Extreme morning sickness can take its toll. We speak to the experts about pregnancy sickness causes, treatments and available support.
Experiencing extreme nausea and vomiting during pregnancy? Hyperemesis gravidarum (HG) is a pregnancy complication characterised by severe nausea, vomiting, dizziness, weight loss, and dehydration.
We speak to Caitlin Dean, a registered general nurse and vice chair for the charity Pregnancy Sickness Support and Dr Clare Bailey, a GP and founder of parenting support organisation Parenting Matters, about hyperemesis gravidarum diagnosis and treatment tips:
What is hyperemesis gravidarum?
It’s estimated that around 10,000 women a year suffer from hyperemesis gravidarum (HG), a condition that at its most extreme can leave sufferers with a torn oesophagus, burst blood vessels, eroded tooth enamel and post traumatic stress disorder (PTSD).
To diagnose women with hyperemesis as “just” bad morning sickness only adds to their suffering.
But all too often the condition is dismissed as bad morning sickness – a term which in itself is misleading, as any women who has experienced the grind of all-day pregnancy nausea will tell you.’Hyperemesis gravidarum can result in vomiting up to 50 times a day and, in extreme cases, hospitalisation to combat dehydration and so that nutritional support can be given intravenously,’ says Dean.
‘To diagnose such women with “just” bad morning sickness only adds to their suffering,’ adds Dean. ‘Luckily, we’re much more enlightened about the condition now, but even so, around 1000 women a year choose to have an abortion because they can no longer cope with the vomiting and constant nausea. Some women can’t swallow because the saliva in their mouth makes them throw up, and others find the smell of their husband or children makes them feel sick, which is very distressing. Often the nausea can be worse than the sickness itself.’
Is it normal to feel sick?
For women expecting their first child, many assume what they’re experiencing is normal – after all, up to 90 per cent of mums-to-be experience some form of sickness during the first trimester.
‘Many women actually find feeling sick a comfort, as it’s a sign the pregnancy hormonesare kicking in,’ says Dean. ‘Hyperemesis gravidarum is a different proposition altogether, but it’s amazing what some women put up with before realising their symptoms are not normal and seeking help.’
Up to 90 per cent of mums-to-be experience some form of sickness during the first trimester.
Maddie Caruthers, 32, had HG with her first child, Ben, now five, and her second, Edie, eight months: ‘With Ben, it started at four weeks and eased off at about 20,’ she says. ‘I can only describe it as a living hell. One of the worst aspects was feeling as though I just wasn’t coping – I’d never heard of HG and just assumed I needed to toughen up. When my symptoms carried on after the 12-week mark, I was devastated. I’d been so sure I’d start feeling better after that milestone and when I didn’t, I was hysterical. Thankfully my GP came to see me at home and diagnosed HG – physically I felt as bad as ever, but at least now I knew it wasn’t all in my head and I had somewhere to go for support. It made all the difference.’
What causes hyperemesis gravidarum?
As to what causes hyperemesis, it’s thought there is a genetic element (you’re 30 per cent more likely to suffer with it if your mum or sister did). ‘It’s multifactorial and often we’re not sure why some women get it and others don’t,’ says Dean.
It’s unlawful discrimination for an employer to treat a woman unfavourably because of her pregnancy.
Sadly, if you’ve had it once, it’s likely to recur with subsequent pregnancies, a fact that saw Maddie delay extending her family by a couple of years longer than she would have liked.
‘It took me a long time to feel mentally ready to be pregnant again,’ she says. ‘It wasn’t so bad the second time around, although I remember holding Ben’s hand when we were out on the street one day and having to kneel down on the pavement while I was sick down a drain.’
What if you’re too sick to work?
You are entitled to take time off work if you have hyperemesis. ‘It’s unlawful discrimination for an employer to treat a woman unfavourably because of her pregnancy or an illness relating to her pregnancy,’ says Dean.
‘There’s also small crumb of comfort to be had from the fact that from around week 18 a lot of women start to feel significantly better, and after the baby is born the sickness stops completely.’
Will HG put your baby at risk?
A study by Dr Rebecca Painter of the Academic Medical Centre in Amsterdam, which looked at the babies of mothers who were pregnant during the Dutch famine of 1944-45 and severely undernourished during early pregnancy as a result, found that they were more susceptible to heart disease, stress-related conditions and obesity in later life.
If you lose more than five per cent of your pre-pregnancy weight, you might need nutritional intervention.
‘Unfortunately, it seems there might be some lifelong complications associated with severe malnourishment during the early weeks, which is why it’s important to seek help sooner rather than later,’ says Dean.
‘It’s just as important we rule out any other underlying cause for extreme sickness, which can sometimes occur as a result of an undiagnosed urinary tract infection (UTI), for instance,’ says Dr Bailey. ‘In a way, hyperemesis is a diagnosis of exclusion, but once confirmed, we can start to treat. If you lose more than five per cent of your pre-pregnancy weight, you might need nutritional intervention so inform your GP.’
Will anti-sickness drugs harm the baby?
‘There is absolutely no evidence that the standard anti-emetic (sickness) drugs used to treat HG are harmful,’ says Dr Bailey.
‘They’re most effective if started as soon as possible and can be used in combination to find the most effective way of reducing sickness in each individual.’
What should you eat?
If you’re struggling to keep anything down, dry, bland, foods such as crackers or plain white toast might help, if eaten very slowly – perhaps just a quarter of a slice of toast every 15 minutes, advises Dean.
Sucking an ice cube may be better tolerated than sips of water. You might want to avoid ginger, however, despite the fact it’s oft mentioned as a traditional cure for sickness. ‘You need to consider how it will feel to vomit ginger back up,’ says Dean. ‘It’s painful. And one of the studies we’ve done on combatting pregnancy sickness showed it not to be effective anyway.’
Hyperemesis gravidarum help and support
For additional help and support, try one of the following resources:
❤️ NHS.UK: to check for any medical issues or be referred to a specialist, visit you GP.
💚 Pregnancy Sickness Support: a national support network of trained volunteers who are peer-matched so that they can offer appropriate advice.
💙 NCT.org: The UK’s leading charity for parents through pregnancy, birth and beyond.