When Morning Sickness Takes Over
Surviving hyperemesis gravidarum
During her six-year struggle with infertility, Paula Johnson envied other pregnant women and was frustrated by their complaints of morning sickness. “I thought I would do anything to experience it, if it meant I could have a baby,” says Paula, “I guess I should have been more careful what I wished for!”
Once pregnant with twins, Paula was debilitated by severe morning sickness. “When the nausea started, it started with a vengeance,” she says. “I felt ill from the moment I got up in the morning until I went to bed. It was just a constant feeling of seasickness. When I woke up during the night to use the bathroom, I felt so terrible that I couldn’t get back to sleep without eating something. The nausea was bad after I ate and worse if my stomach was empty.”
Paula suffered from a life-threatening illness called hyperemesis gravidarum (HG), a condition described by The Hyperemesis Education & Research Foundation (HER) as “a debilitating disease of pregnancy marked by moderate to severe nausea/vomiting that causes rapid weight loss, malnutrition and dehydration in the mother, and unknown consequences for their unborn child(ren).”
Onset of HG
Up to 90 percent of pregnant women experience morning sickness to some degree, with the onset of the nausea almost always beginning by 9 to 10 weeks of gestation, often peaking at weeks 11 to 13, and diminishing by weeks 12 to 14. Only 1 to 10 percent of pregnancies have these symptoms continue beyond 20 to 22 weeks. While regular morning sickness (so called because symptoms are especially worse in the morning when the stomach is empty) is not harmful to either the mother or child, for the two percent of women who suffer from hyperemesis gravidarum there is danger to both their own health and that of their unborn children.
The continuous nausea and vomiting indicative of HG can result in rapid and significant weight loss (usually 5 to 10 pounds or more during the first trimester), dehydration, electrolyte disturbances (imbalances in the vital salts that affect all bodily functions), ketosis and acetonuria (presence of ketones in the blood stream caused by lack of glucose in the blood). These conditions often require hospitalization to replenish liquids and treat malnutrition, and failure of prompt and adequate treatment can lead to irreversible renal, neurological, and hepatic (liver) damage, in addition to emotional exhaustion that leaves many women unable to care for themselves or their families.
Treating and Living with HG
Women with HG respond differently to various treatments, so there is no single effective regimen for all sufferers. HER Foundation founder, registered nurse, and HG survivor Kimber MacGibbon says there are several treatments for HG, usually done in the following order:
- Eat small frequent meals to avoid having an empty stomach. Eat dry crackers, toast, or cereal before getting out of bed or when feeling nauseous.
- Drink lots of water between meals but not much during meals. Wait at least 30 minutes after eating before drinking fluids.
- Eat foods that are easy to digest such as toast, crackers, bagels, cereals, rice, pasta, and potatoes.
- Eat lean protein like chicken, turkey or low-fat dairy products as protein may help decrease the nausea. Try eating protein with snacks too.
- Avoid greasy or spicy foods if they bring on nausea, and avoid strong smelling foods.
Keep a diary of when vomiting occurs and anything that triggers it, such as certain foods, odors, activities, or places. This information can help both you and your doctor.
- If severe dehydration occurs, intravenous liquids may be given in the hospital, clinic or at home.
- Many doctors prefer not to give medicines during pregnancy, however when a woman has HG the risk of using certain medicines is much less than the risk of malnutrition and significant weight loss.
Paula learned as much as she could about her condition and tried all the standard suggestions to combat morning sickness but found that only a few things helped, and even then not all that much: lemon drops, peppermints, ice cold water and lemonade, always keeping food in her stomach, and eating protein with every meal and snack.
“For the first week or so, I was nauseated but had no vomiting. I thought that if I could probably survive if it didn’t get any worse”, says Paula. But things did get worse, and Paula started vomiting up everything she ate or drank and began losing weight.
Paula’s obstetrician was sympathetic but didn’t offer much in the way of help—he simply reassured her that extreme morning sickness was to be expected with a twin pregnancy and that her body would make sure her babies were taken care of. She was then sent on her way with some B6 vitamins and a “hang in there.”
Unfortunately this reaction from medical staff and healthcare professionals is not uncommon. Even those healthcare professionals who are aware of the seriousness of HG will often treat it with older medications with a history of safe usage rather than those newer medications which might do more to relieve the symptoms but which don’t have a long-standing track record.
“As much as I wanted my babies, there were moments when I was so sick that I almost hoped for a miscarriage, just to end the nausea,” says Paula. She finally found help during a visit to her reproductive endocrinologist, who gave her a prescription for Zofran, an anti-nausea medication often given to chemo patients.
As shocking as it may sound, statistics indicate that Paula is not alone in “hoping” for a miscarriage as a way to put a stop to her sickness. According to research conducted by HER, a staggering 40 percent of women terminate their pregnancies because of HG.
Additionally, HG often negatively affects the pregnant woman’s family and relationships, including that with her partner, and may often result in the loss of her job. “Many family relationships dissolve and future family plans are almost always limited,” states the HER Foundation. “Women often lose their employment and are frequently under treated and left feeling stigmatized by a disease erroneously presumed to be psychological.”
While not a complete cure, the Zofran helped Paula manage her extreme nausea and she even regained an appetite. Paula was fortunate to avoid hospitalization and eventually gave birth to healthy daughters. Yet even with the help of the Zofran, Paula does not plan to have any more children. “I don’t think I could care for my daughters feeling like I did when I was pregnant.”
Kimber MacGibbon, unlike Paula, did go on to have another baby and again suffered from HG. “The symptoms occurred much the same as my first pregnancy. I could not tolerate any pressure on my abdomen; motion, smells, the thought of food made me ill, and my gag reflex was extremely sensitive. Thanks to Zofran and Zantac, as well as lots of rest in the early months, I was able to avoid trips to the emergency room, as well as IVs. I still had three really horrible weeks during which I could do nothing but lay on the sofa, and many more times throughout the eight months where I could do very little,” MacGibbon says.
“However, I consider it tolerable compared to my first pregnancy. Interestingly, the food aversions/cravings, sensitivity to smells, noise, and motion seemed less intense this time, unless I missed my Zofran,” which she began at the first sign of nausea, and increased the dose to the maximum (32 mg/day) as she felt she needed it and in accordance with her doctor’s orders.
The recurrence of HG in subsequent pregnancies is not unlikely since the cause is not known and is likely due to more than one factor and because it is not preventable. However, the symptoms are often more manageable and less severe if adequate treatment is given early in the pregnancy, or if you plan ahead and plan your pregnancy by eating very healthily, taking antioxidants and prenatal vitamins for several months, and making sure you are in the best health possible.
If you would like to learn more about HG or how to help someone suffering from HG, please visit the HER Foundation Web site.
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