What to expect from induction of labour for obstetric cholestasis

Obstetric cholestasis, also called intrahepatic cholestasis of pregnancy, affects bile flow in the liver and commonly causes itching without a rash. Blood tests measure bile acids and liver function. The results, your symptoms, gestational age and fetal assessment help your obstetric team decide whether planned birth is safer than waiting.

On arrival, the team reviews your results and examines your cervix. A pessary, tablet or balloon may be used to soften and open it. When the cervix is ready, oxytocin through a drip or breaking the waters may bring on contractions. Your baby’s heart rate and your observations are checked during the process, with the monitoring plan adjusted to your clinical situation.

Take the medicines advised by your maternity team and bring your test results or maternity record if requested. Ask whether you should eat or drink before admission and how long the first stage may take. Tell staff about itching that is worsening, new medicines, allergies or any change in fetal movements. Discuss pain relief early; options may include non-drug measures, medicines or an epidural.

Call your maternity unit urgently if your baby’s movements are reduced or changed, or if you have bleeding, leaking fluid, regular contractions, severe pain or feel unwell. Seek emergency help for collapse, severe breathing difficulty or a seizure. New or rapidly worsening itching should also be reported because it may need repeat assessment.

Ask how your bile-acid results affect the proposed birth plan, whether repeat blood tests are needed, which induction method is recommended and how fetal monitoring will work. Ask when to attend if labour begins before the planned date and what treatment is expected after birth.