Planned Pregnancy, Unplanned Illness: Hyperemesis Gravidarum

Oh Bella, we know how you feel! We feel like we're dying too!
Hyperemesis Gravidarum (HG) is severe pregnancy sickness, affecting just 1-2% of pregnant women. You'd be forgiven if you've never heard of it, I hadn't until I was diagnosed with it myself and then realised it was exactly what my mum had also gone through while pregnant with me (unfortunately she didn't have a GP who realised what the condition was and was hospitalised for much of the pregnancy, sans medication. What a warrior of a woman!) 

HG is absolutely nothing like regular morning sickness, a common aliment in pregnancy which usually passes by the start of the second trimester. If you've ever had salmonella, you will have some idea of the scale of HG. It's not just throwing up one or two times a day, it can be up to 50 times! The difference is I was in and out of hospital after just one week with salmonella, whereas HG can often last anywhere between 20 weeks to the whole pregnancy. 

Having suffered with HG myself these last three months (which is why the blog has been so quiet and my inbox set to 'out of office' ) I've decided to give HG it's own blog post to explain what HG is, what it certainly isn't and what not to say to a loved one who may be suffering with it.

So what is HG?

HG is prolonged and severe vomiting and nausea. For me, the most accurate way to describe my personal experience of the last three months is just like having salmonella poisoning. Some women report vomiting up to 50 times a day, which is a helpful estimate, as many of us simply lose count or even forget how to count, we're just that exhausted. 

Of course, this means that getting food and drink in is incredibly difficult, if not completely impossible. This leads to severe dehydration and malnourishment and even (although rare if HG is monitored and treated) complications for baby (reduced amniotic fluid, ruptured placenta to name a few). 

The majority of HG sufferers require hospitalisation, often repeat admissions, for IV fluids and vitamins depending on the scale of their dehydration and malnourishment. Usually this is clinically measured by high ketone levels in their urine and rapid weight loss, often between 5% and 15% of their pre-pregnancy weight. Staying out of hospital upon discharge means having very little choice but to take medication to ease (not completely cure) the sickness. Some medication can have other side-effects, such as constipation which can be incredibly painful in itself.  

HG is thought to have been the leading cause of death in pregnant women back in the 1930's, when HG was assumed to be a mental illness caused by a subconsciously unwanted pregnancy. What a load of twaddle. Many HG sufferers/survivors, like myself will tell you that their pregnancies are very much wanted, some women may have even been down the long and emotionally exhausting path of IVF treatment in order to conceive. 

Fortunately, we've moved out of the dark ages and health care practice and medicine has significantly advanced. Though sadly, there are still some misconceptions surrounding the condition, even in a world where all the information you could ever need is available at our fingertips. Even today, there are incredibly devastating cases in the news where women have had to terminate their very much wanted pregnancy, often as a result of medical professionals not being aware of the range of treatments available or just unwilling to prescribe anti-emetic medication (which has been used off-label to treat pregnant women for the last 40-50 years, without a statistical increase in foetal abnormalities). 

I have no doubt that the fear of prescribing medication for pregnancy sickness is part of the legacy of the Thalidomide disaster, but them same doctors wouldn't refuse medication to a pregnant woman suffering from an asthma attack or an epileptic fit. The same logic applies to HG, in that without treatment, the woman could die and the risks to the foetus are far higher than of those posed by the medication itself. If anyone denies you the medication or criticises you for taking it, ask them for their evidence base! I want to see cold, hard clinical evidence in peer-reviewed medical journals of these alleged risks (never challenge a hormonal woman with a masters degree from a top research university).  

For those wanting more information on HG and the treatments, I highly recommend the book 'Hyperemesis Gravidarum: The Definitive Guide by Caitlin Dean RGN. and Amanda Shortman' and Caitlin Dean's blog: Spewing Mummy. Also, for those feeling utterly isolated in their experiences, join the Facebook group for Hyperemesis Gravidarum. Scrolling through this group on my phone with just the one tired finger was all I could manage some days, and it kept me going knowing I wasn't alone.

What HG is not and what to not say to sufferers

HG is NOT going to be 'cured' by ginger remedies, sucking on a lemon, wearing acupressure wrist bands, eating small meals, taking tiny sips of water, or any other old wives tale that probably helps regular morning sickness. I feel it will be therapeutic if right now I permit myself to have a bit of a rant about this 'well meaning advice', which I've now been on the receiving end of for 14 weeks. Skip the next paragraph if you dislike ranting/mild swearing.

Think about it, a sodding fabric band around my wrist is not going to reduce the ketone level of my urine. I'm not rapidly losing weight because the meal I ate was too large and I'm certainly not passing out from dehydration and low blood pressure because the sip of water I took was too large. AM I?! C'mon now! As for ginger, whether taken as a drink, supplement, or in a biscuit, that sh*t burns like hell all the way through your oesophagus when vomiting up it's residue for the 20th time that day. That's if you can even manage to get it down you in the first place. Please onlookers to HG sufferers, shut up about effing ginger!

HG is not in a woman's head. She is not using it as an excuse to stay at home, in bed all day and 'do nothing' (other than puke, choke, catch her breath, puke, shiver violently, sip water, projectile puke some more - repeat all around the clock). 

Before I received treatment, I would lay in bed all day for weeks trying to stay as still as possible because I would throw up as soon as I moved. I couldn't brush my teeth for weeks as the toothpaste would make me throw up immediately afterwards. I couldn't shower for days on end unless my fiancé got in with me to hold me up because the warm water combined with standing up would make me faint. All I could do was just lay there, puking into a bucket at my side and really hoping I didn't die of chronic dehydration right there on the bed while worrying like crazy about my precious baby.

I'm sure many women like me will tell you that they are fed up of not being able to go to work (many of us lose our jobs because of the length of time we've been sick), socialising is out of the question and hobbies are just distant memories. HG brings with it a side dish of financial chaos and chronic isolation. I've even cried today because of how badly I miss going to the gym (lazy teenage me would have found that hilarious!). I cannot begin to imagine how a woman with HG copes with looking after her other children and it is this very concern that will probably stop me trying for a second baby in the future.   

The only reason I am sitting at my laptop today is because I'm taking medication and I've isolated myself away in my bedroom from all smells in the house that spark off spewing fits. I'm propped up on the bed by my pregnancy pillow to alleviate heartburn (which also makes me throw up, as do antacids I take to solve the heartburn), sipping my safe drink (either flat lemonade or cold water) through a straw, with a bucket next to the bed for puke attacks. Today is one of my better days. 

These occasionally happen, sometimes I even manage to get down to the shops (usually I'm out of breath by the time I'm at the end of the street and I'm afraid to go on my own incase I faint or end up curled up on the street puking) and see family and friends for a few hours before I go home to puke again. Most of the time, I take to just driving everywhere, because I'm yet to throw up while driving. 

I actually feel quite fortunate compared to other HG sufferers. I'm only 5 minutes away from decent doctors who will prescribe the medication I need and I'm 20 minutes away from a great team of NHS midwives, nurses and HCAs who will check that my baby is OK and pump me full of fluids and vitamins when needed. My fiancé is very supportive and understands what HG is. He knows what my triggers are, he knows I can't help it and he would probably demolish the entire city leaving just the hospital standing if that's what it took to get me to emergency help when needed. I've even returned home from the doctors to find him sterilising my puke bucket (without me asking). I'm certainly, without any doubt, marrying the right man (but I've known that for almost the last nine years)!   

Our much loved and wanted little bean at 13 weeks
I'm sure many of you can imagine just how depressing coping with endless months of HG is. Even more so if the sufferer doesn't have the support and treatment they so desperately need. Please do not interpret a sufferer's moaning or crying as being 'ungrateful' for their pregnancy. I really didn't think I could have children and I am incredibly grateful for that little heart beating away so strongly in my tummy. My scan picture, in a frame on my bedside table, keeps me going on the days where I genuinely feel like I'm dying. I love that little bean (Pudge, Nugget, and Tummy Egg are our affectionate nicknames for the little one already) and my fiancé and I so desperately wanted to conceive and cannot wait to become parents. But I'm not ashamed to say that I don't enjoy pregnancy at all, even though I know with all my heart that I will forever love the baby I give birth to at the end of this treacherous journey. 

None of us HG sufferers/survivors could have known that our pregnancies would be like this. My pregnancy was planned, but I didn't plan for this illness. 

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