The Plan

I’ve had lots more appointments since I wrote this, and not much has changed. The induction is still on and the cholestasis diagnosis still stands. I’ve had plenty of time — and a few therapy sessions — to make my peace with it. And that’s exactly what I’ve been doing.

33-week belly in the lake

I’m not only making my peace with it; I’m taking an active, driver’s seat role in my birth, regardless of the fact that it will be an induction. I’m making lemonade from my lemons (though I’ll need an extra dose of my GERD meds if I want to be able to drink it), and my midwives and I have jointly come up with a gentle induction plan to ease me and baby girl into labor with as few interventions as possible.  The plan, as it stands now, looks like this:

– The day before I’m scheduled for admittance to the hospital, I’ll go in for an office visit with the midwives to have my membranes swept and a Foley catheter inserted. At that point, they’ll send me home for the night to dilate and begin labor on my own, bypassing the usual overnight cervical ripening via Cervidil in the hospital. (There’s lots of good info on the Foley bulb method here. In sum, it’s just as effective as a pharmaceutical cervical ripening method, but less stressful on the baby. Which, with ICP, is definitely the goal.)

– The following morning, I’ll check into the hospital for the induction. If I’ve dilated well and am having some good contractions at this point, the midwife will break my water bag instead of introducing Pitocin.

– If I don’t progress well enough on my own with my waters broken, we can start Pitocin at the lowest possible dose, increasing slowly and gradually as needed.

Belly selfie whilst lounging in the A/C

To help things along, we’ve discussed and agreed to several complementary labor augmentations to ensure the induction is a success.  These include:

– A chiropractic adjustment by my Webster-certified chiropractor before my office visit for the membrane sweep and Foley insert.

– A visit to the acupuncturist to help with labor induction. A skilled acupuncturist can administer a specific treatment with the needles to stimulate oxytocin production and encourage labor. This is common in China.

– Consumption of red raspberry leaf and squaw vine herbs beginning at 35 weeks (though I’ve already been drinking about a quart of Nora Tea, which contains red raspberry leaf, for about 10 weeks now).

– Application of a blend of Geranium and Clary Sage essential oils, diluted in a carrier of castor oil, directly to my abdomen after my membrane sweep and Foley insert. These oils are commonly used during labor to encourage contractions, and according to Wise Woman Susun Weed, topical application of castor oil is effective at stimulating the uterus (and safer than consuming it).

– Nipple stimulation using my breast pump in the evening once I return home from the membrane sweep and Foley insert.  According to this study of randomized control trials, nipple stimulation was far more effective at bringing on labor than any other method (sorry, spicy food fans — there’s no evidence that Indian takeout will do anything but give you heartburn).

– Dates! I’m making homemade larabars like a madwoman trying to get in my daily dose of 6 dates a day. Why? For a shorter labor and more favorable birth outcome, according to this study.

My son, midwifing me and the baby

I’m kind of psyched about this plan. Given that ICP babies are at a higher risk for meconium passage due to fetal distress, my overall goal is to minimize the amount of medical/pharmaceutical interventions employed during the induction. With the help of my doula, my husband, and my handy dandy TENS machine that my chiro ordered for me, I hope to avoid requesting an epidural for as long as possible.  Again, this is for the safety of my baby; I’m well aware that no medals shall be rewarded for an unmedicated birth.

It feels good to have a plan and to be well-supported by my providers and my birth team.  I’ve got just four weeks left to cook this little girl until we collectively evict her. Let’s all hope that she peacefully exits the premises without putting up a fight.