Hyperemesis Gravidarum: A Pregnancy Fit for a Princess?

Hyperemesis Gravidarum: A Pregnancy Fit for a Princess?

As I rubbed shea butter on my Budda belly and choked down my 87^th dose of Zofran, I received a text from my best friend: “Did you see that The Princess is pregnant and in the hospital for severe morning sickness?!”  Like many of us, obsessing over the Royal Family is one of my guilty pleasures.  For weeks, we have been hearing whispers about a Royal Baby, but for me, this kind of confirmation was heartbreaking.  I know all too well of Princess Kate’s “morning sickness” misery. Being 35 weeks pregnant and still wrought with severe nausea and vomiting, I cannot do anything but hope that her road is easier and shorter than mine. 

I confirmed my pregnancy with a home test at exactly 6 weeks. I had felt unusually tired, weak and even dizzy for the 6 days prior- all of which I blamed on the stress of changing jobs and increasing my workout routine. That is, until I went to the grocery store on Mother’s Day and the sight and smell of everything made me nauseous.  I work in healthcare, so it takes a lot to make me turn green. It was then that I purchased, and later took the most expensive test in store.  When the digital “YES +” appeared, I was… all of the things that women are at this point. 

If nothing else, I felt that as a wellness consultant, I was physically prepared to accept all of the beauty and challenges that come with pregnancy. For years, I have been providing nutrition counseling, massage therapy, private yoga instruction and personal fitness to expectant mothers.  I was well versed on natural remedies for everything from nausea to insomnia to low back pain. I had recommended these solutions to clients and they worked. Herbs, oils, supplements, and asanas were stockpiled in my pantry or in my head. I was ready.

My first episode of nausea and vomiting occurred at 8 weeks. It came. It went and I was proudly earning my stripes as a mommy-to-be, with my patented morning “throw-and-go” routine. This transient combo continued for 4 weeks, then just stopped, as every mom said it would. During that time, I treated myself with saltines, club soda, ginger, peppermint tea, and small meals throughout the day.  I was also teaching a 6:15 a.m. yoga class; this early movement actually helped subdue the nausea.  At 12 weeks, 1 day, I returned to Bikram yoga class, as a student and I felt great. Along with boot camp, running, water aerobics, and hiking Stone Mountain, I was working full-time and keeping down all meals.  I was strong. This was going to be a model pregnancy.

Yoga is not only possible, but beneficial at all phases of pregnancy,  photo by Robyn Elicia

Then, week 14 came- the 2^nd trimester, the “glowing period”, right? It was not this for me. The nausea and vomiting returned with a vengeance. It lasted all day, woke me up at night, zapped all energy and turned my well-researched remedies into nothing more than falsehoods, Old Wives Tales, and annoyances anytime they were suggested by someone else.  Every single day, I found myself at the mercy of my gastro-intestinal system.  I had no desire to eat anything. When I forced myself, it came back up- quickly. The crackers, ginger, tea, B12, prenatal vitamins, smoothies, Gatorade, water, ice chips, blood, bile, dry heaves… it all came up, every day, every night, all of it… in the bathroom, in the car, on the side of the road, at work, at the park, in the parking lot, on my clothes, on my windshield, on my dinner plate... I was sick all of the time- easily 6-18 times per day- but my baby was healthy, which is all that really mattered. 

After 6 more weeks of nausea, vomiting, bed rest, acupressure, meditation, self-hypnosis, prayer, a stint in the ER, a burst blood vessel in my eye, and a multitude of research, I finally succumbed to a prescription of Zofran, the pricey, antiemetic medication, typically used for chemotherapy-induced nausea. For someone who does not take medication for headaches, muscle soreness, menstrual cramps or joint pain, this was a big deal.  Fortunately, the Zofran helped almost immediately.  I was able to tolerate small meals, without subsequent vomiting.  So as not to become dependent on the medication, assess how I felt without the medication and limit the amount of “drugs” given to my growing little girl, I took only 4mg every other day. The off day was difficult, until it was unbearable, at which point I began taking 4mg daily. 

            

I am nearing my 3^rd re-fill of Zofran for the treatment of Hyperemesis Gravidarum- a severe, prolonged, unrelenting and often debilitating form of nausea and vomiting that is much different from the more common “morning sickness”.  In fact, let’s not call it morning sickness, at all.  Although it is rare, affecting about 0.5-3% of pregnant women, it can be serious enough to cause fatigue, dehydration, weight loss, metabolic imbalances, and malnutrition, creating the need for short-term, long-term and often repetitive hospitalizations for IV fluids and nutrition.    

 

Hyperemesis gravidarum (HG) lasts well beyond the first trimester and often extends until the birth of the child, even throughout the birthing process. It is thought to be caused by the increase of hormones in the mother, although there is no absolute known cause.  It is more common in women carrying multiples and some studies show that women carrying girls are more likely to experience HG, due to the mixing of their hormones.  There does not appear to be a strong genetic component (my mother was sick a total of 10 times with me, 3 with my older brother). However, if a woman has experienced HG with one pregnancy, she is more likely to have it in subsequent pregnancies than is a woman whom has never had it.  This trend terrifies most HG sufferers and has even led to some abortions.

Perhaps one of the most serious and more overlooked side affects of HG is the depression and anxiety associated with it. There is often a gross misunderstanding of the symptoms, leading to a lack of support or belittling from loved ones.  Women may feel isolated from social activities, especially those surrounding meals. There is often guilt and fear of not being able to properly nourish the growing child due to the mother’s inability to eat or keep food and prenatal supplements.  Despite scientific research, there may be anxiety associated with taking medications that could possibly harm the child.  Many women are forced to miss workdays, which causes additional financial stress. There may be a fear of death and there may be a near equal desire for death- it gets that bad.

For the past 21 weeks (yes, I am counting and journaling all of this), I have experienced all of these challenges, in addition to the selfishly, disappointing feeling of not enjoying my much anticipated pregnancy; and if I am being completely honest, holding more than a little resentment toward my husband and even my unborn child (and feeling incredibly guilty about that).  I already love my little girl more than I could imagine loving anyone else. At the same time, I have a very real fear of getting pregnant again. As strong, knowledgeable and reflective as I know I am, I cannot imagine going through this one more time.

Until now, only a small circle of family and friends has been privy (read: forced to listen) to any of this.  I have either been missing in action or have hidden all of this misery with business as usual, a coy smile, and a few euphemisms to describe a portion of my plight, without demanding attention or sympathy.   Wearing that deceptive shroud, in and of itself, has been exhausting. I was planning on bringing awareness to this rare condition after the birth of my daughter, but Princess Kate has forced the issue. As my journey with HG comes to an end, I am grateful that I have this perspective to grow as a woman and as a professional. For in the words of Jay-Z, “You did it, couldn’t talk about it if you ain’t lived it.” I wish the Duchess and all women enduring this illness, the best of everything, including a strong will and an even stronger support system.   

              

Full disclosure, as an occupational therapist, I have worked in the neonatal intensive care unit (NICU), with infants and children with special needs and with women with pelvic pain and dysfunction following complicated pregnancies and birthing processes. By no means am I believing that HG is the worst pregnancy or birth related condition, but it is one that deserves more awareness and research.