Hyperemesis Gravidarum Pregnancy Four - Eight Weeks

Today at around eight weeks I was sick for the first (and hopefully last) time in this pregnancy. It took me by surprise as I thought it was a fairly reasonable day today but then as I was cleaning my teeth I suddenly felt an uncontrollable need to vomit. First I thought, "Why do I suddenly have an uncontrollable need to vomit?" Then I thought, "I'm cleaning my teeth of course - how silly of me not to realise." Then I finished cleaning my teeth while thinking how ridiculous it was of me to call it 'uncontrollable' when clearly I was controlling it. And then I realised I couldn't. It wasn't as bad as in previous pregnancies though as once it was over it was over and although I don't feel able to eat, I do feel tolerable rather than that intense "I'm just about to throw up" nausea remaining for ages afterwards. Maybe this is what people mean when they say they didn't mind being sick because at least they felt better afterwards - it's quite a novel experience and although I don't really want to repeat it, it is by far preferable to the usual hyperemesis gravidarum vomiting episodes. And successfully maintaining a pregnancy for this long without being stuck in bed throwing up all day is pretty amazing as it's the first time in six pregnancies that I've managed it. Thanks be to God.

Hyperemesis Gravidarum Pregnancy Four - Six to Seven Weeks

Monday 29th July
Last Sunday there was a sudden change where I felt that the medication was only really having a noticable effect for about three hours before wearing off so I increased to 2x8mg which seems to be helping. I'm not up to much and eating is much more difficult but I'm still able to get up and do all the essential stuff in the day while J is out and haven't been sick yet (though I have been close) which is a million times better than being in bed with out of control vomiting.  I even managed a short outing on Thursday for L's birthday on Thursday although it has taken until today to feel fully recovered.

Hyperemesis Gravidarum Pregnancy Four - Five to Six Weeks

Thursday 11th July

Although I still feel worse in the morning, taking the ondansetron last thing before bed seems to have improved that significantly though I'm still unable to eat a decent sized breakfast.  Snacks are necessary through the day to stave off nausea and of course I still need to drink frequently too due to not being able to consume such large quantities at once.  I'm currently writing this after dinner while I have a short rest as despite today not being unusually busy I suddenly feel quite worn out although I'm hoping I will be revived enough to do a few more things later after the children have gone to bed.  Unfortunately today I have also had to start taking antibiotics which make me feel sick even when not pregnant so I am hoping that they not make me feel too sick as the run up to the stage when I am usually at my worst is not really the ideal time.

Monday 15th July
Mornings are still the worst and after improving when I made my evening dose later, they have got worse again but a small amount of nausea in the mornings and being unable to eat large quantities at once is far and away better than being unable to keep anything down which is where I would be heading by now without medication.  I've also found I get tired very easily if I do lots of physical activity so I am having to be careful about pacing myself.  I imagine I must have had this problem previously but the debility caused by nausea and vomiting meant that I wasn't actually trying to do anything other than eat and drink enough I wouldn't have noticed.

Saturday 20th July

Although once it kicks in it is pretty amazing, I'm now finding the effects of the ondansetron are wearing off sooner so I've been feeling more nauseated in the evenings and in the mornings it is a huge struggle to eat a few mouthfuls of breakfast. This morning when I woke at half past four I drank some water because I was thirsty which resulted in so much nausea that I couldn't get back to sleep. Although it clearly is getting worse I am hoping that the additional nausea usually caused by the antibiotics means that it will improve when I stop taking them. This coming week is usually the week when the vomiting kicks in and the first two times got out of control resulting in hospitalisation so I am expecting it to reach the maximum this week which usually lasts for four weeks before a slight improvement and since I finish the antibiotics on Thursday it will hopefully decrease and therefore not be so bad for the following four weeks. But even though eating is a struggle and I am slightly worried about the possibility of vomiting starting (in one pregnancy I was in hospital within four days of onset of vomiting because it gets out of control so quickly) and I do have reduced capability compared to normal I am totally amazed at how much I am capable of and how well I am. I actually feel like it might be possible to have a pregnancy where I am able to live a normal life. Which on the one hand is absolutely amazing and would be a dream come true but on the other hand would mean that I lost twenty months of my life purely down to not being given the right medical treatment. The idea that you should just "put up with it" no matter how bad it is just because it is pregnancy seems ridiculous to me. Firstly just because you might get a baby at the end of it doesn't mean it is reasonable to expect you to endure being so ill unnecessarily. Secondly, it is widely accepted that women should be given all possible pain relief in labour rather than being "made to suffer unnecessarily" even though labour is brief and at most a few days - why is labour different? Surely people should be more grateful and uncomplaining in labour because by that point there is much more certainty of outcome than there is for someone suffering from excessive vomiting in early pregnancy?

Hyperemesis Gravidarum Pregnancy Four - The Early Days

Wednesday 3rd July

I had felt sick since the previous day when my eleven month old had been sick and had assumed initially that my nausea had the same cause.  When it persisted I did a pregnancy test to reassure myself that I wasn't pregnant only to discover that I was.  Given the effectiveness (or rather ineffectiveness) of the medications tried in my previous hyperemesis gravidarum pregnancies, the fact that ondansetron is effective but usually difficult to get a prescription for in the UK and that preemptive medication is more effective, I had intended to make sure a doctor had agreed to prescribe me ondansetron before I next got pregnant.  I booked an appointment with a GP at my surgery for the following morning with the intention to ask for ondansetron and failing that an urgent referral to an ob and a very lovely friend contacted some private obs to find out the likelyhood of an ondansetron prescription and how soon I might be able to get an appointment.  Without medication I knew that within a week I would be very debilitated and that within two weeks there was a high chance of being hospitalised so time was of the essence and I was concerned about whether I would be able to get the medication in time.  As soon as my husband got home from work (and I could go without the six year old who would cotton on quickly if she saw some of the things I was buying), I went out to the shops to buy various things that I needed such as pregnancy vitamins, pregnancy sickness bands (which I feel compelled to use even though they don't work) and various drinks and snacks that I would need.  That evening once the children were in bed, my husband and I sat down together and went through our plan from before the previous pregnancy updating it based on our present circumstances and on what we thought worked well or otherwise last time.  I stayed up late printing out various research papers relating to ondansetron and to preemptive treatment and information from Pregnancy Sickness Support and pregnancysicknesssos.

Thursday 4th July

Although still able to eat, my nausea was pretty constant and I was concerned about how soon I might go downhill.  My appointment was midmorning so I had time to order a few bits and pieces online that would be helpful.  I went in to see the GP who I didn't feel especially optimistic about and explained the current situation, my previous experiences of hyperemesis gravidarum and the fact that I was keen to avoid hospitalisation and listed all the medications I had previously had that had either been insufficient, ineffective or resulted in abreaction.  She agreed that Idefinitely needed to be given something and I said tentatively, "Ondansetron is supposed to be effective and is safe in pregnancy."  She then told me that she had had it after a hospitalisation as she had suffered hyperemesis gravidarum in her pregnancies and so she was happy to prescribe it.  She queried whether it was safe for breastfeeding but thankfully I had recently contacted the Breastfeeding Network to check the safety of various antiemetics during breastfeeding and she was happy with the information I had obtained.  As she was unsure of the dose, she phoned the Pregnancy Assesment Unit (PAU) at the local hospital and asked a midwife.  The midwife then started saying that if ondansetron didn't work then there was "nowhere to go" after that (which is untrue as steroids are an option and are in the hospital protocol that I obtained via Freedom of Information Act request) and that "every pregnancy is different" (a classic phrase used by medical professionals to suggest that women who have had HG previously should still wait until they are very sick before arranging or getting treatment) so I should "work through the ladder" or medications that previously hadn't been effective.  My heart sank as I feared that the ondanstron which had seemed so close would now be snatched away but my GP asked to speak to a consultant and I said that the ondansetron was actually less likely to work if I got it later when I was more sick due to working through other medications which had been shown not to work for me already.  I don't know which consultant she spoke to but based on the conversation it seemed that she had also had ondansetron and said that with my medical history it made sense to have it straight away so I was started on 2x4mg/day with the option to increase it up to 2x8mg/day if necessary.  I was so relieved that I almost cried in my appointment and I don't think I have ever been so happy in my life about being given a prescription.  It was so amazing and I really felt like God's hand was there giving me the right doctors so that I was able to get the medication I needed as early as possible.  My local pharmacy unsurprisingly did not have it in stock and said that they couldn't get it in until the following day so I started phoning pharmacies in other villages.  The first one I got through to could get it in for mid afternoon and it turned out that my husband needed to stop in that village on the way home from work so rather than me trail out with the two children when feeling unwell in order to get it a couple of hours sooner, he picked it up.  According to the leaflet in the packet it can take 1-2 hours to take effect and I was beginning to wonder if it was going to work for me when around 2 1/2 hours after taking it I felt a noticable improvement in the nausea.  In addition to all this excitement, I was also packing and preparing to go away to Birmingham the following day in order to attent the Pregnancy Sickness Support Trust Conference on the Saturday.  I was very thankful that the ondansetron appeared to be helping as I knew that if it didn't there was a good chance that I might not be able to attend the conference.

Friday 5th July

I felt pretty bad in the morning (although still fully functional) until around 2 1/2 hours after taking my ondansetron and worried slightly whether 4mg was enough but once it had kicked in I was pretty good.  We set out on our journey and although I still felt nauseated if I didn't eat/drink frequently enough diligently following my plan to eat and drink something at least every two hours meant I was okay although I found I was unable to eat a normal sized meal in one sitting as I would start to feel much more nauseated once I had eaten a certain amount.

Saturday 6th July

I managed the conference.  I was so pleased as the previous year I was about eight months pregnant and too ill to attend and I had been looking forward to being well enough for this year.  I had to be diligent about snacking and drinking in order to stay okay and could only eat a small lunch but I actually felt reasonably normal albeit still a bit shocked by the events of the last few days.

Sunday 7th July

After what felt like a mammoth trip and lots of sleep disturbance due to the eleven month having a cold and being disrupted by all the travelling I was pretty tired and felt sick in the morning but again it improved around 2 1/2 hours after taking the medication.  I had been wearing long sleeved tops to hide the sea bands from my six year old  who would have recognised them from my previous two pregnancies but in a heat wave this was not really the most comfortable and it's not like they actually make any notable difference so I decided to stop wearing them.  By this time I was not feeling like I really needed to have my evening medication as soon as it was due so I tried having it slightly later in the hope that this would improve the morning.

Monday 8th July

Breakfast is usually my smallest meal of the day anyway but I was unable to eat all of my usual portion.  I really tried to and I kept thinking, "That's 4mg of iron" but I just couldn't do it.  Once my medication kicked in, I felt better and I did my usual frequent drinks/snacks and tried not to overdo it and was reasonably okay.  Since I felt well enough that evening I waited until bedtime to take my ondansetron as first thing in the morning was definitely my worst time.

Tuesday 9th July

Although I didn't feel good in the morning, taking the evening medication last thing before bed definitely made a difference.  I could still only eat a reduced portion of breakfast but I felt less nauseated and more functional.  I had a blood test first thing which had been booked three weeks earlier and although I was slightly regretting it by the time I got there I was actually able to walk there.  I walked slowly on the way back rather than normal speed but was so worn out that I had to lie down and rest until my husband had got everything ready to go to the optician and then on for a picninc lunch in the Botanical Gardens for my Auntie's birthday.  In previous pregnancies I wouldn't have even managed the walk to the doctors surgery so although I found it pretty arduous and exhausting, it was absolutely amazing that I was able to manage our day out.  Once we got home I had to rest for a couple of hours because I was so worn out but then I was able to get up and do a few bits and pieces.

Wednesday 10th July

After a tiring Tuesday, I didn't think I would be up to much but I was surprised to find that I was able to manage all the normal stuff at home in the day such as washing, cooking etc which I was very pleased about.  I still needed to be careful about my eating but frequency was become less critical from a nausea control point of view but was still needed due to my inability to eat a full sized meal in one sitting.  In the evening I popped to the Coop (about 250m away) to pick up a few things and by the time I got home I needed to sit down for a rest and felt like I'd done something much more strenuous.  Although I'm glad to be capable of more, in some ways it is reassuring to be tired more easily.  When I had a first trimester miscarriage, my nausea was fairly similar without medication to what this is so far with medication but I did not have any tiredness or impairment in my capability so the presence in a reduced form of symptoms I usually have but didn't have then seems like a positive sign.

A Poem from 39 weeks with Hyperemesis Gravidarum

The end is near
When will it come?
I want to know
When this is done
The endless nights
And plodding days
I feel I'm lost
Inside a maze
I want to eat
To live again
So do please tell me
When this will end.

Another Poem from 25 weeks with Hyperemesis Gravidarum

I want

I want to get up
To get dressed
To eat my breakfast
In one sitting

To go upstairs
And clean my teeth
To go outside
Walk down the street

To do the shopping
Clean the house
Make my own lunch
For myself

I want to plant things
In the garden
Take my daughter
To the park

I do not want
To lie here watching
While my life
Is passing by

It isn't much
That I am asking
I just want
To live again

A Poem from 25 weeks with Hyperemesis Gravidarum

Awake alone again
Nausea never ending
Through the blackness
Of eternal night
I long to see the dawn
To cast away these shadows
To live and breathe again
And see the morning light

A Poem from 24 weeks with Hyperemesis Gravidarum

A dark fog swirls around my bed
As I lie in it made of lead
If through this fog I can survive
One day again I'll be alive
But now I lie here oh so still
And dream of when I was not ill
The world is there just out of sight
Oh when did I last see its light?
And as the world continually
Moves on does it remember me?
While with this fog I still contend
I cannot seem to see the end
When I will join the world once more
Tho' not quite as I was before.

We Survived

I was just popping some poems on here that I wrote on my iPod while I was ill and I realised that I've never actually announced that the last pregnancy finished successfully.  I intended to maintain an ongoing diary while I was ill but it was just too much to manage and fell by the wayside while I just tried to survive but I have a few half written drafts and I want to try and write up what I can remember when I can.  Anyway, here is a picture of my little girl who was born at home on 25th July 2012 weighing 9lb3oz:

A Poem from 22 weeks with Hyperemesis Gravidarum

Now I have found myself caught up
Inside that cage of fog again
A prison sentence I must serve
Eight months tied down by HG chains
Through endless days inside this fog
I try to eat and drink enough
I wonder if it's in my mind
Am I just weak to find it tough?
The seasons still go flashing by
While here in bed my life stands still
Four months to go - eternity!
Until I am no longer ill

Duchess of Cambridge has Hyperemesis Gravidarum

Yesterday, it was announced to the world that the Duchess of Cambridge had been admitted to hospital for hyperemesis gravidarum.  Whilst I am pleased that this is bringing publcity for the condition and may help sufferers of it, I am not glad that she is suffering.  This is actually my first HG free December/Christmas in three years so I know first hand just how horrible it is to suffer from it at this time of year.  It is a pretty horrendous illness to suffer from especially since it is so misunderstood but to have to live through it whilst under the scrutiny of the world's media must make it far worse.

Already people are criticising both the fact that the pregnancy has been announced "too early" (whatever that means) and the fact that she has been admitted to hospital for "just morning sickness" whilst "us commoners just get on with it".

Hyperemesis gravidarum does not discriminate by social class.  Whilst some claim that her position means she has it easy and gets the best possible treatment straight away, I do not believe this to be so.  Given that admission to hospital meant announcing the pregnancy not just to friends and family at an early stage (which is something that many of us are forced by HG to do) but to the entire world, it is not likely that she would have rushed to hospital unless it was pretty bad.  Many of us have had hospital admission delayed due to prejudice and lack of knowledge but she and William must have had to think of the media attention involved when deciding whether/when to seek hospital treatment.  Hyperemesis gravidarum is not morning sickness - it is incomparable and requires medical treatment.

Just last week she was performing royal duties (i.e. doing her job) and while some critics use this to argue that she cannot be that ill, I disagree.  Firstly, once the vomiting strikes a person can go downhill to the point of needing hospital admission very rapidly.  And secondly, given she didn't know how serious her condition would become and given her position I imagine she forced herself to carry on at a time when many people would have had the option to call in sick for a day or two.

As far as announcing "too early" is concerned, why is it too early?  Yes the pregnancy might go wrong and I imagine that is why they did not want to announce it yet and only did so because they were forced to.  If they had chosen to then that would be their perogative.  Since they did not choose it but had it thrust on them by the nightmare that is hyperemsis gravidarum they deserve our sympathy and not out judgement.  I hope and pray that this pregnancy will not go wrong but I also hope that in the event that it did that people would be sympathetic and not judgemental.  Announcing a pregnancy does not cause it to go wrong and thirteen weeks is not a magic point beyond which it is safe and never goes wrong.

As far as media coverage of hyperemesis gravidarum goes, it has been a mixed bag.  I know that many people have been contacted through the Pregnancy Sickness Support Trust and have had good interviews but there have also been many medical professionals perpetuating the typical misinformation and old wives tales.

Hyperemesis gravidarum cannot be treated with ginger or pear drops.  In fact ginger is a bad idea if you are going to vomit as it burns on the way back up.  I believe research has shown it to have some effect on nausea but not on vomiting which presumably is why it helps with regular morning sickness.  Suggesting it to a hyperemesis gravidarum sufferer is like suggesting a sticky plaster to someone with a broken leg.  It just doesn't work.

Hyperemesis is not benign with no long lasting effects.  When I mentioned this particular claim (apparently made by a GP on national television), he said to me, "Don't some people lose teeth?"  He is correct.  Some people suffer organ failure, damaged oesophagus and other physical effects which can be long lasting.  Sometimes the illness is so severe or access to treatment is so limited due to lack of knowledge in the medical profession that women have to resort to termination of much wanted pregnancies.  Hardly benign with no long lasting effects.  It limits people's family size, destroys marriages and causes people to lose their jobs.  And then there are the psychological effects.  Reminders of the pregnancy and the illness such as the time of year, clothing or food you ate or didn't eat, places you went to etc can trigger flashbacks, nausea and sometimes even vomiting.  Seems long lasting to me.

And what about William?  Spare a thought for him.  Yes he is not the one lying in a hospital bed on a drip.  But he has to support his wife.  He has to see her this ill whilst not being able to do anything about it.  Last time I was admitted to hospital for hyperemesis gravidarum my husband thought I might die.  Money and status does not protect you from that or make it any easier.  I hope that Kate is one of the more fortunate ones whose hyperemesis goes by around twenty weeks but if it does not then he almost has to live with no wife for eight months.  I'm sure privilege and private hospitals do not stop it from being a horrendous experience for anyone and I hope that those around them are well informed and supportive.

14 Weeks Pregnant - A Day In My Life

0200: Wake to alarm, reach out for middle of the night milk and drink it. Go back to sleep. (I can't get through the night with nothing or at least having nothing overnight makes the sickness/ nausea worse and I figure having something in the middle of the night helps me get more calories.)
0530: Wake up feeling very thirsty. Drink three mouthfuls of water, feel sick due to drinking so much water and stay awake for the rest of the night.
0700: J's alarm goes off, take medicines.
0715: Take supplements with a glass of milk (brought to me in bed by J).
0725: Eat first half of breakfast in bed. (Half a weetabix with raisins and milk.) Browse Facebook in bed on iPod.
0745: Eat second half of breakfast then lie down hoping not to be sick.
Pray for a few friends, cuddle A who has just woken up and come through then send her to get dressed. Pray a bit more. Turn down offer of more breakfast.
0840: Wake up with a half dead arm. Open and close fist a few times to regain feeling.
0850: Clean teeth in bed, drink a mouthful of water and lie down again. Regret drinking water due to now feeling uncomfortably full and more nauseous.
0910: Consider running to the bathroom to be sick and narrowly escape needing to. Contemplate whether eating would improve nausea or trigger vomiting and conclude it would be the latter.
0930: Call A (who has just cleaned her teeth) through for a cuddle and a chat. Get A to "write" letters on my back for five minutes (inspired by the "40 ways to entertain your kids while lying down" link I found through Island of Grief, Mountain of Joy) while J is busy then give J some suggestions for today's educational activities.
0945: Listen to J and A discuss birds whilst still feeling too close to vomiting to move. Ponder whether eating more and vomiting might be more pleasant than continuing nausea on the brink of vomiting but conclude even the thought of eating is too unpleasant. Wonder whether getting up yesterday and sitting in an armchair was a mistake.
1000: Read Facebook for five minutes and take homeopathic remedies. Ponder whether I can walk to the toilet without triggering vomiting. Decide I can. Almost vomit in nappy bucket. Grab hair bobble off cistern and tie hair back to avoid vomiting on hair. Almost vomit in toilet. Ponder whether I should have eaten more as a fuller stomach makes for easier and less unpleasant vomiting. On vomiting discover stomach was almost empty. Rinse mouth and gargle with water. Decide not to use mouthwash in case it triggers further vomiting. Worry about teeth being wrecked. Return to bed and ponder whether a snack would be a good/bad idea.
1030: Have mouthful of water and ask J for a cheese scone. Realise there was no blood in the vomit and feel relieved. Listen to 2 Peter on iPod. Feel thankful for iPod. Resolve to be more patient. Drink two mouthfuls of water. Pray.
1100: Hear J cooking and feel sick at the remembrance of Sunday's pea risotto. Daydream about being able to select food without consideration of taste on the way back up and being able to eat an entire meal. Try to remember what that feels like. Decide to go on Facebook/other forums as a distraction from the nausea.
1130: A comes upstairs and gives me a present "to help me feel better".
1145: Eat first stage of dinner in bed (rainbow trout, mushrooms, tomato, broccoli & mashed potato) then chat on Facebook.
1220: Take some supplements and eat part two of dinner.
1240: Ponder how much water I can safely drink and have two mouthfuls in a vain attempt to improve dehydration headache. Chat briefly on Facebook before resting in preparation for trip to library.
1345: Ask J to get my clothes out. Get dressed, take medicine and drink additional two mouthfuls of water. Feel thankful for the ability to dress myself. Look at self in mirror on way out in the hope that I might look pregnant but find I still look thin. Hope thinness is due to my lack of fat and not a sign of SGA baby (Isabella was SGA). Go to car to be driven the 300 metres to the library with A.
1400: Sit in armchair in library for one hour of singing and story time. This week I managed most of the actions although it made my arms ache. (Singing is out of the question - I just don't have the energy/breath.)
1500: Picked up and taken home in car by John. Have small snack and lie down to recover as the activeness of the last hour has put me on the brink of vomiting. (Thankfully I did not need the tubs I took with me to the library.)
1600: Feel almost normal. Chat on Facebook and read the odd online news article.
1700: Eat half a ham sandwich.
1725: Take some supplements and eat other half of sandwich. Feel uncomfortably full and slightly nauseous but not at risk of vomiting.
1800: Eat rhubarb yoghurt.
1820: Sit up to play a couple of rounds of "Guess Who?" with A and have goodnight chat/cuddle. Notice A feels warm so ask J to get the thermometer to check. She announces she will have to sit with me and watch the Mr Benn DVD all day tomorrow due to her temperature.
1840: Feel worse from sitting up so lie down to recover. Reflect on the probability of being sick later.
1900: Pray.
1915: Feel thirsty - risk drinking three mouthfuls of water at once.
1930: Start watching a DVD with J. Feel glad that the planning/preparation I did for being ill means we actually get to spend time together. Regret drinking so much water.
2000: Eat 1/4 serving of M&S apple cake given to us by friends. (J must think he should share it equally as he has been eating equally tiny portions of it.)
2030: Feel too worn out to sit up any longer so ask J to stop DVD. Lie down and catch up with messages and Facebook. Feel very thankful for Facebook and friends on Facebook - that and internet access through the iPod really help me to feel less isolated/bored/lonely when ill and limited in what I can do. I am blessed with some wonderful friends.
2045: J gets fresh pyjamas out and I realise with dismay that thanks to going out I am dressed and need to change for bed. Get changed. Clean teeth in bed. Take homeopathic remedies. Realise I forgot to take them this afternoon. Take final antiemetic of the day with three mouthfuls of ice cold water. Appreciate the ability to drink water and think about how useful it is.
2105: Reflect upon how my character could be improved and resolve to make more effort to be quick to listen, slow to speak and slow to anger.
2115: Listen to J read a chapter of The Horse and His Boy.
2130: Turn light off, pray, note nausea has increased and hope tiredness will outweigh it. Eventually sleep.

Food intake ~1500Cal (about average). Fluid intake ~1.2l (below average).
Overall day in-between average and good relative to the last week.

Hyperemesis Gravidarum Pregnancy Three - Twelve Weeks

Today while J and A were out I went downstairs and cut, buttered and ate a slice of (homemade!) bread. Okay the bread was out on the worktop unbagged because it was fresh and I left the dirty knife on the worktop so it wasn't as much work as it should have been but still, I did it myself

This is exciting for two reasons: 1. In previous pregnancies I couldn't eat HM bread and 2. I would never have gone to such extreme lengths to get food for myself.

Although still limited relative to normal, there are a number of significant things I can eat this pregnancy but couldn't in the others. In addition to the HM bread (I only had a short phase of being unable to eat it) I can drink water and I can eat sweet things. In previous pregnancies just the mention of many sweet things made me feel like I might throw up so it is very nice not to have that. Also it is rather useful to be able to drink water (in my first pregnancy I was worried I'd never be able to drink it again) and I'm sure the ability to drink water has been a big factor in my staying out of hospital this time.

I actually feel well enough to possibly start "getting up" routinely now (ie spending my days in an armchair downstairs instead of in bed upstairs) but as I have my "booking" appointment with the MW on Tuesday I think I should save my energy for that and start getting up once I have recovered from it.

Fog

Engulfed by fog again
The fog I know so well
It sucks away my life
As I try to find my way
I cannot see ahead
To where this path will lead
Yet what I fear the most
Is that this fog might leave

Hyperemesis Gravidarum Pregnancy 3 - The First Trimester

Not long after my last post my nausea disappeared completely. I stopped everything I was doing to minimise/avoid/control nausea/vomiting and the nausea did not return even though I was continuing with my normal everyday life so I assumed the worst.

About a week later (5 1/2 weeks) I came down with the flu and ended up in bed and throwing up right about when I had in my previous HG pregnancies. After a week all my flu symptoms had gone except the vomiting. Initially I thought it was just in my head because of associating pregnancy with being sick but when it started to get worse after almost another week I realised it had to be pregnancy sickness and resumed taking all the medicines/supplements.

Once I started taking everything again I improved a bit and settled into a pattern where maybe once a week I kept all meals down and the rest of the time it was 50/50 whether I kept down one or two. In the first 2 1/2 weeks of sickness I lost 5lbs followed by 1lb in the following week after which my weight stabilised. After Christmas I had a few better days without being sick before getting worse again (nausea almost as bad as the worst bit but actual vomiting less). Now at 11 weeks it seems to have settled down to an average of once a day but ranging from zero to three.

Summarised like that it doesn't really sound that bad. Indeed it's been my best pregnancy so far and having not ended up in hospital due to out of control vomiting I did wonder whether it was legitimate to call it an HG pregnancy. But thinking about it, I'd say it is an HG pregnancy - it is just controlled this time. Although I don't have the out of control vomiting or excessive weight loss, it's not really normal morning sickness when you have had to stay in bed pretty much doing nothing (in addition to all the medicine) in order to achieve that.

I'm convinced that the early disappearance of nausea and how much better this pregnancy is (eg I can drink water, dress and bath myself and stayed out of hospital) are down to the different medication. I am also hopeful that this means I will improve enough to be able to resume some of my normal life during my pregnancy. Which not only would be quite nice as sitting/lying about while your life passes by isn't much fun but would make life easier for J as he wouldn't be having to do everything I usually do AND look after me AND do his normal job.

Hyperemesis Gravidarum Pregnancy Three? Four Weeks

I am currently four weeks pregnant.  I am feeling worse than the shorter pregnancies but better than the previous hyperemesis pregnancies so I am hopeful that a) the pregnancy will last long enough and b) I will not be as ill as I was last time.

So far the times I have felt the worst have been when J was over an hour late making breakfast on Saturday morning and when I walked about 100 metres from the car to church on Sunday morning.  I find standing makes me feel much worse so I did not stand for the singing at church and abandoned attempting to sing half way through the first song.  After the service, J went and drove the car up to the chapel to pick me.  If I wanted to I could actually do all those things but I can tell how much worse they make me feel and knowing that it has a cumulative effect I know it is not worth it in the long run to make myself do things that make me worse just because at this stage I'm not actually being sick.  Next week we will only go to one service as it was definitely a mistake to go to two.

Aside from the usual pregnancy multivitamin, I am taking B vitamins, homeopathic remedies, an anti emetic and other supplements such as ginger capsules.  I am wearing sea bands and to make sure I eat/drink frequently enough I have three meals, three snacks and twelve drinks per day scheduled (along with all the things I'm taking) on my iPod.  J gets up at seven and gives me drinks and breakfast in bed before he goes to work and I get up at 8.30 when he goes out.  I have a two hour rest in bed in the afternoon while A has quiet time and aim to be in bed around nine in the evening.  I made and froze lots of dinners before I was pregnant so J gets one out and puts it in a bowl in the fridge the evening before so that I can just pop it in the microwave when he is due home.

So far the plans/preparations/reorgaqnisation I have done mean that although J has taken over some of the things I usually do his workload is not dramatically increased and he still has time to spend with me.  And although I am not able to take her out, A can play in the garden and I am still able to do all the usual "school" type things with her.

So far so good.  I am really hopeful that by taking pre-emptive medication and doing everything possible that might help pre-emptively rather than reactively I will be less ill.

Hyperemesis Gravidarum Pregnancy Two: Part Three - Hospital Continued

I had been getting a vibe through Thursday and Friday from the midwives caring for me that they didn't think I was really that ill and that I was just "choosing" not to eat. On the Thursday I had been given a "vitamin" tablet and "folic acid" (on a subsequent day they were claimed to be "thiamine" and "iron" but my medical records say they were thiamine and folic acid) and even though I said I could not take them, the midwife had left them by my bedside in a paper cup. On the Friday when I was offered them I again said I couldn't take them but the midwife insisted on leaving them and seemed very annoyed with me when she returned an hour later to find I hadn't taken them even though I had told her I couldn't. She was even more annoyed when she discovered the previous day's tablets where they had been left as if I had been deliberately accepting medication and leaving it lying around when in fact I had made it clear that I could not and therefore would not take it.

That evening my suspicions were confirmed when I overheard the same midwife talking about me. She said she felt sorry for my daughter because I had spoiled her Christmas as I had made myself ill by "refusing" to eat and that if I just stopped "refusing" to eat then I would get better. I knew she was talking about me since she used my full name and considering how far I was from the nurses' station I imagine half the patients in the ward would have heard what she had to say about me. Since the ward was much quieter that night and I was exhausted with having been kept awake by women in labour the first night and babies crying the second night I slept all night long. My third dose of metoclopramide was due in the middle of the night but again I was not given this presumably because I was just "making" myself ill by "refusing" to eat.

This attitude to hyperemesis gravidarum was seemingly widespread; while the healthcare assistants were changing the empty beds in my room that day they discussed pregnancy sickness and how in their day you "just carried on" and it was unheard of for people to end up being admitted to hospital with it because "you just got on with things". (Which is funny because I thought that in their day people died of it but I suppose the people who died of it weren't around to tell the tale.) The healthcare assistants' unprofessionalism was not limited to hyperemesis gravidarum - they also thought that any pregnant woman with swine flu had herself to blame (while there was a pregnant woman lying seriously ill with swine flu elsewhere on the ward) and were unable to wait for me to get out of the bed before starting to strip it.

On Christmas morning a doctor was asked to review me because I was "refusing" anti emetics (i.e. I said that cyclizine made me worse and metoclopramide hadn't helped so I wanted to be given something else). Unfortunately not only had all the anti emetic doses not been recorded but most times I had been sick weren't recorded (and I have just discovered that the records claim I drank 200ml on the Thursday when I had maybe a dozen sips of orange juice) so the doctor did not believe either that I was as ill as I said or that I had had enough medication to be able to tell if it worked (even though I was able to recite to her the times of all the doses). She said that she had to follow the hospital "protocol" and that if I continued with metoclopramide for the rest of the day and it didn't work she would be able to give me something else so I agreed to continue with the metoclopramide.

By now I felt that the hospital staff did not believe I was that ill and were not going to do anything other than provide IV fluids and anti emetics which didn't help even though I was unable to eat and drink and had consumed next to no food in the previous few days and was showing no signs of being able to. I was concerned that if it continued it might cause longer term harm to my health (and possibly as a result harm to the baby) and although he didn't tell me at the time, J was concerned that if things continued the way they were I might die. He did express his concern a number of times and ask whether I could have a glucose drip as I was still ketotic and receiving no nutrition but was always fobbed of with the rather patronising assurance that he didn't need to worry as the baby would be okay which would have been rather a moot point had I died. So on Christmas morning in desperation I phoned J and asked him to find a private hospital who could take me as I couldn't see any other way that I could get decent treatment. Unfortunately there are none in our region who will treat pregnant women so I had no choice but to stay put.

I was given the metoclopramide as agreed and then two hours later was told I was supposed to be given cyclizine in addition to the metoclopramide. Although it had made me worse before I was so ill and so desperate that I agreed to take it. This was a mistake as I ended up with arm tremors and was unable to stay conscious while A opened the two Christmas presents J had been able to find at home and bring in. When the next dose was offered I declined the cyclizine and only accepted the metoclopramide.

Since the next dose of metoclopramide would be due the following day, I considered that I had tried metoclopramide for "the rest of the day" and enquired about being given a different anti emetic but this never materialised and I was offered (and refused to take) metoclopramide and cyclizine for the remainder of my stay. (Of course I wasn't offered the dose that would have been due in the middle of the night so even without my declining I still would not have had a full 24 hours worth of metoclopramide anyway.)

Once I stopped taking either of the anti emetics I started to improve and was finally discharged on Monday 27th December five days after being admitted. Initially I was told I would be discharged with cyclizine and metoclopramide so I told the doctor that cyclizine made me worse and metoclopramide didn't help so she said she would think about what to give me. When the time came for me to be discharged the midwife said I was being discharged with cyclizine. I told her I couldn't have it as it made me worse so she said I would be discharged with nothing.

The clinical summary of my stay sent to my GP states, "she was started on IVT and regular antiemetics. she responded well to treatment and was discharged on regular antiemetics" with the anti emetics I was discharged on listed as cyclizine and metoclopramide and the date of discharge as "Dec 24 2010".

Hyperemesis Gravidarum Pregnancy Two: Part Two - Admission to Hospital

As with my previous HG pregnancy I had been admitted to hospital less than twelve hours after being told by an out of hours GP that I did not need to be admitted. The previous time I had been given excellent treatment and had improved fairly quickly. This time was the opposite.

All the routine things were done such as taking my history, running through the treatment plan (which was as I expected having been through it before), patronising me with reassurance that I didn't need to worry because the baby would still get the nutrition it needed, inserting a canula (this time they only needed to go one size down) and doing various tests. Being dehydrated and having provided a urine sample at the GP I was unsurprisingly unable to provide another one. Despite the fact that I had drunk nothing, four hours later when I was finally given IV fluids they seem surprised that I was still unable to produce one.

In the evening I was offered a "warfarin" injection to reduce the risk of deep vein thrombosis which I declined. Warfarin is particularly dangerous to the unborn child but as I later found out when I obtained a copy of my hospital records it was actually low molecular weight heparin they were offering me and not warfarin.

My first anti emetic was finally given about twelve hours after I was admitted at around 11pm (although recorded in my notes as 7pm). Within a few hours I was feeling much worse so when I said I couldn't manage oral painkillers I was given the antiemetic intravenously. I managed to swallow the pain killers but was sick before the midwife had time to walk to the next person. Even though I had been admitted for hyperemesis nobody had thought to provide me with sick bowls but I had with me the yoghurt pots I had carried for the journey so was able to use one of them.

I was offered the same anti emetic (cyclizine) two or three times the next day (Thursday) but since it had made me worse, I said I didn't want it as it didn't work. Eventually one of the midwives told me that I needed to take it because if I didn't I wouldn't be given anything else. I told her that as I was pregnant I did not want to take unnecessary medication, that since the cyclizine did not work it was an unnecessary medication and that it was unreasonable to refuse to give me something else just because I wouldn't take something that wasn't working. She took my point and at 5.30pm I was given metoclopramide. Although there appears to be no record of this dose anywhere in my notes, when I requested a further dose at midnight I was told I needed to wait a further two hours as apparently it was eight hourly. I asked if there was anything else I could have and the midwife said she would ask a doctor for something else. Although I was awake most of the night due to the crying babies in the postnatal room next to the room I was in, I was not given any anti emetics until the next morning and my records say I was "sleeping" at multiple times through the night which presumably means that I was lying still with my eyes shut as one usually does when attempting to sleep.

After being given my "anti emetic" on Friday morning I was much worse again and on enquiry later in the day I was told I had been given cyclizine rather than the metoclopramide I was supposed to have been given (neither is recorded in my notes as having been given). This meant that instead of receiving three doses in 24 hours I had been given one dose, missed one dose and been given the wrong thing before being given a second dose of metoclopramide.

By now it was Christmas Eve and they seemed to be keen to discharge everyone regardless of how ill they were. One lady who was readmitted with sickness the day after me had been discharged prematurely the day prior to her readmission and another lady who had been in overnight and promised certain medication was then discharged with paracetamol - both commented that they just seemed to want to get everyone out without regard to whether they were ready just because it was Christmas.

Even though I was worse and had only consumed a quarter slice of toast and a few sips of orange juice since being admitted the doctor who saw me that morning had me taken off the drip and told me to drink a glass of water per hour with a view to me going home that afternoon. Although I knew it to be futile I did make some attempts at drinking but every time I had a single sip of water I vomited violently and was unable to make another attempt for some time. I was only actually sick six times that day but the frequent retching in between (which was just as bad - whether anything came out or not was a moot point really) made it impossible for me to consume anything. After three hours off the drip they realised I was becoming increasingly dehydrated again and resumed intravenous rehydration although according to my notes they still hoped to discharge me later that day.

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 http://emedicine.medscape.com/article/254751-overview ).

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.

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.