‘Why pregnancy sickness needs more attention’

It’s 8am on a weekday morning, and I’m walking to the station to get the train to work as normal. Yet I feel anything but. It’s almost like I’m hungover – without any alcohol touching my lips. I’m constantly thirsty, tired, dizzy and lightheaded. I try to reach into my bag to find an emergency sick bag (a green compostable kitchen bin bag was all I could find), but it’s too late. I’m stood vomiting on the pavement, tears rolling down my face, wondering if I have the strength to make it into the office or if I should just turn back around, admit defeat and head home.

Fellow commuters walk straight past me – no one stopping to ask if I’m ok, as the gagging continues – and I wonder what they must be thinking. Perhaps that I went too hard on the vino last night, or maybe that I’m trying to battle my way through the morning sickness typical of the first trimester of pregnancy.

But I’m no longer in the first trimester and this isn’t just ‘morning sickness’. Instead, it’s Hyperemesis gravidarum, or HG for short. For the uninitiated, this is pregnancy sickness on acid. The NHS describe it as ‘severe vomiting in pregnancy’ and it’s thought to affect around one to three in every 100 pregnant women.

‘Hyperemesis gravidarum, or HG for short… is pregnancy sickness on acid’

Unlike ‘normal’ morning sickness – which usually stops by 16 weeks – it may not clear up until the baby is born, although most women see improvements at around 20 weeks. One 2019 study, which looked at women’s treatment and management of HG, as well as the consequences of HG on women’s daily life, concluded that ‘many women described HG as one of their worst life experiences with profound morbidity’.

It can be so severe that women feel they have no choice but to terminate wanted pregnancies. A recent study conducted by King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, in collaboration with the BBC and Pregnancy Sickness Support charity, shed light on the profound impact of HG on women’s lives. The study, which included over 5,000 women, revealed that 4.9% of participants terminated wanted pregnancies due to the severe effects of HG. My baby is so wanted and loved – but I’d be lying if I said that the thought of terminating it, due to the effects of HG, hadn’t crossed my mind.

The first six weeks of my pregnancy went by relatively uneventfully. But then, the extreme fatigue, nausea and constant vomiting kicked in. Every time I tried to eat something, I would be instantly – and violently – sick, sometimes throwing up as many as 10 times a day. My diet switched to all-beige everything – with cornflakes and bran flakes becoming key staples. Even a plain bagel would set me off, and keeping water down became a struggle.

‘I became scared to leave the house in case I needed to be sick’

I threw up in the office toilets at work, on the train mid-commute, in the car out of the blue all down my favourite trench coat, at the side of the road in the middle of the day, while driving, at my friend’s wedding… the list goes on and on. I became scared to leave the house in case I needed to be sick, turning into a shell of who I usually am.

During week 15, I had been so sick, I started to struggle to breathe – my chest felt like it had a dumbbell attached to it, inflamed and heavy from the constant retching. I was so beside myself in pain that it stemmed into a fully blown panic attack. So much so that my husband called 111 and the paramedics swiftly came over (gone midnight FYI) to check my blood pressure and administer an ECG to check on my heart. My results all came back as normal, but they warned me that the severe sickness could have torn my oesophagus.

Like many others, I sought help long before this happened – but, at least at first, I found it woefully lacking. At week 10, after suffering in silence for a month, my GP prescribed me cyclizine – an anti-sickness medicine (antihistamine) that works by blocking a chemical called histamine in your brain that can make you feel sick – but it barely scratched the surface.

They prescribed me 10 days’ worth of medication but caveated that I should only really take it for four days max, since (while there is no evidence that it can harm your baby) it’s best to only take cyclizine for as long as you need to, and I’d surely be ‘feeling better soon’. I remember thinking, ‘but women are pregnant for nine months, how will four days help?’

‘I could barely summon the energy to get out of my pyjamas, let alone wash my hair’

The mental toll piled atop the physical one. I’d quickly gone from someone who usually works out five times a week (fitness is a way of life for me), to cancelling my gym membership and spending most days in the foetal position on the sofa. My social life dried up – with friends no longer inviting me out for group Sunday roasts or Friday night drinks. And I worried about how I was going to keep working at 100mph when I could barely summon the energy to get out of my pyjamas, let alone wash my hair.

Meanwhile, my pregnant friends were running 10k races (and podiuming), hiking up challenging fells in the Lake District and bleating on about the importance of having an ‘active pregnancy’ on social media. All of which made me feel ten times worse.

I felt angry that no one properly prepared me for the isolating reality that comes with throwing up every day for months at a time, and mad at how unfair it seemed, with other pregnant friends complaining about feeling ‘a bit tired’ while I spent days at a time hanging out on my bathroom floor, unable to keep food down, let alone go out for a run or to the gym.

‘Have you tried ginger?’ they’d say. ‘Why don’t you try eating something as soon as you get up?’ they’d add. ‘Make sure you try eating little and often’…. As if I hadn’t already tried all of those things. This relentless rhetoric just made me even more angry.

‘This isn’t something that can be cured with a ginger biscuit’

At my 16-week check-up appointment with my midwife, I completely broke down. She asked me how it was all going, and the tears flowed as I told her the excessive nausea and vomiting had turned my life upside down. She then asked if I’d ever heard of HG, and said it was likely that’s what I am dealing with.

The week after my appointment with my midwife, I ended up in hospital at the emergency gynaecology and early pregnancy assessment unit. I was so dehydrated the doctor struggled to find a vein to insert a cannula – on the third attempt, everything went a bit fuzzy as I began to pass out (making me feel even more melodramatic). I was hooked up to an IV drip and then prescribed some new medication. The doctor reassured me that I could take these for my entire pregnancy if I needed, that the dose could be increased and if they didn’t help, we could try something else. I finally felt heard, validated in my experience and like my sickness was being taken seriously.

And yet, I’m one of the lucky ones. I have the most supportive and loving husband, a caring manager who insisted I worked from home and rested when needed, and sympathetic friends and family who’ve dropped plans to help me get through this isolating and debilitating time. I can only imagine how hard the struggle must be for those with HG without a support system – or for those who are in and out of hospital their entire pregnancy.

‘I had HG and it was so bad,’ one mother told me. ‘The sickness finally stopped at 29 weeks, but I felt nauseous until she was born.’

‘I had HG up to about week 18, I didn’t go to work or leave the house for 12 weeks and threw up what felt like every moment of the day,’ another admitted. ‘If I wasn’t being sick, then I was feeling insanely nauseous and all I ate was breadsticks! I lost about 5kg in my first two trimesters, which feels so wrong when you are growing something inside you. I tried three different anti-sickness medications before finding one that actually helped.

‘I even joined some HG groups on Facebook, hoping that someone would suggest a remedy or just to be in a place where people understood, but I actually just found it depressing. It’s still not something many people talk about.’

‘HG care is something GPs need to know more about’

Clearly, a greater understanding of HG among healthcare professionals is needed, as is increased awareness and research into HG to develop more effective treatments and support systems. This isn’t something that can be cured with a ginger biscuit. In fact, the idea that such devastating symptoms could be overcome by something as simple as eating a ginger biscuit is just offensive.

I’m now at the 20-week mark, and finally able to eat a bit more without being sick. The new meds I’m on have kicked in, and I’ve even started going back into the office. I’m hoping this is a sign I’m finally turning a page.

So if you’re reading this and currently in the depths of sickness, know that I see you – I feel your debilitating pain, and that it will get better. But there’s no doubt about it – more needs to be done to help those suffering from prolonged and extreme nausea and vomiting. I absolutely don’t underestimate the incredible work that GPs do – and I know they can’t possibly know about everything – but HG care is something GPs need to know more about. Because if the right help was offered sooner (instead of making off-hand comments like ‘oh, sickness is a sign of a healthy pregnancy’) and pre-emptively for those in subsequent pregnancies, there would be less chance of hospitalisation and it could help prevent the loss of wanted pregnancies due to this challenging condition.

Any level of pregnancy sickness is unpleasant, but if you are suffering enough that you have come looking for help online then the chances are you are suffering more than ‘normal’.