Tuesday, August 11, 2009

"It's All In Your Head" - Myths of Hyperemesis

If you've been around the hyperemesis world for more than 30 seconds, you will hear thousands of women bemoaning the fact that their condition is belittled and ridiculed as being "all in your head." Such as...

"You need to just get out and get some fresh air. Stop thinking about yourself."

"Stop being selfish and think about the baby's needs instead of yourself. Just make yourself eat."

"So... Why don't you want this baby? Why are you subconsciously rejecting it?"

"Are you having problems at home? Why are you making yourself so sick?"

"Get some therapy."


All of this is, of course, beyond absurd. When was the last time you heard any of the following?

"So you've got gestational diabetes, huh? Why are you being so selfish and only thinking about yourself? It would go away if you'd just focus on the baby."

"Preterm labor? You must need counseling, or else you wouldn't be making yourself sick."

"Pre-eclampsia? Why don't you just go get some fresh air? That's all that's wrong with you - you need to get out more."

Yup, that's right... you don't hear those. So why is hyperemesis constantly (and I do mean constantly... look online for the stories) classified as an "it's all in her head" condition?

Ashli McCall has a great chapter on this subject in her book "Beyond Morning Sickness," so check it out if you haven't read it before. In that chapter she writes,

"Kaltenbach seems to have started this whole "HG as a neurosis" mess in 1891. In 1968 a frustrated Fairweather concurred and published a study that was shamefully uncontrolled and obviously biased. He hypothesized that women with HG had mental issues that basically caused psychosomatic illness."

Additionally, in my own experience I have noticed that any physical experience that is exclusively female (i.e. never experienced by men) has been in the past, or is currently, attributed to "female hysteria," "nerves," etc. - i.e. it's all in her head. Examples of this would include:

- Morning sickness of any kind
- Menstrual cramps
- Labor pain
- Emotional nature of pregnancy
- Postpartum depression

(And by "it's all in her head," people don't generally mean that a disorder is caused neurologically by hormone imbalances, etc. - they mean that the woman willfully brings it on herself by her own selfishness or weakness.)

Unfortunately, a lie is a hard thing to kill, simply because the fallacy of hyperemesis-as-imaginary has been repeated ad infinitum in medical textbooks and references. It is present equally in mainstream medicine and naturopathic medicine - perhaps even more so in the naturopathic world, as naturopaths are more likely to recognize the mind-body connection (which can be important but is usually irrelevant with hyperemesis).

For example, see the following excerp (which I am not going to cite, as I love both the author and the book and don't want anyone reading this to write her or it off!):

In reference to a hyperemetic woman, she writes:

"Loving help should be given the mother with any aspect of her life which makes her unhappy, whether it be her reluctance to have a child, her sex life, her fear of labor, or whatever. Encourage her to increase her activity, rather than laying around, and to do things that will get her attention outside of herself. If you can counsel a woman and give her real help, you can stop a condition which, left to itself, could require hospitalization."

That paragraph alone is enough to make your average hyperemetic woman fully suicidal, if not to send her on an enraged killing spree.

I found a similar passage in another book (which shall also remain uncited!) written by one of my most beloved birth authors:

"It bears mentioning that hyperemesis gravidarum is one of the only conditions for which conventional medicine acknowledges emotional underpinnings, and some midwives do note a correlation between hyperemesis and psychological conflicts or difficulties regarding the pregnancy..... With emotional factors outstanding, suggest counseling. Otherwise, have the mother immediately take ginger root three times daily..... If vomiting persists beyond the first trimester, consult with a colleague...."

Point #1 - See above comment about enraged killing sprees.
Point #2 - Ginger doesn't do squat for hyperemesis! Give it a rest with the ginger!!
Point #3 - If you wait to treat HG till after the first trimester, you (a) are incompetent as a caregiver, and (2) will have an extremely ill mother on your hands whose baby and whose life have been endangered by lack of needed treatment.

So, in conclusion, I will note the following:

(1) It is NOT in her head (or in your head).
(2) Unfortunately, the medical literature is often outdated and will point toward psychological causes.
(3) Ditch any caregiver who goes along with #2.
(4) And rest assured that you are not crazy!

Did I miss anything?

Love to all!


  1. Can you hear/see my standing ovation?!!!!

  2. Excellent post. I am currently suffering with this disease (23 weeks pregnant currently) and wish I felt better "in the moment" to blog and share with women so they know it's not in their head. Thanks for doing this for all of us!

  3. It has been 30 years since my hideous experience with Hyperemesis,and to this day recall vividly how it consumed every inch of my being . . . with ALL THREE PREGNANCIES!! Oh yeah, it's real!

    Angie Tilley

  4. My daughter is in the 10th week of her second HG pregnancy. The first one was so awful, we had never heard of HG and she was so sick. She lost 30lbs in a month and she and her husband moved in with us so I could give her the round the clock care she needed.When she was 12 weeks her doctors put her on steroids, which helped so much and she was eventually able to resume her teaching job.We are in week 10 this time, she has a PICC line and receives PTN ( nutrition IV) everyday here at my home. This is such hell, she is so sick and feels so alone and misses taking care of her child. We are all exhausted, but hopeful the steroids will again help because zofran and reglan have little effect for her. It is very hard for "outside" people to understand how serious this is and want to give advice about crackers, ginger, etc.....

  5. Thank you so much for blogging about this.

    Finding the HER site, and blogs like yours, gave me the courage to finally write my own story and hopefully help others understand just a little more.

    I wish people could understand how much it hurts when they invalidate HG, when all we desperately want is to be healthy and happy.

    I look forward to more of your posts. I can't thank you enough.

    I'm terrified of having another child thanks to HG, and sometimes I feel so robbed. Which of course people don't understand. "At least you have healthy kids". Yes, I do, but I still feel a sense of loss, but only mothers that actually lose their babies or can't conceive get any sort of understanding (which they surely deserve, but it still sucks for us HGers)

  6. Love this blog. I need it as I head toward my 2nd (possibly HG) pregnancy.

    1. The Prof - My apologies for taking such a long time to answer! Welcome! I hope you find good information here, and blessings as you look toward your second pregnancy!!



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