Doula observations

There’s No Such Thing as “TMI” to a Dr or Midwife

“Let’s get some blood work done, and while we’re waiting for results, I’ll get you an appointment for an ultrasound at the hospital.”

This was not remotely what I had expected to hear from my midwife, and the worried look on her face was not reassuring.  I was there for my regular check-up, fresh into my 3rd trimester at 29 weeks gestation.
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A few days before my visit, my hands and feet had started itching.  It was not the stretched or dry skin itching I was used to.  It was not ignorable.  I spent the days before my visit in agony, trying not to scratch at already torn skin.  I was having to put socks on my own hands to reduce damage to my skin.  Sleep wasn’t happening.  I had taken to Google to find obscure treatments for the itching, one of the more obscure of which was rubbing banana peels on the trouble area.  But rubbing turned to scratching and then I just smelled like a warm banana.

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“Why, what do you think is wrong?”

I thought that itching was a common symptom.  I wasn’t swollen, and my sugars were great.  I didn’t expect itchy hands, but it was just irritating, right?

“There are a few things I’m concerned about.  Blood work and the ultrasound will help me be sure what we’re dealing with.”  My midwife sat, took a deep breath, and continued.  “How long did you say you’ve been itchy like this?”

“Ummm, like three days,” I admitted sheepishly.

“Please get seen sooner next time,” she implored.  “This could be an incredibly dangerous condition.  It looks like it might be choleostasis of pregnancy.  Blood test can confirm that.  It also might be PUPPs syndrome, although you’re pregnant with a girl and most of my PUPPs patients are having boys.  And it could be gallbladder issues.  That’s what the ultrasound will check.”

I was sitting there, trying to process this information and trying not to scratch as she continued the visit.  I remember answering a few questions about my health, checking my notebook for the questions I had wanted to ask, and laying back to hear my baby’s heartbeat.  She excused herself to make the appointment for me at the hospital and to write me a prescription for something to relieve the itching.

The ultrasound was scheduled for the next morning.  She set up an earlier appointment with me to go over results and then asked if I had any other questions.  I had a million questions, but the one I remembered to ask was, “This medicine is safe to take while pregnant, right?”  It was.

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My nurse came in to take blood.  I winced and looked away.  I hate needles!  But my nurse was quick and I was on my way quickly. I picked up my prescription and took one of the pills immediately, then I headed over to my mom’s house after my appointment and asked if I could use her computer.  I Googled “choleostasis of pregnancy” and promptly panicked.

Cholesostasis is liver failure.  Bile backs up in the bloodstream, causing the itching.  The only “cure” is giving birth, and many women with cholesostasis need to induce several weeks early in order to be well again.  It’s a relatively rare comlication, but one that I was immediately convinced I had.  (Call me a hypochondriac!)

I read story after story of bloodied hands and feet from the itching, babies in the NICU, “failed” inductions that ended in cesarean births.  One thing felt certain– my birth plan would change drastically.  I resigned myself to living with the discomfort for as long as possible, feeling that my daughter’s life was more important than mine, that her being term was more important than me being healthy.

Silly me.

My mom drove me to the hospital in the morning for my ultrasound.  As immature as I felt it was, I simply didn’t want to go to the ultrasound alone.  I was thankful that at least the anti-itch medicine seemed to help.  I had actually managed to sleep the night before.  The paperwork took forever, but I was finally taken back to the ultrasound room.  The technician was nice, but couldn’t answer any of my questions.

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I had to lay on my left side, my back to him and the monitor.  I strained to see, hoping that I could catch a glimpse of my baby, but he was too far above my uterus.  I even asked if he’d give me a peek but he said he couldn’t.  I was very disappointed.

I asked about my results and he explained that he wasn’t qualified to interpret them, that I would have to talk to my midwife.  We grabbed lunch on the way out and I told my mom that I was probably dying of liver failure.  She told me she was pretty sure I was overreacting.

I got a call from my midwife that afternoon.  She said that based on the bloodwork and ultrasound, she was pretty sure I had gallstones.  She asked if I was okay to switch back to my regular appointment day and time with her and if she could schedule me a consultation with a surgeon for my gallbladder in place of my earlier appointment.  I agreed and everything was scheduled.

Armed with new information, I took to Google again to learn what I could about gallstones.  Within ten minutes, I felt like the world’s biggest idiot.

For months, I had been experiencing sharp stomach pains that had increased in frequency and length.  At first, when they were lasting only five to ten minutes at a time, I had thought they were Braxton Hicks contractions.  I was terrified about labor since BH contractions are called “practice” contractions, which are “relatively painless”.

Later, I noticed that the cramps often started in the evening, particularly if I had consumed any dairy with dinner.  I had even asked my wonderful midwife if it was possible to develop allergies while pregnant because I assumed dairy was causing the pain.

My midwife was always very sweet and thorough with me, always took time to answer my questions, and took her time to make sure we were on the same page. But never once had I told her that I was regularly curled up at night in debilitating pain.  I hadn’t thought to bother her with something I thought was just an annoyance. Even when the itching started I didn’t call.

I met with the surgeon to plan my gallbladder removal before my next prenatal appointment. He mentioned that he actually sees gallbladder issues quite often with pregnant patients. He showed me the ultrasounds and explained that the reason behind the itching and the pain was that I had gallstones blocking the bile duct between my liver and gallbladder, which was causing bile levels in my blood to spike. The bile in my blood made everything itchy and imitated liver failure.

We started talking about planning for my surgery, and he asked what gestation I was. He broke the news that I wouldn’t be able to get my gallbladder removed while pregnant. He explained that there’s a sweet spot for doing abdominal surgeries in pregnancy and that is the second trimester. I had just missed the mark.

I learned a huge lesson because of this. No matter how small the issue might be, your care provider wants to hear about it! My midwife felt awful that I wasn’t able to get my gallbladder issue resolved until after my baby was born. I hadn’t put clues together and I hadn’t mentioned them to her beyond my personal ideas of what was happening.

Self advocacy is important. Remember that your care provider cares about you. They want you and your baby to be healthy. If you feel dismissed or rushed by your care provider frequently, it might be time to advocate for yourself. Demand better care, or consider transferring care. You are literally paying your provider to help you have a healthy pregnancy and birth.

With my second baby, every twinge was brought to my midwife’s attention. Everything I was unsure of. When I had light bleeding in my second trimester, every time I spotted after sex, every clue that something might not be right… and she embraced it all. Because there’s no such thing as TMI to your provider!

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