worried it would be too traumatic. And then I started to push. I pushed and pushed at every instruction from the midwife. My husband said afterwards that he had never experienced energy in a room like that. It was so intense that I even broke a tooth in the process from clenching my jaw so hard. Our precious baby girl came into the world after 20 minutes, with her eyes closed as though she were sleeping. We got to see and hold her, and we named her Tori.
Thankfully my husband and I were surrounded by so much love and support from friends and family that carried us through. We were able to take the time off work, and do what we needed to do to get through. For me, part of the healing process was understanding what had gone wrong, and whether it could be prevented in future pregnancies. I started doing my own investigation into the condition. I visited many doctors and specialists in my city trying to find more information. I trawled the Internet. I asked my friends to find out from their own doctors if anyone knew about the condition. I searched on South African website forums for any other women complaining of a pregnancy itch. The more I searched, the more convinced I became that in South Africa the condition was remaining undiagnosed much of the time. This spurred me on, and I decided that after I found the answers to my own questions, I would help spread awareness about the condition in the hopes of preventing other families from going through what we did.
This is when I came across ICP Support, a charity based in the UK that is linked to ICP specialists because their founder, Jenny Chambers, is part of a research group in London investigating the condition. I was able to ask questions, get research-based answers, access relevant medical articles and connect with other women who had also experienced ICP. Suddenly, I didn’t feel so alone anymore. I read about the causes, the symptoms, the risks, monitoring and medication. A lot of the questions I had were answered, and I could get some closure. Best of all I learned that “active management” (which includes monitoring the mother’s bile acid levels closely, monitoring the baby, administering the medication Ursotan and early delivery) may reduce the risk of stillbirth to about that of a normal pregnancy. This encouraged me and gave me hope for a possible future pregnancy, and a healthy baby.
What is intrahepatic cholestasis of pregnancy (ICP)?
Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy that affects around 5000 women each year in the UK alone; at present this figure is unknown in South Africa.
What are the symptoms?
Itching (also called pruritus):
- Itching usually presents in the third trimester, however it’s important to note that some women may develop ICP as early as the first trimester or second trimester of pregnancy.
- It can be mild or severe, constant or intermittent, localized or general. Many women report that it typically affects their hands and feet.
- It is generally reported as being worse at night, and often interrupts sleep. Researchers are unsure whether this is because women are more active during the day and notice it less or if there is biological reason for the nocturnal increase in severity.
- There is no rash associated with ICP, although scratch marks on the skin are common. Some women scratch until their skin bleeds.
- The severity of the itch does not necessarily correlate with the severity of the condition, and it is possible to itch for some time before blood work becomes elevated
Other less-common symptoms:
- Dark urine
- Steatorrhoea (pale stools)
- Jaundice (yellowing of the skin and whites of the eyes thought to affect less than 20% of ICP women)
- Anecdotally many women report upper right quadrant pain (pain under or close to the right ribs where the liver is situated) but this has not been researched.
- Anxiety and depression
- Loss of appetite
What are the risks?
ICP is associated with spontaneous preterm labour, fetal distress, meconium staining and in severe cases stillbirth. There is also an association of PPH (post partum haemorrhage) but this is thought to affect less than 20% of women with the condition. Recent research has suggested that with active management the risk of stillbirth in an ICP pregnancy is believed to be the same as that of a normal pregnancy (1%).
What are the causes?
The causes of ICP are not yet fully understood, but it is likely to be due to a number of different factors, including:
- ICP only occurs in pregnancy suggesting a hormonal link such as estrogen or progesterone. Recent research has shown that sulfated progesterone metabolites (breakdown products of the hormone progesterone) are always higher in women with ICP and that these also seem to correlate with the bile acid levels. Further research is being undertaken to explore this link.
- Women expecting two or more babies seem to be predisposed towards developing the condition, as are women who have had IVF.
- ICP is more common in certain populations, including Scandinavians and South Americans
- ICP can run in families, including grandmother, mother and daughter (and may also pass down from the male side). Sisters and daughters of women with ICP have around a 14% increased chance of developing ICP in their own pregnancies. The presence of liver conditions and/or gallbladder issues in the mother’s family may be indicative of a genetic link.
- Lots of research has been done to try to establish exactly what the link is, and some genetic variation in women with the disease has been found. However, it should be emphasized that researchers are a long way from explaining all cases of ICP by means of genetic analysis.
- More women are diagnosed with ICP during the winter months.
- Although the reason for this is not clear, it suggests that there may be an environmental trigger for the condition, such as reduced exposure to sunlight or a change in diet.
How is ICP diagnosed?
To make a diagnosis of ICP, other liver disorders need to be ruled out first with either blood tests and/or liver ultra sound scanning. These other conditions may include viral hepatitis, autoimmune hepatitis and gallstones. The presence of gallstones does not necessarily exclude a diagnosis of ICP – it is possible to have both ICP and gallstones. Research shows that women with ICP have a higher chance of either already having had gallstones or developing them in later life.
- Bile acid test: Bile acids are chemicals produced in the liver to help with digestion. In ICP the flow of bile acid in the liver is reduced and they build up in the blood. A bile acid test is believed to be the most specific test for ICP. Bile acids are thought to be harmful because they may be responsible for some of the complications that could affect the baby. It is largely accepted in the literature that a diagnostic cut-off for the diagnosis of ICP ranges from 10 to 14µmol/L (fasting sample). Anything over 40 mmol/L is considered to be “severe”, and is associated with increased risk. In South Africa, bile acid may be sent to Onderstepoort (the Faculty of Veterinary Science at the University of Pretoria) for testing.
- Liver function test: This blood test looks at how well the liver is working by measuring the level of different enzymes. ALT (or AST) is the specific one that is used to help make the diagnosis. It is important to note that not all women with ICP will have raised liver functions.
The most effective treatment is still to be established, but it is believed that with active management the risk of fetal complication drops to that of a normal pregnancy. Current practice includes prescribing the medication UDCA (ursodeoxycholic acid), monitoring bile acid levels and delivering the baby at around 36–38 weeks.
- UDCA (ursodeoxycholic acid): This is believed to be a “friendly” bile acid that displaces the more harmful bile acids from the blood. Many doctors believe that UDCA helps to protect the baby from the damaging effects of bile acid as well as helping to relieve symptoms. A recent pilot trial that looked at UDCA versus placebo showed that the incidence of meconium staining was reduced in those women who received UDCA and that the ALT/AST levels improved. However, it did not show that bile acid levels were improved for a significant number of women. A further larger-powered trial is planned. UDCA is typically administered starting at 500mg per day, and rising in 500mg increments to a maximum dose of 2000mg per day. Some clinicians still adhere to the recommended prescribing policy of basing the dosage on weight i.e. 12-15mg per kg of bodyweight but in the UK where the condition is the subject of extensive research most clinicians begin with 500mg twice a day. UDCA is still unlicensed for use during pregnancy but is prescribed to women with “informed consent”.
- Rifampicin: This is a powerful antibiotic that is traditionally used to treat tuberculosis (TB). Recently it has been found to be helpful in treating ICP if UDCA is not effective. It must be given in addition to UDCA but there has been little research to evaluate its efficacy in treating ICP.
- Piriton (Chlorpheniramine): This is an antihistamine. This type of drug is used to treat itching in other conditions (e.g. allergies). There is no evidence to prove that it helps in ICP, and indeed many women would agree with this. However, another effect of piriton is that it causes people to feel drowsy, and this may help if the itch is interrupting sleep.
- Body cream with menthol: Some women report a temporary relief from itching due to the cooling effect of menthol. It is relatively simple for a pharmacist to make up some aqueous cream with menthol added (1-2% of menthol).
- Oral vitamin K: This practice evolved in the UK because clinicians hoped that it would help to reduce any risk of PPH. However there is no research to support its use although researchers in the UK will prescribe it if the woman reports steatorrhea (pale stools). There is no evidence to suggest that taking oral vitamin K is harmful to mother or baby.
Monitoring the blood:
- Both bile acid and liver function tests should be performed regularly. While liver function tests are indicative of how well the maternal liver is working, researchers believe that bile acid levels are most important in gauging the risk to the baby.
- Bile acid levels can be unpredictable and may go up and down during an ICP pregnancy. Given their association with fetal risk it is reasonable to implement a practice of weekly bile acid levels, perhaps twice weekly from 34 weeks.
Monitoring the baby and early delivery:
- Weekly monitoring from diagnosis is followed by many doctors in the UK but can vary in what it involves. However, it generally includes weekly blood tests (bile acids and liver function), with some hospitals adding biophysical profiles and Doppler flow studies.
- Non-stress tests that evaluate the fetal heart rate may be offered twice weekly, but they are only offered as a way of reassurance. The reason for this is because there have been reported cases of stillbirths 12-hours after a non-stress test was passed so there is no evidence to suggest that conducting this procedure will identify an “at risk” baby.
- Because research has shown that stillbirths tend to occur from 36 weeks the practice of early delivery has evolved. As the risk of sudden IUD (intra-uterine death) is also associated with bile acid levels (and recent research has shown a 200% increase in risk if the bile acids double for a mother who is in the “severe” category) it may be necessary to consider an earlier delivery than 36 weeks. This is a challenging decision for clinicians who have to weigh up the risk of early delivery and increased risk of the baby being admitted to the neonatal unit versus exposure to high bile acid levels and possible stillbirth. Research is currently investigating the exact mechanism for fetal death and has suggested that it is linked to the affect of bile acids on the fetal heart but further research is required before there are any definitive answers.
- Some women choose to keep a kick-chart to help monitor the baby’s movements, although there is much debate on the value of these.
Other things that may help:
- There is no research to suggest that reducing saturated fats in the diet will help but as all women are advised to follow a healthy diet in pregnancy and saturated fats are not of any nutritional benefit it makes sense to let women know this.
- There is no research that suggests that rest and relaxation can help with the condition but it may help women to be able to cope with the psychological impact of having ICP.
- Some women report that cool clothing helps with the itch, as does applying an icepack to the affected area (but these need to be applied carefully to prevent any ice-burns).
- ICP can be a distressing condition, and many women feel depressed and anxious, which is exacerbated by lack of sleep due to itching. Just being able to talk to someone about this may help her feel supported. Referring women to specialist organizations such as ICP Support that has the benefit of having some trained counselors in the team may help. ICP Support is a science-based charity that also offers support via the phone, Facebook groups and an online forum. They can also be contacted via email.
What happens after the baby is born?
- Usually the condition resolves within 48 hours of delivery, but it can take several weeks for the itching to disappear completely.
- Around 6-12 weeks postpartum (although it can take longer for everything to settle), the mother’s liver function and bile acid level should be checked to confirm that it has returned to normal. This is important, as there may be an underlying liver condition that has caused the itching and abnormal liver readings during pregnancy. If this is the case and the mother’s bloods have not improved after several months she should be referred to a hepatologist (liver specialist) or gastroenterologist who has a special interest in the liver for further investigation.
- It is worth noting that some women report a return of ICP symptoms post-partum when using hormonal contraceptives, in which case alternative contraceptive methods may be discussed. It may be a case of trial and error, as what works for some women may not work for others.
- Some women experience “cyclic itching” during ovulation or at the start of menstruation. It generally only lasts for a few days and is not as intense as the itching experienced during an ICP pregnancy. There has been no research to explain why this happens, but current thinking suggests that it happens because the liver has been left ‘sensitive’ to hormone fluctuations.
- Some women have reported that they experience itching again in times of extreme tiredness and stress, but the reasons for this are not yet known.
Will ICP reoccur?
Reported recurrence rates vary, with some researchers stating 60% and others up to 90%. What is known is that women who have ICP in one pregnancy are very likely to develop it again in a subsequent one.
More information and support
All information in this article was sourced from ICP Support, a UK-based charity who are involved with research into the condition, and who are linked to ICP specialists. Other information and current research papers can be downloaded directly from their website. For more information, please visit:
Facebook group: www.facebook.com/groups/icpsupportsa