Hyperemesis Gravidarum

• 22 February 2012

I've written this post ten times in my head over the past year and a half.  Why it's taken me until now to actually post it, I don't exactly know.  But, what I do know is that I feel compelled to share my experience with hyperemesis gravidarum here with you...in hopes that something shared here helps the few of you out there that experience this condition (p.s. I'll be referring to it as "HG" going forward). A couple of you have written to me over the years when pregnant and we've consoled each other via email, but I feel like it's important to reach more of you and offer up support in the form of this post...chock full of advice, tips and validation.  I guess you could say I've learned a few things over the course of four pregnancies with this condition. If something I share helps you in the smallest way, it will have been more than worth my time. 

Described by WebMD as "a rare disorder characterized by severe and persistent nausea and vomiting during pregnancy that may necessitate hospitalization", hyperemesis gravidarum affects less than 3% of all pregnant women; so chances are you don't know a lot of women who experience HG.  But if you do, it's important you understand what she is experiencing, as best as you can. She will always remember how you stuck by her side during a horrific period and hold you dear for the rest of her life (I know this because I feel that way about those who helped me!).  Or, more importantly, if you have HG, it's important you have as much helpful, positive information on hand about this disorder as possible.

If you're interested in reading more on the subject of hyperemesis gravidarum, please click "read more" below.  As always, please chime in on the comments if you'd like to add to the conversation and share your own thoughts/tips/advice.  I realize every woman's experience is slightly different than that of another so the more information presented, the better :)  Also, if you have any questions for me, please comment on this post so we can all learn from each other.  Thanks!

update: dear friends, those who suffer from infertility may read these words and think, "well, at least you were able to get pregnant...I'd endure anything, including HG, just to have a baby", and I want to say that those are valid feelings.  My heart goes out to you if you are experiencing this challenge.  Pregnancy, in all forms, is a sensitive issue indeed; all we can do is try to support one another and show empathy for each other's different trials in life. 

When it comes to alleviating symptoms, these are the tips and tricks that worked for me during all of my pregnancies.  Keep in mind that every woman's pregnancy is different, so they may not be the perfect solutions for you; but, they should get you on the right path to your own self discovery.  Also, note that none of my pregnancies were exactly alike--they varied due to the baby's sex, how many children I had to take care of while suffering from HG, and my age.  But honestly, all of the things I've shared below helped me during each and every one of my pregnancies and I can only hope they do the same for you.  Good luck and know that my heart goes out to you during this challenging stage in your life.  Oh, and keep in mind these are not professional opinions, only my personal thoughts.  Please consult with your doctor before taking any of my advice :)

Here it goes--everything I want to share with you about HG--in no particular order:

1.  Women who experience hyperemesis gravidarum are more prone to depression both during and after pregnancy.  Make sure those who are close to you are aware of this as you will likely not be able to self diagnose.  You'll be so miserable and focused on trying to make it through your days that you likely won't have depression on your radar.

2. If you feel like a shell of the woman you used to be, rest assured that it's a normal feeling for those with HG.  Feeling like you're operating at 5% is very discouraging and it's very difficult to smile during these times.  Telling yourself that it's only temporary and that you'll feel like your old self in less than one year is key.  You must remind yourself that this is temporary.  And oh how lucky we are that it doesn't go on and on, like many of the health challenges that other people face.

3.  There is a possibility that you will become so high maintenance and unenjoyable to be around that you'll actually lose a friend (or two) during your pregnancy.  Not everyone is willing to stick around when the friendship feels one-sided (i.e. you have zero energy to put into the relationship).  If this happens to you, know that this happened to me too (and other people I've known or heard about).  In fact, during pregnancy #4 a friend asked via text if I was pregnant to which I confirmed 'yes'; and then I never heard from her again.  As painful as it is, I'm grateful I discovered the meaning of a true friend--an invaluable life lesson. 

4.  Zofran will become one of your best friends.  Originally developed as a drug for cancer patients experiencing severe nausea post chemotherapy, it's now prescribed to women with HG.  I've had 3 different ob/gyns for the 4 pregnancies and each had a different philosophy on the usage of Zofran.  I don't know what your doctors' opinions are, but I do know that while Zofran didn't cure my symptoms, it certainly helped take the edge off under certain circumstances.   I found that Zofran's success was greatly due to it being used regularly and consistently and in conjunction with lots of sleep and lots of water (as much as you can keep down).  I found that 8 mg (max dosage I believe), every 8 hours created my best-case scenario--taken right when I woke up, then 8 hours later, then right before bed.  Thankfully a generic version is now on the market (it used to be $42/pill!) and the cheapest place to purchase it is at Costco. 

During my fourth and final pregnancy, I started max dosage of Zofran as soon as I had a positive pregnancy test (I had a prescription in my wallet ready to go from my ObGyn).  This gave me about 10-14 days of moving the Zofran through my blood stream before the heavy nausea and vomiting symptoms took hold of my body.  I found this approach to be helpful and wished I'd learned it sooner!

5.  You will find that you will at times be required to receive IV's at the hospital or your doctor's office and in some extreme cases, a PICC line.  The latter brought me back to life during #3 and while my experience with it was a positive one, it's a dangerous course and is truly a last resort.  Scheduling your IV's with your obgyn (versus going to the ER), will cut down on your health care costs if this is a concern for you as it was for me. 

6.  Lack of sleep exacerbates Hyperemesis Gravidarum so try to get as much shut-eye as possible.  I can't emphasize this enough! During pregnancy #4, I basically had to go on bed rest for the first 4+ months, just to stay alive it felt like.  My husband prepared a simple breakfast everyday of the one thing I could keep down (a scrambled egg with gray sea salt) and brought it to me in bed because I found that trying to put something in my body before getting out of bed greatly increased the chances of it staying down.  After eating your light breakfast, linger in bed a little longer so the power of gravity can make an attempt at helping you out. When you do get up, take it slow. 

7.  Drink as much water (or another liquid you can keep down) as you can.  Try taking frequent, little sips throughout the day.  Maybe warm water will taste good to you, maybe icy cold water with a cucumber slice will do the trick.  I typically found that cool (not warm, not cold) water worked best from me if sipped through a straw.  Super random, I know, but it worked for me.  Find out what works for you, what sounds good, and you'll have a better chance at trying to stay hydrated (very important!).  If you're drinking Gatorade, try the lemon-lime flavor...it's the only one I could sometimes keep down.  Only one.  Lemon lime...not the lemonade :)

8.  Well meaning friends will try to offer you things like ginger, tea and saltines, thinking these will help you feel better.  Say "thank you" and be gracious, but keep in mind that any redeeming qualities these forms of nourishment have do not apply to those with HG.  I won't tell you how often I vomited Saltines, but suffice it to say I do not ever want to eat one again in my entire life.  HG is so beyond crackers and ginger when you're trying to keep down a tablespoon of water. 

9.  Positive self-talk is super important and somewhat relates to the depression mentioned earlier.  I found that making attempts to talk myself out of vomiting helped control the severity of my situation when I was at a point where I could rapidly digress or try to somewhat stabilize myself.  Not always, but sometimes.  I learned to control my mind in a way, and while it never took away the symptoms, it often provided my body with a much-needed distraction.  I know the number of hospital visits I experienced would've increased had I not practiced the power of positive self talk.  You may think this sounds hokey but I promise it works.

10.  Be social...well, as much as you possibly can endure.  I found that I rarely threw up when I was in the company of friends and family (just after and before!).  I'm not exactly sure why this was the case, but I can only deduce that the social exchange was a healthy, mental release from the disorder taking over my life.  These face-to-face interactions presented an opportunity for me to try and feel normal.  Often I didn't have the capacity or desire to be social (even though I knew it would help), so my husband typically created and encouraged them for me.  You too may find that you feel the same, in which case you'll need to enlist your spouse to help.

11.  If you find that you can't keep anything down, try a potato--baked or roasted.  This heavy son-of-a-gun has a difficult time making it back up (thank you again gravity!) and is actually full of nutrients (in the skin mostly).  There was a time when all I ate for 9 weeks straight were roasted potatoes.  I popped them in, one at a time, and offered a silent prayer with each bite :)

12.  Find a series that you genuinely enjoy--one that provides a mental escape.  For me, it was LOST; for you, it may be Downton Abbey.   I'm not a big TV person, in fact, we haven't had cable since 2003, so making this recommendation is definitely saying something.  When you have HG, it's all about survival and you have to do what it takes to make it through another day.

13.  HG is often a genetic issue, but not always.

14.  HG becomes more severe with age and is slightly more challenging when you're carrying a girl.  

15.  Know that upon giving birth, you will feel instantly better.  The Hyperemsis Gravidarum will be gone and you will feel like a normal woman who just gave birth to a baby.  Instead of dreading labor, my attitude was "bring it on!" because I just wanted to feel well again.  The anticipation makes the event even more exciting.  Plus, instead of thinking the hospital food is gross like every other patient, you'll laugh while you're eating it with delight because you'll just be so darn happy you can eat again and know that you will in fact keep it down.  It's a wonderful feeling an I laugh every time I think about how happy I was my tray was delivered to my bedside.  Bliss I tell you!

As mentioned earlier, feel free to share your own stories, tips or questions.  I'm happy to help in any way I can!

image via Justin Hackworth (he also took these pregnancy pics); thank you Justin!


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