Being nauseated is such a common part of the pregnancy experience that up to 80% of women experience it, and up to 50% of women experience vomiting. But, for 0.5-3% of expecting moms, morning sickness morphs into a ghastly nightmare–hyperemesis gravidarum (HG). This is such a severe case of vomiting during pregnancy that (if untreated), can lead to the death of not only the baby, but the mother as well.
I developed HG in my very first pregnancy. The pregnancy books I was voraciously reading told me to expect morning sickness to start around 6 weeks, be at its worst around 9 weeks, and resolve by week 16 or so. When I started feeling nausea around week 3, and began vomiting at week 4, I actually initially found this relieving–the pregnancy books also said that nausea was a good sign of a healthy pregnancy.
But it never got better. I missed days of work due to intense vomiting and my diet–once diverse and healthy, with tons of leafy green salads and grilled salmon and whole grains, perfect for pregnancy–rapidly shrank to crackers, popsicles, and dry cereal. I began losing weight, had constant headaches, and was so fatigued that if I managed to go to work, I could do nothing but lie prone on the couch. The nausea was so bad that if I even smelled food being cooked, I would vomit–my housemates had to air out the kitchen everytime they cooked, wildly inconvenient during the winter.
I worried constantly about the pregnancy–I wasn’t even just eating an unhealthy diet, I was sometimes not eating at all. At what point would the malnutrition affect the baby? I tried every nausea tip under the sun–acupressure wrist bands; Unisom and B6; ginger in all its varieties; constant small snacks; sour candies; peppermint essential oil; BRAT diet; lemons in water; popsicles; lying down–you name it, I tried it. Some things offered minor relief, but nothing staved off the symptoms from growing steadily worse.
When my wife and I found out right before Christmas that I was carrying twins, we thought that was the reason I had been so sick–but even time didn’t improve things.
On Christmas day (week 9 of the pregnancy) I was so sick that I vomited stomach bile (there was no food left in my stomach) the entire way back from the family gathering and couldn’t even keep down ice chips, let alone water, let alone any sort of food.
Malnutrition or not, dehydration was blatantly bad for the babies and me and would hurt us all a lot sooner than missing meals. My wife and I went to the ER the next day. By now I had lost 8lbs in 3 weeks–over 7% of my pre-pregnancy weight, another worrisome marker.
A local nurse shared some insights, however, requested her full name remain anonymous. She is referred to as M. throughout the rest of the article.
M., who has her master’s degree in both stem cell biology and nursing and currently works with local pediatric patients in Ann Arbor, confirms that although there’s no clear line for when nausea and vomiting is worrisome in pregnancy, it starts to get dangerous when the mother gets dehydrated.
“When you’re dehydrated, the baby is also in danger too,” M. said. “There can be a gray area where you need to get labs done to know if you’re dehydrated. You can track simple signs such as the skin test where you fold your skin up and watch it: if it remains tented up, that’s a sign of dehydration. Thirst is also a good indicator, as is if your urine is getting darker (you want a pale yellow color).”
As I was hooked up to IV fluids and nausea medication, my lab results came back. No one was surprised that I was dehydrated, my electrolytes were imbalanced, and my blood volume was reduced. But my urine had a worrisome amount of increased ketones in it. Essentially, I was so malnourished that my body had started to eat itself in order to keep the babies alive.
Keto might be a popular diet, but when pregnant, the last thing you want is for your body to enter into ketosis. I had developed hyperemesis gravidarum.
HG is, frankly, morning sickness from hell. It starts earlier than “normal” morning sickness and sometimes doesn’t end till after birth. It’s so awful that up to 15% of women will terminate a desired pregnancy because their symptoms are so severe.
One mother in my HG Facebook group had to terminate her pregnancy because she was going to lose her job otherwise, and her family couldn’t afford to live without it.
At its worst, HG leads to the death of the baby as well as the death of the mother. Even during “normal” cases, where it’s diagnosed and treated, HG causes dehydration, malnutrition, and starvation.
The fatigue with HG is wildly beyond “normal” pregnancy fatigue–even going up one flight of stairs or walking to the kitchen can exhaust a mother, let alone trying to make it through a work day. It can cause brain encephalitis, organ damage, esophageal tears, vomiting blood, headaches, dizziness, fainting, low blood pressure, rapid heart rate. It also causes extreme social isolation, depression, and anxiety; and can cause severe financial concerns because most women need time off work, and some can’t work at all if they choose to keep the baby.
I experienced many of these symptoms. For almost a month, if I even just sat upright (let alone stood) for longer than 15 minutes, I would start heaving or vomiting–just that simple pressure from sitting upright put too much pressure on my esophageal sphincter. I lost my job because I couldn’t make it through a complete workday, I couldn’t make any food for myself, and I felt wildly socially isolated.
Pre-pregnancy, I saw friends multiple times a week; now, all I could do was lie on the couch. Even when friends kindly offered to come over and see me, it was emotionally and practically difficult to schedule–what if they did and then I was just in the bathroom vomiting the whole time?
But there are treatment options that are often very successful for HG. In the ER I was put on Zofran, a nausea medication which helped immediately, and began weekly hospital trips for IV infusions of fluids, medication, and vitamins. Although I was still nauseated constantly and vomiting occasionally, this was a massive improvement. I was so dehydrated that the first 2,000ml of IV I received in the ER, I gained 5lbs in water weight that day and still didn’t need to pee for hours afterward.
Raising awareness around HG, both socially and medically, is critical to supporting moms who are suffering from it because many of the women who choose to terminate their HG pregnancy were not properly diagnosed, were dismissed by their doctors, or were not told of treatment options, essentially being told they just had to suffer or get an abortion. Knowing that there are options could help these mothers keep their babies.
Lisa, a local mom with two daughters, was hospitalized three times for severe dehydration during pregnancy because her OBGYN didn’t know much about HG and thought Lisa was just experiencing “extreme morning sickness”. It was only after weeks of Lisa vomiting 40 times a day, losing too much weight, and finally getting a kidney infection that she was able to receive her HG diagnosis and get prescriptions for anti-nausea meds, which helped her get through the remainder of her pregnancy.
Lisa says that the lack of awareness around HG, not only from friends but also from medical professionals, was wildly apparent.
“It took so many hospital visits for the exact same thing before my doctor would consider HG to be a diagnosis I would qualify for. When you’re so dehydrated that your pee is brown (if you can pee at all) and you’ve been puking without keeping water down for two days, you know something’s wrong,” Lisa said. “That’s not just morning sickness.”
Her doctors should have known this too, and her journey to get diagnosed was “long and horrible” because they didn’t.
HG also often forces moms to tell other people about their pregnancies far earlier than a lot of people prefer to.
With more HG awareness could come more general societal support–a mother with HG often literally can’t prepare food or go to the grocery store, and having family, friends, and partners who are understanding of the severity of this illness and willing to come over and help out with food and house chores was a tipping point for several women in my Facebook HG groups on whether they could keep the pregnancy and make it through, or not.
M. recommends if a pregnant woman is worried she’s experiencing signs of dehydration, electrolyte imbalance, or malnourishment, that she reach out to her doctor and ask for tests to determine her health and the health of her baby.
Many moms are understandably worried about being on medications while pregnant. And for an ordinary pregnancy, you probably don’t need nausea medication! But an HG pregnancy is not only about your comfort and quality of life (which still matter), it also puts your and your baby’s nutritional needs and ability to grow at risk.
I went off all of my medications before conceiving, so I totally get being hesitant to go back on medications! I did an extensive amount of academic research into each medication that my doctor prescribed, and although there are some side effects, I was greatly consoled that the positive impact for both the babies and me far outweighed them. The HG Foundation has a thorough treatment protocol of several levels for HG.
I’m now 28 weeks pregnant–close to the finish line with twins. Once I was diagnosed and began getting HG treatment, the vomiting subsided substantially and the nausea, although not eliminated, improved. I’ve been able to gain weight and worry less about my babies and me.
But HG has left its mark: my pregnancy has been so difficult and full of so much pain and financial cost that I’ve decided this is likely my only pregnancy. HG has a 75-85% recurrence rate, and over ⅓ of moms with HG decide it’s too risky to try for another child, even if they originally really wanted to.
If you or a fellow mom feel worrisomely ill in your first trimester, check out the HG Foundation’s criteria for determining if you may have HG.