A good friend of mine developed appendicitis at week 17 of her pregnancy. She had an anesthetic, the appendix removed via surgery, and then she was pumped full of both IV and oral painkillers and anti-emetics. At no point during her weeklong stay in the hospital did the staff raise questions about the safety of the medications for the growing fetus. She'd had a life saving operation and we were all grateful for modern medicine. Her general practitioner also provided repeat prescriptions for medications during the next few weeks while she recovered from the operation. The little boy she was pregnant with is now my godson.
Yet recently, through my role with UK charity Pregnancy Sickness Support, I spoke to a woman in London, also 17 weeks pregnant and on the same anti-emetics that my friend had taken. But her prescription from the hospital was not for post-operative nausea – it was for hyperemesis gravidarum (HG). So when she went to her GP for a repeat of the medication, which was now keeping her out of hospital, he refused it, stating that “we don't know if it's safe for the baby.” The medication in question is one which has been used in pregnancy for decades without any evidence of any problem for the fetus whatsoever. She had contacted the charity because, of course, once she stopped the medication she rapidly spiraled back to severe vomiting and was close to needing readmission to the hospital.
So why was one of these women provided with medication without mention of safety in pregnancy and the other lady was denied it? It boils down to the condition they were treating. You see, there is incredible stigma surrounding pregnancy sickness and it's extreme presentation, hyperemesis gravidarum. Appendicitis, on the other hand is understood and appreciated as the lethal condition it is, regardless of whether the sufferer is pregnant or not.
Truth versus myth
There are a number of incorrect myths about pregnancy sickness and HG that are common place in both the public and medical world's standard knowledge which undermine the value of treating sufferers. The reason people think these myths are true is because, for the mild and common presentation of pregnancy sickness, known as morning sickness, they are. Here are some common beliefs, which while true for morning sickness are totally incorrect for HG.
- It's over by 12 weeks
- It doesn't affect the baby
- It's a good sign of a healthy fetus
- It can be helped with complementary and alternative medicine (CAM) remedies such as taking ginger, wearing acupressure bands and so on
- Every pregnancy is different so you might not get it again
- It won't kill you
As I say, these may well be true for morning sickness, certainly it often goes away at 12 weeks, doesn't affect the baby, won't kill you, and each pregnancy is different. Whether or not CAM therapies hold any value other than a placebo is open to debate. Even moderate pregnancy sickness, although highly unpleasant for the sufferer, ultimately could be a good sign of a healthy pregnancy.
When it comes to hyperemesis gravidarum, these myths could not be more wrong. It is almost never over by 12 weeks. In fact, although many women see an improvement of symptoms around 20 weeks, around 60% of women will still have symptoms right up until delivery. Dehydration and malnutrition can indeed be harmful to the fetus and pregnancy outcomes. Nearly 10% of wanted pregnancies are lost through therapeutic termination as a direct result of HG not being treated properly in the first trimester . Those who still have uncontrolled HG in the second trimester have an increased risk of complications, such as small for dates babies and placental abruption, among other things.
There is unlikely to be any benefit for HG through CAM and when used for HG, it could potentially cause harm by delaying women seeking or being provided with safe and effective medical treatment for their symptoms. The most common suggestion of ginger for nausea and vomiting is particularly problematic for the sufferer. Ginger is a highly unpleasant substance to vomit and can increase acidic symptoms which exacerbate HG. The constant suggestions of trying ginger can significantly add to the psychological suffering of women with HG, increasing their feelings of isolation.
It is a falsity that every pregnancy is different. In fact, once a woman has suffered HG once, she has an 86% chance of suffering from it in the next pregnancy. The problem with this myth's prevalence in society and among medical professionals is that it can prevent women being able to make effective pre-pregnancy plans with their doctors. Pre-pregnancy planning has been found to significantly reduce the overall severity of the symptoms and needs to be incorporated into mainstream HG care.
Finally, the notion that HG won't kill the sufferer is also false. Indeed, before modern anti-emetics and IV fluids were developed, it was the leading cause of death in early pregnancy. The last deaths in the UK were in the 1990's caused by Wernike’s Encephalopathy as a direct complication of excessive vomiting. Untreated HG rapidly causes serious dehydration and malnutrition, which pose a threat to the life of the mother. In addition, sufferers are often bedbound, which combined with pregnancy, significantly increases the risk of deep vein thrombosis and the potentially lethal pulmonary embolism.
Furthermore, the long-term mental health impact should not be underestimated. Post traumatic stress disorder and post-natal depression have both been linked with HG. In addition, ongoing anxiety around food, emetophobia (fear of vomiting), agoraphobia (fear of going out) and tokophobia (fear of pregnancy) are all commonly reported after HG.
It is time that stigma around pregnancy conditions requiring medical treatment ended. We all know the old saying “pregnancy is not an illness” and luckily for the vast majority it is not, but for some women pregnancy causes significant illness. It is thanks to modern medicine that those women are able to survive their illnesses.
About Caitlin Dean
A three time hyperemesis gravidarum survivor, Caitlin Dean now dedicates her time and energy to raising awareness about the condition, providing support to sufferers, and writing prolifically on the subject through her Spewing Mummy blog. As a registered general nurse and trustee for UK charity Pregnancy Sickness Support she is involved in research, pioneering services and health care professional education about HG. Her book Hyperemesis Gravidarum – The Definitive Guide is due out in September.