by Caitlin Dean and Amanda Shortman
But the vast amount of column inches devoted to Kate and her ‘morning sickness’ has underlined just how notoriously under appreciated and misunderstood HG is.
The reasons for this are varied, from the lack of definitive cause as to why some women have more severe symptoms than others, to myths about the teratogenicity of drugs due to an understandable fear created by the thalidomide disaster in the last century.
However, it is the myths and misunderstanding which can significantly add to the suffering and distress of women at a point in her life when what she needs above everything else is understanding, support and appropriate evidenced-based treatment.
Women with HG often report that they are bombarded by advice about taking ginger, eating crackers, thinking positively and how it will end at 12 weeks. In addition, they report being made to feel selfish and weak for not just ‘getting on with it’.
Yet these are women who may be vomiting in excess of 20 or 30 times a day, whose body ejects even the tiniest sips of water let alone a big capsule of ginger which, if kept down long enough, can be painful to vomit again later. The intense nausea can be constant and can go on for months and months, so it is no wonder the condition is linked with post traumatic stress disorder.
Feeling out of control is another commonly reported experience of HG sufferers, and this is where healthcare professionals can really help. By making a plan with the woman and including her in the management of the condition, she can regain some of the control over her life, along with her hopes of a happy glowing pregnancy.
In our recently published book, Hyperemesis Gravidarum – The Definitive Guide, we have a section for healthcare professionals that addresses the causes of pregnancy sickness, medications and treatments available, and the management strategies required to provide holistic, evidence-based care to women with HG.
The book contains self help for women that midwives can use to advise women, as well as information about the recovery period after HG.
The following cheat sheet is from the book and contains facts and figures about the condition. It is also available to download via the book’s accompanying website, along with various other useful charts, care plans and management tools.
• Nausea and vomiting of pregnancy (NVP) affects approximately 70–80% of all pregnant women.
• 35% of pregnant women experience symptoms that are of clinical significance.
• 30% of pregnant women require time off work to manage their symptoms.
• It is estimated that up to 1.5% of pregnant women suffer from hyperemesis gravidarum (HG).
• The cause of HG remains unknown, and there is no ‘cure’. Treatment usually revolves around trying to limit the severity of the symptoms.
• Milder forms of NVP may end between 12 and 16 weeks; however, those with more severe symptoms and HG often report that although the intensity of symptoms may decrease around this time, up to 60% continue to suffer from nausea and/or vomiting until birth.
• ‘Morning sickness’ is an erroneous term as most women experience symptoms of nausea and vomiting at various times throughout the day. Pregnancy sickness is a more appropriate term to use.
• The advice to eat ‘little and often’ may help in milder cases of NVP, but dietary changes are often not enough for more severe forms, especially HG.
• Similarly, the advice to eat such things as ginger and dry crackers may help milder forms of NVP but is often completely irrelevant to a woman who is struggling to keep any food or liquid down.
• Rest is a vital aspect of managing the symptoms of nausea and vomiting as stress and exhaustion can exacerbate symptoms. Pressure to ‘carry on as normal’ can make matters worse.
• Symptoms can become so severe that the pregnant woman may experience dehydration, production of ketones, nutritional deficiencies, electrolyte imbalances, and weight loss.
• Admittance to hospital for IV fluids may be necessary.
• Prior to the development of IV treatment, HG was a significant cause of maternal death. The last deaths in the UK due to complications of HG were as recent as the 1990s, and the severity of this condition should not be forgotten or underestimated.
• Anti-emetic medication may be prescribed to try and limit the severity of the symptoms. Though none are currently licensed in the United Kingdom for use during pregnancy, many have been used successfully for decades without any known effect on the foetus.
• Pregnant women whose weight gain is low in association with HG throughout their pregnancy have a higher risk of preterm labour, babies with low birth weight, and babies who are small for their gestational age. The risks increase if HG is uncontrolled or untreated in the second trimester.
• The emotional stress of prolonged and severe nausea and vomiting is high and support is crucial.
• Antenatal depression, postnatal depression, and post traumatic stress disorder may accompany or follow a pregnancy complicated by severe NVP and HG.
• HG can be so traumatic that sufferers may request a termination of their pregnancy and/or decide against further pregnancies.