PREGNANCY IS MEANT to be a happy time for mothers and fathers-to-be. Of course, it comes with its difficulties and side effects for women, but the majority carry on to lead their lives as normal.
However, between one in every 100 and one in 200 women suffer from severe vomiting, known as hyperemesis gravidarum (HG), which can profoundly debilitate women.
The condition got a lot of attention when Kate Middleton was expecting her first child. Her condition was so severe it resulted in her hospitalisation.
However, some women have spoken about coming up against a battle for their illness to be taken seriously by the medical profession.
While many women suffer from regular morning sickness (which can actually occur at any time of the day) HG is a lot more serious.
So, what makes it different from regular morning sickness?
If you’re suffering from HG, you’ll probably find you struggle to keep anything down.
The HSE states the symptoms of hyperemesis gravidarum include:
In addition, the symptoms can have a significant effect on your life and may lead to further complications, such as depression.
While morning sickness is common, questions have been raised as to whether enough information is being conveyed to women suffering from HG.
A number of women, who wish to remain anonymous, spoke to TheJournal.ie about their experiences and the tough battle they had with being taken seriously by medical professionals.
‘I left feeling unsupported, extremely sick and quite down’
“My sickness started immediately after finding out I was pregnant. It consisted mainly of nausea and vomiting. My days became a repeat of waking up, getting sick, going to work, still getting sick and coming home until I got to sleep.
Getting sick was better than being nauseous, as at least I got some relief.
“Every single minute felt like I was sea sick or car sick. I had no quality of life, I didn’t speak or talk to anyone for weeks on end and it was even a struggle to do basic task like showering.
“I went to GP to discuss it at 10 weeks pregnant and I was told I could be carrying twins because I felt so bad. The doctor told me there was nothing she could do for me that it would pass. I had heard from a friend of a friend there was a new drug on the market with the main ingredient being vitamin B that was meant to be very effective (it was used in Spain and the states for years with good results).
“So, I asked the GP about it, but she didn’t know it, she never heard of it and asked me to spell it so she could Google it. I left with nothing other than a sentence “it will pass”.
“A number of weeks passed, and I still felt terrible, so I went back to clinic, but to a different GP. This time she told me she wouldn’t give me any drug as none of them work. She gave me the advice that cold milk and Rice Krispies helped her during her pregnancy.
“I left feeling unsupported, extremely sick and quite down.I went to work one day and I hit rock bottom. I was sent home, I was so upset and ill. I went to GP again – same clinic – now a male GP [previous doctors were female].
“He had a lot more empathy, and wanted to know what I had been taking to help. He was shocked when I said I had attended other GPs in the same clinic and been given nothing to help me. He prescribed me a drug, but it didn’t work. He prescribed another, it didn’t work. Life continued feeling chronically ill and depressed.
“I couldn’t work, so I decided to go into Holles Street Hospital emergency room.
“There I was assessed and prescribed the drug I had originally asked the GP about in the clinic.
“Sickness and nausea stopped within two days of me taking the drug called Cariban. It’s an expensive drug, but worth every penny. I took it for many weeks and then tried to come off it thinking I was through it, but as soon as I did the sickness and nausea came back. I went back on the drug and within days was perfect.
“The drug for me was effective and saved my sanity. I returned to work and got my life back. I think GPs should be trained to be aware of the latest therapies that may be effective, where others have failed.”
Another woman recalls how she was admitted to hospital multiple times as she was getting sick up to 20 times a day.
‘I was sent home from hospital with no help’
“My experience started early on at about eight or nine weeks when my GP sent me to the hospital for a drip as I was dehydrated from vomiting. I continued vomiting until my son was born. I last vomited in the labour ward.
“I went from being told not to eat at all (and vomiting up stomach acid until the vomit turned red) to being scolded for not eating to being assigned a dietician who warned me of the dangers of not eating on my baby. I was given a diet sheet designed for elderly patients with no appetite.
“I then got sent home from hospital with no medication by a female consultant who told me I should limit my vomiting to before or after work like she had done and sent me home.
“As I had only vomited four times that day, she didn’t think there was a need for me to be in hospital unless I vomited more than five times a day. I was readmitted 18 hours later with severe dehydration, having vomited 20 times since leaving including in the lift and car park. I had HG on both pregnancies and I found it debilitating.
“At eight weeks on my first, I was vomiting up to 50 times a day. At one point I went to a GP after not eating for 8 days, and I was told to “lay off the chips, I’m hardly wasting away”.
“There are so many cases our health system cannot deal with the effects of pregnancy, especially the mental health impact. The advice I was given about pre and post-natal depression was to go for a 20 minute walk every day, and if I didn’t feel better, walk 20 minutes in the other direction.”
‘All I could take was small sips of water but nothing was staying down’
“I found out I was five weeks pregnant when I was 23. My nausea got progressively worse, I found I was vomiting quite a number of times throughout the day. I was finding it hard to keep down fluid, so I spoke with the nurse. She suggested I keep drinking water.
“When I advised that everything was coming up, she suggested smaller sips. I maintained that I was taking small sips, but still nothing was staying down. At that stage, she called in a GP who suggested I take an eye-dropper and squeeze each drop onto my tongue individually. He then laughed, told me this was normal, and left the room. Skip forward to two weeks later.
“At this stage, my vomiting was so bad that I hadn’t eaten in eight days. I didn’t have enough energy to leave my bed to vomit, so I kept a bowl on the floor so I could turn my head when something was coming up. I was sipping water, flat 7up, cold black tea (as suggested by the nurse). I even tried the eye-dropper trick. Everything came up. I counted one day. I had vomited 50 times.
“I had pains in my sides which I attributed to being bent over the bowl, I couldn’t shower or bathe. I had called the practice nurse on this, she kept telling me that this was perfectly normal, that it showed the baby was healthy, and that it will end soon.
“At 10 weeks I decided to visit my GP. I got a taxi the 500 metres to the practice and was seen by a locum. She seemed a lovely, grandmotherly type lady upon first impression. I explained my situation to her, breaking intermittently to retch. Again I was told it was normal, that she had five kids, she knows what she is talking about. She suggested I lay off fatty foods, especially chips.
“I explained that I hadn’t eaten in over a week, her response was to look me over and say “Well, you’re hardly wasting away”. She also told me under no circumstances should I go to hospital over this as it is only for “really sick people” and I would be taking up a needed bed.
“Later that night, I was still bringing up this brown sludge, filling bowls of it, when my partner ordered me to the hospital immediately. When I arrived, the emergency room was full so I stayed in the waiting room for four hours with a bucket, as triage indicated I was not a high priority.
“My partner eventually carried me to the bathroom, where I lay on the floor. I couldn’t get up, could barely lift my head. I’m ashamed to remember it, but I had the incredibly selfish thought this if this didn’t stop and I couldn’t continue with the pregnancy. I felt like I was dying, and I don’t say that lightly.
“When I was eventually seen, I was told that I had severe ketonuria from dehydration, and I had ripped a hole in my stomach lining causing my to bring up the blood. I was chastised for “letting myself get into this state”, and told I should be drinking more water.
“I was admitted for three nights, given an injection for the nausea, put on several drips, tests were run on my kidneys, and I was on a course of antibiotics. I was told again that sickness was perfectly normal, showed a healthy baby, and that it was my fault for letting it go so far. On discharge, I asked for something to stop the vomiting – again I was told to keep drinking water.
“I was admitted three more times in the next three weeks for IV drips, and had lost about 15% of my body weight. I was still not provided with a prescription for anti-nausea medication. My complexion was grey, and I had broken blood vessels from my eyes down to my shoulders.
“At 13 weeks, I met my private obstetrician for the first time. He took a look at my history and talked me through the sickness. He explained I had Hyperemesis Gravidarum, which affects less than 2% of pregnant women.
“He took this seriously, gave me actual advice, a prescription, and a referral to an outpatients fluids clinic which I could attend when needed (which I was never provided with before). I continued vomiting until 16 weeks, but never as badly as before.”
When contacted by TheJournal.ie, a spokesperson for the Irish Pharmacy Union said HG can be “very severe” for mothers as it can result in very serious dehydration.
“Mothers can get dizzy and faint from being sick so much and they can sometimes even vomit blood.” If this happens, patients should go straight to their GP, she said.
However, she added that there was no medicine available to help HG.
If a woman presents to the hospital with, she will be placed on a drip, she added.
Drug gives women their quality of life back
Dr Mary Higgins from the National Maternity Hospital in Dublin, said there are medications that can help women in this situation.
Cariban (mentioned in first personal story above) is available in the Coombe, Rotunda and Holles Street maternity hospitals and has been for the last two and half years.
Having done training in Canada, Dr Higgins said she observed that nearly every woman suffering from this condition was on the medicine: “You just didn’t see women being admitted for IV fluids”.
She explained Cariban, a vitamin B6 antihistamine, was first developed in the 1970s.
However, due to a class-action suit taken in the US in relation to a small number of babies being born with anomalies, and due to the concern at the time in relation to thalidomide scandal, it was taken off the market. She said when this happened, there was a huge rise in the number of women presenting to be admitted.
The practice then was to just admit women and give them IV fluids.
However, since the 1980s, there has been a staggering amount of research carried out on the drug.
“It is the most studied pregnancy drug,” said Dr Higgins, who said studies have been carried out on more than 200,000 women.
She said one published paper on the medicine goes so far as to say that it is now “unethical not to give it to women”.
GPs are given regular training in the National Maternity Hospital about the latest therapies available on the market, she added.
“There is still a lot of nervousness out there about prescribing anything during pregnancy. However, other medicines like Sentinel are being prescribed more and that has not been studied as readily as the new one, which has a bigger safety market,” she said.
Dr Higgins said there still is a certain amount of “put up with it” attitude out there but explained, “This condition can really make people miserable – it really comes down to quality of life while you are pregnant and some women simply don’t have that when they have this condition.”
She said the drug does not work on every woman and it is also not available on the medical card. The tablets can cost €1 each and women can take up to four per day, so it can be expensive.
Dr Higgins said that all other methods should be tried before a woman is put on medication. This includes trying ginger, nuts, avoiding spices, and eating low fat foods. She also recommended women visiting a dietician who can give important advice to women during pregnancy.
“Only when all of these have been tried and are not working should medication be considered.”
It is also not recommended for women who suffer with asthma and epilepsy.
Dr Higgins said a new information leaflet is currently being drafted on the new medication and should be available soon.
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