HG & Me.

My 12 week ultrasound

I went into my first pregnancy feeling relieved and excited. Despite suspected PCOS [edit: now PMOS] I had not had difficulty conceiving, and looked forward to experiencing first-hand something I knew so much about in theory. Of course, with the knowledge I had as a midwife I knew that for most it was not the easy, radiant picture that the media paints pregnancy to be.

I was expecting nausea in my first trimester. An aversion to smells, maybe, or unusual eating habits. I knew I'd be uncomfortable in my third trimester, maybe have trouble sleeping or aches and pains as I walked.

I didn't expect Hyperemesis Gravidarum.

The nausea, vomiting and aversion to food started when I was 6 weeks pregnant. I expected this. I ate plain food, nibbled at ginger biscuits, sipped water - everything I advised people to do when it (nearly) inevitably hits. I rested, I slept. I told myself it would pass as I hugged the toilet and lay on the bathroom floor.

But it didn't pass.

I would tell myself "next week it will get easier", and it would get me through those difficult hours. Then it was "in my second trimester it will get easier". I hit 20 weeks and my colleagues were surprised I was still vomiting. 25 weeks and I was still having to take time off work because I couldn't move without the waves of nausea hitting me. 28 weeks came and went, and I was still surviving on potatoes and crackers. I was scared of going outside because the smells of restaurants, people, traffic and cigarette smoke made me dry heave. As a community midwife who walked around Hackney all day, this caused constant anxiety that I was going to throw up on the pavement, or worse, in someone's house.

In the first half of my pregnancy I lost 10kg. I downplayed it to my midwife, because I could still eat something, so that means I'm fine, right? There were moments I look back on where I definitely should have attended triage and been admitted, but the thought of getting out of bed to the hospital was too much and I struggled through at home. I contacted my GP and got generic advice like 'have you tried ginger?'. The medication I was prescribed didn't work, and I have to admit I gave up. At that point I was young, had only been qualified a year or so and hadn't yet developed the backbone I do now. I had successfully managed to gaslight myself into thinking that it wasn't a big deal, I just needed to power through, it was only temporary. I didn't want to be a bother.

[Also bear in mind this was 2021 and I never actually saw a GP face-to-face and they were pretty hard to get hold of]

Despite the weight I'd lost, the amount of sick days I needed to take and the obvious struggle I was facing, everyone (including colleagues!) still referred to my condition as 'feeling sick'. The first time someone mentioned 'HG' to me was actually a patient on my friend's caseload, when I was 36 weeks pregnant and about to go on maternity leave. I called her to do a postnatal checkup and she asked me how I was doing and said she heard I was suffering from HG like she did. It completely stopped me in my tracks. She reassured me that it went away when baby was born and I didn't have long to go! That phone call did more for me than any professional had done. It gave a name to what I was feeling, even if I still wasn't convinced I was worthy of that diagnosis. I wasn't admitted to hospital with an IV in my arm, so surely it couldn't be HG? I was just bad at coping with pregnancy, right? Around the same kind of time the new definition of HG was updated to "characterised by severe nausea and/or vomiting, inability to eat and/or drink normally and strongly limits daily activities" (Windsor, 2021).

Well, I certainly ticked all the boxes.

The day I went into labour, at 39+1, I was still vomiting like I was 6 weeks pregnant.

The relief when he was born was insurmountable. It immediately ceased, and I started to heal. I craved food that wasn't crisps or plain potatoes. I drank my first cup of tea in 9 months, and got my liquids from actual liquids, not ice cubes. My mental health improved, that I didn't even realise was slowly declining.

It changed the way I practised midwifery. I advocated for women the way I hadn't for myself - I made sure they explored all their options when it came to treatments, ensured they attended triage when they were unable to cope. And most of all, it made me realise that we were not adequately trained in so many aspects of midwifery. If I couldn't even recognise HG in myself, what else was I missing?

So I started researching. I came across Pregnancy Sickness Support - an invaluable charity that I wish I knew about during my pregnancy! They have a huge amount of resources for both professionals, pregnant people and family/friends of those suffering. I learned so much more than I ever did in practice.

We still have such a long way to go. When I have patients with HG they often tell me I'm the first person to take them seriously. I'm often emailing GP's with guidelines asking them why they haven't considered a certain line of treatment. And I'm discussing the guidelines, new medications and new research with colleagues and students.

I went into my second pregnancy armed with knowledge, guidelines and support. I had my pregnancy plan downloaded from PSS, GP on speed dial, and briefed my manager on how I needed support at work. I still suffered, especially during my 3rd trimester when I was admitted for fluids, but nothing compared to that first traumatic experience of HG.

But that's a story for another day!

For more information, stories of HG survivors, ways to access support and learning - visit https://pregnancysicknesssupport.org.uk/

Kirsten x