Cholestasis of Pregnancy and VBAC Questions

Dr. Silvio answered this question from a 22 week pregnant mother hoping for a vaginal birth without pain medications for her upcoming birth:

“7 yrs ago, when my first kid was born, I had cholestatis and doctors asked me for early delivery by inducing for 2 days. Failure to progress resulted in c section. And after 3-4 days of delivery, blood started coming out of the stitches and clots were formed. I had to get them redone and be in bed for another 15 days. Wish nothing would have happened in the manner it did and this second time would have not been as fearful as first. I have still fears of my first experience and wish nothing repeats this time.”

Dr. Silvio's Answer

There are several aspects that need to be answered:

1) cholestasis – cholestasis of pregnancy is essentially a benign condition for the pregnant woman, with the exception of the itching and sometimes, in more severe cases, jaundice. Complications of cholestasis can happen, but the rule of thumb is that it is benign. It goes away after the pregnancy.

The reason why she was induced is because there have been reports of the baby being a stillborn, for no apparent reason. I don't know at what gestational age she was induced, nor do I know if, at the time of the induction, there were any signs of fetal compromise. It is known that cholestasis of pregnancy may recur in subsequent pregnancies. No way to know in advance, unless she has some liver chronic problems, which would be quite rare in a young woman.

2)incision problem: the description of the problem appears to perhaps have been the result of a bleeding vessel in the skin, subcutaneous tissue or abdominal muscles. Unfortunately it can happen. I have no idea why she had to be in bed for 15 days. We like patients to ambulate the next day after such an occurrence because lying in bed predisposes to deep venous thrombosis. There must have been some other reason. From the information in the question it does not make sense.

3) VBAC: If the cesarean section was a low transverse incision (in the uterus. What the incision looks on the skin does not matter)she certainly can attempt a VBAC. Otherwise, an up and down incision in the uterus, known as a classical cesarean section, is much more risky in terms of uterine rupture, than the low transverse incision which has about 1% complications. But as you well know, 1% has no meaning if it happens to you. If it happens to you it's 100%. She must therefore make her decision based on information that her doctor gives her and what her doctor advises.

About the author 

Kristen

Kristen is childbirth educator, student midwife, and a mama to 8 - all born naturally! She has spent years helping mamas have healthy babies, give birth naturally, and enjoy the adventure of motherhood. Find her on her website NaturalBirthandBabyCare.com and helping families through her online childbirth class MamaBabyBirthing.com

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