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. 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
(Definition from HelpHER.org)
HG usually extends beyond the first trimester, often lasting the entire pregnancy.
HG is NOT "a little case of hyperemsis," but far more times than acceptable, women suffering from HG are not provided adequate care, and their condition is made light of. Women with HG often feel isolated and depressed, during what many of them thought would be a beautiful life stage.
I became a prisoner in my own home. A prisoner enslaved by the sickness that had overrun my body and the IV pole I was attached to. Never mind that I was growing a sweet precious miracle in my womb.
Madison, a Tempe mother who survived HG, shared with me her story of suffering through HG before finding proper care, describing,
To be quite honest, I have very little memory of what happened next. I vomited in the bathroom, I vomited in the kitchen, I vomited in the car, I vomited in public, I vomited in my own hands. It was not pretty, but that was my reality.
and the difference it made when she found a suitable treatment that worked for her!
Twenty seven weeks into my pregnancy I ate and didn't throw up. I could function, I could exist, I could feel something besides sick. I could finally just be pregnant.
I hope that in sharing Madison's story, more women can advocate for the care they need, and be aware of the treatment options available. However, we still have so far to go!
You can read Madison's complete story below, or click here to visit her blog.
November 19th 2015. I had spent the day helping set up the nativity display at the Mesa Temple Visitors Center. It was a nice day and I was having a good time with family and friends, but was noticeably more tired than what seemed normal. In fact, I had been fairly exhausted for a few days. Some simple math indicated that there were two explanations, and I seriously hoped for the one that didn't involve bleeding for a week. Finally finished for the day, I headed home by way of the grocery store to casually pick up a few things and also a pregnancy test. But really, I mostly needed that bundle of bananas, can of diced tomatoes for dinner, and bag of tortillas. Obviously I could not wait until the next day to go to the store. Discreetly strolling through the pharmacy section, I noted that what I needed was behind a glass case. Awesome. Up to the window I went to sheepishly ask for it to be unlocked and awkwardly I was told that it was already unlocked and I could help myself. How nice. I have never checked out and left a grocery store so quickly before in my life. I got home forgot about the food, ran to the bathroom waited two minutes and then stared at a blank stick. Confused, I decided to try again. Well, there was some water chugging that went on first. Two more minutes went by and I sent Sam a text reading "Congratulations Daddy" with a picture of a little blue plus sign.
I had never felt so excited, happy and hopeful in my entire life and I had absolutely no Idea what I would be facing.
First trimester "morning sickness" hit around 2 weeks later at 6 weeks gestation. I was uncomfortable, exhausted, and most of all nauseated. Trips to the bathroom were taken at a run after meals, snacks, and smells, among other things including but not limited to-tasting garlic, smelling garlic, looking at garlic, hearing the word garlic, driving, the smell of my car, brushing my teeth, moving too quickly, bright lights, loud sounds, and pretty much just existing. Eight weeks in I had my first midwife and was told how morning sickness sucks but it means I will have a viable pregnancy and a healthy baby. Sounded good. I got some nausea pills with B6 and an antihistamine and scheduled a follow up for a month down the road.
Week twelve finally arrived with all of the hope from that moment I got my positive. Between week 8 and week twelve, I had already been to the ER twice for IV hydration and had received at least one IV treatment at home administered by a kind paramedic/family friend. I was ready to walk into that appointment, hear my baby's heartbeat, and go home nausea free. Surprise! That is not even close to what happened. My appointment started out with the nurse not being able to find the baby's heartbeat on the doppler. No biggie, the midwife would be able to find it. Not. Lots of tears and feelings of panic and I headed in to have an ultrasound. Relief flooded my soul as the heartbeat rang out clear and strong on the screen above me. So one issue had been resolved-I knew my baby was there and healthy. I, however, was still sick beyond words. I pleaded with the midwife to prescribe me some actual nausea meds. This was just the beginning of me throwing my ideals of what a pregnancy should be like out the window. So much for going au natural. I needed to stop puking and I needed to stop like a month ago. The midwife was hesitant to prescribe the medication as "throwing up 8 to 10 times a day was not really that uncommon and I really should start feeling much better in the next two weeks."
Three days later I was back in the emergency room with what my male nurse very endearingly called "a little case of hyperemesis." Come to find out, there was nothing little abut it at all. After a few more weeks and a few more jerry-rigged IVs, I made the extremely difficult yet logical decision to seek more involved and intense medical care.
Fifteen weeks down and still no relief was to be found from the incessant nausea and uncontrollable vomiting. My new OBGYN was my only saving grace. I limped into his office looking grey and weak weighing nearly twenty pounds less than I had on November 19th. Immediately he knew that something more had to be done for this poor woman who was quite literally starving to death. By this time I was vomiting somewhere between 10-15 times each day. Home healthcare was the only option at this point. More hope and lots of boxes of medicine, an IV pole, and bags of fluid entered my life. Two days later I was visited by a perky nurse who started an IV in my arm and showed me how to poke the end of my zofran pump into my stomach. I was so beyond ready for this to be the answer. I was going to feel better. This was going to work. And it did. For about three weeks the vomiting slowly decreased as every 5-7 days my IV site was replaced and every 24 hours I stuck myself again to continue the constant flow of antiemetic into my body. Light was appearing at the end of a tunnel that had seemed unbearably long. That light was small and fleeting as I began to pass kidney stones at 18 weeks along. Weeks and weeks of dehydration had created the perfect breeding ground for those nasty little stones, and sudden hydration began to flush them out.
Eighteen weeks pregnant and I was admitted to the hospital for more hydration and pain management as I passed stone after stone. Because of a decision made by a misunderstanding had by an on-call physician, a medication was administered incorrectly triggering the nausea and vomiting once again. Hyperemesis Gravidarum was back again and had no intentions of taking it easy on me. I was discharged from the hospital having passed upward of 8 kidney stones, and now vomiting a whopping 15-20 times per day. Lovely. So much for the constant zofran and the IV fluids administered at will. Nothing was stopping HG this time and my once bright hope was waning by the second. A week or so later, I was so dehydrated that it became nearly impossible for the home health nurse to start an IV.
Another trip to the hospital and another visit to the OB resulted in the decision to have a PICC line placed in my arm and for a higher dose of medication to be administered from my pump directly into my aorta to be more efficiently dispersed throughout my system.
Round the clock IV fluids were to be run through the line. I became a prisoner in my own home. A prisoner enslaved by the sickness that had overrun my body and the IV pole I was attached to. Never mind that I was growing a sweet precious miracle in my womb.
The subsequent six or seven weeks were a blur. To be quite honest, I have very little memory of what happened next.
I vomited in the bathroom,
I vomited in the kitchen,
I vomited in the car,
I vomited in public,
I vomited in my own hands.
It was not pretty, but that was my reality. When I wasn't vomiting, I was questioning my ability to actually be a mother. How could I love and care for this thing that was killing me slowly? On November 19th I had been filled with so much hope and joy and it was all gone. Emptied from my soul and flushed down the toilet with each heave. Spent doesn't begin to describe the state I was in. To say that it was simultaneously the most frightening and disappointing time of my life so far would be a huge understatement. Despondently and faithfully I showed up at my OB's office every other week to be told over and over that I hadn't gained any weight-and for the nurse to tell me the same story of the one other patient she had seen in her more than 40 year career who had been as sick as me. Super encouraging. But the sound of my son's heartbeat at each appointment filled me with the only relief I could find. Amidst my desperate pleas for my doctor to try anything else, he was able to refer me to another doctor in the hopes that, as a specialist, he would have a new idea. Once again a small ray of hope sparked and I made yet another doctors appointment.
Twenty seven weeks along I had an appointment to see Dr. John Elliot, a Perinatologist in the area. I had absolutely no idea what to expect. Sitting in the waiting room, all I knew was that I would get a 4D ultrasound of my baby. Finally I would have definitive reassurance that he was growing and developing despite my own lack of nutrition. Knowing this alone gave me peace. Seeing my son blink and move, looking like a little person was one of the brightest moments of this dark journey. Patiently I waited in an exam room to see the doctor for what seemed like hours. What could this doctor do for me that we haven't already tried? Whatever it was, I was willing to try it.
At last a redheaded nurse came into the room to take my vitals. "You are here for the injections, right?" she casually asked as she took my blood pressure. I had no idea what she was talking about. No one had told me about injections but I was willing to try anything. Dr. Elliot, she explained, had been trying out these injections that could stop a person's nausea and vomiting within seconds. It sounded too good to be true. Too easy. After all of this time, all of this suffering, all I needed was a couple of shots. Another wait followed her excited explanation of how the doctor would inject a local anesthetic into my back, numbing the nerves that lead to my stomach. How he had not tried it on many patients yet, but had seen miraculous results so far. An eternity passed in that exam room waiting to hear the words "Dr. Elliot will see you in his office now." this was it. A story was told and an explanation was given behind the science and discovery of these miraculous injections. Something about how initially he discovered the procedure using botox but had opted for a local anesthetic to use on pregnant women instead even though he knew that botox could be much more effective. Really, the details of the whole conversation went straight over my head. Two days of relief or two weeks didn't make a difference for me as long as I could go a few hours without throwing up. Marcaine was then injected into my back. Oreganos was around the corner, and it was calling my name. Twenty seven weeks into my pregnancy I ate a salad, a slice of pizza, half of a bowl of spaghetti, and a pizookie. Twenty seven weeks into my pregnancy I ate and didn't throw up. For 24 glorious hours, I ate and ate and ate. Nausea slowly crept up and into my throat and by day two, I was hit with the HG semi once again. Up and down the next few weeks went. Injections were given, followed by ever worsening sickness. The level of relief was only to be matched by the level of hell to follow. I could not continue like this 24-48 hours of relief was not worth the price I paid when the effects were gone. At least before, I had acclimated to to being sick. It was my new normal. Now, I had small glimpses of what normal could be only for them to be cruelly snatched away from me by the ticking clock. "Yes" was the only response I had for the doctor when he cautiously suggested trialing botox. I would be the first pregnant patient to receive this treatment. Risks were minimal, but I would still have to sign a consent form. Yes. That was it. Two weeks compared to two days did make a difference.
Thirty weeks into the most trying period of my life I once again experienced and understood quality of life. Like clockwork every two weeks, I would run to the office for a few injections and go on with my life.
I could function, I could exist, I could feel something besides sick.
Pregnant. I was pregnant with a real baby that I would love, and enjoy, and care for. Appointments came and went and I heard the words "you gained two pounds" and then five and then ten. Although it was not flawless, it was indeed a miracle. At thirty weeks pregnant I could finally just be pregnant.
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