Beyond Morning Sickness: Understanding Hyperemesis Gravidarum

Editor’s note: Our friend and occasional contributor, Jessica Martin-Weber mother of seven and founder of The Leaky Boob, candidly shares her experience with Hyperemesis Gravidarum. HG affects up to 2 percent of pregnancies and is a severe manifestation of morning sickness, causing frequent nausea and vomiting during pregnancy.

Being careful not to jostle me, my nurse expertly uncapped the extra port on my PICC line and screwed on the syringe with 4mg of Ondansetron (brand name, Zofran), a powerful antiemetic commonly used for cancer patients going through chemotherapy to help control their vomiting.

The emesis basin next to me wasn’t even half full. I hadn’t had enough by mouth yet that day to fill anything, but after properly disposing of the syringe, she charted the little bit of bile and water in the basin before rinsing it and putting it back within my reach. She asked me if I thought I could eat yet, but she and I both knew that wasn’t likely. I told her I would try anyway. In an optimistic attempt at getting food in me, she asked what sounded good and suggested the one food that had stayed down for me the day before.

Willing to try, my reply was cut short as heaves started, and I reached for the basin knowing my stomach wouldn’t rest until whatever happened to be in there, at this point just bile, had been evacuated. When I finally laid back on the pillow again, worn out, sore, and having deposited bile and blood in the emesis basin, she suggested we give the Ondansetron a little more time in my system before we talk about taking anything in by mouth. We both knew I would have to try eventually. My morning weigh-in showed I had lost another 2 pounds, bringing my total weight loss that week to 12 pounds.

Things were getting serious.

I didn’t have cancer. I was just pregnant. And I didn’t have morning sickness, I had hyperemesis gravidarum.

Before we ever get pregnant, most women have an idea of how we will spend our time gestating. We envision planning out our space to welcome our growing family. Conscientious, many of us intend to eat well, have regular prenatal care, remain appropriately active, and move forward with our lives with the addition of knowing we are growing another person even as we deal with some minor discomforts that go along with the privilege of carrying and growing life.

Our intentions are to do everything “right” from the very beginning, to give our offspring the best possible start in life. We do our research, learn how to arrange our lives accordingly for this little person we already love so much, purchase the safest products, explore how to reduce the toxins our families are exposed to, and educate ourselves to make informed decisions that will help make space for the healthy, happy homes we imagine for our loved ones.

That was certainly my plan. I looked forward to the care of a midwife and a planned home birth, imagining what it would be like to eat a healthy, balanced diet to grow my baby. Already a physically active person, I was certain I would maintain my activity level and even learn new ways for me to engage my whole mind and body not only for my well being but for my children-to-be.

In my mind, there was no doubt that I would have a drug-free pregnancy and birth. Everything would go according to the books, I would be mindful of everything I put in my body and eliminate any unnecessary risk.

A headache would be something I could suffer through before risking exposing my baby to some pharmaceuticals that 20 years from then would turn out to have caused her some kind of brain damage or given her cancer. I would do everything natural and avoid putting any pharmaceuticals into my body as I grew my babies.

It was a good plan. But it couldn’t be my reality.

All the ginger, crackers, small frequent meals, essential oils, slippery elm, papaya enzymes, wild yam root, acupuncture, chiropractic, and every other sage advice that helps ease morning sickness failed me. My midwives, obstetricians, naturopath, herbalist, friends, and my husband looked into and tried everything to help me.

Over the course of 19 years and 7 children, yes, I was crazy enough to do this 6 times, I have tried every remedy, every herb, every cleanse between pregnancies, every gut healing diets (gluten-free, GAPS, you name it), had every test (no, I have not tested positive for h.pylori the three times I’ve been tested), thyroid levels, meditation, therapy, and more, without relief from hyperemesis gravidarum.

Some of my friends on the support boards for moms with HG found relief with these protocols. Most of us had to go for those big, scary, pharmaceuticals though. My personal drug protocol cocktail doses me with more medication in a single day of my pregnancy than I would take in a year of not being pregnant.

Recently the Duchess of Cambridge, Kate Middleton, has brought attention and awareness to hyperemesis gravidarum through her two pregnancies though even with official announcements from the royal family and her medical providers, much of the media continued to call it severe morning sickness.

An understandable mistake to a degree, however, HG isn’t just bad morning sickness with a little bit of nausea and vomiting. It isn’t comforting to a mother that it is a sign of her pregnancy sticking due to strong hormones, HG has proven fatal for some women and has ended many very wanted pregnancies. There is nothing comforting about feeling your body die and fear for your growing baby.

If you’re wondering what the difference is and if you could possibly be suffering from something more than morning sickness on a kind of ego trip, here are some indicators of hyperemesis gravidarum as put forth by the Help HER (Hyperemesis Education and Research) Foundation:

Hyperemesis gravidarum often recurs and follows similar patterns in future pregnancies, though severity may vary each time.

• Anemia
• Body odor (from rapid fat loss & ketosis)
• Confusion
• Decreased urination
• Dehydration
• Dry, furry tongue
• Excessive salivation
• Extreme fatigue
• Fainting or dizziness
• Food aversions
• Gall bladder dysfunction
• Headache
• Hypersensitive gag reflex
• Increased sense of smell
• Intolerance to motion/noise/light
• Jaundice
• Ketosis
• Liver enzyme elevation
• Loss of skin elasticity
• Low blood pressure
• Overactive thyroid or parathyroid
• Pale, waxy, dry skin
• Rapid heart rate
• Rapid weight loss of 5% or more (from pre-pregnancy weight)
• Secondary anxiety/depression
• Vitamin/electrolyte deficiency
• Vomiting of mucus, bile or blood

If your pregnancy includes any combination these indicators, you can find help at helpher.org and with your health care provider. With proper and aggressive care management that focuses on prevention and treatment, often the mores serious risks of HG can be controlled.

Whether we find ourselves facing pregnancy induced hypertension, preeclampsia, placenta previa, HELLP syndrome, PUPPP (Pruritic urticarial papules and plaques of pregnancy), gestational diabetes, or anything else that drastically alters the course of reality from the vision we had is difficult.

Even though we know things will be different than we had imagined, it is a tangible loss to have what should be an exciting and beautiful time with minor discomforts turn into something frightening and alienating.

I have had to grieve, several times over, the loss of the pregnancies I had always hoped for, the time of health and bonding with my baby as she grew inside me, and acknowledge the risk I took in taking medications not intended for pregnancy. A risk I made peace with, without it my babies and I most certainly would have died of starvation and dehydration induced organ failure. I had to settle for us just surviving.

For me, my 6 beautiful home births and holding my 7 strong and healthy daughters have been healing and powerful in reclaiming my journey into motherhood back from HG. I feel incredibly blessed by that, but not all of my HG sisters get that opportunity to heal.