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A Royal Hyperemesis Baby

3 Dec

So the impatiently anticipated royal baby has finally been conceived. While Hyperemesis is no walk in the park for anyone, royal or not, I can’t help but wonder what the circumstances of pregnancy mean for the public perception of Hyperemesis sufferers.

Many people have commented on the Duchess of Cambridge’s thin figure, and one of the first reports of her hospitalisation mentioned that it is often women of slight stature who suffer from Hyperemesis. This is true, of course: women who are not overweight, under 30 years of age and non-smokers have the highest risk of developing it.

However, I can’t help but predict that media coverage of Kate Middleton’s HG will imply either that she brought it on herself by being thin, thus suggesting that she’s too concerned with her appearance or not strong enough to be a good mother, or that over-sensitive women insist on going to hospital when others just power through. Well, just to be clear: HG just happens, particularly in a first pregnancy when many people don’t even know it exists. Hospitalisation is usually the result of several weeks of eating and drinking very little.

Perhaps I’ll start a ‘royal pregnancy watch’ to see whether my predictions hold true.

Baby Angst

19 Oct

I have a huge issue with other women’s pregnancies – whenever a friend announces theirs on Facebook or a celebrity announces theirs in the media, I feel a searing jealousy and sadness that is difficult to describe  to others and to understand myself.

It more or less started the day my daughter was born, possibly even before then. During my pregnancy I’d had hyperemesis and was completely bed-bound for  about 4 months, and I only left my flat between 10 and 15 times during the whole of my pregnancy. That includes antenatal checks and wedding-related appointments (my daughter’s dad and I got married when I was 7 months pregnant). This made it pretty clear that a further pregnancy would take careful planning and lots of support. When I was still in the throes of hyperemesis I begged my husband to remind me if I ever mentioned the possibility of another baby that I could never go through this horror again.

Then my daughter was born and from the first moment I saw her proved to be an amazing, captivating and utterly heart-melting tiny being. When she popped out, my first thought (after ‘wow, so there was a real baby in there!’) was ‘I want to do this again’. This thought got louder and louder with every gurgle, smile and milestone. When she started noticing other children I thought ‘She would be really great with a baby sibling’.

And then my husband and I separated.

A year and a half later I am still trying to come to terms with the dashed dreams of my perfect family. I feel sad for my daughter who has now lived in a single-parent household for longer than she ever did in a two-parent household. Co-parenting is a nightmare at times. I’m dreading the possibility of her dad’s insistence on overnight stays. The idea of a potential step-mother for my daughter makes me feel sick to my stomach.

So now I have no idea if or when I’ll have more children. And it’s so difficult. One reason it’s so difficult is that I just don’t understand why I feel this way.

But sometimes I read something that throws a little tiny light on the jumble inside my mind. Today it was this post about the representation of motherhood as a reward.  Katherine Don from bitch magazine says:

I’m wary of Bravo’s chronic portrayal of motherhood as some final reward for being a no-nonsense, hardworking, trend-setting capitalist.

My most recent friend to announce her pregnancy comes from a family of travellers. She went to an excellent school thanks to a grant system which no longer exists, received counselling while at school to help her deal with her mum’s emotional abuse, got her A-Levels, got her degree, passed her driving test and bought a car, trained as a secondary school teacher, got engaged, bought a house, got married this summer, and is now expecting a baby. She’s a middle-class capitalist dream come true.

Part of the reason why hearing of my friend’s pregnancy has thrown me back into a downward spiral of melancholy is that my friend has chosen to organise her life in the traditional way that most people around me choose too. It’s not how I’ve done things, but it’s how I wish I had done it. Constructing a family by numbers (car – tick, job – tick, house – tick, husband with stable and moderately impressive job who likes to play football in his spare time and gets on well with your girly friends and their boyfriends – tick) symbolises safety for me. Being a single mother while studying rather than being in a stable relationship and working makes me feel like a teenage mum whose lifestyle is frowned upon by all of society. I worry that when my daughter goes to school I’ll be the flaky mum with the odd dress sense who is shunned at the school gate and thus ruins her daughter’s social life and emotional development forever. I keep thinking that perhaps if I quit the PhD and get a ‘proper’ job, I can have another baby. Now I know that I’ve been trapped in a ‘motherhood as reward’ thought.

On the whole giving birth and being a mother has been a hugely positive, transformative experience for me so far. For the first time in my life I have a feeling of purpose. Although I am frequently uncertain about how to deal with tantrums and how I will ever manage the potty training hurdle, I am a lot more confident than I was before I had my daughter. I seem to have endless reserves of strength and energy. I just need to get over this feeling of sadness and disappointment.

Hyperemesis Support Update

11 Oct

Further to these two posts, I have recently come across some very useful websites about Hyperemesis Gravidarum (extreme nausea and vomiting in pregnancy). One problem for sufferers in the UK is that treatment is, well, a bit antiquated compared to that available in the US and Canada. So these websites are especially useful because they are tailored towards the UK medical system.

Pregnancy Sickness Support is a great website giving an overview of facts, figures and causes, information about how to cope with the illness in a general way, information for carers (very important too – how partners and families care for HG sufferers has a huge impact), a literature review, and, most crucially, a treatment overview.

There is also a Facebook group which, I think, is linked to this website.

Next, we have the really excellent Pregnancy Sickness SOS, which is a very comprehensive site listing medical research, nutrition tips, information for midwives and a ton of other helpful things. I wish something like this had existed when I was pregnant. They seem to be in the process of setting up a UK Sufferers’ Support Network to help Hyperemesis sufferers via phone, email or in person, which I think is such an excellent idea that I signed up straight away. If you are currently experiencing HG, there is a form you can fill in so someone can hopefully get in touch with you.

Last we have a really lovely blog by a two-time HG survivor who is pregnant again, the aptly named Spewing Mummy. The treatment and lack of support she received from the medical community during her first two HG pregnancies sounds remarkably similar to my own, and she is now doing what she can to raise awareness and treatment standards. Thank you!

Reading Recommendations

14 Jul

When I posted this the other day, I really wanted to include more information in case someone suffering from Hyperemesis comes across my blog. One book I am definitely planning to read before my next pregnancy (whenever that will be) is Ashli Foshee-McCall’s Beyond Morning Sickness: Battling Hyperemesis Gravidarum. At over 500 pages this book promises to be very useful to women in a variety of awful situations. According to the table of contents on the author’s website, it includes the author’s own experience with HG in her four pregnancies, and personal stories of several women. There is also an overview of available treatment. The book is aimed at American readers, so not all of it will be possible to put into practice in the UK, and the names of some medications are different here. It was written in consultation with a doctor, and would be, I imagine, a useful tool in convincing UK doctors to work out a reliable treatment plan.

The same author has also written a children’s book: Mama Has Hyperemesis Gravidarum (But Only for a While), which seems like such a good idea for Hyperemesis sufferers who also have to worry about older children.

I can’t recommend the HER Foundation enough, it really is a useful resource, albeit aimed at an American readership. Though the Blooming Awful website (similar to the HER Foundation, but in the UK) seems to have shut down, there still seems to be a Yahoo Group.

Hyperemesis Gravidarum: When Pregnancy Makes You Ill

12 Jul

The other day a friend introduced me to a fellow student who is pregnant and suffering from Hyperemesis. Seeing how frail she was and hearing about her struggle to eat and stay sane brought back many unpleasant memories.

What is Hyperemesis?

Hyperemesis is extreme nausea in pregnancy and affects around 2% of mothers. It can last for most of the pregnancy, and women can vomit more than twenty times a day. It is classed as severe when the woman loses more than 5% of her pre-pregnant bodyweight. Many women struggle to get back to their former weight before the end of their pregnancy, which obviously can have implications for the health of the baby. Sigmund Freud thought that the nausea was caused by the mother’s subconscious wish to expel the baby. This is generally not considered to be accurate anymore as researchers now think that it may be caused by pregnancy hormones or be an immune response to the foetus.

I suffered from Hyperemesis from the 5th week of pregnancy until the 17th week, and its aftereffects (general queasiness, anxiety, depression, muscle atrophy) affected me even beyond the end of my pregnancy. I was hospitalised at six weeks, ten weeks and twelve weeks due to dehydration. From my 8th week until the 10th week I ate only two yoghurts and two bread rolls and I lost 11% of my bodyweight. I left my flat only around ten times during my entire pregnancy as I frequently felt lightheaded and nauseous even after the worst bit was over.

There are many drugs which can alleviate the nausea, but doctors are extremely cautious because the Thalidomide scandal is always in the back of their minds. During my stays at hospital and the home visits I received, I was only given two drugs, even though other drugs are available. The HER Foundation has an excellent overview of the different types of drugs and their appropriate use. The problem in the UK is that doctors are very conscious of the fact that they are not simply treating one person, as any medication the mother receives will of course be passed on to the baby.

What does Feminism have to do with Hyperemesis?

I found out most of what I know about Hyperemesis now a long time after my daughter was born – during my pregnancy even reading about nausea made me feel ill. But now I am almost angry at how little responsibility the doctors took on: due to the nature of hospital rotas, I never saw the same doctor twice, so no one took on the job of working out a medication regime or flowchart for me, they simply gave me the two most gentle and basic drugs and pumped me full of Hartmann’s solution until I was rehydrated enough not to be ketotic anymore, so they could send me home, where I would be fine for a few days and then hit a downward spiral until I had to go back to hospital. The doctors at my GP surgery were extremely cautious and on occasion refused to give me Stemetil injections even when I couldn’t swallow tablets. During a particularly bleak moment I considered having a termination (many women who suffer from Hyperemesis make this difficult choice in order to save their health), but as we had already told my husband’s parents about the pregnancy and they had lost a baby shortly after birth some years ago, I did not pursue this thought further.

Throughout all of my medical treatment I felt as if my well-being didn’t matter because I was simply an incubator for my baby. I will probably always remember the NHS Direct nurse who almost shouted at me that I was putting my baby at risk by not eating, as if I chose to refuse to eat and enjoyed it. Of course it is good to be careful, but most of the antiemetics used for pregnancy-related nausea have been tested a lot more extensively than Thalidomide ever was. Of course they are not licensed for use by pregnant women, but that is for ethical reasons, not because they necessarily endanger the baby. Malnutrition during pregnancy is now thought to cause behavioural problems in children as well as multiple health problems, so you have to find the right balance of risks.

I even still have to listen to comments from my family about how medication taken by the mother affects babies a lot because they are so small. Well, not eating and drinking would affect the baby too, and it would stay small rather than grow!

What people need to realise is that although a pregnancy only lasts 9 months and is finite, poor treatment, emotional support, mental health, and coping mechanisms developed during pregnancy can affect the mother for years following her baby’s birth. For example, I only tolerated a limited range of food and drink during my pregnancy when I was finally able to eat. So for several weeks at a time I only drank orange juice, then Dr Pepper, and I could only manage not to feel too nauseaous when I drank through a straw (no idea why!). Obviously this has affected my teeth (although I managed to avoid cavities), and I still only drink through a straw at home, while being fully aware how ridiculous this must look to visitors, because otherwise I feel queasy. For several months after my daughter was born I rarely went outside because I felt uneasy having to interact with the outside world having been in my own little bubble for so long. Although this didn’t happen to me, I know that some mothers develop problems with their oesophagus or a hernia from constant vomiting.

So what to do?

I hope to have more children one day, even though the risk of hypermemesis recurring is around 66%, and I know now that I can do things differently. First of all I would start a ‘hyperemesis dossier’ before even attempting to get pregnant. This would contain sheets on which to note symptoms, medical articles on recommended treatment strategies, a flowchart of what medication is recommended according to symptoms and previously tried medication with cross references to the relevant articles, a calendar on which to mark sickness days and ketotic days as well as food consumption. This is just an idea, and I would spend a lot of time filling this folder, but my plan would be to take this folder with me every time I had to see a doctor for help with hyperemesis. I am hoping that having all this information thrust at them would convince them to think about my treatment seriously rather than taking the wait-and-see/gentle approach. Of course they might think I’m doubting their ability to do their job, but to be honest, if it is known that aggressive treatment has better outcomes, but they insist on a more gentle path, they would be correct in their assumption.

Pregnancy is not just about the baby, how a mother feels during this stage of her life is important too. Indeed, how we perceive ourselves as mothers is a process which starts during pregnancy, so a lack of support and an abundance of criticism is unlikely to produce very confident mothers. There is a lot of discussion about the construction of motherhood at the moment, and the experience I’ve made is that the mother who actively wants to receive medical treatment in pregnancy is seen as incapable of generally ever putting her child’s needs ahead of her own, and therefore a bad mother. This perception needs to change.