I’ve birthed three children and have experienced weird pregnancy symptoms that really ran the gamut. And at one point during my second pregnancy, my doctor became concerned when I couldn’t stop scratching at my skin. I was so itchy. My doctor muttered something about a rare condition that could have been the cause of my itchiness: cholestasis of pregnancy. But luckily for me, I tested negative — and was given a big tub of coconut oil to relieve my skin. Not all moms are so lucky.
American actress Kate Mara, who rose to fame playing a sleuthing reporter in the hit show House of Cards, recently opened up on Dr. Berlin’s Informed Pregnancy podcast about her frightening experience with the rare gestational condition. Mara, 36, who is married to British dancer and Rocketman actor Jaime Bell, gave birth to their daughter via cesarean section at on May 27, 2019, at 37 weeks pregnant — after developing a fever of 102 and requiring emergency medical intervention.
Mara’s public story about her experience with cholestasis underscores the seriousness of this little-known condition. Mara told Dr. Berlin that while she was giving birth she had “terrible shakes” from the pre-surgery medication. “I thought my teeth were going to pop out, my jaw was clenched so tight from the shakes, and then I thought, ‘I definitely can’t hold her because I can’t move.’ My arms were locked.” She also had severe bleeding that required a blood transfusion.
What is cholestasis of pregnancy?
Cholestasis is a condition that affects the liver and can slow or stop the flow of bile — aka the green acidic stuff that breaks down fats in the digestive system. The liver produces bile, and the gallbladder stores it until the body needs to use it. But when the flow is slowed or stopped thanks to pregnancy hormones, it can cause the overflow to seep into the bloodstream, which is where things get pretty dangerous.
According to Healthline, the infamous main symptom of cholestasis is extreme itchiness, which can make moms nervous, since stretching belly skin is already pretty darn itchy. However, when it comes to a diagnosis as serious as cholestasis, the itchiness isn’t the only symptom to be wary of: Itchy hands and feet (not the belly), dark urine color, pale stools, and pain in the upper abdomen are all signs of cholestasis.
But expectant moms shouldn’t worry too much (ha, easier said than done) — because although this condition can be hair-raising to read about, it’s also exceedingly rare.
How common is it?
“Cholestasis of pregnancy affects less than 1% of pregnancies,” OB/GYN Melissa Lee, MD explains to She Knows. “It is diagnosed with lab tests showing elevated bile acids and liver function tests. Diagnosis is generally in the late 2nd or early 3rd trimester.”
To put this information into perspective: 1 out of every 1,000 pregnancies will be diagnosed with cholestasis. But even among those cases, not all of them will result in scary situations like Mara’s.
Is it always an emergency?
Not necessarily. “As with many disorders, there is a severity range,” nurse and nursing professor Clare Kranz tells She Knows. “Large concentrations or increased exposure to bile are needed to see complications with the fetus. However, [those complications can be] significant: preterm labor, meconium-stained fluid, and stillbirth. Therefore, once diagnosed, the mother will be closely monitored. The amount of acid circulating in her bloodstream can predict the exposure to the infant.”
But yes, according to Kranz — and various studies, including this one published in Contemporary OB/GYN, cholestasis does increase incidence of stillbirth. That’s nothing to take lightly. OB/GYN Jessica Shepherd, MD, urges expectant moms that the most important thing is that “[cholestasis] should be monitored by an OBGYN…significant advances have been made in the last two decades in the study of this disease, but it still continues to be, [as it has been] for a long time, a puzzling disease of pregnancy.”
What is the treatment?
Treating cholestasis can be as simple as taking an oral medication to relieve the symptoms associated with the gestational condition. And, fortunately, most cases will clear up soon after birth. The symptoms may be incredibly uncomfortable, but don’t go looking for medical alternatives for relief. According to the Mayo Clinic, there are virtually no studies to show the safety or effectiveness of alternative medicines to treat this potentially deadly condition. Therefore, it is widely recommended that mothers who are diagnosed with cholestasis follow their OB/GYN or midwife’s advice closely.
For as straightforward as the treatment plan may seem, it doesn’t always mean that cholestasis isn’t going to leave a lasting mark on the mother. Mara, for one, described the sadness she felt having to have an emergency c-section, which was not how she wanted to deliver her baby: “I was just super sad,” she told Dr. Berlin. “I remember that moment very clearly because I burst out crying and was like, ‘I’m scared.’”
Of course, birth experiences rarely go as planned, and a c-section is nothing to be ashamed of. Plus, there are plenty of reasons a mother might need a c-section that have nothing to do with cholestasis — and not all cases of cholestasis will result in a c-section.
So vaginal birth is still possible?
Yes. In fact, there is almost always an option for vaginal birth. Mara, of course, was experiencing an emergency situation. But for other moms who undergo regular monitoring and who have strong supports in place, vaginal and/or unmedicated birth can still be an option, even with cholestasis.
Kranz agrees, noting that “induction doesn’t always mean cesarean section! If you really want to deliver vaginally, just tell your doctor or midwife; they’ll do their best to work with you and make it happen.”
If you think you have symptoms that look or feel suspiciously like cholestasis, it is important that you call your OB/GYN or midwife as soon as possible and ask to be tested. Once a diagnosis is made, symptoms can be treated and a plan can be put in place to help keep both mom and baby safe.
To learn more about cholestasis, check out the American Pregnancy Association here.