Pregnancy after pregnancy, battle after battle with hyperemesis. I swore the next one would be different. Although I enjoyed feeling my babies move, I also counted down the days to delivery. I was excited to meet my little one, but also knew that each day that I got through was one day closer to being free of the nausea that consumed me.
Although I was aware of nausea and vomiting of pregnancy (NVP), I didn’t really understand how awful hyperemesis was until I had it myself. I was also asked how someone could become so sick when “Others were able to cope with morning sickness” which I felt implied a weakness of someone that can’t cope with what’s perceived to be a “normal” pregnancy symptom. NVP has a range of severity and impact, and Hyperemesis Gravidarum (HG) is far from “normal”. Despite being more commonly known as ‘morning sickness’, NVP can occur at any time of day or night and affects 8 out of 10 pregnant women. HG affects a smaller percentage somewhere between 0.3-3.6%. Kate Middleton’s experience of HG helped to raise awareness but still there is work to be done.
What is hyperemesis gravidarum?
Hyperemesis gravidarum is severe and prolonged nausea and vomiting of pregnancy. According to the the RCOG (Royal College of Obstetricians and Gynaecologists) guidelines, it can be diagnosed when NVP results in more than 5% pre-pregnancy weight loss, dehydration and electrolyte imbalance (salt and minerals normally present in the body). It usually starts between weeks 4-7 of pregnancy and reaches a peak around week 9. The cause is unknown but thought to be linked to hormonal changes associated with pregnancy. Other theories include genetics, fetal gender, digestive changes, and vitamin deficiencies. A variety of tests may be carried out to check that there isn’t another underlying cause, support the diagnosis, and guide management.
I had HG for 20 weeks of sickness with my first baby and all the way through in my last two pregnancies. I also have a family history of HG.
What are the signs and symptoms of hyperemesis gravidarum?
- Severe nausea and vomiting
- Weight loss
- Becoming dehydrated
- Feeling dizzy, faint or light-headed
- Heightened sense of smell
Managing hyperemesis gravidarum
The mainstay of treatment is re-hydration, anti-sickness medication, and nutritional support. Steroids may be recommended in severe refractory cases.
The most important thing I learned was the need to stop the cycle of increasing levels of nausea. I made many mistakes thinking I was feeling a bit better and trying to return “to normal” and failing. The journey to work was nauseating and it was impossible to reduce my exposure to triggers. I drank and ate less, resulting in me going backwards, all in my attempt to go forwards. Always remember that an empty stomach will actually make you feel sicker and continues the cycle.
Reducing symptoms of nausea
The following is a list of all the things I tried in my attempt to combat the nausea:
Studies have shown that ginger may be effective in reducing nausea so it’s worth a mention, but if you have HG, you’ve probably tried it already yet still had it suggested a thousand times by well-intentioned people. I only found ginger helpful during the early mild nausea.
The evidence appears to be mixed. I used Sea Band acupressure wrist bands when the nausea first started. At the beginning it seemed to help and I felt quite hopeful but sadly not for long.
I heard that taking a multivitamin before pregnancy may help prevent severe symptoms but unfortunately it seemed that prenatal vitamins worsened my symptoms. I chose to just take folic acid, B vitamins, and vitamin D after that. In my next pregnancy, I switched to folic acid, B vitamins, and vitamin D when I found out I was pregnant. There is suggestion that vitamin B6 may reduce the severity of symptoms.
It’s natural to worry about taking medication during pregnancy. By the time I started medication I was vomiting many times a day, dehydrated, and feeling like I was going to collapse. There also may be a reluctance to prescribe in early pregnancy depending on experience. Choice of treatment may be influenced by medical history, severity of symptoms, and previous experience. The Bumps website is a great read for information on medication in pregnancy.
Everyone will come to know what makes their nausea worse. I found eating very small amounts more frequently to be helpful, eating a biscuit very soon after waking up, and snacking on nuts and raisins. Lollies were good for when I couldn’t tolerate fluids, but only blander flavoured ones. Bland, non-fried/non-oily/non-greasy, odourless foods are generally better tolerated.
Consider whether reflux is making it worse
Signs of reflux include heartburn, an unpleasant taste in the mouth, sickness, feeling bloated and excessive burping. Reflux can begin in the first trimester due to hormonal changes. I found that cutting back on reflux aggravating foods helped. The following foods may possibly aggravate reflux (this will also vary on an individual basis): high fat foods, tomatoes, citrus fruits and juices, garlic, onions and spicy foods, chocolate, coffee and tea, and salty foods. I have heard others often say that salty foods helped them, but for me it aggravated my HG. I had trouble tolerating fresh dairy products and found switching to non-dairy alternatives helped me.
Hypnotherapy isn’t recommended as a treatment in the UK. I tried an app called Nevasic after I read that a study had suggested it was effective for morning sickness. I felt that it helped initially, but reached a point during it’s use where my nausea started increasing and I couldn’t stand listening to it anymore. It was almost as if the sounds were now associated with nausea. I also remember listening to music a lot trying to take my mind off the nausea and the song Uptown Funk by Bruno Mars was being played frequently at the time. I couldn’t listen to the song for years as it reminded me so much of my nauseated feelings. That song was Baby Shark in my third pregnancy. Be careful of your associations!
Avoidance of triggers
This is a tough one if you can’t control your environment. Speaking to your manager/occupational health may help to support workplace adjustments.
It can feel so hard to allow yourself to rest when you need to look after other children or have work commitments. Tiredness worsens nausea and will just continue the cycle. Look after yourself
If you’ve had hyperemesis before, you are more likely to have it again so it’s worth planning ahead if you can. Looking after other children whilst you have hyperemesis is tough so it’s better to be over-prepared than under. Some examples include:
- Preparing food ahead and freezing. These can then be rotated with other quick prep food or external help for when the sickness hits.
- Outsourcing if possible. Planning for childcare, arranging for a cleaner to come at intervals, considering easy/quick prep food subscriptions, and help from friends and family
- Planning easy activities for the children. I prepared activities that could be done whilst resting requiring little movement on my part, or minimal mess to clear
When I first had hyperemesis, the sickness was so severe, I felt absolutely dreadful. It felt like I was suffering from a terrible illness that was going to go on indefinitely. I loved reading a book I had called Pregnancy Day by Day. Each page counts down a day in the pregnancy and tells you all the amazing changes taking place and I feel like it really helped me keep positive when the sickness was at it’s worst. I found the counting down of the days positive rather than negative (e.g. I have managed another day, only X days to go now). The following was also helpful:
Engaging with a support network
Seeking help early
No one should feel that they are ‘weaker’ for needing help with their symptoms, the need to struggle on through worsening symptoms, or feeling guilty for needing to take time off work. I didn’t feel too good about needing medication in pregnancy or surviving at times on what some might consider to be a less healthy diet, but the reality would have been far worse otherwise. ‘Mum guilt’ is a terrible thing and starts well before the birth of your first baby
Practicing mindfulness or another therapeutic activity
I started the at home Beautiful Belly yoga program by Briohny Smyth that was available on Daily Burn. I had to take a break during the worst part of my sickness and then could only manage short sessions here and there, but I still found it calming and lovely for connecting with baby.
e.g. massage, pedicure. Be sure to let your therapist know if any particular smells trigger your nausea.
What have your experiences with hyperemesis been?
1) Royal College of Obstetricians and Gynaecologists (RCOG). Green-top Guideline No. 69: Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum. 2016; Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg69-hyperemesis.pdf
2) O’Donnell A, McParlin C, Robson SC, et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment. Southampton (UK): NIHR Journals Library; 2016 Oct. (Health Technology Assessment, No. 20.74.) Scientific summary. Available from: https://www.ncbi.nlm.nih.gov/books/NBK390535/
Amal is a paediatrician and mum/step-mum to four wonderful children. She started MedicMum101 to share tips and experiences on all things motherhood. She enjoys writing about parenting, health, and wellness, as well as other life musings from time to time. When she is not working, writing, or running after the kids, you can often find her working on a new piece of art.