There's Morning Sickness, and Then There's...

"Nine months of nausea is a mind-altering experience." - anonymous HG survivor

I had the honor of attending Jo last year for the birth of her little boy. And, just recently, I received that special call that every doula loves to get, "I'm pregnant again!". I am so very excited for Jo and her family! But, she has been plagued this pregnancy, like one before, with severe Hyperemesis Gravidarum (HG).

I am not sure how much you all know about HG, but Jo's story has given me a front row seat to how under-served and misunderstood HG is. With her story being the second that I had personal experience with, I was sympathetic but ignorant about how difficult it is to endure this or how to support her. So I was encouraged when she told me this:

May 15th is the first ever Hyperemesis Gravidarum International Awareness Day

What a great excuse to learn more about HG and to help the public know more about it as well! So, I did what any good blogger would, I asked her to write a guest post about this very subject.

After having a pregnancy with severe hyperemesis gravidarum, I was determined to research ways to prevent it in my next pregnancy. I maintained a healthy weight, took all the recommended vitamins and exercised daily. I was determined to have a “normal” pregnancy. I continued taking the vitamins and exercising when I got my positive test. I started to feel symptoms of morning sickness at 4 weeks and prayed it would stay just that.

I did not want to take any medications to help and had researched the Weston A Price diet for pregnancy and breastfeeding. I felt this was the best diet for babe, so my goal was to stick to it. I got to 6 weeks and full blown hyperemesis hit. I was devastated and losing weight quickly. I ended up in the ER for bags of IV fluids and a shot of Phenergan. It helped some and I was sent home with a prescription for Zofran. I filled it, but planned not to take it unless absolutely needed. Unfortunately I NEEDED it by the next day.

I was throwing up more than 15 times a day. I lay on the couch counting the hours until my next dose of Zofran and until my husband would be off to help me with my son and I could fall back asleep. I would wake up the next morning and it all started all over again. I saw my internist the next week and she gave me more Zofran. In combination with that I had to add Colace and Tylenol to counter the side effects of the Zofran. I felt so ashamed and guilty for having to take medication, so I researched and tried homeopathies.

They did very little to help, so I had no choice but to go back to the Zofran. I had a complete aversion to meat, so the diet I longed to stick to was failing. The only thing that even had a chance to stay down was the dreaded processed food. That too made me feels like the biggest failure and was quickly slipping into depression. I am sick of being sick and sick of failing. Many days I just laid there are cried wishing for it to end.

 By around the 10th week, I started to feel a little better. I was able to eat a little meat and some eggs and eliminated the processed food, but was still relying on the Zofran. Now at 16 weeks, I have good days and bad days. On the good days I am able to take care of my son, cook and even exercise. On the bad days I once again lay here and count the hours until I can have relief. I have realized that sometimes you need help and need to take medication. It is better for my precious babe to get nutrition and take medication then it would be to continue throwing up 15 plus times a day and continue to be dehydrated and depressed.

Hyperemesis is real. I hope this post helps get it out there and one day there will be a cure.

I love The Her Foundation. They are a great resource and have forums for mamas who are suffering or for family and friends who are supporting a mama.

About Hyperemesis Gravidarum:

"Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. 

It is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids.

If severe and/or inadequately treated, it is typically associated with: loss of greater than 5% of pre-pregnancy body weight (usually over 10%) dehydration and production of ketones nutritional deficiencies metabolic imbalances difficulty with daily activities HG usually extends beyond the first trimester and may resolve by 21 weeks; however, it can last the entire pregnancy in less than half of these women. 

Complications of vomiting (e.g. gastric ulcers, esophageal bleeding, malnutrition, etc.) may also contribute to and worsen ongoing nausea. There are numerous theories regarding the etiology of hyperemesis gravidarum. 

Unfortunately, HG is not fully understood and conclusive research on its potential cause is rare. New theories and findings emerge every year, substantiating that it is a complex physiological disease likely caused by multiple factors. 

Diagnosis is usually made by measuring weight loss, checking for ketones, and assessing the overall condition of the mother. If she meets the standard criteria and is having difficulty performing her daily activities, medications and/or other treatments are typically offered. Treating HG is very challenging and early intervention is critical. HG is a multifaceted disease that should be approached with a broad view of possible etiologies and complications. 

When treating mothers with HG, preventing and correcting nutritional deficiencies is a high priority to promote a healthy outcome for mother and child. Most studies examining the risks and outcomes for a pregnant woman with nausea and vomiting in pregnancy find no detrimental effects long-term for milder cases. 

Those with more severe symptoms that lead to complications, severe weight loss, and/or prolonged nausea and vomiting are at greatest risk of adverse outcomes for both mother and child. The risk increases if medical intervention is inadequate or delayed. The list of potential complications due to repeated vomiting or severe nausea is extensive, all of which may worsen symptoms. 

Common complications from nausea and vomiting include debilitating fatigue, gastric irritation, ketosis, and malnutrition. 

Aggressive care early in pregnancy is very important to prevent these and more life-threatening complications such as central pontine myolinolysis or Wernicke's encephalopathy. After pregnancy and in preparation of future ones, it is important to address any resulting physical and psychological complications. 

Hyperemesis Gravidarum impacts societies, families and individuals. Recent, conservative estimations suggest HG costs nearly $200 million annually just for inpatient hospitalization. Considering many women are treated outside the hospital to save costs, the actual cost is likely many times greater. 

Beyond financial impact, many family relationships dissolve and future family plans are almost always limited. Women often lose their employment because of HG, and women are frequently undertreated and left feeling stigmatized by a disease erroneously presumed to be psychological." - from the Her Foundation

A woman recounts her own HG experience through a 'picture book':

"With HG, you will vomit so much the acid will erode your esophagus.  Every drop that comes back up burns all the more greatly as it comes back through your ravaged esophagus.  The doctor will look down your throat and see places where the skin has been burned away.  Your esophagus, like many parts of your body, will never be the same after HG.  Pregnancy only lasts 9 months, but HG damages you forever."   - TLT

And another local doula's client-account starts this way:

"During my first pregnancy, I really had no way of knowing how much vomiting was “normal” during pregnancy.  When I told people at the doctor's office how far along I was, they wanted me to come to a class, have a pregnancy test, get some information and then they would make me a preliminary appointment.  So I started the process.  At the class, I clutched a plastic bowl and managed to raise some red flags with the nurse.  She got me an appointment two days later.  However, before I made it to the appointment, I ended up on the floor of our bathroom.  Almost like contractions in labor, the bouts of vomiting kept getting closer and closer together.  All I could do was pull a couple of towels down next to me.  I would lift my head up just enough to heave and vomit onto the towel.  I had nothing in my stomach, not even water.  Bile and dried blood were all that came up.  My throat was raw and sore. It was when I began to beg God to let me die so that I wouldn't have to endure the pain any more that I realized the severity of my predicament.  I asked Tom* to take me to the ER.  Once there they gave me fluids and anti-nausea medication.

Many more trips to the ER followed through the rest of that pregnancy, it terminated in a miscarriage three weeks later,  and the two following pregnancies.  It was during one of these trips that the second episode occurred, although I don't remember when exactly it was.  I was once again vomiting from an empty stomach.  I begged the nurses and attendants to give me water.  Tom asked them for water. They refused because they knew I was too sick to keep the water down.  They were going to give me IV fluids and medication and told me I needed to wait for that.  The problem was that in the 15 or so minutes that I had to wait, I would throw up multiple times.  I craved the feeling of cool, clear water coming back up my throat as opposed to the harsh and bitter bile that was coming up anyway." - HG: a Personal Account

Remember, May 15th is the first ever Hyperemesis Gravidarum International Awareness Day! Ways that you can help:

• Please consider spreading the word about, and thus the understanding of, this affliction by sharing this post
• Share your story in the comments section 
• Like the HG International Awareness Day on FB
• Tell your local media about HG and the first ever HG International Awareness Day
• Be understanding and compassionate toward anyone experiencing this affliction

Together, we may be able to help find a cure!