Birth of your baby
Note: the information on this page has been updated following the publication of the third edition of the RCOG Green-Top Guideline on 9 August 2022.
- 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. As with any first-time mother-to-be, this means induction may not work and your risk of having to have a c-section increases.
- 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 should have a liver blood test and your bile acids checked around 6–12 weeks following your baby's birth.
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.