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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    I’m 32 weeks pregnant and was just diagnosed with Cholestasis of Pregnancy due to elevated bile salt (aka bile acid) levels in a blood test. My bile salts are 13.4. My doctor told me they watch any levels over 8 (meaning I have to get non-stress tests twice a week and blood tests once a week) because there’s an increased risk of stillbirth. I’ve been planning for a natural childbirth, but my OB group told me if my levels go up to 40, they’ll induce labor. If they stay where they are, they’ll induce labor at 39 weeks. Even if I go into labor naturally b/4 39 weeks, the doctor said I’ll need to be on the Electronic Fetal Monitor continuously, which I was hoping to avoid. Do you know anything about Obstetric Cholestasis or normal bile salt levels? What are the true risks of stillbirth associated with it? Is it necessary to induce labor to prevent stillbirth? I’d like to know any information you are aware of.

    Thank you,

    Alison
    By: Alison
    Archived User

    I don't have any information on this pregnancy complication. I suggest you ask the questions you posted of your care provider. I also recommend asking where you can go to get further information on your problem, its potential consequences, and the treatment for it. What I can do is provide some questions to ask that will get you the information you need to make informed decisions about your care. For treatments, the list is:

    * What exactly is involved with this treatment? This should be explained to you in language you can understand.
    * What are the benefits of this treatment? How likely is it that I will get the benefits?
    * What are the potential harms of this treatment, and how likely are they to occur? There always are some. For example, inducing labor roughly doubles the chance of your having a c/sec, and inducing at 38 wks increases the likelihood of the baby having breathing and beastfeeding problems, but those are risks you may well wish to take if inducing reduces the risk of stillbirth.
    * What are my alternatives, including doing nothing?
    * What are the potential benefits and harms of my alternatives, including doing nothing?
    * How urgent is it that we begin treatment?

    For tests, you will want to know pretty much the same thing with one addition: How accurate is this test? And, of course, you will want to have test results explained to you in language you can understand.

    For further information on the issue of making an informed decision, take a look at Informed Decision Making on the Childbirth Connection website.

    I hope all goes well with you and your baby.

    -- Henci

    Archived User
    Alison,

    I don't have the stats you are looking for either; however, I have worked with a woman who developed choleostasis as well who had been planning a natural delivry with a midwife, and had to change her plans. Apparently, there is a serious increase of the stillbirth rate at a certain point. This woman was monitored and induced at 37 weeks. I'm sure that the timing of induction has to do with the bile salt values, etc....

    In any case, she is due again, and since choleostasis often repeats, she consulted her sister-in-law and brother-in-law who are both naturopaths who advised her to do a number of things to encourage healthy function of her liver. Their main goal was to help her have daily bowel movements, and this can be assisted by: warm water with lemon in the morning, followed by a brisk 30-minute walk, breathing exercises, lecithin capsules, extra fiber and fluid, and various herbs. I would suggest that for yours and your baby's health (no matter how the birth actually goes) that you consider consulting someone expert in dietary therapies who has knowledge if not experience of this condition.
    Good Luck!
    Shayna By: shayna

    All Times America/New_York

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    Please note that this Forum is intended to help women make informed decisions about their care. The content is not a substitute for medical advice.



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