Wednesday, May 7, 2008

Hyperemesis Gravidarum: A Primer

Today I thought I'd just post some sketchy notes on the subject of "I've got HG - what on earth do I do now?" These notes may be of marginal value, coming from someone who had only a moderate case of HG. However, I'll do my best

Determining if you have Hyperemesis Gravidarum

(As opposed to normal morning sickness, that is.)

Well, it's pretty easy to tell. If you're desperately searching the internet for remedies for the "morning sickness" which is taking over your life and driving you to despair, or if you are too ill to be on the internet and are just hanging out in bed throwing up, there's your answer.

Morning sickness, like most conditions, occurs in many manifestations all over a continuum of intensity. There's no exact dividing line between "morning sickness" and "hyperemesis gravidarum."

Here's a good description of HG, taken from the Hyperemesis Research Foundation Website.

"Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. It is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. If severe and/or inadequately treated, it is typically associated with:

- loss of greater than 5% of pre-pregnancy body weight (usually over 10%)
- dehydration and production of ketones
- nutritional deficiencies
- metabolic imbalances
- difficulty with daily activities"

Check out this website

It will give you all the basics about hyperemesis - how to get help, how to find a care provider, lots of resources, etc.

Order this book

"Beyond Morning Sickness" by Ashli McCall

Ashli has been there, done that, having had HG four times. This is the best book I have read so far on the subject. If you can, order a couple - one for your immediate family, one for extended family, and one for your care provider.

This book provides tons of information on how to deal with HG, find a care provider, decide on treatment and drug options, etc.

There are other books out there, but I haven't read too many of them yet. This is the only one I can recommend having read it.

Get an advocate

You are probably too sick to do the work that needs to be done in caring for your health. Hopefully your husband will fill this role; perhaps your mom or sister or a friend. You need someone who will do research, call doctors, go to appointments with you, etc.

Ask for help

This is something that your advocate can do for you. You will probably need help with housework, childcare, etc. Ask for the help you need!

Find a care provider

Your advocate can help you with this too. Ask for recommendations from friends, or have your husband/advocate call doctors' offices to ask if they are willing to treat a client with HG. Do not settle for anything less than persistent, aggressive, and compassionate treatment. Three BIG warning signs with a care-provider: (1) He/She tells you that this is just "normal morning sickness," that it will go away eventually, that you need to just get some fresh air/eat crackers/drink ginger ale/etc. (2) He/she tells you that it's all in your head/that you must really not want this baby/etc. (3) He/she suggests abortion as a remedy. Shocking as it may seem, this is not too uncommon. Many OB's do not want the high work load that comes from dealing with an HG mum, and pro-abortion doctors may recommend an abortion to "solve the problem" and get you off their hands.

Stay hydrated

If you can eat, eat whatever you can and don't fuss about nutrition. For the first couple of months after recovering from the worst of my HG, I was only able to eat ice cream and barbecued pork. Prenatal vitamins didn't happen for months (couldn't even think about trying to get those puppies down). Eat what you can.

If you have moderate hyperemesis and are only able to keep liquids down, try the following: diluted Gatorade, jello, and nutrition drinks such as chilled Boost, SlimFast, Ensure, etc. (nutrition drinks will also help make up for not being able to take prenatal vitamins, if you can't manage those). Drink something often (perhaps hourly) to keep something in your stomach. Remember, keeping those liquids down will keep your blood sugar up and will keep you hydrated - both low blood sugar and dehydration will make the nausea much, much worse.

If your HG is more severe, this will not work because liquids will not stay down. In that case, have your hubbie drive you to the hospital NOW.

While dealing with the medical establishment, you may have a great experience or a crummy one. It's kind of a toss-up. Be prepared for doctors and nurses who may be patronizing, contemptuous, unsympathetic and impatient - who think you are taking up bed space and crowding out patients who are "really sick." This is part of HG, unfortunately. HG tends to fall into the category of diseases which are dismissed as being "all in one's head" (other diseases in this category would include depression, chronic fatigue syndrome, etc.)

Don't give up hope

This WILL be over at some point. You WILL have a beautiful baby, and you will feel WONDERFUL. Hang in there!

For those of you in more desperate situations, please remember that abortion is never the answer. You will replace temporary suffering with a lifetime of pain. There are ways to effectively treat hyperemesis - all you need is a good care provider and time. No matter how dark these days are, there is a beautiful baby waiting at the end of the tunnel.

Prepare to be frustrated

If you are like 99.9% of HG mums out there, you are going to be bombarded with the most frustrating comments in the world. This is not the fault of the comment-makers - it is just the fact that HG is an unknown disease, and most women have had morning sickness of some sort which makes them feel like they "know what you're talking about." Here are some comments to expect:

"Oh yeah, I had bad morning sickness. I couldn't eat onions for weeks."
"Go outside and get some fresh air. Stop thinking about yourself so much."
"Eat something! You can't think of just yourself. Your baby needs food."
"Just get up and get active. Go for a walk. You'll feel better."
"We've all been there."
"That's just the way it goes!"

Unfortunately there's no way to stop these comments, so just find another HG mum and commiserate. :)

When all is said and done, HG is just one heck of a miserable experience. It is one long, hellish experience that leaves most women scared to death of pregnancy for life (I know it has for me). HG ladies, if you see anything I should have added to the above, please let me know and I'll add it pronto.

Love to all!

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