Hyperemesis: When a Dream Pregnancy Becomes a Painful Nightmare
Women are told to expect to be sick in the first trimester, but what is a ‘normal’ amount of sick isn’t defined.
Pregnant women are even more vulnerable in the Covid pandemic and hyperemesis can greatly increase their chances of needing hospitalization or special care even as the pandemic rages around us. I share my story here in the hopes that it could help even one fellow sufferer.
In late November 2019, I excitedly called my husband over to look as two coveted pink lines appeared in the window of the pregnancy test I had just taken.
Little did I know that this longed-for pregnancy would turn into one of the most isolating experiences of my adult life.
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By January 2020, I was in the emergency room of our local hospital on yet another course of intravenous (IV) drips given to treat dehydration caused by frequent throwing up, sometimes as many as 15 to 20 times per day.
Hyperemesis Gravidarum (HG) aka ‘extreme pregnancy sickness' had wrought havoc on my life and more was yet to come. When I wasn’t throwing up, it seemed like I was constantly retching.
For me, there was no pregnancy ‘glow’. I didn’t feel particularly excited or blessed, as people would often say I should. I only felt near-constant nausea, hunger and dread waiting for the next round of vomiting.
HG is a rare condition, which by some estimates affects about one to two percent of pregnant women.
If you have heard of it, it’s likely as the thing that made Kate Middleton sick in her pregnancies.
The Duchess of Cambridge isn’t the only famous HG sufferer. It probably resulted in Charlotte Bronte’s early death and recently, American comedian Amy Schumer has been vocal about her HG experience.
I had little awareness of HG before getting pregnant. When the sickness set in, my husband and I were far from home, in Yokohama, Japan where I was attending a conference.
When I showed up after spending the morning being terribly sick, a colleague asked me if I had partied too hard the previous night.
I was mortified.
By the time we moved on to the personal leg of our trip in Kyoto, I began to fear that something was terribly wrong.
I was carrying plastic bags around in my coat pocket to avoid throwing up on pristine Japanese pavements. I managed to drag myself to a couple of world-famous sights, only to feel exhausted soon after and return to the hotel.
Due to the persistent nausea, Japanese food, which I had craved before the trip, became a torment. Oddly enough, the only thing I could stomach were cold McDonald’s burgers and fries.
Looking back, I wonder why I hesitated to cancel the trip.
My only explanation is that women are told to expect to be a bit sick in the first trimester. What is a ‘normal’ amount of sick isn’t clearly defined.
The tipping point for me was when I phoned my father, a doctor, in India. "Just cancel and come back. This isn’t normal and you need treatment."
His decisiveness helped me accept that things were not going as planned.
It was only later, through long months of living with and learning about HG that I understood that even the medical community has trouble agreeing on how to diagnose or treat this condition.
Consequently, women with HG are often asked to just ‘put up with it’ and suffer horrifically, even sometimes resulting in medical termination of otherwise wanted pregnancies.
Thankfully, I had a very proactive gynaecologist and began a course of oral medication and IV treatment.
This would help shore up my strength, and then some more sustained nausea and vomiting would wipe it all out again.
With my worried spouse frequently having to travel for work, I survived the first trimester largely thanks to the loving care of my parents who brought me home for a time to live with them.
I cannot count the number of times my mother prepared a meal only for me to be overcome by waves of nausea before even taking a bite.
‘Nevermind’, she'd say and patiently go away to whip up an omelette or scrambled eggs—amongst the few things my body didn’t instantly recoil at eating.
Never one to suffer from motion sickness, suddenly car rides became torturous.
The farthest I could go without throwing up was about ten minutes, so I only visited places close by where I knew a clean toilet could quickly be found.
Due to the heightened sense of smell, most scents triggered more retching.
This included formerly welcome smells like my husband’s deodorant or the smell of any food cooking in the kitchen.
The pain of sickness was only compounded by the customary code of silence in the first trimester.
As in many cultures, in India too, pregnancies aren't widely revealed until the fourth month. At the same time, I was longing for help and human connection.
Holed up indoors, I was lonely, often tearful and steadily becoming deeply depressed.
Months later, in our pandemic struck world, this feeling of isolation and struggling to cope is a feeling I think many others can identify with.
Revealing my pregnancy to a handful of close friends and talking about HG was a key step which, in hindsight, helped shore up my spirits over the next months.
Now, on short visits to friends’ homes, I didn’t have to try to hide my sickness; I could rush to the loo as many times as I had to, or lie down and curl up exhausted.
There were times when I felt I couldn’t take it anymore, and on more than one occasion I broke down saying ‘I can’t do this.'
What really helped me through this was that my husband, rather than reacting in shock or exhorting me to ‘be grateful’ for the pregnancy as others had done, calmly asked what I wanted to do.
This gentle approach gave me the space to express how miserable I was feeling without judgement and to consider, and reject, any alternative.
Although I prayed for HG to pass with the 12-week mark, then 20 weeks, then 25 and so on, eventually it became clear that my symptoms would likely last until delivery.
At some point, the vomiting eased, but the endless nausea persisted and any attempt to lessen the dose of medication resulted in a quick relapse.
After reading Atul Gawande’s moving and informative essay on HG in his book ‘Complications’, I resigned myself to riding out the rest of the pregnancy with the aid of whatever drugs I was prescribed to take.
Although very few people are familiar with HG, many tried to provide well-meaning but totally misplaced advice.
One friend asked, "are you sure it isn't just psychological?" I was also frequently told to try various remedies.
These would range from, “drink lots of orange juice, lemon shots, ginger tea” to “try ajwain or amla sweets or sucking a clove”.
Others would suggest, “you should become a vegan", or "avoid the smell of petrol", or "walk vigorously until you sweat," or “Stop having sugar”. “Try homeopathy or flower therapy or probiotics or XYZ tablet.”
There was also a "lie down with a smile on your face”.
The problem with such suggestions is that remedies like ginger tea which may combat pregnancy sickness don't really work for HG.
The result of all this unsolicited advice from people with little understanding of HG is often more frustrating for the person who is suffering and who has possibly already tried everything to feel better.
In June-July 2020, the world was well in the grip of the Covid-19 pandemic.
India was in its third month of lockdown and hospitals were running short of beds.
I was thankful that the very worst phase of my HG had passed just before the pandemic took hold.
I often think of the many women who may now be making their hospital visits for IV or even admission, and I wonder how they will cope.
Entering my ninth month of pregnancy, I was more exhausted than excited, looking forward to birth not just for the arrival of a beloved child, but also for release from the relentless physiological and psychological pain this condition had wrought.
Having read about the increased risk of HG survivors for Postpartum Depression and PTSD, I became afraid that I would find it hard to bond with the baby after delivery.
I reached out to a therapist and spoke frankly with her about my fears for the future.
She equipped me with some tools to begin reframing the narrative and to consider which aspects of this experience were still in my control.
She suggested some simple visualizations that could help build more positive associations through the final stages of my pregnancy and I practiced them daily.
In late July 2020, in the small hours of the morning, I gave birth to a beautiful baby girl.
As I held my daughter in my arms for the first time, I realized my fears had been unfounded, the connection in my case was instant and intense.
I was nauseous all the way to the very end, right up to the point they wheeled me into the delivery room.
Soon after the baby was born, the placenta followed and along with it, my nausea too melted away. There I was feeling a whole lot better just like that, where before, even the strongest antiemetic drugs (originally developed for cancer patients) hadn't completely worked.
Months of anguish ended as mysteriously as they had begun. The human body is a strange, strange thing.
A few hours later, I eagerly wolfed down the standard maternity ward breakfast of cold omelette, white bread, butter, gelatinous jam and chai. Food had never tasted so good before, even if it was just hospital food.
I was so overcome by the simple joy of being able to eat effortlessly, I even went for seconds (my husband volunteered his own meal).
Nearly a year later, with the benefit of hindsight, I can honestly say that even though my pregnancy was harder than I had ever imagined it would be, it was all worth it in the end.
Here Are a Few Things I've Learned From My Own Experience
First, HG is not normal pregnancy sickness. Ask your doctor for a diagnosis if you suspect you have HG.
While the use of many medications is contraindicated in pregnancy, don't assume it's better to just suffer through symptoms of HG, which if left untreated can cause severe complications.
There may be treatment available, speak to your doctor and read up on available medication, including second-line treatments such as ondansetron.
At the same time remember there’s no ‘magic pill’ and while treatment can help, it may not completely alleviate your symptoms.
In some cases, you may have to live with HG until the end of the pregnancy (in very rare cases even some way beyond).
Eat what you can, when you can.
Try and identify which part of the day your symptoms are mildest and try to eat then. Don't get stressed if you can't keep up with all the advice on eating healthy in pregnancy.
If all you can keep down are crackers or fries, then go ahead and have them, unless you have other underlying health conditions like high blood sugar that require a restricted diet.
In order to keep down food, it also helps to avoid triggers, like specific smells, where possible.
Remember that you are not alone.
Consider reaching out to your support system even if it's early on in your pregnancy. This can provide much needed psychological and practical support.
Partners should advocate for HG sufferers.
Partners should advocate for HG sufferers. The illness can really impact a woman’s ability to cope with medical appointments or to seek adequate help. Where possible, partners, family and friends can offer to help out with daily tasks.
Even something as simple as grocery shopping can be impossible to navigate with HG.
It helps if people around the HG sufferer read up on the condition so they can understand what may be triggers and help avoid them.
If you have a supportive employer, consider speaking to your manager and HR.
See if you can draw on your organisation's sick leave and flexible working policies to make it through the toughest months.
Don't ignore the psychological aspects of HG.
Where possible, reach out and speak to a counsellor. Ask your gynaecologist for a referral, if needed. Ignore all unsolicited or unhelpful advice from the uninformed, or try to laugh at it (as I eventually learned to do).
Finally, remember you will get through this one way or another.
You will find strength that you didn’t think you had. You are not alone.
There are others who have been here before you. We stand with you.
This article originally appeared on the author's Blog.
(Neenaz Ichaporia is a teacher trainer and Academic Manager in online / digital education. She's also a former journalist. Her interests include reading, photography and travel.)
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