Hyperemesis

As if morning sickness wasn't grim enough, there's an extreme and debilitating form called hyperemesis gravidarum. If you're vomiting repeatedly, have dark yellow urine (ie you're dehydrated) and are losing, rather than gaining, weight during your pregnancy, you need to see your midwife or GP.

Fortunately, it's not very common - it affects between 1% and 3% of pregnant women - but it's potentially harmful to you and needs checking out.

When you're undernourished, your body burns fat for energy and produces chemicals called ketones, which can be detected in your urine. You can monitor your levels using ketosticks, available from pharmacies, and if they're high you should tell your GP or midwife.

The Hyperemesis Education and Research (HER) has a factsheet to help you work out whether or not you have hyperemesis or pregnancy sickness.

"If you tell most doctors/midwives that you are being sick, they'll just tell you it is a feature of your pregnancy and it will wear off. You need to stress how bad it is." Debsb 

How is hyperemesis treated?

There are a number of antiemetic (anti-sickness) drugs your GP can prescribe. Initially, you may be advised to use anti-nausea strategies similar to the general advice given to any pregnant woman.

These may help in the initial stages of hyperemesis, but Mumsnetters say they become ineffective once hyperemesis is in full swing.

You may be able to cope at home, but if you can't keep anything down at all, you may be admitted to hospital to be put on a drip, to replace lost fluids and nutrients, and given drugs to minimise the vomiting.

If there are ketones in your urine, you may need extra minerals, and these can be added to your drip.

"Shout to get treatment quickly! My GP got the injection sorted within 30 seconds of me saying 'I am being rather sick'. Once the injections got on top of it, the tablets are working but they have killer side-effect on me of total knockout pills. And yes, it is all too possible to be sick on an empty stomach. I found ice worked a bit - couldn't keep water down - but when it comes up still frozen you know things are bad! It is worth it, but for the next person who says to me, 'So you won't be having a football team then, love?' I will vomit on their shoes!" Stripeybumpsmum

As many posts on Mumsnt Talk testify, hyperemesis is severely incapacitating for some women and seriously mars their pregnancy:

"It may sound odd but the best times were when I was admitted to hospital as the loneliness of having to stay at home being so physically incapacitated was unbearable. There were days when I didn't think that I would make it through the next hour, let alone to the next day. I think the level of sickness and debilitation plays with your mind and I wouldn't wish some of the blackest days on anyone. I didn't cope very well at all until I got the medication I needed." Harrysmum

How long does hyperemesis last?

For most women, hyperemesis peaks in the first trimester and tails off or disappears completely later in the pregnancy. The usual advice for morning sickness is that it will improve after 12 weeks. The majority of women with hyperemesis find that it takes longer than this.

Unfortunately, some poor souls suffer severely for their entire pregnancy. Others find that it improves but that they suffer from nausea and occasional vomiting until the birth.

Relapse is common, especially if you have tried to return to your normal, busy life. Be very careful about resuming work and normal household activities and stopping your medication. Resume activities very gradually and resume medication at the first sign of the condition returning.  

Possible complications of hyperemesis

Dehydration, vomiting and malnutrition can have lead to a number of associated symptoms such as constipation, headaches, cracked lips, mouth sores, acid reflux, heartburn, tooth enamel erosion, sleep disorder, vitamin and mineral deficiency, excessive salivation and depression. 

Repeated vomiting can cause tears in the gullet, called Mallory-Weiss tears, which cause you to bring up fresh, red blood. But if you bring up vomit that looks like coffee grounds you should seek immediate medical attention as this is old blood and can indicate a bleed further down.

Will hyperemesis affect my baby?

Babies born to women who have endured hyperemesis are generally absolutely fine. So, difficult as it can be to believe that something which is making you feel so wretched isn't harming your baby, you shouldn't worry.

The NHS says that if you experience weight loss during pregnancy then there's an increased risk (but only a risk) that your baby may be born with a low birth weight.

The HER says that although research suggests that prolonged stress, malnutrition and dehydration in the mother can potentially put an unborn child at risk for chronic disease (eg diabetes, heart disease) in later life, no long-term follow-up studies have yet been done on babies born to hyperemetic mothers. And note the words 'potentially' and 'risk' ie it's not inevitable, so try not to worry yourself even sicker.

The effect on your other children

There are sad threads on Talk from mums who feel their other children have been badly affected by seeing mummy so unwell.

"My older son was only 18 months when I was in the throes of sickness with my second pregnancy, and I do feel bad about what he went through. There were many, many days when the poor mite just sat and watched me while I lay on the sofa puking and crying. Of course I don't regret having DS2, but in a parallel universe I think I would wait another couple of years to have the second pregnancy, so that the older child would be at school, or at least be old enough to understand that the mother is ill, not just bad-tempered. I'm sure my son thought I'd had a personality transplant, and definitely was very upset by the whole experience." Rowan1971

Enlist supportive friends and family, and don't beat yourself up or feel guilty. If you had extreme vomiting and fatigue as a side-effect of an illness, no one would expect you to bustle around caring for others and maintaining all your normal activities (and if they did, you'd justifiably feel hurt and cross).

Getting emotional support

If you need empathy from women who actually understand what you're going through, you'll find it on Mumsnet Talk.

Search for and bookmark the hyperemesis support thread in the Pregnancy topic on Mumsnet Talk. It's run by women who have (or have had) hyperemesis and it's packed with practical advice on coping, information about medication and, just as important, sympathy and understanding from women who know exactly what you're going through.

Stretch marks | Weight gain | Morning sickness | Tiredness | Constipation | Swollen ankles and fingers | High blood pressure and pre-eclampsia | Cholestasis | Symphysis pubis dysfunction | Vaginal bleeding | Gestational diabetes