Unreasonable not to want antiemetics?

[MrsFionaCharming]

I’m currently 9+1, I’ve had slight nausea for a few weeks but since Monday it’s got significantly worse.

I vomit shortly after waking, then approximately every 2 hours until bedtime. I generally feel ok between episodes as long as I don’t try to do too much.

Obviously I can’t be in work like this, and I think being in work would make it much worse (hot, busy, smelly hospital ward).

On one hand, I could ask my GP for some antiemetics, and if they work, be able to go back into work.

But I really don’t want to! I’m very nervous about taking any medications. I looked at the RCOG guidelines, and some of the drugs they suggest are not recommended in pregnancy according to the BNF. I know thousands of women take them without issue, but I really don’t want to risk anything.

So I guess I’m hoping you’ll all tell me it’s fine not to take them and just stay off work until it gets better? I have a horrible feeling I’m being very unreasonable!

Is the GP prepared to sign you off for that long ?

Is your workplace prepared to have you off work for that long?
What will not eating or drinking much do for the health of your pregnancy?

And finally the RCOG do really know what they are talking about. They haven't made up their guidelines to hurt women or unborn babies.

Have you tried things like ginger tea. You dont want to get dehydrated. I would speak to your g.p. and ask for sick leave, its pregnancy related. Maybe occy health can offer you advise about possibly working different hours or a different area, are you a nurse.

It's such a short amount of time in the larger scheme of things. If you don't want to take them then don't, this period of pregnancy can be difficult, deliberately I think to make us take better care of ourselves. Rest, recover, you should be a lot better in a few weeks, if not then revisit your decision

I can sympathise I had morning, noon and night and during the night until I was 38 weeks with my first, 37 weeks with my second but only until 35 weeks with my youngest. 🥳. I carried plastic bags in the car for emergency stops etc 🥴😄

I didn't use any anti emetics, like you, I didn't want to risk taking anything if I could avoid it.

I am a nurse too and I worked right through without really needing to take any time off. My colleagues knew that I may disappear for a few minutes from time to time, the closest I came to an "accident" was when I was dressing a pilonidal sinus so I did have to excuse myself on that occasion but I don't think it was due to the dressing, I think it was just bad timing!!

I had HG in all pregnancies and took ondansetron it didn’t cure it but helped enough to allow me to function and it’s safe to take

You can do what you want with your body and pregnancy but as someone who suffered with Hyperemesis throughout both pregnancies and took 4 x different anti sickness drugs since 6 weeks and turned out two healthy children I don't really see the downside. Even with all the drugs I wasn't able to work.

I had HG for both my pregnancies and would definitely have put my baby and my own health more at risk without antiemetics. This is due to dehydration, risk of tearing oesophagus etc.

I still needed to be admitted for fluids a couple of times and that was with the meds and less vomiting.

The BNF usually states that something is not suitable for use in pregnancy as it has not been tested in fully controlled trials on pregnant women (generally seen as not ethical!). The RCOG uses evidence based information from off-label use to consider if there is any evidence of harm.

As someone who suffered HG through 4 pregnancies all the way through, I would say that you should discuss with your GP (or midwife / consultant if your GP is not sufficiently informed) the risks of constant sickness in terms of lack of nutrients for your body vs the risk of the drugs they are suggesting. While you feel you can cope now, the long term lack of nutrients has a significant effect on you and may be something you have not yet considered. I also suffered damage to my throat and mouth/teeth from the acid effects of constant vomiting.

I guess if it was bad enough to be hyperemesis, that would make the decision for me. But it’s only every 2 hours or so, and I’m able to eat and drink fairly normally in between. My obs are fine and I don’t have ketones in my urine.

I’ve got ginger everything, and anti sickness wristbands, which do seem to help a little (but would have to remove at work due to bare below the elbows requirements).

I’m a PA not a nurse, I honestly don’t know how nurses would cope with this! Even before this week I’d had to alter what I was doing slightly. I was having to take a sitting/ drink break mid ward round, and was avoiding doing longer procedures where I’d be with patients for extended periods of time.

I don't mean to sound unsympathetic but being sick every couple of hours doesn't sound like a reason not to go to work. I worked through similar. It's unpleasant but do-able.

But agree at 9w you could wait and see if it.passes before taking meds.

Is your Consultant sympathetic, could you move to outpts if thats easier for you.

So long as you’re able to stay hydrated without antiemetics I think this is absolutely fine and wouldn’t expect anyone to work vomiting 2 hourly. If you become more unwell and need antiemetics then please do trust the guidelines, they are good and evidence based. Good luck and congratulations

BNF is not useful for medication in pregnancy, it basically says everything is unsuitable! (Also rubbish for breast feeding). This is due to licensing not safety profiles.

Either check your hospital or rcog guidelines. Antiemetic treatment is well established and safe.

I understand where you are coming from. I had terrible sickness with my first but I powered through and refused to take antiemetics.

I’m now 7 weeks with my second and I’m already on my second type of antiemetic because of HG. Yes the worry is there but tbh the benefit outweighs the risk. Carrying on being sick and dehydrated is more of a risk to the baby than taking an antiemetic. I’m still needing to get signed off work though even with the antiemetics as the nausea is still constant and being a pharmacist would be impossible!

I’ve bitten the bullet and called my GP… and have been asked to call back at 8 tomorrow morning.

I agree about not needing to be off work for vomiting every 2 hours, but sometimes I get t zero notice it’s coming. I was standing in the hall yesterday talking to my husband, and mid sentence vomited into my own hands because I didn’t have a bucket close enough! I can’t be near patients if that’s a possibility.

I think if you feel OK between the vomiting and are able to eat and drink enough despite it then it's totally your call whether you want to try medication or prefer to avoid it and take a couple of weeks off work. If you're 9+1 already you are probably close to the peak sickness now. I agree with someone up-thread that though obviously HG is ghastly and v. dangerous if untreated (have had it v badly three times!) ordinary "bad" morning sickness is probably designed to make sure you rest for a bit rather than bustle around, so maybe it's not a bad idea just to go with that if you can.

If you do try the medication, you'll probably still need a few days off anyway as they generally start with an anti-histamine like cyclizine (been used for years & years, v. safe) which can be quite sedating for the first few days until you get used to it.