“Pregnancy should be the most amazing time in a woman’s life but it was honestly the worst time of mine,” says Eileen MacFarlane, mum to two-year-old Oscar. “When I was pregnant with Oscar I was first admitted to hospital at nine weeks with severe nausea, I had to get an injection of Stemetil and two doses of IV fluids.”
MacFarlane was suffering with hyperemesis gravidarum (HG), a severe illness in pregnancy in which women experience excessive nausea and vomiting. Approximately one in every 150 pregnant women will be admitted to hospital like MacFarlane due to dehydration and malnutrition. Unlike regular morning sickness which affects about 70 per cent of pregnant women, HG is not normal and needs to be treated.
Fertility expert Helena Tubridy reports that it is a misunderstood condition, with plenty of myths and more than a fair share of stigma attached to it. "HG brings confusion, anxiety, depression and can lead to post traumatic stress disorder. It can keep the happiest mum-to-be away from work, family, friends and social gatherings at a time that's meant to be joyful," she says.
MacFarlane was not aware of the condition until she experienced it for herself. “The first time I had heard of HG was when it was written down on my notes after the admission. My own consultant was very understanding and willing to prescribe me medication to help ease the nausea but not all doctors are like that. I was induced early because I was so exhausted from vomiting. I just needed the baby to be born!”
There is a misconception that any vomiting in pregnancy is considered to be normal morning sickness and women should accept it as such. This is not the case as the severity with which pregnant women suffer with HG has consequences beyond the pregnancy.
"I think it's a little bit trivialised now in the sense that if I mention that I had HG, a lot of women will say, 'Oh yeah I had morning sickness too'," says MacFarlane who shares her experience of HG on her blog, 2 Nerds and A Baby. "It's a serious condition, one that not only made me fear for my unborn child's life but my own too. It took months after Oscar was born for my mental health to recover and it really affected my bond with him before he was born."
Nicola Awford of Hyperemesis Ireland, a new charity that provides useful information and support for women with severe forms of nausea and vomiting in pregnancy, recognises that the awareness of HG and the models of care provided to women must be included on a higher agenda. "We hear of some very positive examples of care, particularly in some of the bigger maternity hospitals where sufferers can access a range of services such as outpatient IV fluids, dietary advice and mental health support. However, we do still come across horror stories all too often, eg women not being taken seriously or being told there is nothing they can take for the sickness. We would like to see greater awareness, and more consistent use of the HSE clinical guidelines for treating hyperemesis as these outline the best, evidence-based practices for treating the condition."
The Rotunda Hospital's chief pharmacist, Brian Cleary, says, "In the Rotunda, medical and midwifery staff see women with severe nausea and vomiting of pregnancy in our emergency room, gynaecology ward and day ward. Women are assessed and given intravenous fluids if required and medicines to reduce the severity of nausea and vomiting. Our dietitians and pharmacists also see these patients and provide the necessary dietary advice and information about medicines in pregnancy."
Women commonly have concerns about the use of medications in pregnancy which Cleary recognises can lead to undertreatment of a potentially serious condition and significant suffering. He says: “Women can get information on the safety of medicines in pregnancy from their pharmacist. One of the medications used in the management of severe nausea and vomiting of pregnancy is not currently covered by the medical card or Drugs Payments Scheme. This can result in significant costs for women with HG.”
The symptoms of HG can be so severe that the mental wellbeing of patients presenting with the condition is of high priority. In the Rotunda, a perinatal mental health service is available with mental health support midwives at hand.
Tubridy has noticed an increase in women who have suffered with this condition who are presenting with postnatal anxiety or depression. “I treat women with hypnosis to stop the vomiting, ease fear and anxiety and encourage appetite,” she says. “We focus on rebuilding confidence, too. Feeling heard, supported and understood by a midwife and hypnotherapist who offers real and immediate relief is important for these women. EMDR [eye movement desensitisation and reprocessing therapy] helps dissolve the PTSD [post-traumatic stress disorder], anxiety and depression associated with it.”
Hyperemesis Ireland runs an online support group with more than 500 members and a one-to-one peer support network with fully trained volunteers. "We also have a number of resources for women planning to try for another baby," says Awford, "as research shows varying rates of reoccurrence, some studies suggest it is as high as 80 per cent. We include tips for eating and drinking and maintain a list of medical practitioners we know who are particularly experienced in working with HG."
MacFarlane, who is pregnant with her second child says that she struggled for the first few months and regretted getting pregnant again. “It’s the worst feeling in the world to resent your baby,” she says.
“We often hear from women who say they simply cannot be pregnant again, even though they would like a bigger family,” says Awford. “We often speak to women who are very nervous about trying for another baby. It’s important for these women to be fully prepared – emotionally, financially, physically – to go through it again.”
Tubridy highlights that at one of the hardest stages in a woman’s life, we need to mind our mums-to-be in each pregnancy. “HG brings so much anxiety and dread of another pregnancy blighted by this horrible and dangerous condition. Facing into motherhood is tough, and many times worse after a rough and worrying pregnancy,” she says.