How to Cope with Excessive Nausea in Pregnancy

The Mum Club9 February 2023

How to Cope with Excessive Nausea in Pregnancy

When I was pregnant with my first child, my morning (noon and night) sickness routine was as regular as clockwork. I’d throw up as soon as I woke up, and once again just after 5pm in the evening. At my workplace, I recall those ever-so-stressful days of swiftly packing my belongings before the clock struck 5, saying a quick goodbye to my colleagues, before dashing to the toilets to bring up the contents of my lunch up. It was awful, and it went on for months. At the time I remember thinking if this is what pregnancy is like I don’t intend to ever do this again.

Looking back, my situation was mild in comparison to what some women have to endure while pregnant. In truth, most of us mums have had our fair share of pregnancy sickness horror stories. But spare a thought for those women who experience a sickness so severe and unrelenting that it can last throughout the entirety of their pregnancy.

Hyperemesis gravidarum is a medical term given to women who experience excessive nausea during pregnancy. It manifests as severe nausea and frequent vomiting (four times a day or more) and can be accompanied by other symptoms such as dehydration, constant dizziness, and even weight loss. Unlike traditional morning sickness, Hyperemesis gravidarum is less common and is said to affect 1 to 3 in every 100 women according to nhs.gov. The sickness can become so debilitating that some women may require hospitalisation. The condition may not improve or clear up until the baby is born but may subside at around the 20-month mark.

What causes hyperemesis gravidarum

Experts still have no definitive explanation as to why hyperemesis gravidarum occurs. The most common theory is it’s caused by rapidly rising levels of hormones specifically oestrogen and human chorionic gonadotropin, which is the hormone created by the placenta. There is some evidence to suggest that HG may also be a condition that runs in families, so if you have a mother or sister that experienced it, you may be more likely to get it as well. Similarly, if you had it during a previous pregnancy, you may get it again during your next unfortunately.

Morning sickness vs hyperemesis gravidarum

With up to 80% of women suffering from nausea and vomiting during pregnancy, it can feel like hell when you’re in the midst of it, and some women may in fact wonder if they are themselves experiencing this particularly intense and extreme form of pregnancy related nausea. Lesley Gilchrist, registered midwife, and co-founder of My Expert Midwife is keen to emphasise that there is a clear distinction between the two. She says, “While most women find their morning sickness eases after the first trimester unfortunately, 1-2% of women will develop hyperemesis gravidarum, which can cause severe dehydration and hospitalisation. Hyperemesis gravidarum is diagnosed when a patient’s wellbeing and ability to have a normal lifestyle are compromised due to the sickness and nausea they are experiencing.” So, what are some of the things women need to look out for if experiencing sickness during pregnancy? “Women should seek help as soon as possible if they experience any of the following symptoms: you are unable to keep down any food or fluids for 24-48 hours, you are not passing any or very little urine and it is dark in colour, or you feel weak or faint and not able to stand up for any length of time.”

The mental toll

The physical symptoms associated with hyperemesis gravidarum are pretty much well-documented within the medical profession, but what isn’t discussed as much is the mental toll that this condition has on women. The hormonal and bodily changes experienced during pregnancy are overwhelming enough, no matter how many times you’ve given birth. So when you add this distressing condition to the equation, it can seem like too much to bear. Dr Carla Runchman is a clinical psychologist and two-time sufferer of HG in pregnancy who states that it’s equally important to discuss the psychological elements of the condition, so women won’t feel so isolated when experiencing it. She says, “A key aspect, often overlooked at medical appointments, is the crushing loneliness of HG. You are typically shut off from your normal routine, work and socialising. Well-meaning friends and family might not ‘get it’ and make well-meaning but ultimately undermining comments about ‘morning sickness’ or, worse, ginger biscuits. Women can be on their own, feeling dreadful, for long periods, and this can lead to rumination – when thoughts end up in a negative spiral. This happens because you are feeling low, due to the nausea and the limiting impact on your life, and the fact that you are left alone with your thoughts.” With such an utterly depressing assessment of the situation, how does Dr Carla suggest we implement mechanisms to cope? “From a psychological point of view, if you are feeling out of control (which is understandable in HG), try finding something that helps occupy your mind, and gives you a sense of control, however small. Can you try a repetitive but easy activity like crochet (I have several crocheted blankets that unfortunately now make me nauseous at the sight of them!). Your partner can help; what would make you more comfortable? Simple things like having fresh bedding every day, or supplies of whatever food/drink you can get down, or a book/magazine to read can make a huge difference to how you are feeling.”

Treatments available

Thankfully there are also treatments available now that can help to lessen the physical symptoms of hyperemesis gravidarum and they include anti-sickness drugs, vitamins B6 and B12 and/or steroids. If the symptoms are unable to be controlled at home and the excessive vomiting continues, a more invasive approach can be taken with treatment being administered intravenously directly into a vein through a drip. “If you are admitted to hospital for treatment, a doctor will assess you, and a plan of care will be made for your needs”, explains Lesley Gilchrist, registered midwife. “Although treatments can temporarily relieve symptoms, it is common for them to return. If you are diagnosed with hyperemesis gravidarum you can expect to be offered an anti-emetic (anti-sickness) medication via an injection until you can tolerate this in tablet form. You may also be offered intravenous fluids (IV fluids) to rehydrate you whilst the right medication is found to help ease your sickness.” Although it’s easy for someone not going through it to say this – it’s crucial to remember that there is an expiration date on this condition, and there will become a time that you no longer have to endure it. In the meantime, we hope you find the strength and will to cope if you’re currently in the thick of it.

Written by: Keysha Davis

The Mum Club9 February 2023