Ashlee Barnes

Facebook Moderator

I am the mother of three ICP babies. I am also a doctoral-prepared family nurse practitioner, practicing in family medicine and psychiatric medicine. Additionally, I serve as faculty at a local university. Therefore, I can understand the physical and emotional toll that ICP has on pregnant women from a professional and personal perspective. My goal is to bring awareness to ICP and educate women, so that they can advocate and protect their unborn child.

My ICP journey began with my first pregnancy at 5 weeks gestation. I found out that I was pregnant at 4 weeks gestation, a week later I began to persistently itch. I spoke with a local emergency room nurse early on, my OB, a new OB and made countless trips to OB triage during this pregnancy as I itched horribly. Each doctor had a different rationale for the severe itching including, my skin stretching, allergies and hormones. I was told to take an antihistamine and take oatmeal baths. By my third trimester, I began to experience right upper quadrant pain along with the itching and was told it was the position of the baby. It was so bad that I could not sleep at night. However, at 38 weeks I went into my OB office, tearful as the right upper quadrant pain was extremely excruciating. Again, my doctor convinced me that it was the position of the baby. Unfortunately, like most women, I believed every doctor. I begged my OB to induce me due to the pain and she agreed to induce at 39 weeks and two days. All these symptoms should have been red flags for ICP and not once did any medical professional evaluate me. I was induced and my daughter was born with severe respiratory distress. She was intubated after birth and later required a tracheostomy; however, doctors were perplexed as to why. As they stated, there is no reason medical reason behind her distress. Years later we discovered that it was undiagnosed ICP that caused her complication, then vocal cord paralysis secondary to intubation. Furthermore, at 10 weeks postpartum my liver enzymes were extremely high, and I had to have my gallbladder removed.

In my second pregnancy, I started itching at 20 weeks. The itch was much milder than my last pregnancy but persistent. I truly thought it was my allergies, however no allergy medications helped. By 32 weeks, the itch was severe. I mentioned it to my new doctor, and she was not knowledgeable about the itching. I was knowledgeable by this time, I told her that I believed I had ICP and she stated that I did not without thoroughly assessing me. I joined the ICP Care Facebook board to reassure what I believed, and I was correct. I went to labor and delivery and they assessed and tested me for ICP. The doctor stated I had ICP and treated me with ursodeoxycholic acid. I switched doctors at 34 weeks and 6 days and was referred to MFM for further evaluation. I safely delivered my second daughter at 37 weeks.
For my third pregnancy, I started itching at 12 weeks. I had the same doctor, so she was very cautious with this pregnancy based on my history. I was tested weekly from 12 to 35 weeks. I had severe itching early in my pregnancy so my doctor and MFM diagnosed me with cholestasis and treated me with ursodeoxycholic acid. They agreed to continue testing and to deliver no later than 37 weeks. At 35 weeks, despite being placed on ursodeoxycholic acid my levels became elevated. My daughter was delivered safely at 37 weeks.

After my first traumatic birth experience and multiple ICP pregnancies, I learned about the importance of advocating for all women with ICP. I have vowed to continue to help women that experience ICP symptoms, as I never want another woman to experience the emotional stress that I experienced after my first daughter was born.