I saw in the news today that two thirds of women with extreme sickness in pregnancy (hyperemesis gravidarum) are not given the information they need to manage it (Guardian BBC). I wanted to help address this problem in this blog.
Of course its normal for many women to have some nausea in early pregnancy but for some it’s a much bigger problem. Some vomit many times in a day and can’t keep food down. It can make them feel very unwell and at worst can cause them harm if they get complications from it. Its really important for any woman feeling unable to manage their symptoms to be given the support they need. In different countries they can get the support in different ways. Some will see a community midwife, others a GP and others will go to the hospital. There are also options of seeking advice through more modern techniques such as apps like ‘Ask the Midwife’.
I thought it would be useful for you to know what treatments you can have so that they can ask their healthcare provider for it. Their healthcare provider can then work with them to work out which of the options is best for that women as there is no one size fits all policy.
What can you try at home?
Remedies to try at home: see my earlier blog on Pregnancy Morning Sickness
What can your healthcare provider offer you?
Importantly they first must assess you to decide if your sickness requires treatment and if so what kind of treatment. The assessment should include observations such as your pulse, blood pressure and weight to look for dehydration and the severity of the condition. They should then ask questions and do any relevant tests to rule out another cause such as gastroenteritis as just one of many examples. If the sickness is not that severe you may not require further investigation at this stage. However, if this is the advice given but your symptoms get worse or are prolonged, please go back to your healthcare professional as they may then change your management plan.
If it is more severe, your healthcare provider should then order some basic investigations like a urine dipstick (looking for signs of starvation due to not being able to keep food down (ketones) and infection (leucocytes and nitrites)). They should send the urine off for testing for infection as this can be a cause of vomiting. They should also organise blood tests looking at your thyroid function, kidney function, electrolytes and liver function. They should also organise an ultrasound scan of the pregnancy to look to see if you are having more than one baby or if it is actually a molar pregnancy.
They then can offer you treatment either at home or in a hospital depending on the severity of your symptoms. Most women are managed at home. They can offer drug treatments to help you with your symptoms, fluids if necessary and in some cases vitamins, electrolytes and nutrition to replenish what you may lose.
More information can be found about regimes for treatments on the NICE Clinical Knowledge Summary website. NICE is a UK based organisation that uses evidence to select the best treatments for women. Currently they advise that first line anti-sickness treatments (known as anti-emetics) would be promethazine or cyclizine. These should be tried for 24 hours before trying further treatment such as metoclopramide, prochloreperazine or ondansetron. All of these medicines are not without risk of side-effects which is why not all women are given them. The healthcare professional will discuss with you the benefits and risks and work out, for you, whether the benefits outweigh the risks. It will be important for the healthcare provider to monitor you, once established on the treatment, to help you decide when to stop taking the medicines as you are unlikely to need them for the whole pregnancy and are likely to be able to stop around week 16 of pregnancy although this isn’t the case for all women.
What other support is out there?
The Pregnancy Sickness Support charity which is UK based has written information on their website but also has a telephone information line. They provide everything from real life experiences of women for other women to learn from to advice about employment.
The HER foundation in the USA has information for healthcare professionals and also has a research arm.
In Australia there is a Facebook support Group for women with Hyperemesis.
The Health Navigator website in New Zealand has information for women.
I really hope this blog helps and remember to approach your doctor/GP/midwife if you feel you may have hyperemesis.
Any questions or comments do get in touch @PregnaPouch or PregnaPouch@gmail.com.
The PregnaPouch team