Sunday 18 November 2018

Hyperemesis gravidarum- harsh realities of extreme morning sickness

Kate Middleton
Kate Middleton
Kate and William with their first baby, George
Kate Middleton.
Kate Middleton.

Aoife Stuart-Madge

As Kate Middleton is treated for hyperemesis gravidarum - an extreme form of morning sickness - Aoife Stuart-Madge talks to the experts about this 'debilitating' condition.

The announcement that Kate Middleton is pregnant again has been somewhat overshadowed by the news that she is being treated for hyperemesis gravidarum - the same acute form of morning sickness that she suffered throughout her first pregnancy. And for thousands of Irish women, morning sickness can cast a dark shadow over what is supposed to be one of the happiest times in their lives.

The term 'morning sickness' is a bit of a misnomer, explains Paula Barry, who runs a midwives' clinic in the Coombe Women & Infants University Hospital. "It doesn't just occur in the morning. For some women, it's the evening and for others it can go on all day," says Paula. "The symptoms can range from nausea and vomiting, to headaches, dehydration and fatigue.

In very severe cases, it can require hospitalisation for IV hydration, anti-sickness medication and vitamin and mineral replacement. Pregnancy is supposed to be a happy time, but morning sickness can be an awful thing to have to deal with, particularly when it's severe as it's so debilitating."

As many as eight in 10 Irish women will experience episodes of nausea and vomiting during pregnancy, but only around one in 50 will suffer the same extreme form of sickness experienced by the Duchess of Cambridge.

If you suffered hyperemesis gravidarum in your first pregnancy, like Kate, it's likely you will get it in your subsequent pregnancies, while your mother having the condition can make you more likely to get it too, and having a multiple birth also ups your odds. "Morning sickness is linked to the HCG pregnancy hormone - the same hormone that is picked up when you do a pregnancy test - which comes from the placenta," explains Paula. "With a twin pregnancy, the hormone levels are higher and the mother can really be sick."

And while morning sickness typically eases off after the 16-18 week mark, for some, the symptoms can persist throughout the duration of the pregnancy. According to Paula, who has seen countless women with the condition, the impact of morning sickness shouldn't be underestimated.

"It's often a case of 'Sure, you'll be grand, get on with it,' but it can be a real struggle to suffer nausea for weeks. Some women are in and out of hospital throughout their pregnancy and they are miserable."

Alison Edwards, senior lecturer in Midwifery at Birmingham City University adds that extreme morning sickness symptoms should not be underplayed.

"With hyperemesis, it is constant. You are constantly being sick, you can't keep anything down and it can make you very drained. It's like having gastric flu for weeks on end. It's awful. You can be hospitalised for six, seven weeks, possibly more. That has a massive affect on everything: your social life, family, your mood."

The good news is that it shouldn't affect the baby's development. "Babies will take from the mother what they need, so the baby won't necessarily come to any harm unless it goes on for a prolonged period of time," says Alison. "In those cases, the woman would be admitted to hospital to have the right nutrients fed through a drip."

While there is no cure for morning sickness, there are ways to help ease symptoms. Nutritionist Sharon Morey has this advice: "It's difficult to eat a well-balanced diet when you have morning sickness because you simply don't want food. The key is to take in plenty of fluids: fresh water, fruit and herbal teas.

There is anecdotal evidence that drinking flat coke can settle a stomach, but I would not advise that as there is no nutritional value. That said, if it works for you, drink it in moderation, but just make sure you are getting some nutrients from the rest of your diet."

And if you can't stomach a big meal, eat smaller, regular snacks. "Normally, I wouldn't advise to go overboard with carbs, but they do tend to settle the stomach, so you may find snacking on dry bread and crackers helps. A lack of vitamin B6 is cited as a cause of morning sickness, so snacking on B6-rich sunflower and pumpkin seeds are a good alternative to crisps."

Sharon adds "As your sense of smell is heightened during pregnancy, avoid anything with a strong smell. Try to keep your meals bland. You may find hot meals trigger nausea more than cold meals."

Pharmacist Sunil Kochhar says that while there is a limit to what can be given over the counter, there are homeopathic remedies that might help. "A lot of women find acupressure bands ease their symptoms. We recommend them first, along with ginger chews."

For severe cases, your GP may prescribe medication. "You can get antihistamines to help with nausea or a drug called prochlorperazine. Again, your doctor has to weigh up the benefit of you taking the medication against the risk. In severe cases, where the mother is vomiting severely and is dehydrated, we would suggest anti-nausea or anti-emetic medication."

Acupuncturist Emma Cannon, author of You and Your Bump, treats clients with morning sickness through acupuncture.

"One of the acupuncture points for morning sickness, Pericardium-6 (P6), is the same point that works with travel sickness bands. It works to settle your stomach."

But while acupuncture can ease mild symptoms, it is unlikely to ease extreme symptoms. In any case, Paula urges that you seek help. "You don't have to suffer in silence. Help and support is out there, so talk to your midwife."

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