Everyone seems to know about Hyperemesis gravidarum (HG) in pregnancy now that it has affected a royal’s pregnancy. However, back in the ‘dark days’ this condition was often disregarded as ‘severe morning sickness’ and unless you were dehydrated, exhausted and clinically malnourished and in need of hospitalisation then women were often left to suffer at home. I have personal experience of HG, which I suffered profoundly with in both pregnancies until 14 weeks. I have experienced this condition first hand and know the physical and emotional impact it plays on you. HG robs you of the ability to motivate yourself and the physical strain of the sickness/vomiting and the feeling of isolation of the condition can leave you feeling very alone and low. I try to provide the help and support to women that I was unable to receive.
It’s not known what causes HG, or why some women get it and others don’t. Some experts believe it is linked to the changing hormones in your body that occur during pregnancy. HG usually starts at 6-7 weeks, peaks between 8-10weeks and resolves around 12-14weeks. Some women may experience throughout the whole of pregnancy and should be monitored very closely by their maternity team with medication. If you are unable to tolerate any food or fluid within a 24hr period you must speak to your midwife or GP to be assessed for dehydration, ketosis and low blood pressure.
A recent conference (Oct 2017) by the charities – Pregnancy Sickness Support & the British Pregnancy Advisory Services identified that more than half of women (53%) with this condition have difficulty accessing appropriate treatment. Researchers are now tentatively gaining funding for research into this medical condition in pregnancy. An interesting lead into this condition identified a possible genetic link for HG. Professor Fejzo, who researches Hyperemsis at UCLA and USC said ‘Mounting evidence supports a genetic link. If your sister has HG, you have a 17-fold increased risk of also having HG.’
The conference also highlighted the much less talked about impact of the condition on a woman’s mental health when suffering with this condition and throughout pregnancy. The effect on my mental health is what I remember most about the condition. As well as the physical drains of the condition the mental impact of being bed bound for 6-8 weeks can take its toll. I personally felt emotionally abandoned by my family and friends after the first week of vomiting. Life does have to carry on and people can’t be there all the time throughout. However, that feeling of being alone in your sickness, isolated from your life and lonely in your illness changes pregnancy from this wonderful exciting news to something you just need to get through day by day.
The battle to stomach and keep any food or drink in your system is unwinnable, any hint of interest in food or drink is unrecognisable to your body and you become locked in this cycle of exhaustion from lack of food and fluids, to no hunger, to trying to eat and then inevitably vomiting, too scared to eat in case you vomit again, to being too exhausted from lack of food. You can end up deteriorating so much that women end up being hospitalised with malnutrition and dehydration which is dangerous for you and your baby.
So how do you break this cycle when you have HG?
I am going to step outside the set response from the health professionals on this and try to give you some practical tips to manage this condition. IF YOU HAVE HYPEREMESIS YOU WILL NEED TO BE NURTURED BACK TO HEALTH, you will need to be looked after.
Making any attempt to contemplate food let alone make a meal and deal with food is almost unmanageable at the peak of the condition. Leaving your house becomes an almost impossible task. However, this cycle needs to be broken and the simple fact is that you will need to eat and drink to make yourself better and keep yourself out of hospital.
Survival strategies:
- Take each day at a time – seeing weeks ahead of you feeling so sick and tired is mentally draining. Just concentrate on getting through the day and surviving the day not the weeks ahead.
- Rest – I cannot emphasise the importance of rest. The more you rest the better you will feel.
- Ask for help. This is one time you do need to accept help wherever it comes from, you cannot do this one on your own!
- If you have family members, a rota of friends, your husband/partner or mums from school it will be these helping hands that can help nurture you back to health. Make a list of ways others can help, what foods you are tolerating that week, and let them know you need help to get through this. The simple act of providing meals, companionship, friendship and someone looking after you in your time of need is truly bonding and simply necessary.
- If you have limited support and can afford to hire help, consider a teen, local university/college student or doula to help out.
- Do whatever is necessary to cope including taking sick leave or hiring help. If possible, avoid major stressors such as moving until you have recovered.
Food
- Eat little and often – try eating small amounts throughout the day rather than 3 large meals. This is easier for the body to digest and reduces the risk of you vomiting up all nutrients from foods.
- Try to stick to simple foods, complex meals with strong smells are very off putting as your sense of smell is like a sniffer dogs! Highlight this to anyone who may be making you food. Have a list of the foods you can tolerate.
- Starchy foods tend to be tolerated really well such as; bread, rice, pasta and potatoes as well as white meat such as chicken and turkey.
- Try to eat what you want, if you are craving a food go with it. It is normally your body telling you what nutrients you need. Certain exceptions include: Paté, Liver, Soft Cheeses and uncooked eggs (which may contain harmful bacteria).
- Try having some cold foods you can tolerate cut up so you can munch on them throughout the day. Reaching for a bowl of prepared food is easier then having to prepare food throughout the day.
- Avoid high sugar and high fat foods such as biscuits, sweets and red meat. They tend to initially make you feel great as there is a surge in your blood sugar level, but when your blood sugar levels drop you will feel a lot worse . It is about keeping your blood sugar as stable as possible throughout the day.
- Try ice/ice drinks to tolerate fluid – Some women find this very helpful to crunch on ice rather than drink
- Order your food online and arrange a delivery tie when someone can be in to help and put it away.
Other considerations
- Arrange for someone to visit to avoid depression and isolation. You may not feel like it every day but it is important to have that contact. Try to arrange for the time of day you are least nauseous.
- Ask others to drive you to appointments and stores so you can lay down and rest in the car. Doing both can be too much.
- Try Sea Bands – acupressure bands that have been shown to help nausea in pregnancy. The bands won’t take it away but can help to lessen the symptoms.
- Your urine should be the colour of pale yellow straw, if it is dark yellow and a small amount it can be an indication that you are dehydrated and you should be reviewed by your GP.
- If you are advised that you need to be hospitalised discuss what options are available at your local hospital.
It can feel bleak when you are in the midst of your hyperemesis, but every day you manage to get through is one more day will never have to experience again. For most women it will resolve between 12-14 weeks. You will find that you may not have felt so bad for the whole day and the next day is a little better and the periods of not being sick begin to increase until you can get through a whole day and have managed to not vomit or even think about how you are feeling. You realise that you have got through it and survived.
I offer full support and plan of care for women suffering hyperemesis as well as nausea and vomiting in pregnancy. They say only a woman who has been through hyperemesis will truly get it and I have been there, got the badge and got the insider knowledge. Who knew the midwife has something in common with a royal! You can get the royal treatment with a little extra help and the knowledge to successfully manage this condition.
Emma Mills - Private Midwife 