The critical 28 week pregnancy results

Everything was going fine apart from the tiredness and trying to adjust to the anticipation of becoming a parent. The overwhelming emotions of knowing the responsibilities and the worries you will have when becoming a parent, counting every day as a blessing as your child thrives and grows up and faces the challenges in life. Thinking about how to be less overprotective so that they can develop their confidence. Can you imagine thinking all this and your child isn’t even born yet?

Sometimes, you as a new mom your mind is blocked and all  you can think about is up to the day you expect to have labour. That fear of giving birth is completely stimulated by people’s difficult experiences and that all amazing TV. Then, on-top of it all… the current reality hits you.You think you have done all you can to have the optimum birth, but sometimes physiology takes over!

This is where my nightmare started: My results up until this point were normal and then suddenly my liver function test (ALT) levels rose to double what was the upper limit. ALT in this country goes up to 60, my results were 131. I had specifically asked my midwife for these test as I had read about obstetric cholestasis and had some of the symptoms, so I wanted it investigated. It is not part of the routine check ups, but I recommend anyone having IBS, family history of gallbladder stones, liver problems etc to have this test performed.

My thyroid was also tested due to the tiredness I was experiencing, but that was normal.

The night I found out about my results was one of the worst nights of my life, at that stage having parents who knew medicine was worse than having parents who wouldn’t have known. My husband didn’t eat a thing and I was crying and panicking. Words like stillbirth, premature labour and maternal death kept spiralling in my head.

I went to my antenatal class and cried to my fellow mom’s to be and midwife teacher. I think what made it difficult was that no one had called me to let me know and I found out my results through my father, so I called the hospital later and they said that everything was normal even though i asked them specifically to look into the ALT. I had a brief couple of days of relief, until my midwife was on shift again that Sunday and gave me a call to let me know that further tests were required and that that were slightly worried. So the panic continued till the next set of results came out, worse than before. This time my bile acids were also in the abnormal range (normal is from 0-14 and mine were 24). And so it went on for 3 weeks,numerous irregular results. So I was sent to hospital straight away after my third lot of results and put on a fetal monitor and more bloods were taken.

This is the start of my moaning about the NHS service here in Basingstoke. Lot’s of capable staff, the unit was completely under-resourced and I feel for the midwives working there.

The midwife was very busy, but she kept popping her head in and out of the room assuring me that the doctor would soon come and see me. 5 hours went by and none of the doctors came, I was handed a prescription with the normal meds for treating obstetric cholestasis. I knew the meds were for this diagnosis as I was well aware of the condition, however thinking about it now makes me sick because a patient with no knowledge would be extremely confused at this point as they would have not even known what that meant at all.

No doctor spoke to me about the risks of taking the medication, the risks to the baby, the condition etc. I found it unacceptable and got rather angry. I wanted to see a doctor! The midwife said that the doctor was too busy to see me and demanded to be called to discuss the medication before commencing it.

On my way out of the ward I was greeted by my consultant father whom I briefed about my situation, he was furious and demanded to see the doctor that hands out prescriptions without seeing his patients.

They sat us back down in the waiting room and the midwife went to call the doctor. She came back and said “The doctor wants to know if the woman wants to see him or if her father wants to see him, because if it is the woman then he will come and if it’s not then he won’t.” I was shocked, firstly I didn’t appreciate being called by my name, I might as well have been called a cow or another number. Secondly, I requested him to come and therefore he should have had the decency to do so.

I told the midwife that I wanted to see him in the presence of my father. The midwife scurried off wasting more of her time being the doctor’s go between person. She came back and said “The doctor cannot see you now, he is leaving. He will do handover and you will have to wait longer, because the doctor he is handing over to has an emergency to attend to.” I found this even more insulting, he could not face me for his mistakes and was a coward. Also, it shows a complete disrespect to me as a patient and medicine as a profession!

I immediately informed the midwife that I would file a complaint. She asked me if she should go and let the doctor know, I said that whether she did or not I would raise a complaint anyway. She told him and he said I should just go and do it. The midwife then brought in the general manager who actually knew me. She said she was sorry and was going to arrange for someone to see me. Which later turned out to be a consultant who was rather shocked at my story. She explained all the related risks and about the medication, then she handed me a guideline about treating OC. This guideline wasn’t being adhered to and thank goodness I could understand it because I have some medical knowledge, but to another person it would be like reading ancient greek.

We requested all the tests as per the guideline and as of yet I am waiting for some of them to be performed.

You will all be pleased to know that the medication I was prescribed (ursodeoxycholic acid) with a combination of a good fat free diet (minimal meat, no diary, and low intake of breads and such foods) has brought my bile acids and ALT back to normal. The only problem with this diet is that you need to make sure that you are eating other foods rich in iron as you can become anaemic.

Also, even though your bloods can come back to normal you will still before offered to be induced at 37-39 weeks. I would recommend you wait as long as you can if your baby is healthy and happy, because you face risks of your baby getting respiratory related problems and a failed induction, which can be quite stressful and problematic.

Anyway, I have accepted what is going on with me and just taking every day as it comes. Monitoring myself regularly and being as balanced as possible.

Now I can look forward to my easy birth, which is something that keeps being reiterated to me at my daisy birthing antenatal classes.

Next time I am going to write to you about blood transfusions between relatives. Please let me know if you have any questions regarding any of the above. OC is nothing to be worried about, it just needs to be monitored and well treated and things should go smoothly.


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