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Hyperemesis gravidarum

02 November 2017
Volume 25 · Issue 11


Hyperemesis gravidarum has gained increasing recognition since the Duchess of Cambridge was first diagnosed in 2012. Yet, as Claire Axcell writes, it is still a misunderstood condition

Hyperemesis gravidarum (HG) is a condition characterised by extreme vomiting and nausea during pregnancy, and affects 0.3–3.6% of women (Royal College of Obstetricians and Gynaecologists, 2016). Its symptoms are often severe and debilitating for those unfortunate enough to suffer from it. The exact cause of hyperemesis is not known; however, if there is a family history of the condition or it has been experienced in a previous pregnancy, the condition is more likely to occur (Dean, 2015; 2017). In the media, the focus is on the Duchess of Cambridge, who has suffered from the condition, causing her to be admitted to hospital while pregnant, and forcing the revelation of her pregnancies perhaps before she would have wanted.

Despite the extensive media coverage of the Duchess, the condition still carries stigma and a lack of understanding. I found it vastly disappointing when, catching a glimpse of a report on HG on This Morning, ginger was suggested as a potential cure. In clinical practice, watching women be admitted for severe dehydration and being given fluids, strong anti-emetics and anti sickness drugs through an intravenous drip, advising them to try ginger feels like advocating a water pistol in putting out a bonfire. In fact, research suggests that ginger can do more harm than good when used by those suffering from HG (Dean, 2015).

Recently, for a class presentation, I and others in my cohort were asked to lead a presentation about the condition. Since going back out into practice, I have come across several women suffering from HG, many of whom felt misunderstood and frustrated at their state. Going from feeling healthy and well and finding out about a much wanted pregnancy, to facing multiple hospital admissions destroys the joy of what women feel should be one of the happier times of their lives.

Under normal circumstances, if a person was vomiting 20–30 times per day or more, losing weight, unable to eat or keep fluids down, that person would be marched to the nearest doctor with demands for extensive testing. Yet it seems that if the person affected is pregnant, it is just ‘bad morning sickness.’ The effects of HG are wide-ranging, however: it can limit a woman's ability to work, or can harm her ability to maintain friendships, due to the isolating nature of the condition. It can also lead to depression, anxiety and post-traumatic stress disorder (PTSD).

At the beginning of October, the second international conference on HG was held in Windsor. The conference was chaired by Caitlin Dean, an author who has suffered from HG with all three of her pregnancies. One of the measures discussed was outpatient versus inpatient treatment for HG, which was studied in the hyperemesis in pregnancy trial (McParlin et al, 2016). An earlier study showed that there could be a important quality of life component to outpatient treatment, which would mean less time off work, and less time away from older children (McParlin et al, 2016).

Most importantly for those who are suffering is understanding and the knowledge that they are listened to and taken seriously. Those who have had HG speak of feeling stigmatised and dismissed when speaking to health professionals about the effects of the condition on their lives. Women who have HG should not have to fight for their condition to be recognised and medicated properly so that their quality of life improves. However, as midwives, being supportive and signposting women to outside agencies can go a long way in helping a woman feel validated and that she is not ‘making it up.’