When I found out I was expecting twins, I knew she was waiting for me high-risk pregnancy. Carrying multiples is inherently risky, and even though I was young and generally healthy, I couldn’t avoid it. But the first and second trimesters were pretty smooth.

With each clear ultrasound and “everything looks great” from my doctor, I began to wonder if I might make it through my twin pregnancy without any major hiccups.

But as I entered my third trimester, my belly started to itch. Then an angry, red rash appeared. At first I thought it was just dry skin – the humidity decreased with the change of season and my skin started to stretch over my belly. But the rash was getting redder and more itchy day by day, and I was extremely uncomfortable. Eventually it got so bad that I had to get out of bed multiple times during the night to jump in the shower, alternating between hot and cold water to get some relief.

That itch started appearing on other parts of my body as well: down my arms and legs, on my hands and feet, across my chest and on my neck. Luckily the rash didn’t touch my face – but every other inch of my body was covered. I knew it was time to see my doctor.

My worries and discomfort were dismissed

While I saw a wonderful and compassionate doctor most of my pregnancy, the doctor in the office I met with today was new to me. He did an ultrasound, measured my stomach and said everything looked good. When I started telling him about the rash, he waved his hand in the air as if dismissing my concern. They’re just stretch marks, he insisted.

There was no further discussion of treatments or ways to get relief. He also didn’t mention any other warning signs that I should look out for that might indicate there is cause for concern. He acted like absolutely nothing was wrong. I felt like my concerns and questions were dismissed as insignificant.

My symptoms were too dire to ignore

After that check-up, the rash quickly started to get worse – and the itching started to spread to my chest and down my limbs within days.

As a prenatal health journalist, I’ve heard of a condition called intrahepatic cholestasis, or cholestasis of pregnancy, that can cause itching. It is very rare, affecting only one to two out of every 1,000 pregnancies, but it is also serious. This can cause premature birth and breathing problems for the baby – or even a stillbirth. And, like most pregnancy complications, it is more common among women carrying multiples.

I wondered if cholestasis could be the cause of my aggressive itching, although this rare condition does not usually cause a rash. Considering how serious this condition is, I did something that was not natural for me: I called the doctor’s office again to schedule a new examination.

Standing up for myself may have saved my babies’ lives

The physician’s assistant who did my follow-up exam took one look at my rash (which at this point was mostly localized to my abdomen) and said that what I was experiencing looked more like PUPPP, or pruritic urticarial papules and plaques of pregnancy. This was another condition I read about in my own research and flagged it up with my care team.

PUPPP is incredibly uncomfortable for expectant mothers, but ultimately poses no real health risk to the mother or baby. There isn’t much one can do to deal with the discomfort of PUPPP, but the condition usually resolves after delivery, she said.

Even after this diagnosis was made, the PA still listened to my concerns about cholestasis and ran tests to check for that as well. Soon after, I got a call from the gynecologist: I was diagnosed with PUPPP and cholestasis. I was immediately prescribed an oral medication and my due date was moved up – it was recommended that I not carry my twins past 37 weeks.

At my request, my doctor also scheduled twice-weekly non-stress tests (NSTs) to monitor my baby’s heartbeat and movements. And that’s when my pregnancy started to feel like a full-time job. It was exhausting and overwhelming, but I was so grateful for those regular reassurances that my babies were safe.

At what was supposed to be my last NST at 36 weeks, we discovered that my blood pressure was elevated. I was alone in the hospital as the nurses crowded around my chart trying to get answers about how best to proceed with my case. I was diagnosed with preeclampsia that day, a few days after my scheduled c-section. Preeclampsia could have been fatal for both me and my baby, so I was relieved when the nurse came in and informed me that my doctor had consulted with a maternal-fetal medicine doctor (a provider who specializes in high-risk pregnancies). They decided to deliver that day.

It was a terrible day, but it could have been a lot worse

My children were born prematurely and one of them had to spend time in intensive care, but in the end they made it safely into the world. My c-section, although earlier than originally planned, went smoothly.

But I can’t help but relive my experience and wonder, “What if?” What if I hadn’t asked for another check-up or pushed for that blood test that showed I had cholestasis? What if I didn’t have those extra NST tests that showed I had pre-eclampsia? I don’t know what would have happened to me or my baby if I hadn’t given birth when I did.

Maybe another doctor would have paid attention to my discomfort at the follow-up examination, maybe I would have given birth safely without a diagnosis, maybe I would have given birth just a few hours after an emergency C-section.

But I could have suffered in silence and something terrible could have happened. I’ll never know. If I could share one thing from my experience with expectant parents, it’s this: Standing up for yourself can save lives—ours and our babies’.