I'm pretty sure that most people have heard the news about the Duchess of Cambridge being admitted to hospital for Hyperemesis Gravidarum (HG). I'm also just as sure that many are thinking "oh just get over it!" because that is the reality of HG, hardly anyone knows what it is or understands how truly awful it is. And unfortunately, with the media spewing out misinformation a mile a minute by using terms such as "acute morning sickness" and inviting doctors onto their shows who obviously have no experience with treating HG, this isn't going to change very fast.
And so, as a HG survivor who has dedicated most of the first year of her child's life to researching about the condition, writing a book about it, networking with others and raising awareness, I feel it is time to turn over my blog for a while to the subject.
So let's start by passing on my sincerest best wishes and support to the Duchess. Hyperemesis is a truly awful condition, terrifying in its severity, isolating in the fact no one understand what you're going through, and a battle from start to finish. If, like most of us, her symptoms peak between around 7 and 10 weeks, it is going to get worse before it gets better, and could be with her throughout the entire pregnancy. And she has to do this all in the public eye. My heart goes out to her, as it does to any woman suffering from HG!
So what is it?
Well, for starters, it is a severe form of Nausea and Vomiting of Pregnancy (NVP). The term itself basically translates as lots of vomiting (hyperemesis) in pregnancy (gravidarum). It is not "morning sickness", in fact we need to get away from using that term altogether. It is an outdated term, that trivialises the condition, not only for those with HG but also those with mild-moderate symptoms.
NVP affects up to around 80% of all pregnant women in some form or another. Perhaps this is why there is so much judgement and so little support and understanding for those with more severe forms, as anyone who has "felt a little queasy" for a few months may find it difficult to equate their experience to that of another. However, around 30% of women require time off work to cope with their symptoms, and 35% have symptoms that are of clinical experience. So whilst only around 1% of women suffer from HG, NVP is still nothing to be laughed at!
For those 1% who do develop HG, their pregnancy can go from joyous to a nightmare in a matter of days. The severity of sickness doesn't just build up slowly, it can go from next-to-nothing, to manageable, to totally debilitating within a week. So for all those who wonder how the Duchess could have been so very active and well last week and hospitalised this week, that is why.
Thankfully, since the invention of IV hydration, HG is not the life-threatening illness it once was. However there is still a major need for treatment. Women with HG become dehydrated easily, they can suffer from electrolyte imbalances which can lead to further complications, and they can lose weight extremely quickly. HG is often described as being present in women who lose more than 5% of their pre-pregnancy weight, but many women lose double this amount and more.
IV hydration and anti-emetic medication can help to control the symptoms and make eating and drinking more manageable for the HG sufferer, but unfortunately due to so much misinformation and a fear of treating pregnant women, many have to fight for the treatment they need and deserve. This should not be the case! There is plenty of research out there that includes safety data of various anti-emetic medications and the importance of timely treatment. I have included links to some of these at the bottom of this post.
There is a lack of awareness in the medical community. Many GPs and midwives continue to treat women with HG as having "morning sickness", giving out the usual advice of "eating little and often" and trying "ginger", neither of which are helpful for a woman who is vomiting multiple times each day and unable to function. There is a real need for better education on the condition, and it seems there is also a very real need to raise awareness of it in the media as well.
I feel both sorry for the Duchess and relieved that it is finally being covered by the media. But we have a long way to go. Even the BBC is using the term "acute morning sickness", and this needs to change. The charity Pregnancy Sickness Support, who I am closely connected to, are working tirelessly to change this. But we need help. We need you to retweet, to reblog, to share on other social media sites, to work with us to effect change.
Please don't just read this news and think "poor Kate" and then forget about it. HG affects a woman for life. Antenatal Depression, Postnatal Depression and Post-Traumatic Stress Disorder often accompany a HG pregnancy. Women and their families affected by it are left with the awful decision of whether to face another pregnancy to expand their family or choose not to have any more children. It doesn't end after 9 months. So please, read about it and spread the word.
For more information check out:
The Hardest Decision (my post on choosing not to have another pregnancy)
Time for the truth about Kate Middleton and Hyperemesis Gravidarum (my article on iVillageUK about the need for support for Kate, not judgement!)
please feel free to email me your own links to add!
Asker C, Nordstedt Wikner B, and Källén B. 2005 Use of antiemetic drugs during pregnancy in Sweden. European Journal of Clinical Pharmacology 2005; 61: 899-906
Christodoulou-Smith J et al. 2011 Posttraumatic stress symptoms following pregnancy complicated by hyperemesis gravidarum. The Journal of Maternal-Fetal and Neonatal Medicine
Ebrahimi et al. 2009 Nausea and vomiting of pregnancy: using the 24-hour Pregnancy-Unique Quantification of Emesis (PUQE-24) scale. Journal of Obstetrics and Gynecology Canada 31 (9): 803-7
Einarson et al. 2004 The safety of Ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG: an International Journal of Obstetrics and Gynaecology 111: 940-943
Farrell N. 2008 Hyperemesis gravidarum: how midwives can help. The Practising Midwife, 11: 12-14
Gadsby R and Barnie-Adshead AM. 2011 Nausea and Vomiting of Pregnancy a Literature Review. Pregnancy Sickness Support Website
Ismail SK and Kenny L. 2007 Review on hyperemesis gravidarum. Best Practise & Research Clinical Gastroenterology 21 (5): 755-769
Jarvis S and Nelson-Piercy C. 2011 Management of nausea and vomiting in pregnancy Clinical Review article. British Medical Journal, 2011-12-23, 342; 1407-1412
Koren G et al. 2005 Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. Journal of Obstetrics and Gynaecology 2005; 25 (3): 241-244
Koren G. and Maltepe C. 2004 Preemptive Therapy for Severe Nausea and Vomiting of Pregnancy and Hyperemesis Gravidaum. Journal of Obstetrics and Gynecology 2004; 24; 500-503
Matok I et al. 2009 The Safety of Metoclopramide Use in the First Trimester of Pregnancy. The New England Journal of Medicine 2009; 360: 2528-35
Mazzotta P and Magee LA. 2000 A Risk-Benefit Assessment of Pharmacological and Nonpharmacological Treatments for Nausea and Vomiting of Pregnancy. Drugs 2000, 59 (4;) 781-800
McCarthy FP et al. 2011 A Prospective Cohort Study Investigating Associations between Hyperemesis Gravidarum and Cognitive Behavioural and Emotional Well-Being in Pregnancy. Plos One, 6: 7.
McParlin C, Graham RH, and Robson SC. 2008 Caring for women with nausea and vomiting in pregnancy: new approaches. British Journal of Midwifery 2008; 16 (5)