Wednesday, 28 September 2011

Hyperemesis Gravidarum Pregnancy Two: Part One - Descent into sickness

Since I was so ill in my first pregnancy (too ill to look after myself let alone a baby or toddler) we felt we needed to allow a large age gap before another pregnancy in case I was ill again and A was 3 1/2 when I next had hyperemesis gravidarum.  In some ways I was relieved when I realised it was a hyperemesis pregnancy as I had recently had miscarriages of non-hyperemesis pregnancies and the sickness made me feel more confident of a good outcome.  (In my first pregnancy the doctors kept telling me that the good news about having bad sickness was a much lower risk of miscarriage but at the time when you are that sick you don't really care.)

In the intervening years since my first pregnancy I had forgotten how bad it was.  In some ways the actual sickness is not the worst thing.  The worst thing is that people do not believe how bad it is.  I had people say that they were able to carry on working during pregnancy because they just had to keep going even though they felt sick.  As if I could keep going but was just choosing not to.  Many people who have only had morning sickness seem to think that the reason you are ill is because nobody has told you that you just need to eat ginger or eat before you get up in the morning or eat crackers or whatever it was that helped ease their much milder sickness/nausea.

As a result I actually started looking into how serious hyperemesis gravidarum is.  Until the introduction of intravenous rehydration in the 1940's it was actually the leading cause of death in pregnancy:

"Hyperemesis gravidarum was a significant cause of maternal death before 1940. In Great Britain, mortality decreased from 159 deaths per million births from 1931-1940 to 3 deaths per million births from 1951-1960. Charlotte Brontë is thought to have died of hyperemesis gravidarum in 1855. In the United States, 7 deaths from hyperemesis gravidarum were reported in the 1930s. Today, although hyperemesis gravidarum is still associated with significant morbidity, it is still a rare cause of maternal mortality.
Hyperemesis gravidarum is a debilitating illness that can cause severe suffering, which profoundly affects both patients and their families. In about half of the women there is an adverse effect on spousal relationships, and 55% have feelings of depression. In one study of 140 women with hyperemesis gravidarum, 27% required multiple hospitalizations.
(from ).

It was only at this point that I realised that without the IV fluids, it is quite possible that I might have died in my first pregnancy.

I saw my GP for an anti emetic but within a week I went back because I was being so sick.  Unfortunately whilst not easing enough for me to not be losing weight my sickness did vary enough that when I saw him I was not ketotic so he sent me home with a different anti emetic and told me to come back if I got worse and that if I became ketotic he would refer me to the hospital.

The rest of that day (Monday) I wasn't sick but the following day I started being sick again and when I checked in the afternoon I was ketotic so I asked J to book me a doctors appointment for first thing Wednesday morning.  As the evening progressed I realised that I needed to be admitted to hospital for IV fluids so J phoned the out of hours service.  The doctor he spoke to said that he should bring me in and if I tested positive for ketones he would have me admitted to hospital.  Unfortunately by the time we got there (after J had packed me a hospital bag and got A up and ready to go out) there had been a shift change and the doctor who saw me seemed to think the best possible thing was to keep me out of hospital for as long as possible and gave me a buccal version of the anti emetic I already had.  This did make me well enough to take a few sips of water overnight and the following morning I saw my GP who promptly referred me for hospital admission.

The previous time I had been in hospital for three days and had improved fairly quickly so since I had managed to control the sickness better (due to experience) and had only lost five pounds by the time I was admitted I was fairly optimistic that I would soon be improved and thought I may only be in for two days which would have allowed me to be home before Christmas Day.  Unfortunately this was not to be.

Wednesday, 21 September 2011

Hyperemesis Gravidarum Pregnancy One

Before my first pregnancy I had never even heard of hyperemesis gravidarum.  I had heard of morning sickness and knew that some people had it bad enough to need medication but I had absolutely no idea that pregnancy sickness could be so bad.

The first time I was sick was at three weeks pregnant.  The next week I hardly got anything done because I felt rotten and then when we went on holiday the next week we had to greatly reduce our planned walks as I just couldn't manage them without feeling very ill.  Little knowing how bad it would get, it was actually a great relief when I got a positive pregnancy test at five weeks as I'd been beginning to wonder if something was seriously wrong with me.

Around five and a half weeks I had to see the out of hours doctor because I was unable to keep anything down and was given an injection and some tablets to take.  Over the next week as they didn't work I was given various different tablets and the morning after being told by two different out of hours doctors that I did not need to be admitted to hospital I saw my GP who actually took notice of the fact that I'd lost a stone in weight and referred me to be assessed at the hospital.  The doctor who admitted me thought I was so bad that he actually set up the drip himself almost immediately and asked us why we'd waited so long.  Because I was so dehydrated he had to ask for a child sized cannula as my veins were so small.

After three days of IV fluids and medication, I was well enough to be discharged.  When I asked about being given medication to take at home I was told that they don't give you medication when you leave and you just had to be readmitted if you get bad enough.

Even after I'd been in hospital, people generally didn't seem to realise how ill I was.  One person asked how I'd managed to be admitted to hospital when she hadn't but then in the next breath said that she only took the anti emetics if she was sick three times in a day as it interfered with her life too much to not be able to drive.  At the time I would have loved to only be sick three times in a day and for anti emetics to actually make a difference.  And driving was a moot point since I was so ill I had no life for lack of driving to interfere with.

Although I was sick all the way through the pregnancy, it did decrease over time to the point that in the second half of my pregnancy I was occasionally able to manage the three minute walk to the doctor's surgery for my midwife appointments.  One day when visiting some friends we went for a walk but two minutes down the hill J had to go and get the car to drive me back.  In the early days when I was too ill to read or sit at the computer I watched daytime TV to relieve the boredom of sitting at home on my own all day doing nothing other than attempting to eat and drink and not be sick too much.  Unfortunately daytime TV is mind numbingly boring and I was very relieved when I felt well enough to read albeit only easy reading such as children's fiction.

My typical day in pregnancy looked something like this:
0800: Eat breakfast in bed, clean teeth in bed and go back to sleep.
1100: Get up. Watch TV or read a book.
1230: Get dressed with J's help (he came home for lunch almost every day while I was pregnant to look after me). Talk to J while he makes lunch then eat lunch.
1315: Watch the news/other TV.
1430: Do a few admin jobs on the computer if well enough.
1530: Watch TV/DVD/read a book.
1630: Sleep
1800: Get up and watch the news.
1900: Eat dinner then watch TV/read while J washes up and does a few other jobs.
2100: Go to bed.

I quite often had a long bath in the evening to break up the monotony but it was quite tiring and created even more work for J who was already working full time, doing everything essential that I usually did and looking after me.  I was constantly tired but at least sleeping 12-16 hours a day meant that I didn't have so many hours of feeling sick, tired, bored and lonely to endure.

The transformation when A was born was amazing.  Two weeks before she was born, I would hand J paper tissues to put in the bin because the bin was a meter away but two weeks after she was born I was easily going for two mile walks every day.  In the week after she was born I did more household jobs (not counting baby related tasks) than I'd done in the month before (possibly even more than the whole pregnancy - I only cooked one meal beyond four weeks pregnant).  Some friends thought it was strange that I was happy to stay at home all day and wasn't bothered about meeting up as they said they would get lonely staying at home "on their own" all day.  But for me the contrast with pregnancy was so huge that I was perfectly content.  I wasn't sitting at home on my own any more - I had A with me and I was no longer doing nothing so I was too busy to be lonely.  I actually felt quite baffled that suddenly people wanted to meet up/visit now that I didn't need it after I'd been stuck at home on my own for months on end without them ever offering to visit.

And that was my first pregnancy.

Saturday, 17 September 2011


The purpose of this blog is twofold.  Firstly it is a place for me to record my own experience of and thoughts on hyperemesis gravidarum and secondly it is shared in the hope that it will cause others to be better informed about an illness which due to lack of knowledge and understanding causes both great misery and loss of life.