This is part two in our series on nausea in pregnancy. You can find part one, “158 Things That *May* Help Morning Sickness” here. Unfortunately, there are times when none of those previous tips are going to cure your nausea and vomiting.
What is HG?
The HER Foundation defines Hyperemeis Gravidarum (HG) as ” a severe form of nausea and vomiting in pregnancy. It is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. If severe and/or inadequately treated, it is typically associated with:
- loss of greater than 5% of pre-pregnancy body weight (usually over 10%)
- dehydration and production of ketones
- nutritional deficiencies
- metabolic imbalances
- difficulty with daily activities”
You can find the differences between normal Morning Sickness and Hyperemesis Gravidarum here.
My HG History
I am personally a HG survivor from each of my pregnancies so far. I say survivor because it was a dark time of just surviving to another day. It has been one of the hardest sacrifices I have ever made for another human being. With my first, I didn’t know why my “Morning Sickness” was so much worse than everyone around me. I went undiagnosed and was continually dismissed by medical staff. I pushed through, somehow, working 12 hour shifts when I hadn’t kept anything down in two days. Working while so severely dehydrated I was continuously on the verge of passing out. I’d sip apple juice and praying it would stay down, only to go and vomit it all back up. I remember crying when the Dr at Instacare said that I “seemed well” and that I just needed to try harder. I have the ability to come off really positive in the worst of situations. I also hate to complain. It was really hard to advocate for my IV fluids. Thankfully a sweet nurse saw me completely breaking down (with no tears because of dehydration), and pushed for my fluids and IV Zofran. It was my first baby, first round of HG and I had no idea what I was dealing with. I didn’t know what I needed. I didn’t know what options exited. I was just healthy enough to avoid emergency, but every day, every hour, every moment was survival. I now know what normal pregnancy is like, and how many warning signs I had. In that same situation now I would go straight to the ER to be fully evaluated instead of the urgent care or calling my Dr and getting tips like crackers.
I have continued on with 3 more HG pregnancies. Crippling in daily activities. Unable to work. Unable to clean. Unable to give my kids very much attention. Unable to feed them without dragging my weak self to the kitchen to throw up multiple times while there. I have been blessed to survive HG without organ failure, inpatient hospitalizations, or feeding tubes. For me personally, Zofran and IV fluids saved me. I still had to battle with my insurance that refused to give me enough medicine. This resulted in the inablitiy to keep anything down for days and end up back in for fluids and IV medication.
What I’ve Learned
I am not alone. You are not alone. There are communities of HG support. While I never found them when pregnant, being apart of them now, is still healing and supportive. I will list some below in the Support Resources section.
Find help. If you can possibly afford it, hire someone to come in to clean or help with childcare. You may have some good days where you can take care of your other kids. However, using all of your strength on catching up on chores, trying not to pass out, trying to keep swallows of water down, isn’t the most important thing for you to do. There are doulas that will come in and help during pregnancy. Some are called Antepartum Doulas or Bed Rest Doulas. Many Postpartum Doulas will also do this. The role is pretty similar. I have yet to officially serve in this role, but would be more than happy to. Maybe family, neighbors, church community can chip in and help.
You may have to educate others on HG. Sometimes people think that mom’s with HG are exaggerating. However, I have learned that usually HG moms don’t tell the full story. They may say that they’ve been sick that day. When the reality is that they have been laying on the bathroom floor for hours unable to do much more than pull themselves up to the toilet every time their stomachs collect enough spit or stomach acid to have fluid to throw up again. Print out resources. Explain to others that this isn’t just morning sickness, that this is a serious condition that can and has lead to organ failure and even death. It is essentially starving to death. There still may be those that don’t understand, but hopefully you are able to get enough people that understand to have the help you need.
Along with this, if your medical provider is dismissing your condition, find a new one. There are amazing doctors out there that are wonderful with HG. There are also those that do not understand it, or aren’t educated in proper ways to handle it. Some providers are very naturally minded and may want you to try more natural solutions first. However, sometimes, medicine is needed and life saving. Be honest with your provider. Be your own advocate. It is okay to complain to them. As in all things if you don’t feel like you are being taken care of, get a second opinion. There are so many options for HG.
Kids are strong. Often moms feel like such failures to be unable to give their kids the attention they want. It can be such a sacrifice to not be there for your kids how you want to. Safety is, of course, very important. Make sure your kids have a safe area and what they need. However, giving them more tasks to do and responsibility can be good for them. I worried so much about my older two children when I was pregnant with my third. However, after my pregnancy, I was amazed at how much my kids had grown. They became more independent and worked better together. Seeing me sick certainly wasn’t easy for them, however, it also showed them a glimpse of all that I have done for them. It showed them that sometimes things are hard, but we can still make it through.
If you don’t know your options you don’t have any. Providers can be wonderful sources of information. Often you have to ask. Ask your provider. Search the HER Foundation and talk with others out there. Keep searching and learning. I am amazed at all of the resources available. So many that I didn’t know anything about during my pregnancies.
First and foremost needed is support. There is the HER Foundation. It stands for Hyperemesis Gravidarum Research. There is a whole community there. They have comprehensive medical information, medicine options, volunteers in your area to talk to, and so much more.
There are many Facebook Groups. A big one is Hyperemesis Gravidarum (HG). There are currently over 7,000 members. It is a great place to be heard and validated. They also have many resources and links to other HG groups that are more localized or based on religion, military, etc.
There is a blog of stories from HG surviors, titled We Are Hyperemesis.
Medical Treatment Options
Protocol: The UNC School of Medicine has an alogrithim for HG. It can be found here. It may be helpful for you and your provider. It outlines what treatments may be needed when.
Medications and Methods of Delivery: There are many different medication options, anti-nausea, anti-emetic, steroids, and more. I have not listed many details or doses about the medications below, since I am not trained to do so. You can learn more about them by talking to your provider, and visiting the HER medications section, found here.
IV Fluids. Dehydration can make your nausea and vomiting worse. If you can’t get ahead of it, and are showing signs of dehydration. Seriously consider going in for some IV Fluids. An IV placement can last up to a week depending on clotting, infiltration, and infection.
Midline Catheter. This can be used in place of IV access. This can be left in up to a few weeks. It goes about 3 inches into the vein.
PICC line for fluids and medications. This is for prolonged access. It reaches much further than the Midline Catheter. It enters a vein in the arm and extends until the Superior Vena Cava.
B12 and Unisom or Diclegis
Nexium or Protonix
Zofran recommended with daily Miralax for constipation side effects. Zofran has several different forms and each one works differently for different people and even at different times.
- Zofran ODT: This is the Orally Disintegrating Tablet. It has a stronger taste and may cause a gag reflex in some individuals. It also tends to have more of the possible headache side effect. It can be helpful for those that cannot keep down a swallow of water. However sometimes the taste leads to throwing up. Even if you do throw up immediately after, it usually will help for the next few hours.
- Zofran HCL: This is a pill that you swallow. They come in different sizes all on the small side. If you can take it with a half swallow of water and keep it down for about 15 minutes then it should have some effect.
- IV Zofran: If you are going in for IV fluids often IV Zofran will also be given. There isn’t the worry of throwing it back up. For some individuals a dose of IV Zofran with IV fluids can help for a few days. For others they need it more regularly.
- Zofran Pump: Similar to an Insulin Pump set up. This is an option for some women. It has the benefit of frequent doses without vomiting complicating it.
Kytril/Granisetron/Sancuso Patch: An alternative to Zofran. It is not as well known. You can bring it up with your provider and ask them to research it with you. Constipation can also be a side effect.
Reglan: Works for some, strong negative reaction with others.
Medical Marijuana is a controversial substance that doctors sometimes suggest in areas where it is legal. However, in those areas where it is not legal, drug testing can occur at any time in pregnancy and postpartum. Positive results can lead to CPS interactions and possible child endangerment charges.
Nutritional Therapy: It is important to get the needed nutrition. For mothers barely able to stay hydrated they are often malnourished. See more here. These are some ways that HG moms may get those nutrients.
- IV Vitamins and Minerals
- NG tube
- Central Line
Other Therapies: There is a list of descriptions of therapies by the HER foundation (they are a wealth of knowledge). You can read more here. Some of these are listed below.
- Complimentary and Alternative Medicine (CAM). This can include Energy Work and many others. They usually do not “cure” HG but can decrease the effects.
- Behavioral Therapy
- Bed Rest
- Sensory Deprivation Therapy (SDT)
What Can You Do to Help Someone with HG
- Listen, and validate. You do not have to understand exactly how she feels. Many of the complications of HG are similar to those going through chemo. She is not making it up. It’s more common that she is downplaying how much she is actually going through.
- Know she is not doing something wrong to cause HG. She is probably trying with all that she has to eat and drink, but her body is fighting against her. Be compassionate. If she could fix it, she would.
- Know that what works for one woman, might not work for another. She has probably gotten most advice out there. Feel free to share, but do not approach any possible help as a cure.
- Do her dishes. Washing dirty dishes from people’s food remnants can trigger even more vomiting. This increases if she hasn’t had the strength to do the dishes every day and they sit for a day or so. It can be an unbearable task. She also may be fighting passing out from weakness just to stand to do them.
- Help with chores, house and yard. Her partner may be helping out more with the house and kids. If the lawn needs to be mowed, do it.
- Drop off ready made food for her or other family members. Does she have kids at home? Send over some sandwiches in zip-lock bags and some snacks that the kids can get themselves. Preparing food is a big trigger for many women with HG.
- Offer to babysit. This could be for a nap, while she’s sick, or for her to go get IV fluids and treatment.
- Don’t expect her to do as much. Getting out of the bathroom may be a feat, let alone getting out of the house. Please be patient if she has to flake out of lunch dates or PTA assignments.
- Offer her a ride if she ever needs to go in for an IV or other care. Many women, myself included, have held off in severe dehydration longer than they should because they aren’t stable enough to drive themselves.
- Pray for her if she is okay with that.
- Encourage her to take her medication if she needs it. Some moms feel guilty to take their medicine and worry about the effects on their babies. However, there is a much bigger risk of side effects from severe malnutrition. If the medication helps mom stay hydrated and healthy then it ise helping baby. If it isn’t helping or having negative effects on mom then that’s a different story and something for her to talk over with her provider.
- Ask what she needs.
Hyperemesis Gravidarum is a severe and serious condition which has no cure. It can sometimes be helped by those things from Part One. However, they do not fix it. Often medicines and nutritional therapy is needed. It is important for HG moms to have understanding support and help with the day to day life. This will not last forever. It may last the entire pregnancy, however, thankfully pregnancy does not last forever. If you have HG, please take care of yourself and get all the care that you and your baby need. Wishing all those struggling, relief, calm stomachs and good days. I hope you find something that helps in your unique situation.