Birth of your Baby

• There is no evidence to show that it is safer for your baby to be born by caesarean section (c-section), but as you may need to meet your baby earlier you are likely to be induced. The process of induction doesn’t always work (and it’s nothing you will have done) so there is a chance of you needing a c-section if this happens especially if you are a first-time mother-to-be.

• Your doctor may recommend that your baby will need to be continually monitored during labour. You can watch what experts say about this here. The revised RCOG Guideline (published August 2022) has the following:

  If the woman or pregnant person has existing obstetric or medical conditions that influence decision-making around fetal monitoring in labour, these should be taken into account when planning intrapartum care. In women with mild ICP (peak bile acids 19–39 micromol/L) and no other risk factors, intrapartum care can follow national guidelines. In women with moderate ICP (peak bile acids 40–99 micromol/L), the decision should be made on an individualised basis, explaining that the benefit of continuous electronic fetal monitoring is uncertain; the presence of any other risk factors should be taken into account. In women with severe ICP (peak bile acids 100 micromol/L or more), in light of evidence that there is a risk of adverse perinatal outcomes in these women, continuous electronic fetal monitoring should be offered. Women with moderate and severe ICP are more likely to have meconium-stained liquor, and this will influence the need for continuous electronic monitoring in labour.

• Having an early baby can be a worrying time for you, especially if your baby decides to come without giving you much notice! But if you do know that your baby may have to spend some time in a special unit (referred to as a neonatal intensive care unit (NICU), neonatal unit (NNU) or special care baby unit (SCBU)) you can ask to be shown round the ward so that you can prepare yourself. It can look quite overwhelming when you first see it: lots of machines and monitors, and some very tiny babies. Many parents have been in this situation and are very happy to talk to you about their experiences, so come and find us on Facebook, where we will be waiting to support you.

• Your baby will not need any special checks after the birth, but you will need to have a liver blood test and your bile acids checked around 6–12 weeks following your baby's birth. If your blood results are normal this confirm the diagnosis of ICP but if there are still raised liver enzymes or bile acids you will need to be re-checked. If the problem continues it may be that you will need to be referred to a hepatologist (liver specialist) for further investigations. From our experience of seeing what people report in our support groups, we know that it can take a little longer than 12 weeks for the blood tests to come back to normal, so try not to worry of this happens to you. It may be helpful for you to know that breast-feeding may cause one of the liver enzymes called alkaline phosphatase to be raised. This doesn’t mean that you will have to stop breastfeeding.

  It is important that you know that because ICP is a genetic condition your baby may have inherited your genetic changes. This may mean that if you have a girl she has around a 14% chance of ICP in any pregnancy that she may have. If you have a boy, he may pass the genetic change down to his children. There is also some suggestion that children of ICP women have a slightly increased risk of developing Type 2 diabetes in later life. This is still being researched.

Note: The Ovadia research (that established the threshold at which increased risk of stillbirth occurs – 3.44% when bile acids exceed 100 μmol/L) is based on singleton pregnancies only, as there were insufficient twin (or more) pregnancies in her research to draw firm conclusions. However, experts in ICP currently use Ovadia's findings to guide their management of the condition in twin (or more) pregnancies.