Hyperemesis Gravidarum

Hyperemesis Gravidarum

Becoming pregnant should be a joy, but for women who suffer from Hyperemesis Gravidarum, it becomes something more akin to a nightmare. Here sufferer Johanne Jakeway herself a midwife explains her story

Most of you may not be aware that Charlotte Bronte, who died in 1855, four months into her first pregnancy may well have done so as a result of severe vomiting. Her sufferings were written in her diaries in detail and described her nights of vomiting with no reprieve at all. Does this sound familiar? It certainly did in my case.

Like Charlotte Bronte I also wrote down my experiences in a diary. I wrote constantly about the effects that I was suffering because of Hyperemesis Gravidarum (HG). This is a severe and debilitating form of morning sickness a HG sufferer will prefer to use the term time of the day sickness as being a more accurate description and has been described as intractable vomiting before the twentieth week of pregnancy resulting in disturbed nutritional status. Although I am a midwife, and knew of it before I became pregnant, I had no idea how bad it could be until I suffered from it. And looking back at my diary now, I wrote with such bitterness and contempt for the condition that had made me become a shadow of my former self.

Hyperemesis made me very lonely and depressed. I would cry uncontrollably for what seemed to be hours, but I didn even have the strength to produce tears.

Movement makes the condition worse, so I found myself spending days upon days lying still in bed, unable to make even the slightest movement for fear of vomiting. The only time the nausea left me was when I slept. I couldn even tolerate my husband sitting on the bed beside me and I would scream for him to move, even the smell of him would make me vomit.

At 13 weeks, I was at an all time low. Having having lost two stone in weight, I pleaded with my family to help me to terminate my pregnancy. This was a much wanted and planned baby, but at the time it seemed to be my only option. I needed to be normal again. Now I wonder how I could have even contemplated such a thing? But Hyperemesis makes you think irrationally. I would have given anything for the nausea to subside.

If it wasn for the love from my family, and my eternal hope that it would eventually ease, things might have been very different. Colleagues would pass me by when I was ill in hospital not recognising me. Usually I worked with these people, but now I was unrecognisable to them. That upset me all the more.

The nausea and vomiting carried on relentlessly for another nine weeks. I had spent most of this time in hospital and was able to go home only for short periods. The management of my condition continued to be very difficult. There is no miracle cure for HG, no single treatment seems to be effective. My treatment ranged from anti emetics to antacids, supplements to vitamins and corticosteroids to acupuncture and homoeopathy.

Eventually the nausea did subside. At 24 weeks I was able to manage small meals as well as keeping fluids down. But I never ate and drank at the same time. Even though I continued to be weak, I was now able to function relatively normally, I never had anymore vomiting after that, but my husband and I lived in fear of the nausea returning and rearing its ugly head.

On 6th February 1999 Daniel James Jakeway arrived by emergency caesarean section. He weighed in at 8lb 10oz, amazing when you think what he put his mother through. It just goes to show that even though you are going through hell, it is only in very severe cases that a baby may be born with a lower than average birth weight.

But the effects of the HG didn’t just go. Certain smells or foods brought that that feeling of nausea back and it took me years to try again. I did though, and the Hyperemesis returned. I felt better able to deal with it this time, but was back on a drip again. I was also depressed, and my relationship with Daniel did suffer.

But Isobel was born on 27th July 2004 weighing 7lbs 1oz and also perfectly healthy.

Times have changed, but HG is still an awful condition!

In the past, severe pregnancy sickness or Hyperemesis Gravidarum (HG) was a significant cause of maternal deaths the only form of treatment available then was a therapeutic abortion.

Nowadays, the outcome is not so bleak. Thankfully, maternal morbidity and mortality are extremely rare, with the advancement of medicine and intravenous therapy, complications such as Wernicke Encephalopathy (owing to thiamine deficiency) can be avoided.

Hyperemesis Gravidarum does however continue to be a tiring and miserable condition that can have profound effects on the woman and her family.

Despite this, it remains a complication of pregnancy that is neither understood nor widely acknowledged throughout the medical profession. As a result many sufferers and their families are not receiving the appropriate emotional support that they desperately require.

Whilst it has been documented that nausea and vomiting in pregnancy affects up to 50% of pregnancies, only a small percentage of women have HG. The true incidence continues to be unknown, but having examined the literature it varies from between 0.3% to 3%.

It is not known what causes some women to become so desperate during their pregnancy as a result of HG, that terminating much wanted pregnancies seems to be their only means of escapism from sheer hell. The sooner that people realise HG is far more than ginger biscuits and sea bands the better!

Trying to manage HG

Many women may be able to manage their condition at home with various remedies to prevent them from having to be hospitalised. These range from taking small regular meals, never eating and drinking together, avoiding fatty foods and caffeine based drinks and sucking on small sweets, which may help with excessive saliva.

It is essential that midwives have a basic understanding of the condition, as well as ensuring that there is an up to date written protocol for the management of women who present with severe HG in hospital. These must be evidence based, including the most effective treatments presently available, until hopefully there is a gradual improvement in their condition as the pregnancy progresses.

It has been stated that a request for a termination must not be assumed that the pregnancy was not wanted or unplanned, but an indication of the degree of desperation felt by the patient.

As a health professional, I feel that it is our duty to maintain confidentiality during these sensitive periods as well as encouraging expression of thoughts and building upon a trusting relationship.

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Hyperemesis Gravidarum