Real Complications, Real Voices: Hyperemesis Gravidarum
By: Cara Terreri on Jul 12, 2013
In this series, Giving Birth with Confidence addresses well known and lesser known pregnancy and birth complications by sharing practical information and voices from real women who have experienced them. While most birth complications happen infrequently, they do happen. If you or someone you know is pregnant, it's important to be aware of the signs and symptoms of complications. We encourage you to join in the conversation in the comments section. The following information is not meant to replace diagnosis or information from your care provider.
Morning sickness is a well known form of ongoing mild nausea that affects the majority of pregnant women at some point during their pregnancy (generally in the first trimester). Hyperemesis gravidarum (HG) -- an extreme form of morning sickness -- is not as common but affects approximately 60,000 women annually in the United States. Unlike morning sickness, women with hyperemesis gravidarum experience significant health risks and disruption to their daily life. HG usually resolves by 21 weeks, but may last throughout pregnancy for a small number of women.
The biggest obstacle in diagnosing and dealing with HG is the misconceptions that surround it. Many brush it off as the more mild morning sickness and may lead a mother to believe she is exaggerating and should just "deal with it." Continual vomiting and unrelenting nausea is not a simple case of morning sickness. If any of the following symptoms describe your experience, seek professional help as soon as possible.
- Nausea that does not let up combined with severe vomiting
- Anemia (low red blood cells)
- Body odor (from rapid fat loss & ketosis)
- Decreased urination
- Dry, "furry" tongue
- Excessive salivation
- Extreme fatigue
- Fainting or dizziness
- Food aversions
- Gall bladder dysfunction
- Hypersensitive gag reflex
- Increased sense of smell
- Intolerance to motion/noise/light
- Liver enzyme elevation
- Loss of skin elasticity
- Low blood pressure
- Overactive thyroid or parathyroid
- Pale, waxy, dry skin
- Rapid heart rate
- Rapid weight loss of 5% or more (from pre-pregnancy weight)
- Secondary anxiety/depression
- Vitamin/electrolyte deficiency
- Vomiting of mucus, bile or blood
Your care provider can diagnose HG by measuring the amount of weight loss -- it's usually associated with a greater than 5% pre-pregnancy body weight loss -- as well as by checking your urine for ketones (chemicals produced when the body burns fat or energy for fuel), and assessing your overall condition. Alternative, more natural remedies include bed rest, acupressure, acupuncture, herbs, hypnosis, and regular chiropractic care.
The earlier a mother is treated for HG, the easier it is to manage and prevent more serious risks and complications. Depending on the severity, HG is treated with medications to reduce nausea and vomiting, IV fluids to treat dehydration, and nutritional therapy via vitamin supplements, intravenous nutrition, or tube feeding.
Most risks and complications resulting from HG occur from untreated or prolonged symptoms. Risks include:
- Gall bladder disease
- TMJ disorders
- Difficulty maintaining healthy weight
- Motion sickness
- Preterm labor
- Potential future health risks to an infant whose mother was malnourished (caused by HG)
The cause of hyperemesis gravidarum is yet unknown, though there are many theories
all centering around the hormonal changes changes that occur during pregnancy.
There are no known ways to prevent hyperemesis gravidarum.
For more extensive resources and research on hyperemesis gravidarum, visit the Hyperemesis Research & Education Foundation at www.helpher.org
Real Voices of Mothers who Experienced Hyperemesis Gravidarum
Shana was diagnosed with HG in her first pregnancy (in addition to a second trimester diagnosis of gestational diabetes). Initially, she thought it was just typical morning sickness, but realized it could be something more after talking to other moms and her doctor. She recalls:
I did not have a glowing, happy pregnancy. Now that I have my beautiful son, it's hard for me to look back and accurately remember how miserable I was, but I have a pregnancy journal that does a pretty good job of jogging my memory.
Though I desperately wanted to eat well, just getting near food would set me off and my husband would come home from work to find me sobbing because all I had managed to eat that day was five Saltine crackers and I was afraid I was hurting our baby by not getting enough nourishment.
No one talks about HG and if it hadn't been for that one acquaintance, I would have never known that what I was going through was not the usual course of morning sickness. I was also lucky enough to receive a the book Managing Morning Sickness from my husband's aunt, who works as a nurse on a high risk maternity ward. From that book I learned that HG can be way, way worse than how I had it and that some women can be hospitalized for months. I also learned about other triggers, like flashing lights and motions, which explains the vomiting bout I experienced after stupidly watching the movie Twister with my husband one night!
I still feel like my body is not good at being pregnant, like I am somehow missing that magical happy pregnancy capability that I see other women have. It made me doubt in my body's abilities. I also often felt afraid.
Holly experienced a severe case of HG in her fourth pregnancy, after having three prior pregnancies without it. Because of the diagnosis and complications from the illness, it was also her first out-of-home birth. Holly details her experience:
The first time I threw up when pregnant with my fourth baby, I was excited. We desperately wanted another baby and my quick counting let me know the timing was right. Testing later that day provided a strong, early positive.
By a few weeks later I was spending all day vomiting and all my efforts to stay hydrated were failing. I knew things had to change when I called the midwife in tears from my bathroom floor, too sick to move, too dehydrated to vomit more and yet still gagging, and I heard a suggestion for more protein and small sips of water. I ended up going to the ER for IV fluids -- the first of many ER trips for my pregnancy.
After switching to an OB for care, I began taking antiemetics, antibiotics for a UTI exacerbated by chronic dehydration, steroids, and receiving home nursing care to get fluids and medications administered at home. I continued getting liters of fluids and vitamins at home, as well as iv medications. Despite this, I was still sick.
I was terrified of dying. I was petrified of falling on the stairs, either by myself or while carrying my young toddler. I began to scoot down them on my bottom, like a small child. I told my two older children what to do if I fell and didn't get up, or if they found me sleeping and couldn't rouse me. We practiced reciting our names and addresses in case they needed to call 911 while my husband was at work. I was lucky and had a very supportive husband, circle of friends, and medical team. My church brought over meals and members came to sit and visit with me. My home health nurses were professional and caring.
By my third trimester I was having strong early contractions and added more medication to try to stay pregnant. I was terrified of having gone through so much and losing my baby. When I finally was full term I delivered my baby in the hospital. My labor was relatively short but I was nauseated the whole time. My baby was born healthy and strong -- he is the easiest of my children so far and deeply treasured. And my nausea ended as soon as I had him.
For all the support I received I also received a lot of criticism. Perhaps it was my attitude. Perhaps I needed more chiropractic care, or acupuncture, or seabands. Was I eating organic? As horrible as I felt physically, the guilt I felt when people told me there was something else I should have or could have been doing other then taking medications and endangering my baby was horrible. It was terrifying to take medications after having had natural pregnancies and home births. I wish I'd had a way to articulate to people that I tried. I didn't fail. My doctor was amazing and my body and baby are amazing. Hyperemesis gravidarum, is not.
HG appeared for Kathy in both of her pregnancies, approximately 5 years apart. Without the assistance of medication (her doctor did not prescribe any), she discovered tricks to cope with the nausea and vomiting.
After two months of eating less than a full meal per day my weight was dropping. I started out at about 112 lbs and dropped to 100 and change. It was demoralizing as much as physically diminishing. I distinctly recall curling up on the floor of the shower, crying as the water washed over me, feeling like a failure because I couldn't nourish my baby. That was a particularly low point. Assurance from my OB that the baby would get what he needed, one way or another, was not that helpful. I couldn't even keep a prenatal vitamin down. The one trick that sometimes helped was to suck on a hard candy before a meal, as the introduction of some sugar to my system seemed to ease the process. Too much food at once was only asking for trouble.
In my second pregnancy, symptoms came on at about the same time but had a distinct pattern: one day of feeling miserably ill, followed by a slighter better day, then a third day where I could keep more food down. This three-day cycle repeated for weeks. In the process, I made a discovery that was very helpful. Despite all the suggestions to nibble on something bland before rising, my best bet, in terms of keeping food down later, was to empty my stomach of the excess acid right away. Because I was running out of foods I could eat and then throw up (it's hard to down some oatmeal knowing it's meant to come right back up), I hit upon water. I kept a glassful on my nightstand, and when I awoke I'd take a big gulp, run for the bathroom, and be done with it. I continued to have a mix of good days and bad, but by emptying out the acid first I seemed to have better luck keeping food down. I still lost a fair amount of weight with that pregnancy, close to 10% of my weight like before, but the symptoms were relieved and I felt like I had more control. That was huge.
In both pregnancies, I delivered healthy babies, my son weighing in at 8 lbs 8 oz and my daughter just four ounces less. My son was eight days overdue, but otherwise the pregnancy and delivery went fine once the HG passed.
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