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.