Upon completion of this course, the learner will be able to:

• Identify those at risk of Intrahepatic Cholestasis of Pregnancy (ICP), and offer prevention techniques
• Identify the signs & symptoms of ICP
• Explain diagnostic testing recommendations and normal ranges
• Explain the clinical relevance of different levels of elevated bile acids
• Explain potential holistic and alternative treatments
• Develop and/or explain an ongoing and individualized treatment plan (depending on scope of care)
• Identify when to transfer care out of midwifery


Intrahepatic Cholestasis of Pregnancy (ICP) is a complex liver disease which typically presents in the third trimester of pregnancy. 

This course reviews the evidence for the best approach to risk-based management, and provides a plan for holistic preventative support of at-risk clients as well as the holistic treatment of clients with mild ICP in an out-of-hospital setting.


HiveCE is an approved provider of continuing education by the California Board of Nursing, and this course meets the California Board of Nursing criteria for 3 hours of continuing education. Provider approved by the California Board of Registered Nursing, Provider Number 17686, for 3 contact hours. (This is widely accepted nationwide as continuing education for nurses and midwives.)

May be used as Category I CE for CPM renewals through NARM.

Approved for the NARM Midwifery Bridge Certificate, Category 1.

Previously approved by MEAC for 3 hours of continuing education. approval number M2122-44-1201DE  through December 31, 2023,approval number M1920-33-1109DE through November 30, 2021.

Note: Course completion does not authorize the learner to use skills outside their scope. Please refer to your state guidelines for determining scope of care.

For information regarding our refund policy and other Frequently Asked Questions, please refer to our FAQ. If you have additional questions, please email [email protected].


This course is a fundraiser for the Midwives Association of Washington State (MAWS). 

Course Evaluations

Shared with permission from our

“I love having this holistic protocol in my arsenal! We have managed a few ICP cases over the years and they seem always to end up in the hospital. Love these lab value cutoffs for safety and an approach that focuses on prevention!”

Meg G

Certified Professional Midwife

  • Ashley Jones, LM, CPM, MSM

    Instructor Bio:

    Ashley Jones began her work in birth in 2011, following her second hospital birth. Ashley graduated with honors from the Midwives College of Utah in November 2017, and began her master program in January 2018. Ashley graduated with honors, receiving her Masters of Science in Midwifery in August 2019. Her thesis, original research on her self developed holistic protocol for Intrahepatic Cholestasis of Pregnancy, is in the process of being published. She speaks 1-2 times per year at various midwifery conferences on the topic. In addition, Ashley is Adjunct Faculty with Midwives College of Utah, and on the Board of Directors for the Midwives' Association of Washington State (MAWS).

    Ashley Jones

    LM, CPM, MSM

Course curriculum

  • 01
    1: Understanding and Diagnosing ICP
    Show details
    • 1.1 What is ICP?
    • 1.2 Maternal and Fetal Etiology
    • 1.3 Recent Meta-Analysis of Stillbirths Rate by Bile Acid Level
    • 1.4 Risk Factors and S/S
    • 1.5 Diagnostic Tests
  • 02
    2: Prevention and Treatment
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    • 2.1 Medical Management
    • 2.2 Holistic Support and Treatment Options
    • 2.3 A New Protocol: Holistic Prevention for ICP Recurrence
    • 2.4 Expectant Management in the Community Birth Setting
    • 2.5 Case Study
    • 2.6 Continued Research
  • 03
    3: Take Aways
    Show details
    • 3.1 Points to Remember
    • Printable PDF: Holistic Management Protocol for ICP
    • 3.2 Q&A with Live Audience
    • Article: Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses
    • Article: RCOG Guideline No. 43 Obstretric Cholestasis
    • Article: Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy
    • Reading: Association of Severe Intrahepatic Cholestasis of Pregnancy With Adverse Pregnancy Outcomes: A Prospective Population-Based Case-Control Study
  • 04
    Evaluation & Post-test
    Show details
    • MEAC Evaluation Questions
    • Post-Test

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Reviews

  • By Jacqueline Rowan

    “I really learned a lot from this class. The information was presented in an organized way, the risk screening criteria was also very clear, and the medical and holistic treatment protocol was also very clear.”

    “I really learned a lot from this class. The information was presented in an organized way, the risk screening criteria was also very clear, and the medical and holistic treatment protocol was also very clear.”

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  • By Kristin Brennan

    “Excellent. I used the protocol that was suggested for a client that had cholestasis in her prior pregnancy. And it worked! I felt so confident and informed after this class.”

    “Excellent. I used the protocol that was suggested for a client that had cholestasis in her prior pregnancy. And it worked! I felt so confident and informed after this class.”

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  • By rivka max

    “I found this topic very interesting. I had always understood that the only thing to be done about ICP was to have an early induction to prevent what was a very high rate of still birth. This course opened a whole new set of possibilities! It w...”

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    “I found this topic very interesting. I had always understood that the only thing to be done about ICP was to have an early induction to prevent what was a very high rate of still birth. This course opened a whole new set of possibilities! It was well presented, and her protocol sounds amazing! Thank you Ashley for the research and the time you put into this!”

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  • By Rachel Pugh

    “This was a fantastic training! I have used the information with a current client who had ICP with her first pregnancy and this pregnancy has been complication free and my client feels amazing! She is so surprised how different she feels when she c...”

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    “This was a fantastic training! I have used the information with a current client who had ICP with her first pregnancy and this pregnancy has been complication free and my client feels amazing! She is so surprised how different she feels when she compares her pregnancies. I contribute it all to the information in this training and a wonderful client who followed it to a T. Thank you for offering this training! ”

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  • By Korina Pubanz

    “The practice protocol and useful information in this online course will valuable reference material. I will look forward to the presenter's' ongoing research on the topic. Thank you”

    “The practice protocol and useful information in this online course will valuable reference material. I will look forward to the presenter's' ongoing research on the topic. Thank you”

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  • By Jennifer Miller

    “This course was very helpful in deepening my understanding of ICP and its implications, but also gave very practical guidance on when and how to manage it in an OOH setting and when to transfer out. ”

    “This course was very helpful in deepening my understanding of ICP and its implications, but also gave very practical guidance on when and how to manage it in an OOH setting and when to transfer out. ”

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  • By Karen Quigley

    “Excellent Course. I highly recommend to all midwives. ”

    “Excellent Course. I highly recommend to all midwives. ”

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