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What is acute morning sickness?

Date

Linda McSweeny

Don't suffer alone ... help is at hand for hyperemesis gravidarum sufferers.

Don't suffer alone ... help is at hand for hyperemesis gravidarum sufferers.

English novelist Charlotte Bronte died an awful death in 1855. Faint, exhausted and a slave to incessant nausea and vomiting for months, the fragile writer was unable to stomach food and water despite wearily trying to summon strength.

Dehydrated and delirious, with no modern medicine to save her, Bronte died while four months' pregnant from the effects of an illness still inflicting misery on pregnant women - hyperemesis gravidarum - excessive, persistent vomiting and nausea which can linger for an entire pregnancy. It drives some women to terminate.

"A wren would have starved on what she ate during those last six weeks," a friend of Bronte's is reported to have said.

Left untreated, hyperemesis patients lose weight because they are unable to eat or drink without vomiting.

Sydney GP and sufferer Dr Melinda Griffiths likens the feeling to a continuing bout of gastroenteritis. It's like being on the cusp of vomiting, without respite.

"You can feel your mouth drooling, you feel really, really nauseous. You can't get comfortable. It feels like you're stuck at that point because even after a vomit you might get relief but if you do it will be short-lived. I felt well enough for five, 10 minutes and then it would come back. It just felt like being caught in that stage for week after week," Dr Griffiths says.

In 2010 women are usually spared the same deadly fate as Bronte thanks to intravenous fluids and anti-nausea medication, but nobody really knows why the condition afflicts up to 3 per cent of pregnant women.

It has been suggested heightened sensitivity to the pregnancy hormone human chorionic gonadotrophin (hCG) in the blood may be the culprit. While there are many unknowns, there are some risk factors - those who have had a previous hyperemesis pregnancy and those carrying twins. Its recurrence rate has been estimated at up to 95 per cent.

A University of Southern California geneticist, Harvard PhD graduate and former sufferer, Dr Marlena Fejzo, thinks genes play a part.

Dr Fejzo's research indicates women whose mothers had hyperemesis are 30 per cent more likely to get it, while the rate is 20 per cent for those whose sisters experienced it.

"There's kind of a misconception about genetics that people think I'm just doing this so we can have a genetic test for it but that's not the reason,'' Dr Fejzo says. ''That might come out of this but the real reason is once we find the predisposing genes, we'll have an idea of what the biological cause is.''

Dr Griffiths vomited blood while sick for 10 weeks with hyperemesis, with massive weight loss. She recovered well and has a healthy child. But as soon as she told others of her plight, stories of terminations emerged.

"When I was really sick I had two close colleagues who were really lovely and sympathetic [about my illness] and told me they actually ended up terminating because they felt they couldn't continue, it just felt so awful," Dr Griffiths says.

"I don't think I can put figures on it [the number of women terminating] but I certainly think it's a reality."

About 15 per cent of women sufferers surveyed by the Hyperemesis Education and Research Foundation said they had at least one termination due to the condition.

Dr Griffiths, who was admitted to hospital three times while pregnant and says she was depressed until the illness passed, thinks the issue of severe nausea and vomiting in pregnancy (NVP) is trivialised. She says concerned pregnant women should seek medical attention.

"I wasn't able to work … I took to my bed. My husband would come home at the end of the day, empty the vomit bowls and cook me food which inevitably I would vomit up again, he would help me down to the shower in the morning. I think I saw two friends in that time because I was absolutely overwhelmed with what was happening and mortified that this very much wanted pregnancy had turned me into this vomiting person who wasn't able to do her job or communicate properly with anybody," she says.

Sydney mother-of-two Tegan Hole had terrible nausea and vomiting throughout her pregnancies but says she tried to play it down because she felt it was part of having children and that she had to be stoic and not whinge.

"I think the main reasons I had really bad days were dehydration and exhaustion," Hole says, likening it to constant motion sickness.

"Emotionally I was a wreck. I had no energy for myself, my partner or, in my last case, my child. I felt I was not providing anyone with what was needed and subsequently I suspect I was possibly depressed."

Malavika Vaikunta, of Bellevue Hill, who is enduring hyperemesis for the third time and is due to give birth next month, says the illness forced her to quit her job while pregnant.

"Nine months is a long time to be controlled by something that should be nothing but a pleasurable, joyous experience," she says.

"Basic things like taking a shower, bathing my child, washing my hair etc felt like a monumental challenge at the peak of my illness. Walking into grocery stores, past restaurants or watching a food ad on TV would trigger a gagging reaction. I just wanted to sleep all the time in a dark room and wake one day and have the baby. It is a very debilitating feeling. On some days I felt like the ground was slipping away beneath my feet."

Dr Debra Kennedy, a clinical geneticist and director of MotherSafe, a service for those concerned about exposures during pregnancy and breastfeeding, says women's attitudes that pregnancy must be "toughed out" are often compounded by unsympathetic health professionals who are reluctant to suggest medication.

MotherSafe recommends women start treatment with a combination of the drug Doxylamine - which helps with sleep - and vitamin B6 because it is considered safe.

But Sydney obstetrician Dr Siobhan Lee says "the great silently suffering majority" do not seek medical help and it angers her that hyperemesis and nausea and vomiting in pregnancy "are brushed off as transient, inconsequential conditions except when someone requires hospital admission because they cause a lot of morbidity that is avoidable".

"I believe that there is complacency within the community regarding NVP and HG and an attitude that 'it is just part of pregnancy so deal with it'. That attitude is unhelpful and in fact harmful because it prevents many women seeking treatment," Dr Lee says.

Not all treatment involves medication, she says, with acupuncture, sleep, regular snacks, vitamin B6 and ginger all shown to help.

Clinical nutritionist Tabitha McIntosh concurs with Dr Lee, saying she often treats women with ginger root, vitamin B6 and chromium and recommends three-hourly protein snacks, as tolerated.

Dr Lee believes there is weight to the argument hyperemesis is genetic, as does obstetric physician Dr Sandra Lowe, who works at the Royal Hospital for Women and Prince of Wales Private Hospital and sees two or three hyperemesis patients each week.

Dr Lowe says prompt, aggressive treatment is often effective and can be given safely in early pregnancy. At Royal Hospital for Women, treatment includes medications and intravenous fluids at a day-stay unit. Women should be aware much can be done to reduce their suffering and prevent symptoms in future, she says.

"I think one of the hardest aspects of having hyperemesis is being so out of control," Dr Lowe says. "You can't manage your own symptoms. You can't eat, you can't drink. You get all those negative thoughts about the pregnancy and the baby. The way we manage this is to support women and place control back in the women's hands."

Emergency doctors and obstetricians need to be better educated about hyperemesis and women need to be more proactive in recognising when they need help, she says.

"Women are often told to just put up with it, it's just part of being pregnant,'' Dr Lowe says. ''Education is needed to improve both recognition and management of this poorly understood condition. It certainly doesn't help to blame the woman."

At Royal Prince Alfred Hospital, clinical practice guidelines have been introduced for treating pregnant women who present to the emergency department with severe nausea and vomiting.

Emergency staff specialist Dr Kendall Bein says the emergency department has a short-stay admissions unit doctors can use for hyperemesis, and the new approach gives women back some control over their illness.

"We have an approach which is based more on the principle of trying to keep them well in the community. We'd rather have them able to come in … be treated quickly and effectively before they get very unwell and be able to go home within a few hours well again," Dr Bein says.

 

70%

of pregnant women are affected by nausea and vomiting

 

0.3%-3%

of pregnant women experience HG

 

5%

of body weight - the minimum weight loss of women with HG

 

16 weeks

the gestation period when HG usually settles down in most women. A small minority can experience severe symptoms up until delivery

 

15.2%

of women sufferers surveyed in a Hyperemesis Education and Research Foundation survey said they had had at least one termination due to HG

 

95%

the recurrence rate for HG

 

Charlotte Bronte

(1816- 1855)

''She was attacked by new sensations of perpetual nausea, and ever-recurring faintness. After this … had lasted for some time, she yielded to [her husband] Mr Nicholl's wish that a doctor should be sent for. He came, and assigned a natural cause for her miserable indisposition; a little patience, and all would go right. She who was ever patient in illness, tried hard to bear up and bear on. But the dreadful sickness increased and increased, till the very sight of food occasioned nausea …

Martha tenderly waited on her mistress, and from time to time tried to cheer her with the thought of the baby that was coming. "I dare say I shall be glad sometime," she would say; "but I am so ill - so weary -" Then she took to her bed, too weak to sit up … Long days and longer nights went by; still the same relentless nausea and faintness … About the third week in March there was a change; a low wandering delirium came on; and in it she begged constantly for food … She swallowed eagerly now; but it was too late.''

 

From The Life of Charlotte Bronte, written by her friend Elizabeth Gaskell


For more on parenting and pregnancy see essentialbaby.com.au

29 comments

  • My sister had this severely with her last two out of three pregnancies and was vomiting from very early in pregnancy right up to giving birth. It never got better her whole pregnancy. She was vomiting from it even while giving birth and had to be admitted to hospital and put on a drip at least several times during pregnancy as she had dehydrated due to it.

    i really dont know how she managed to go throu all that.

    Commenter
    taniaaust1
    Location
    Sth Australia
    Date and time
    June 03, 2010, 10:54AM
    • I suffered sever hyperemesis with my first child, and the physical and emotional toil was almost unbearable. I was unable to take care of myself and took to my bed for about 18 hours in the day. The other six were spent lying on the sofa in an attempt to be 'sociable' when my husband returned from work and to give me a change of scenery. By nine weeks I wasn't even keeping sips of water down and spent many tearful hours sitting in the bathroom by toilet. Needless to say I ended up in the ER on a drip and on medication until the third trimester, but this only gave me respite for 30 minutes (I could only take the tablets once very six hours). But that 30 minutes was a life saver. I cannot explain the debilitating effect of feeling on the verge of vomiting 24 hours a day, and I am grateful for this article if it encourages women to seek help before the condition goes too far. HG is not just 'bad morning sickness' therefore can't just be dealt with (which is the uneducated and ignorant opinion of many). And it scarrs emotionally for many years to come after your beautiful baby arrives. Thank you for treating it seriously - and for encouraging expectant mothers to seek help.

      Commenter
      Distressed
      Date and time
      June 03, 2010, 10:57AM
      • 21 years ago I was pregnant with my third child. I had been very sick with the previous two but this one was worse. I vomited for months. One night I had sent my husband with the 2 kids to Christmas Carols and then I started again, I kept thinking I had to drink to prevent dehydration but it was just a never ending cycle for hours and hours. It did settle down after months but then the heartburn and reflux started. There was no question of a 4th child, we both rushed to be sterilised.

        Commenter
        bmg
        Date and time
        June 03, 2010, 11:06AM
        • How terrifying :(

          Commenter
          Jess
          Location
          Mascot
          Date and time
          June 03, 2010, 11:11AM
          • That's so sad :(

            Commenter
            Shelley
            Date and time
            June 03, 2010, 11:17AM
            • I had hyperemesis for 2 pregnancies, and so did a maternal aunt (but not my mother). For the first pregnancy I took Debendox which helped, but then there was all the controversy over that particular drug and it was unavailable by my second pregnancy. This of course was not long after the Thalidomide catastrophe. On the second pregnancy I remember having to go to my GP about twice a week for an injection (of?) to prevent vomiting, in the first few months. Without this medication I would certainly have become dehydrated and ended up in hospital or terminating as my aunt had been forced to do decades before. The problem resolved by about 5 - 6 months in my case. It was dreadful and I am sure my family history is also evidence for a genetic effect of some kind. Perhaps the Thalidomide disaster (it was a "morning sickness" drug - for those too young to recall) turned researchers off. Whatever the reason, it is certainly past time to develop better treatments now that women's health is maybe getting some attention. It is not all about breast cancer and The Pill!

              Commenter
              pattythepleb
              Date and time
              June 03, 2010, 11:40AM
              • This happened to me and I was so sick I contemplated suicide just to make it go away. I constantly had ideas of just walking to the end of the street and throwing myself in front of a bus. If it wasnt for the fact that there was no way I could physically get to the end of the street (I would have already thrown up 5 times by then - as soon as I got out of bed... walking to the toilet... having a shower... getting dressed... again at the front gate....) and the fact that I had already been scheduled for a termination (I knew I just had to hang on for a few weeks) I probably would have done something.

                I am never having children as I have no desire to go through that again. It was, and remains, one of the worst experiences of my life.

                Commenter
                Never Again
                Location
                Victoria
                Date and time
                June 03, 2010, 11:40AM
                • Thanks for posting this article and highlighting this horrible illness.

                  I am working through PTSD brought on from suffering HG for an entire pregnancy and also coming to terms with the realisation that I will never have the large family I had hoped for. It has been a life-changing experience I would not wish on my worst enemy.

                  If there is one thing readers should take from this article, it is: if you see a woman (loved one, friend, co-worker) suffering bad "morning sickness" please talk to them about HG and get them to ask their Dr for more info. If treated in early stages, the effects can be minimised and some of their suffering eased.

                  Commenter
                  scarred
                  Date and time
                  June 03, 2010, 11:54AM
                  • I was so pleased to read this because it made me realise that I wasn't alone! I have so many friends who, in the early stages of pregnancy say, "I have really been suffering from morning sickness" and when I show sympathy, they add, "yeah, I felt so sick this morning I nearly even threw up"!!!!

                    I vomited several times a day from about 3 weeks into my pregnancy until about 22 weeks, carried a vomit bucket everywhere I went, discreetly tucked into a large paper shopping bag and worst of all, worked in a restaurant at the time! I took several weeks' sick leave and often took food to a customer and then had to run to the toilets and vomit. Fish & chips was the worst!

                    I was offered a prescription for Maxolon, but declined because of worries about effects on the baby, but in hindsight would definitely try it for future pregnancies.Blackmores do a B6 ginger travel sickness tablet which is great, but because the tablets were so big and my gag reflex so strong, I would often just vomit them back up as I tried to swallow them...

                    I only discovered acupuncture in my third trimester to deal with carpal tunnel syndrome and oedema, but would definitely try it for future pregnancies to try and control the nausea.

                    I was really relieved when my acupuncturist pointed out that 6 months of almost constant nausea can be a trigger for serious depression and resentment of the baby because she honestly spelled my feelings out for me.

                    I am too scared to try for another baby (our daughter is five) because of fear that I will face this again, and reading the figures above (95%!) isn't reassuring at all!

                    Commenter
                    mum of one
                    Location
                    Sydney
                    Date and time
                    June 03, 2010, 11:54AM
                    • lol @bmg - YES! as soon as the nausea stop, the heartburn and reflux kicks in! I find even now, 5 years after giving birth that I still get very bad heartburn and have a much weaker stomach for motion sickness or hangovers.

                      Does anyone else who has suffered from this find that they rarely drink excessively any more or do anything that might trigger nausea (boat trips etc) because they feel like that they have vomited more than their fair share for one lifetime?!

                      Commenter
                      mum of one
                      Location
                      Sydney
                      Date and time
                      June 03, 2010, 11:58AM

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