Hyperemesis Gravidarum: surviving severe pregnancy sickness

Over the last few weeks and months, whilst I’ve been fortunate enough to be pregnant, I’ve also been suffering with a condition called Hyperemesis Gravidarum (HG), which means severe sickness in pregnancy.
It's a condition most people have heard of only via the news that Kate Middleton has been suffering with it, and the reporting in that context is not always very clear or accurate. So I wanted to write something about HG in case putting a bit more information out into the world about it might help someone else.

How I imagined I would be in pregnancy...

I thought I was going to transform into a glowing goddess in pregnancy, I was going to eat all the vegetables and do all the yoga. I was basically going to morph into Beyoncé and become a superwoman earth mother.





My actual experience...

I have instead experienced severe sickness for months, vomiting almost every day between 5 and 20 times a day - despite taking anti-sickness medication of ever increasing strength. Some days even being sick brought no relief from a general nausea that for the first few weeks filled every waking moment and most of my dreams. Now that I’m 25 weeks pregnant there is more nausea than vomiting and I'm rarely sick more than once a day (which is still not the most pleasant, but I can function quite well which feels like a victory). HG truly is a horrendous experience and is one of the hardest things I have ever been through.

In saying this, I should also mention that I’m somewhat lucky to have experienced the milder end of the spectrum of HG and I even sometimes question whether I can really use the term to describe my own experience (though I think it's really common for women with HG to minimize their own experiences and how ill they have been). I have narrowly avoided hospital admissions for IV fluids, despite a few horrible middle of the night trips to the out of hours GP, and on my worst days was sick about 20 times. For some women with HG vomiting 20 times would be classed as a good day and they can regularly vomit up to 50 times a day leading to weight loss and severe dehydration, and are therefore admitted to hospital. I can’t even begin to imagine how they survive it either physically or mentally and I will forever be in total awe of these women.

Here are a few things that I think could be helpful if you are unlucky enough to go through this, or if you know someone who is. 

•          Pregnancy sickness is not a magical different kind of sickness that’s somehow easier to bear than regular sickness. That was how I had somehow imagined pregnancy sickness to be before I became pregnant - I was even weirdly looking forward to the nausea as a sign that everything was progressing well with the pregnancy. It is very much like having a bad stomach bug or food poisoning, but for weeks or months instead of days. A lot of people ask me if I've got used to it, and the answer is no, though being sick has eventually become an expected part of my life it never has never felt normal or very bearable.  

•         HG is NOT the same as morning sickness (a term I now hate anyway as it is very minimizing), it is not something you can just push through and get on with (and sometimes morning sickness isn’t either- any level of NVP is horrible). There is no way to get on with life when you are vomiting every 15 minutes - it’s just not possible. Apart from medication, rest is the only thing that really helps, and that can be very hard to accept and allow for yourself when you just want to live your life. I felt very guilty for resting and made myself do a lot of things that I probably shouldn’t have, I've even been sick all over myself whilst driving on the motorway. It may also be difficult for some women who have experienced milder NVP and managed to keep going with normal life to understand why a woman with HG can’t. It is natural to try and compare things to our own experiences to try and make sense of them, but it is really not a very helpful comparison in this case.

• Periods of recovery and relapse are also really common in HG, so if you see someone with HG out at a social function it doesn’t mean that they are better or like that all the time, just that they are having a good patch (or that they are bravely battling through feeling like hell). Activity is often closely followed by relapse, so that one day or evening might then knock them for a good few days or weeks after.

•          One of the hardest parts of the HG experience is the toll it takes on mental well-being. HG sapped me of all hope and positivity at a time when I’d expected to be glowing and happy. It is also very isolating and lonely, because it can feel like no one really understands what you are going through. On the occasions that you are able to get out of bed or leave the house, going into public spaces comes with the risk of vomiting in front of people, and I have felt constantly anxious in lots of public spaces and have thrown up in a fair few too. On bad days even having a shower is impossible and feels like running a marathon. I became very dependent on the people around me to help with basic things like making food and drinks (the smell of the fridge, food, or even the kitchen will probably set off a round of vomiting), and the helplessness was very scary.

      I found the fear that HG brings very difficult to cope with because being unable to keep any food or drink down really made me feel that I was dying, and produced a very visceral and physical fear in my body that hung around even when the vomiting has passed for a period. On top of the fear for myself there was the added fear for my unborn baby.

Over the last few weeks I often felt that I was failing at pregnancy as I was unable to nourish my body or look after myself or my growing baby.  So much of the advice in pregnancy is about the importance of a healthy diet that I found it really difficult to believe that my baby could develop properly when I was barely eating (though it turns out that the baby did happily manage to get everything it needs from me).

The utter hopelessness and physical horror can also lead to resentment of the baby. Women with very much-wanted pregnancies can feel like this, and it’s an awful way to feel. If you have a friend with HG it is likely that they won’t feel very excited about their pregnancy, no matter how wanted the baby is, so don’t necessarily expect them to sound happy or excited when talking about their pregnancy whilst they are ill. On an abstract level they might know it will be worth it in the end, but particularly in those dark early weeks the end of a hopefully healthy, happy baby is so far away she might doubt that she can get there. When HG is very severe some women are even forced to terminate their much wanted pregnancies for their own survival. The fact that the sickness will definitely end does provide some comfort, but not that much, because each day becomes so difficult to get through and the end feels such a long way away. 

• The best thing you can do to support a friend with HG is just to ask how they are and try to empathise with how horrible it is, even though it is really impossible to understand exactly what she is experiencing.  Remember that empathetic responses rarely begin with the words 'at least' ( eg. 'at least you are pregnant') so avoid those. Send her messages to see how she is, even if she doesn't respond – looking at a screen or even talking might sometimes be impossible for her and she will probably have to isolate herself socially for a few months - little bits of contact just to know that her friends are still there for her will make a massive difference. I was very lucky to have lots of people in my life who did this. If you are a close friend you could also offer to help with practical tasks at home or to look after any existing children she might have.

•          The home remedies that help with morning sickness just don’t with HG. Whilst you might really want to help a friend going through this by suggesting things they could try like ginger or crackers, unfortunately this is not likely to help and could lead her to feel that you don’t understand the severity of what she is going through. I have learned through bitter (and I mean bitter!) experience that ginger (a morning sickness remedy that many will recommend) is NOT pleasant to throw up, and women with HG often joke to each other about being 'gingered' as it's so common for people to advise ginger as a miracle cure. Even poor Prince William recently got gingered by a well meaning older lady on camera.  

             Eating little and often also often helps with morning sickness, and whilst this can benefit women with HG sometimes, often it’s just not possible to eat when the sickness is in full flow and the range of foods that can be tolerated is very small. I even experienced a GP asking me, whilst I was in their room with a sick bowl having kept nothing down for 24 hours, whether I thought that eating a biscuit would stop the sickness in its tracks so I could keep my anti-sickness pill down (a hint is that if anti-sickness tablets aren't working or staying down a biscuit probably isn't going to cut it!).

•        Healthy food often makes you feel worse and it’s perfectly acceptable for a woman with HG to survive on things like white carbs, ice lollies, ice cream and sweets – this is probably all she can stomach. Food intake should be thought of in terms of calories (trying to get enough of them into your system) rather than nutritional value. On my worst days I couldn’t even keep any fluids down, and I just slept on the bathroom floor.

•          HG is unfortunately unlikely to disappear at 12 weeks. Though this is soul crushing to hear if your just 6 weeks pregnant and suffering, research shows that 60% of women with HG will experience symptoms much beyond 16 weeks of pregnancy. Most doctors will still insist on telling women that it will get better at 12 weeks, and I made lots of plans beyond that point thinking I’d be fine. I’m 25 weeks now and still having to rest a lot. It is not uncommon for HG to continue throughout a pregnancy, though women rarely feel as bad towards the end as in those first few weeks. 

•         HG totally warps sense of smell and it will most often be smells that will set off the vomiting. Perfume and chemical smells were particularly hard for me to stomach, and I could smell people's washing powder on their clothes as they passed me on the pavement and my stomach would immediately turn. This is really debilitating because it feels like you are being assaulted by smells wherever you go (even in your own house!).

•       Access to medication is really important and shouldn't have to be a battle, there are various anti-sickness tablets that are fine to take in pregnancy. Research indicates that early medication can prevent progression to HG, and I think the fact I received medication early is why I’ve gotten off relatively lightly compared to some others. The medication will not cure HG but it can help to make it a bit more tolerable and stop at least some of the vomiting, if not the nausea, and there are tablets of increasing strength that can be tried.

        If you think you might have HG get yourself straight over to the pregnancy sickness support website www.pregnancysicknesssupport.org.uk . It is a lifeline and there is loads of information on there, they are also very supportive for any level of nausea and vomiting in pregnancy (NVP). If you want to help a friend with HG, recommend this site to them. 

S    Some GPs can still be reluctant to prescribe anti-emetics in pregnancy because of concerns over safety to the baby, but the common ones have been used for many years without any problems. I was really lucky with most of my contact with GPs, but a lot of women aren’t so fortunate and there is still a lot of ignorance about this condition – pregnancy sickness support can help you to advocate for the treatment you need. There are printable resources about the 'treatment ladder' that you can take to your GP if you feel you need back up in asking for medication.
 

      Possibly the only real comfort is that it will eventually end, and focusing on small things to look forward to in the short term can be very helpful - as can having a sob over how awful it is and just allowing that rather than thinking you should be feeling happy. I cried a lot in those first weeks. A lovely friend of mine who also suffered with this sent me some audio books which were brilliant, as light from TV can be over stimulating. The main thing is that just having people who are there for you, who will listen and try to understand, can help to make HG feel survivable.