Intrahepatic Cholestasis of Pregnancy is one of the most common pregnancy related liver diseases. Its clinical significance lies primarily in the potential fetal consequences. Maternal risks, including intractable itch, can be a significant cause of morbidity in this population. Historically, multiple therapies, including Cholestyramine, S-adenosyl-methionine and Dexamethasone have been prescribed, with varying levels of improvement in symptomatic control. Treatment guidelines currently recommend oral ursodeoxycholic acid as the gold standard to reduce symptoms of pruritis. Current evidence for induction of labour prior to 37 weeks suggests risks of prematurity outweigh benefits of delivery. Our case series describes three women in their third trimester, with progressive LFT derangement and intractable itch, who were treated with Rifampicin as a second line agent. One patient received a Naloxone infusion in addition to oral rifampicin for symptomatic management for pruritis. Other options, including UV B, Mirtazapine, and Amitryptline, which have been described in literature for the treatment of non-obstetric cholestasis, were considered. Balancing maternal symptoms, and both maternal & clinician anxiety in the context of high bile acids can be challenging. Despite progress in diagnostics, there is limited evidence to drive clinical decision making around pre term delivery in the context of high bile acids and intractable symptoms.