What is hyperemesis gravidarum?
The condition causes almost constant nausea and excessive vomiting that means you are often unable to keep down enough food to keep you nourished and hydrated, or cope with everyday tasks. No one knows precisely what causes it – but it's likely to be hormonal changes to which some women are more sensitive than others.
It affects between 1% and 3% of pregnant women and while it usually causes no harm to the unborn baby, it can be dangerous for mothers – so it's very important to seek help if you are suffering.
You may be more predisposed to getting hyperemesis if:
- You had it in a previous pregnancy
- You're having twins or more
- You're having a girl
- Your mother or sister had it
- You're usually prone to migraines and/or travel sickness
- You experienced sickness when on the oestrogen contraceptive pill
- You're a younger mum
- You are overweight
How is hyperemesis different from morning sickness?
In short, it is much more severe. Don't be fooled – morning sickness can be absolutely horrendous – but hyperemesis is on another level. It's not always clear in the early weeks of pregnancy whether you have just a very bad case of morning sickness or HG, but here are some of the symptoms that might tell you it's hyperemesis you are suffering from:
- You've lost more than just a little weight (anything more than 5% of your pre-pregnancy weight
- The vomiting and nausea is meaning you aren't able to get enough food each day (rather than just at certain times, or it being certain foods or smells that cause it)
- The nausea is constant rather than coming and going
- You vomit bile, or blood caused by repeated vomiting that creates tears in the gullet (if the blood is brown and looks like coffee grounds rather than red it should be looked into immediately as that's old blood and can indicate a bleed further down than the gullet)
- You have signs of dehydration (dry mouth and skin, dark urine, dizziness)
- The sickness doesn't ease at all after the first trimester
- You're unable to work for weeks or even months (as opposed to the odd day or two, here and there)
When does hyperemesis start, and how long does it last?
The bad news is, unlike “bog standard” morning sickness, hyperemesis lasts beyond the first trimester, often until around 15 weeks, sometimes up to 21 weeks, and, for an unfortunate few, for the entire pregnancy. It is a case of finding ways to cope with it in the long term, but there is lots of help and support out there.
When should I see a doctor about pregnancy sickness?
If you suspect you have hyperemesis gravidarum rather than ordinary morning sickness, see someone as soon as possible. The earlier you get treatment, the more likely it is to work.
If your GP refuses to prescribe you antiemetics, ask to see another GP and ask them for a referral to an obstetrician. Find out whether your local hospital has an early pregnancy unit – they will know if you can self-refer and be admitted directly on to a gynaecology ward, rather than having to go through A&E if you're dehydrated.
Traditional remedies for morning sickness don't work for hyperemesis gravidarum. It's essential you get antiemetic medication from your GP or via a maternity assessment unit as soon as possible. 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 (nibbling on ginger biscuits, sipping peppermint tea and the like). These may help in the early stages of hyperemesis, but Mumsnetters say they become ineffective once hyperemesis is in full swing.
As well as antiemetics, your GP may also prescribe vitamins (B6 and B12) or steroids, or a combination of those. If you can't keep anything down at all, you might 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. You may be advised to keep an eye on your ketones by using ketone sticks, available from pharmacies.
“To anyone in the early stages, or not yet 'diagnosed' please, please seek medical attention now. Fight for medication, or get others to do so on your behalf if you are too ill (as I was). The longer you leave it, the worse it gets. Proper medication can help you function better. I wish I had not left it for so long.”
What are the possible complications of hyperemesis?
The dehydration, vomiting and malnutrition caused by HG can lead to a number of associated problems such as:
- Cracked lips
- Mouth sores
- Acid reflux
- Tooth enamel erosion
- Sleep disorder
- Vitamin and mineral deficiency
- Excessive salivation
- A tear in the oesophagus
- Bed sores (due to having to rest so much)
- Incontinence (caused by softening of the ligaments in pregnancy and vomiting frequently)
- Increased risk of blood clots due to dehydration and being immobile (there are drugs available to reduce this risk)
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.
Can hyperemesis cause miscarriage?
It is extremely unlikely and not something to worry about. With treatment, both you and your baby will be fine. If you happen to have a miscarriage, it is very unlikely to have anything to do with the sickness.
Your body is naturally predisposed to take everything it needs from you for the baby, leaving you feeling even more wretched, but safeguarding the baby's health and growth. That might not sound like great news to you, but it is definitely the best option.
How to cope with hyperemesis
Even with anti-sickness medicine, you may still have trouble eating, drinking and following your normal lifestyle. The following advice from Mumsnetters is about how to cope once you're on a suitable medication regime:
Tips for coping with hyperemesis physically
There may not be a cure for hyperemesis gravidarum, but there are lots of practical things you can do to help lessen the vomiting and cope with it when it does happen.
- Rest. At all stages, the most important coping strategy is rest. Tiredness makes the nausea worse. Don't think you are being a wimp if you feel dreadful after trying to do the simplest thing. Listen to your body, and rest. If you work, get a sick note from your GP. You may well find that you feel a bit better after a few days' bed rest, but don't be tempted to try and get back to business as usual too fast – the sickness is likely to come back with a vengeance.
- Eat whatever you can. Just for the moment, shelve all thoughts you had of following all the usual pregnancy dos and don'ts to the letter, and just eat anything you can keep down. In a normal diet, too much salt and sugar is bad for you, but when you consume nothing else, this may be your only source of calories, ﬂuid and salt for the day, so don't worry about what you eat. Many sufferers find eating vegetables and some fruits causes immediate vomiting, but sweet and salty foods are more likely to stay down than healthy foods.
- Eat whenever you can, too. Lots of women with hyperemesis say they have only a small window of opportunity each day in which they are able to stomach anything, so take advantage of that feeling when it comes and try to have a snack on you at all times.
- Avoid becoming dehydrated if possible. Sip water if you can. Lots of sufferers say fruity drinks and lemonade are easier to keep down than other drinks. If you can't tolerate drinks at all, try sucking ice cubes made of juices, sipping very slowly through a straw or even just holding liquid in your mouth. If this doesn't work, then accept that you may be admitted to hospital. A drip and intravenous antiemetics can give you hours or days of respite, which is important for your physical and mental health.
- Avoid nausea triggers. For some women the slightest thing will trigger nausea, including the sight of food or even hearing someone talking about it. Avoid cooking and shopping if you can, and make sure that the windows are open and you are far from the kitchen while food is being prepared.
- Keep a diary. Note down what times of day you were sick, if anything set it off and if there are times when you feel ok. This will help you isolate any nausea-free times, so that you can make the most of them by eating and drinking then.
- Carry a “sick kit” with you. A small bag with a couple of aeroplane sick bags or nappy sacks, a larger carrier bag to wrap it in, wipes and a bottle of water will do the trick. It means you can at least deal with a vomiting attack with a bit less stress if it happens.
“In my experience, once it's past the peak, you can cope if you either take meds or get loads and loads of rest. What you absolutely cannot do is not take meds AND rush around like a normal mother.”
Coping emotionally with hyperemesis
Don't underestimate the emotional side of it. Being so sick for so long is utterly horrible – some women suffer depression and even trauma as a result – so don't feel guilty about needing help at home or staying off work. You wouldn't be expected to carry on regardless if you were ill with anything else that caused similar symptoms. The house, your other children, partner and work may have to fend for themselves for a while. If you push yourself, the vomiting will get worse.
- If you have small children to look after, do everything in your power to sort out childcare – lean on relatives, nurseries and friends. You might well feel that any older children are “missing out” on you, and that's hard for you both, but keep in mind that the best thing you can do for them is stay as well as possible.
- Try to keep your spirits up while you're resting. Comedy box sets or just a good book (or an audiobook if TV makes you nauseous), will help pass the time. Or ring a friend and ask them to talk about anything that doesn't involve vomiting!
- Only think a few days ahead. Crossing days off a mental wall chart of '25 weeks left of feeling this way' will make it feel like a prison sentence. Just concentrate on getting to the next milestone – this weekend when your partner might be at home; next Wednesday when your mum is coming to help out, or whatever it may be.
- Hyperemesis can sometimes cause anxiety and depression (and no wonder, really) so if you're feeling very low, take time to take care of yourself emotionally and speak to your midwife or GP about getting some extra support.
- It's also a good idea to speak to others who have been in a similar boat. Try Mumsnet's Pregnancy Talk boards or the association Pregnancy Sickness Support.
“I was waking in the early hours of the morning and feeling very low in mood. Looking back now, I realise how tough the last few months have been, being a virtual prisoner in the house and practically bed-bound for much of the time. I went and discussed it with my GP, and found this really helpful – it was as much about acknowledging to myself how I felt as telling the GP. He didn't want to prescribe anything unless I started to feel worse, but has asked to see me regularly just to keep an eye on things.”
Coping with unhelpful advice when you have hyperemesis
Women with hyperemesis are often told by clueless friends and family that morning sickness is a normal part of pregnancy, and they just have to put up with it. And even from other women there can sometimes be an attitude of: “Well, I had morning sickness and I just got on with it.” It just isn't the same and you're well within your rights to tell them so.
Enlist supportive friends or family who can ﬁrmly, but politely, fend off these comments. You may have no energy to deal with it yourself. But if possible, explain to the person giving the unwanted advice that you're not suffering from morning sickness, but a condition called hyperemesis gravidarum and direct them to sources of information.
“I think what was worse than the condition was the complete lack of empathy from everyone. I had comments such as: 'You can't be sick if you haven't eaten anything' (paramedic); 'You need to be more positive, it's all psychological' (ward nurse); 'I know you can't keep anything down, but try Dioralyte' (GP); 'You look awful – like a skeleton' (sister-in-law); 'You're pregnant, not ill' (colleague).”
Can hyperemesis stop and then come back again?
Yes, it is possible. Some women also have “episodes” of hyperemesis that see it return for a couple of weeks and then leave again. Like the typical unwanted guest, there's no real way of knowing how long it intends to hang about for – but for the majority of women, it is something that starts in early pregnancy and improves by the third trimester.
I began to feel better at about 16 weeks, but do seem to have dipped again. The nausea is present for a lot of the day, but thankfully without the puking.
If I had hyperemesis before will I definitely get it next pregnancy?
Unfortunately it is more likely, yes. But it's by no means a certainty. The Hyperemesis Education and Research Foundation says that statistics show that around 50% of women who experienced hyperemesis in their first pregnancy will have it again the next time.
The prospect of another pregnancy can feel really frightening after the misery of hyperemesis with a first child. Some women feel so worried about it, it actually stops them having another child, so you certainly aren't alone in your anxiety.
Try to stay positive. It isn't a certainty that you will suffer again and if you do, simply being prepared for it the next time around can make it much easier to cope with.
If medication worked in your previous pregnancy, have it ready to take as soon as you feel ill. Studies show that the quicker you get on top of the sickness, the better the medication works. Because hyperemesis can start within days of missing your period, see your GP as soon as you know you're pregnant.
If you're thinking about trying to conceive again, work on the theory that you might well have hyperemesis and look at your options early, in terms of getting extra help at home and preparing to tell work that you will need time off.