Hyperemesis Gravidarum

Surviving Extreme Morning Sickness By Tamar Weiss

Sarah Krengle, a mother of three children, has suffered from hyperemesis gravidarum (HG), or severe morning sickness, during all of her pregnancies. She remembers the duration of her pregnancies as extremely debilitating. "I was completely dysfunctional," she says. "Sometimes I could muster up only enough energy to crawl to the bathroom."

Unpleasant as Sarah's experience sounds, it is only a fraction of what she and other women afflicted with HG endure. For most women, pregnancy is challenging both physically and emotionally; yet many women who experience hyperemesis gravidarum describe their pregnancies as the most difficult times of their lives.

What is Hyperemesis Gravidarum
Hyperemesis gravidarum, says Dr. Arianna Sholes-Douglas, perinatologist and coordinator of Mercy Medical Center's High Risk Pregnancy program, is a complication of pregnancy affecting fewer than 1 percent of pregnant women. In cases of hyperemesis gravidarum, the expectant mother is afflicted with extreme and persistent nausea and vomiting (20 to 30 times a day), will lose between 10 to 20 percent of her body weight and will suffer electrolyte imbalance. Sometimes, as a result of severe dehydration, liver damage will occur.

Hyperemesis gravidarum may last the duration of the pregnancy, but often becomes less extreme as the pregnancy progresses. Most women suffering from HG undergo serious agitation, worrying about harmful effects to the fetus. There is generally little danger to the fetus in these cases, though. Acting as a parasite, the fetus will receive the nourishment it requires.

There is no proven answer as to why hyperemesis gravidarum arises, though there are many theories. Many people believe HG is a result of rapidly rising levels of hCG, human chorionic gonadotropin, which is secreted by the fetus. Some attribute it to carrying multiple fetuses.

How to Treat HG
According to Dr. Linda Harel, assistant head of the department of obstetrics and gynecology at Mayanei HaYeshua Hospital in Israel, intravenous hydration is the primary treatment in the case of hyperemesis gravidarum. A patient will be admitted to the hospital when she is "severely dehydrated, in a negative metabolic – or catabolic – state, and/or ketones are found in the urine," she says. Anti-emetic drugs, those used to stop the vomiting, are often administered.

"With severe hyperemesis, not much works to help the patient feel better," says Dr. Sholes-Douglas. She adds that in her experience, she has had a good success rate with nasal gastric tube feedings. "In this case, nourishment enters the body by way of a tube in the nose; the patient need not smell, taste or swallow – which can often be helpful to these women."

Once a patient is released from the hospital, Dr. Harel recommends eating and drinking small and frequent meals. She further advises women affected by HG to "stay away from any possible stressful situations," as stress can exaggerate the problem.

Surviving HG
The fact that it is uncommon does not make hyperemesis gravidarum less real – only more difficult to cope with. Few people truly understand the extent to which someone undergoing hyperemesis gravidarum suffers. "I felt like no one was out there," says Sarah. "It seems that so few women go through it, and on top of that, even less women are experiencing it at the same time as you are."

Laurie Agne also suffers from hyperemesis gravidarum. During her pregnancies she felt that people who did not experience the condition had a hard time relating to her misery. "They did not know how to react and usually would say the wrong things like, 'Why can't you control this?' or You can't go to the hospital just because you throw up a lot; all pregnant women throw up,'" she says. Being misunderstood at a time when you are living such a crisis can be depressing and lonely.

Dr. Sholes-Douglas explains that it is important for family and friends to understand that women experiencing hyperemesis gravidarum don't have control over it. Laurie's husband is particularly sensitive to her needs when she is unable to function as a mom and wife. "He knows that when I am sick I can't do most things that moms have to do," she says. "He does it because he knows I just can't."

Expectant mothers going through this ordeal need a lot of emotional and psychological support. Dr. Sholes-Douglas often advises her HG patients to meet with psychologists.

Not only does the condition debilitate pregnant women, but young children watching their mothers become violently ill can become terribly frightened as a result. Sarah found that if she made light of what was going on around the kids, they felt a little more secure. "I would sometimes try to put a big smile on my face when I came out of the bathroom, hoping that the kids would only be as scared as my fear warranted," she says. "If I put on a brave face, they felt better." Children may also become frustrated when Mom is unable to play, read or do anything that she used to. "You forget what it's like to be you," Sarah says. "I would ask my husband, 'Are you sure I used to run around, eat what I wanted to, function as a normal person?'"

One may wonder how women afflicted with hyperemesis gravidarum ever decide to become pregnant again. Difficult as it may seem, some women are able to look beyond the condition once it passes. Sarah is thankful that after each of her pregnancies she was blessed with the ability to put it behind her and move on.

Upon seeing the new baby for the first time, vivid memories of what they've endured may dissipate for some HG sufferers. "I think that if every woman did not get pregnant just because of the possibility of all the things that could happen, the human race would die out," Laurie says. "It is worth it in the end."

Want to see more?

• Overcoming Morning Sickness
• Carpal Tunnel Syndrome During Pregnancy
• Coping With Morning Sickness: How to Help Your Partner
• Talk about it!

About the Author: Tamar Weiss is a freelance writer.