We’ve all heard of morning sickness, and it is true that nausea and vomiting are common in pregnancy, affecting up to 90% of pregnant women.
Typically it occurs in the first trimester and, although it's awful to have, regular pregnancy sickness is generally manageable with small adjustments such as eating little and often, wearing travel bands or taking ginger.
Hyperemesis Gravidarum (HG) on the other hand is not a normal part of pregnancy. Women experience severe nausea and vomiting which can result in serious complications such as weight loss, dehydration, electrolyte imbalance, vitamin deficiency, oesophageal tears, anxiety and depression.
Unfortunately there is still a lot of misunderstanding surrounding HG, and women suffering with it are sometimes viewed as exaggerating or being melodramatic. However, it is more than “just morning sickness”.
For a woman with hyperemesis, normal functioning becomes an impossible task. Vomiting can be relentless, day and night for weeks or months on end. As much as turning in bed can bring on an episode of vomiting. It is a very lonely and isolating experience; often women are housebound, prisoners in their own bedroom with only a basin for company.
The misery is compounded by feelings of guilt at not being able to care for other little ones at home, or keep family life functioning as normal.
Having personal experience I can confirm all of this! Living with severe nausea and/or vomiting for a prolonged length of time can have a hugely negative effect on a person's health and well-being.
Weight loss and dehydration can happen quickly and often in these situations IV fluids and medications are required. Around 1 in 100-150 pregnant women will be admitted to hospital due to the dehydration and malnutrition that hyperemesis can cause. Many more will need time off work.
Although the exact causes of pregnancy sickness are not fully understood, it is thought to be caused by the pregnancy hormone HCG. Symptoms usually start between 4 and 7 weeks gestation and peak around week 9 and for the majority resolve by 16 weeks.
However, for an unfortunate number of women (<10%) symptoms persist into the second and third trimester.
Pregnancy sickness is on a spectrum: at one end there is the expected state of feeling pretty ropey, queasiness, with some vomiting but still managing to keep yourself hydrated and functioning somewhat; at the other end is hyperemesis and there are many stages in between.
There is a persistent stigma and misconception that medication should not be used in pregnancy. This is not true - there are many safe treatments available. If nausea and vomiting in pregnancy is impacting your life or your ability to eat and drink, then you need to seek treatment. The effectiveness of medication can vary from one woman to the next, and although it may not result in complete resolution, medication can help to manage and control symptoms.
The Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland has produced national guidelines for treating HG and nausea and vomiting of pregnancy in Ireland. The guidelines contain information about each of the medications available in Ireland and an algorithm for which to try and when.
Cariban (doxylamine 10mg and Vitamin B6 10mg) is a treatment that many women are finding helpful. It is safe for mother and baby, the major drawback is that its pricey. There also many other anti-sickness medications that can be used, which you can talk to your doctor about.
These include cyclizine, prochloperazine (stemetil), and promethazine (phenergen). Others are metoclopramide (maxolon) and ondansteron (zofran). If you have heartburn, an acid reducing tablet called ranitidine can be helpful. If none of this is working, steroids can be successful, but these are usually prescribed by an obstetrician.
It is so important to maintain hydration: try to have water in different ways eg ice cubes, bottled water, flavoured fluids etc. If you are not managing to drink or keep fluids down, you will need assessment in hospital as you may need an IV drip.
Support is essential. Don’t be afraid to ask for help, whether it’s with help caring for other children, cooking, cleaning, or even just a sympathetic ear. Hyperemesis and severe nausea/vomiting in pregnancy can really take their toll on a woman.
If you feel lost and are wondering where to go for help, talk to your GP, midwife or obstetrician. There are some great online resources also including www.hyperemesis.ie, an Irish charity offering support via text, email, phone or sometimes face to face.
www.pregnancysicknesssupport.org.uk is also a great source, providing information leaflets and an online support forum on their website.
Just remember, if you are struggling with these symptoms, you do not need to put on a brave face - there is help out there. Speak up and avail of it.
