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Thursday
Dec062012

Hyperemesis Gravidarum

The Duchess of Cambridge, Kate Middleton, is newly pregnant (hurray!), but sadly has already been hospitalized with a rare illness of pregnancy called Hyperemesis Gravidarum. One can Google the term and get a decent clinical explanation, but I knew there was a better way to learn about HG: Ask the women themselves. So I did. This is what they said:

HH: HG is miserable.HG is almost total incapacitation for 8 months. HG is the reason I haven't had another baby yet.

CAM: I only had HG with my first! I lost 19 pounds in the first 5 months, hospitalized 4 times before having a pick (PICC) put in and a nurse come twice a day to give me IV fluids! I started at 110 lbs ended at 102 lbs had my daughter at 34 weeks because I went into labor at 28 weeks was put on bed rest until 32 weeks, was hospitalized and went into heart failure! HG sux! Oh and I busted most of the blood vessels in my eyes from the vomiting so I looked like a pregnant zombie!

JS-J: I had it with my twins. 18 hospital visits. A mediport (permanent IV implanted in my chest), IV fluids running constantly, 4 anti-nausea meds given every 4-6 hours around the clock, and still vomiting 30-70 times a day. I vomited so hard my cervix bled from the pressure. I ate 1 milkshake per week, not because it would stay down, but because it was the least offensive thing to throw up. I lost 20 pounds and gained back 7. I'm convinced that the lack of nutrition in the first 5 months caused me to deliver at 26 weeks (no nutrition=weak placenta and amniotic sacs). Oh, and I still vomit at the drop of a hat. Especially during PMS times.

JL: HG is hell on earth. At my worst, I was vomiting 15+ times a day- and that was while I was on the strongest anti-emetics that could be prescribed. I was ultimately prescribed a Zofran pump which, though a life saver, required me to give myself two painful injections every day as the sites would quickly become irritated. That, in combination with home IV therapy, and total bed rest just barely kept me from having to have a pic(c) line inserted. All told, I lost over 20% of my body weight with both pregnancies before I was through the first trimesters.

LML: The single worst experience of my life. 4+ years later, I'm still picking up the emotional and physical pieces.

ESG: Losing 20lbs in the first trimester. Needing fluids regularly in the ER. Throwing up in every bathroom in Ann Arbor, Michigan. Never knowing if something I ate will agree with me or not. Misery, misery, misery. I only had it with my twins, thank goodness. Every pregnancy after that had less and less vomiting.

KDK: From the purely objective side... without meds I would vomit 12-20 times a day. If I kept 2 oz of fluid down that was a good day. I've had PICC's and midlines and Zofran pumps. Home nursing care and home IV hydration. It would end around 20 weeks and then I would be fluffy. This is considered mild HG. I was never admitted to the hospital, I never needed a feeding tube. I know women who are NPO for months, my longest stretch was 4 weeks. My cocktail was Zofran, Phenergan and Doxylamine. I have a permanently wonky gag reflex and damaged teeth. This.is.mild.HG.

Psychologically HG is brutal. HG moms are at far higher risk of peri and postpartum depression and anxiety.

I looked like I had the measles from the broken blood vessels in my face. Love hate relationship with Zofran. The side effects of Zofran can be as miserable as the nausea/vomiting.

JA: No personal experience other than supporting a client who had HG... but I did gladly participate in this study and hope that many others who will as well.

For those needing support and information, this seems to be the organization to turn to:

HER Foundation: Hyperemesis Education & Research

AP: Jessica at The Leaky B@@b had it with all six pregnancies. She's got some horror stories, including providers (mw and ob) being AWFUL to her.

PB-G: I vomited 12-20 times a day for 7.5 months (and then a few times a day for the remainder of my pregnancy) despite being on a high dose of prescribed Diclectin and Gravol. I lost 20 pounds in the first two trimesters and was medically required to quit my graduate school internship, thus not finishing my Master’s Degree pre-baby as planned. I also bled for 10 weeks of my pregnancy, and although we never nailed down the cause, it seemed linked to happen primarily during vomiting episodes.

BK: Hyperemesis gravidarum is what had me losing 90 lbs. with my first child. I was unable to keep my job because I was so sick. I wasn't hospitalized for it, but that is ONLY because I loathed hospitals and was too damn stubborn (and probably stupid) to go. It can become an immensely dangerous condition if it gets to the point where mom is dehydrated and anaemic because she can't keep anything down. I don't think I've met anyone who had to be hospitalized for the condition, but I do know that there are women out there who have.

TW: Horrible! Hard to believe your having a baby feels more like dying slowly; just thinking about it makes me want to cry!

EEC: It's the thing that makes me hate pretty much every single minute of being pregnant and probably the biggest obstacle in getting a VBA2C. By the end, I just want it all to END and the instant relief of a C-Section is much more alluring than throwing up through labor. We are currently working up the nerve to try again and every time we get to the point of trying, my PTSD goes through the roof knowing what I am about to put my body (not to mention my family) through. It's pure hell and I am really glad that it's getting a little bit of media attention, I just hope my miserable managers are taking note and having an "Aha" moment and will treat the next employee that has HG with a little more respect and understanding. (That felt good!)

KT: Nausea and sickness so bad that I was signed off work. I had to drive with a sick bowl in the car for almost 7 months. Some days could barely keep down water. At its worst, that horrid feeling overshadowed any excitement I felt about being pregnant. And the hardest part was knowing that I couldn't make it go away. It lasted 27 weeks. After it stopped I felt amazing!

SS: HG robbed me of a positive pregnancy experience. Society, your friends, family, and partner can't even begin to understand what you are going though, how isolating it feels. Everyone tells you to enjoy your pregnancy. That hurts a lot. It's not easy to enjoy something that is killing you.

Your kidneys can stop functioning, you can't think clearly, you don't pee for days, or have a BM for weeks. You encounter healthcare providers that tell you are being over dramatic, and that it's all in your head. So you go home, even more defeated than when you came in for help.

Your body is eating itself you are truly starving to death. You know what it feels like to be starving, truly starving for food/water. You lose five pounds, then fifteen, then thirty. Your friends and family laugh and tell you that you should be happy to lose weight instead of gaining during pregnancy. If they only knew what you would give to be able to gain, even a LITTLE weight.

You vomit the contents of your belly, then you vomit bile, blood, and when there is nothing left, you dry heave. You can't swallow your own saliva. You carry a plastic zip lock bag with you everywhere you go so you have somewhere to puke no matter where you are.

Your esophagus becomes damaged, and every time you vomit, or try to drink/eat, you feel a million pieces of glass cling to the inside of you.

Smells, commercials, visuals, even the words surrounding food/eating make you puke again. Your family can't eat in front of you, or have the smell of food in the house. The smell of a hot meal in your home and you wretch all over.

Shampoo, soaps, cleaners, lotions, hair spray, deodorant all have a scent that is vile. Even though the bottle will tell you it's unscented.

You sleep on the floor next to the toilet (which is now ALWAYS sparking clean) because you are too weak and tired to move from your newly assigned post.

You lose your sense of self, you lose your ability to care for your family/children, you lose the ability to work, you rack up medical bills.

You are so thirsty, and the glass of water mocks you. If you let it touch your lips, and pass down the burning esophagus it comes right back up burning you a second time.

You try sea bands, saltines, ginger, pregnancy pops, herbs, OTC nausea meds, prayer, acupuncture, acupressure, pot, Phenergan, Zofran, Reglan, steroids, NGs feeds, pumps and PICCs. The nausea/vomiting remains.

You worry.

"Is my baby getting enough to survive? What will these meds do long term to me? to the baby Will I still have my teeth left when this is over? What if I vomit so hard that my blood vessels in my eye rupture?”

“What if I vomit so hard that my placenta detaches?"

Your teeth are forever ruined. The acid has eroded them and wore them down.

All for a chance at saving your life, and the life that you are trying so hard to create.

For further reading: The ABC’s of HG.

KDK: Spit cup, how could I forget that but I had a towel. A cup full of rank spit was just another trigger so I would spit into a towel.

IPV: It’s kinda like dying a slow death.

ESG: Oh yes, bursting blood vessels in the face! I'd forgotten about that ::shudder::

KDK: Best place bar none for HG info is hyperemesis.org. Their forums are a lifesaver, literally. I encourage all birth workers and women to familiarize yourself with that site so you can refer clients/ loved ones.

NgM: SS: Tears are streaming down my face at your description, so apt and so true.

All of you, so brave and strong to stay alive with such pain and struggles. I'm so sorry pregnancy is so hard for you. I know people forget having a baby isn't all beautiful and joyful for everyone.

I think the worst is that people think you're faking it. Not many of you mentioned that, but that's what I've heard the most. That "it's all in your head" and if you just embraced your pregnancy (or this or that or the other) your vomiting would disappear. Being told it's your fault is so demeaning and cruel.

Along those lines, my own experience with HG and clients, the thing that's helped quell it somewhat has been mindfulness-based stress reduction (a type of meditation), but even that doesn't work all the time and I would never consider saying someone didn't do it right and that's why they still had HG. It works for some; not for others... and who knows why. Just like some of the meds can help some sometimes, but not others. Hit and miss most of the time, with miss the majority of the time.

Again, you all are so brave and I totally understand the fear of not getting pregnant again. It would terrify me, too.

KDK: Getting pregnant after HG is terrifying. Been there done that a few times. Best remedy ishaving a treatment aggressive OB ready to go; early and aggressive treatment can make a huge difference in severity and duration.

KY-P: I endured three HG pregnancies. My first was the most severe weight loss, and went undiagnosed. I vomited until I was well into the second trimester, had a relapse, and then ended up admitted in pre-term labor at 27 weeks on magnesium sulphate with a severe uti. I went in for fluids many times at the end.

Number two was bad, I did not lose as much weight and was able to take some Diclectin. I had 9 er visits for fluids, sometimes up to 8 pokes for IV and blood work because I was so severely dehydrated. Constant bladder and kidney infections. I would vomit all day without meds, with meds I was barely alive. I even fell at work in the bathroom once, totally passed out... Luckily I was working at the hospital so was able to just take a wheel chair down to emergency. I vomited all through labor and was denied medication, despite having an IV but I was thankful for fluids.

Number three was the most severe nausea of them all. I learned to take things into my own hands, because my midwife would not agree to a picc line or fluids, but a local natural doctor agreed to run bolus fluids for me preventatively with vitamin support and some B vitamins. I stayed at my desk job and did not move 8 hours a day (that saved my life, being out of the hospital). My husband took care of the cooking and physical work.

My son is now 18 months old, and I still have flash backs. My body has violent reactions when I am nauseous or sick with gastro bugs. My teeth survived, but my dentist said the enamel is worn. I have a hernia as well, and reflux. On a five year wait list to see a gastric specialist... Canada is wonderful for some things and awful for others.

All in all I had mild to moderate hyperemesis and was lucky that I did not gain weight (lose weight?), but I vomited daily despite treatment for over 40 weeks. I am still physically recovering - my muscles were so wasted that a back injury I had between baby one and two was definitely exacerbated by lack of tone in my supporting core. I live with severe daily back pain as well. Anyway, just my experience. I love my babies, but I hate HG and what it did to my family.

AO: Vomiting up blood, bile, and anything you dare attempt to eat. ourbananafamily.blogspot.com

PLB: I had mild HG, but also am severely emetophobic (phobia of vomit/vomiting).

I had a lot of suicidal thoughts. I'd sit for hours staring, trying to will my body not to heave, fighting back tears because crying would make me lose control and heave again. My husband couldn't eat anything in the house for my entire pregnancy. He experienced caregiver burnout that almost destroyed our marriage.

Zofran and Phenergan around the clock. Lost weight until 8 months and finally gained a few because I was finally able to eat 2-3 light meals per week-- thank you, frozen blueberries for staying down.

I rarely left the house for fear that I'd come in contact with something that would trigger me to be sick and I'd be trapped out somewhere. On the handful of occasions I did leave, I brought a whole sick kit with me in case I did get sick.

I, too, have nausea and heaving still, 2 years PP, especially during hormonal fluctuations.

JP: Ugh. I HATE HG. Had it with both of my pregnancies. The helplessness, realizing how much longer you have to deal with it. I'm lucky in that I was able to take Phenergan, Zofran, and Reglan around the clock and keep the vomiting down to a handful of times a day (never mind the severe nausea). Off meds I couldn't move from bed and vomited every 20 mins or so. Even on meds I spent 3-4 months on the couch. I didn't see daylight for over a month. I missed a part of my daughter's third year while preggo with my son. I can never get that time back in her life.

It hurts when people say it's in your head, or if you just release your fears you'll be fine, or you should just buck up and deal with it. You look at food so differently. There aren't cravings, just fear. I want so badly to enjoy my pregnancies!

I had a cousin who had HG, she only had 1 kid. No one else has it that I know of. I also get Gestational Diabetes. I'm unsure if they're somehow related. My water broke both times at start of labor/right before contractions (lack of nutrition?). Thankfully both kids were term and had no issues (both small, born at 6 1/2 lbs).

I'm just thankful I have a 'mild' case that meds helped and didn't need hospitalization/home health as we don't have insurance. I did require an IV with fluids once with my first. I'm sure I needed it with the second, but I was too sick to get in the car or care to leave the apt for it. I also still get nauseated easily, and get hit hard by gastro bugs.

MH: Not able to keep anything down. Throwing up water and the color of bubble gum. Throwing up everyday til the baby is born.

SH-W: Nurse told me that my hg was "natures way to get me to lose some weight". Lost 30 lbs first tri gained back 9. Vomiting blood. Spinning room. For months! My hubby gave me daily shots in the butt of an anti emetic. Only way I made it. Had to wean 26 month old over night because I was hospitalized with borderline organ failure. And my mom says that I was "just like her with my morning sickness" and wouldn't come see me in hospital. Awesome . Very misunderstood condition. Much love to all with hg. Every time I think of having another baby hubby looks at me like I'm nuts. I had nausea everyday of every preg but only hg in 3rd.

TC: I had a psychiatrist tell me that HG was me trying to "throw up my baby" because I was depressed (was depressed before pregnancy, too, btw) and she was an unplanned pregnancy. It was really hard to get a diagnosis or someone to take me seriously. I was miserable and got used to throwing up everything. Worst was when I tried to eat rice pudding after drinking lemonade (almost the only thing I could drink). Worst thing ever to throw up. I subsisted almost entirely on goldfish crackers, lemonade, and eventually found I could eat plain noodles with soy sauce (apparently my sodium might have been low, hence the craving).

Smells, car rides, putting food in mouth, even someone just touching me meant terrible nausea. I was unable to work and was actually on a sub-cutaneous pump of anti-emetics for several months, with occasional at-home nursing care for IV fluids because I didn't have reliable transportation to the ER. It finally let up around 31 weeks, when I then had premature labor that had to be stopped, and then an emergency c-section at nearly 36 weeks. I was not a glowing beautiful example of a pregnant woman, heh.

And like others I want to stress that my experience was a MILD one. I was not hospitalized and did end up with a net gain in weight of a few pounds. No PIC(C) line or catheter, "just" IVs and antiemetic pump. Many of the moms on the HelpHER forums had it much worse than me and made sure I kept my suffering "in perspective".

KHM: Misery. Pure misery. Zofran took the edge off. I was in fmla for a month at the beginning of my pregnancy with Lorelei. With Coralynne it was bearable because I had a desk job with a bathroom right across the hall. I was very worries that my lapband was going to slip, but it stayed intact.

JL: Clinically I had HG as lost 10% bodyweight in first pregnancy but compared to what some of you ladies have been through... I don't think I'll ever moan about it again!

KWM: I've had it three times and they were the worst experiences of my life, and, four years after my last pregnancy, I still have a PTSD response (shaking, anxiety, dizziness, nausea) if I think or talk about it too much.

I thought I was dying (and sometimes wanted to) from what I can only describe as "blinding" nausea and constant, violent vomiting. Nothing stayed down, I literally starved. Lots of aversions to food, smells, sights. I lost my first pregnancy because of it, which was devastating, and a heartache I still feel 15 years later. My second & third pregnancies, I lost weight, lost my job, lost my tooth enamel, lost muscle mass I've never gotten back, and often had periods of losing my joy of pregnancy, and, eventually, lost the dream of a bigger family. And I had relatively MILD HG!!! Other people have it much worse!

My heart goes out to Kate Middleton, and I sincerely hope she ends up championing HG, and helping raise much-needed research money for this devastating, mystifying condition.

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Reader Comments (7)

HG is horrific and people who think it's just bad morning sickness are idiots. One of my favorite bloggers had this excellent post about her struggles with HG.

http://www.teenlibrariantoolbox.com/2012/04/abcs-of-hyperemesis-gravidarum.html?m=1

December 6, 2012 | Unregistered CommenterKristin

My pregnancies don't quite meet the diagnostic criteria for HG, but all 3 were quite close. I think the biggest thing that I couldn't explain to people was the fear. The fear of eating anything, only to have it come back up. The fear of being in public and needing to throw up. The constant 'vomit planning', where you walk into a room and IMMEDIATELY scope out your escape routes, mapping out how far away the bathroom is, if a trash can is closer, and in case both are too far away, a potted plant. The fear of even speaking to someone, lest it trigger your gag reflex. The fear that I was of no worth to anyone around me. That all I was was a burden, that people would get sick of helping me, that my children would be forever scarred because I couldn't care for them. Someone can see you're sick and sympathize with your physical feelings, but no one quite understands the fear and constant emotional beating unless they've been through it. Tears of gratitude and empathy are welling up, that not only does someone understand, but that they are talking about it.

December 6, 2012 | Unregistered CommenterAimee

It might be of interest that HG is the cause of the death of one of the Bronte sisters -- I can't remember if it was Charlotte or Emily -- so it can indeed be a fatal condition. There were no means of Iv rehydration or balancing electrolytes at the beginning of the 19th century, and even today, in poorer parts of the world such treatments are often impossible for women to receive.

December 7, 2012 | Unregistered CommenterAntigonos

As for the Duchess, I can't help but think that her extreme dieting before the wedding may have contributed to her current situation. Actually, I mentioned to a friend of mine that I hoped that she was eating much better now if they were trying for a baby. Traditional societies used special nutrient-dense foods to prepare a couple for conception of a healthy baby and an easy pregnancy. As a health researcher, it seems likely that nutritional deficiences (magnesium and sulfur, especially) are a factor in why women develop HG.

December 7, 2012 | Unregistered Commentersara r.

Sara dieting does NOT contribute to HG.

December 8, 2012 | Unregistered Commenterliz

One of my friends had HG. I'd have had an abortion, then my husband would have had a vasectomy. That's how awful it is. You'd have to really want your child to be willing to continue a pregnancy with HG.

December 10, 2012 | Unregistered CommenterJennifer

I know several women who terminated their pregnancies because of HG.

December 10, 2012 | Registered CommenterNavelgazing Midwife

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