Morning Sickness vs. Hyperemesis Gravidarum: A Primer

Mar 18, 2005

The Bottom Line There's a lot more to morning sickness than crackers and ginger ale.

Here I am, 13 weeks pregnant with child number four, a huge shocker, since I had a tubal ligation when I had my youngest 19 months ago. Even more shocking was the development of something I'd only read of: a condition known as hyperemesis gravidarum (HG), which roughly translated, means "puking too much due to pregnancy." I'd had morning sickness before, but morning sickness is nothing like this.

::: Morning Sickness Is a Misnomer :::

As I knew from my previous pregnancies, the term "morning sickness" is really a misnomer, since the nausea and vomiting of pregnancy (NVP) can strike at any time. A large percentage of women have some form of NVP, ranging from a bit of nausea in the morning, to occasional vomiting. Regular-old garden-variety NVP is one of the least enjoyable ways I can think of to spend my time, but I've lived through it three times. My NVP was severe enough with my previous three children that I would walk around the house with a small garbage can in case one of my sudden vomiting episodes came on, and I spent a good portion of each day nauseous. I grinned and bore it, and by the time I reached about 12 or 13 weeks, it started to taper off. I was even given medication with my daughter, as I was borderline dehydrated, so I thought I knew all there was to know about NVP.

::: When NVP Is Actually HG :::

One of the first indicators I had that my tubal ligation might have failed was an unsettling bit of nausea combined with the sneaking suspicion that maybe my period was late. Within a week of the positive pregnancy test, however, I was one very hurting person. Unlike the NVP of my previous pregnancies, I could not keep ANYTHING down. Not a Saltine, not a sip of water. Nothing. Even swallowing saliva would have me retching, and after I had thrown up whatever I'd injested, then bile, I'd still be dry heaving, with nothing coming up.

I've gone to the hospital for intravenous fluids. I've tried Seabands and saltine crackers and a cute little candy called Preggie Pops. I've sucked on hard candies and chewed fruit-flavored taffy. I've tried ginger ale, ginger candy, candied ginger, Gatorade, popsicles, children's Pedialyte, dry toast... the list goes on. Every single time anyone suggested ANYTHING that helped with their morning sickness, I tried it, from a combination of dry Cheerios and Gatorade before getting out of bed to sour lemon drops, I've tried it.

When all else failed, my obstetrician turned to medication. Vitamin B-6 combined with Unisom often helps, but not here. Then we moved on to Phenergan suppositories, then to a medication called Zofran that is often given to chemotherapy patients. I am now on a medication called Kytril also used with chemo, that costs a whopping $40.00 per pill. Taken twice a day, that's a cost of $80.00 a day, and all that does is slow the vomiting; I am still nauseous all day, but I'm down to vomiting once or twice a day, something I often thought was unbearable when I was pregnant with my other kids, but I now know is more manageable than a lot of women are.

::: Getting Support :::

One of the only things that has kept me from the edge of a bridge is the support of other women who are, or have, suffered from HG. For some reason, there is a tendency among women to "compare war stories" but moms with NVP (and that includes me up until about two months ago) have NO IDEA what it is like having HG. I can remember being in the hospital after having my youngest and having a girl across the hall from me who had HG and hearing her retch all day long. I can remember thinking to myself "I could never do that." But here I am. Other moms have compared their NVP to what I'm living through, only to tell me that they gained 50 pounds during their pregnancy. Last week, I had the dubious distinction of losing approximately a pound a day, and I've lost a total of 12 pounds in the past six weeks, and that's WITH keeping some food down (and some seriously fatty food, at that... I managed pot pies for about a week) and sipping Gatorade when I am able to keep liquids down.

The best thing for me was finding these other women through a forum at a web site called the HER Foundation, which stands for Hyperemesis Education and Research Foundation, and is found at . The forums on the site have been invaluable to me, from sharing funny things doctors have said to us in terms of how to cope to venting about husbands who don't understand how debilitating and depressing this condition can be. The other women on the site have shared everything from treatment protocols that they found worked to "foodments" which are food items that were tolerated surprisingly well.

::: Things to Know :::

One of the hardest things for me has been explaining to friends and family just how bad HG is. Some have given the usual "crackers and ginger ale" suggestion (which is useless for a mom with HG), only to realize as I'm attempting a phone call with them that I'm actually having to pause in the conversation to vomit. Others say they want to help, but ask what I need. I need to stop vomiting! My house and life are so out of control at times that I don't know which end is up, and I'm unable to coordinate volunteers. The friend who has been the most help was one who didn't ask and just did, who showed up one morning to take my daughter to school, informed me that she would see me at the end of the school day, and has chauffered my daughter to and from school for the better part of two months, even though it's out of her way to do so. Others have taken my two older kids for the weekend, leaving me with the more easily managed youngest, who could be gated into a room with me with a selection of videos.

::: Depression :::

Perhaps the hardest part of having HG for me has been how utterly depressed I am. I can't drive at all, because merely backing the car out of the driveway will often have me vomiting. I ride along in the passenger seat when I do get out with my bucket clutched firmly in front of me. My bucket has gone everywhere with me: doctor's waiting rooms, my parents' house, even over to my son's daycare across the street to pick him up, because I'm afraid I will vomit in a friend's house, or in a doctor's office. At least one of my children has been vomited ON as I attempted a particularly messy clean-up when he had a stomach bug.

But the worst part is that I feel like a failure. I can't take care of my children properly. I can't get down on the floor and move around and play with them, and most days, if I make it from my bed to the couch next to my computer, I'm having a good day. My oldest, Beanie, claims to understand, but how can she? For two months, we've done no craft projects, and many times, even a game of checkers in bed is more than I can handle. My husband is frustrated by my inability to get around and do simple tasks like grocery shopping and banking and cooking dinner, and my friends go without so much as a phone call.

On top of it all are many doctors who either don't know or don't believe HG is a condition. One on-call doctor returned my call letting them know I wasn't keeping anything down by telling me to lay in bed and "don't move [my] head." Well, that's handy. How do I keep an eye on my kids? Or go to the bathroom?

::: An End to My Rambling :::

I know something now that I'm very glad that I didn't know when I was pregnant with my three children: the difference between "morning sickness" and HG. Morning sickness is a truly awful experience that was nearly unbearable at the time. It's named incorrectly, and is frustrating. However, hyperemesis is hell on earth, plain and simple. I have no doubt in my mind that I will volunteer as a buddy on the HER forums when my stint is done, providing whatever sympathetic ear I can to other moms going through the same thing. The one thing that I hope anyone bothering to read through this takes away is how severe this condition can be. I'm one of the lucky ones: I don't have a PICC line for fluids; I get them only on occasion when I know I'm severely dehydrated. I've found a medication that gets me to a manageable level where I can keep some food and liquids down. There are many more moms out there who aren't as lucky as I am, who are getting hyperalimentation for nutrition, and spend nine solid months doing nothing but vomiting with no relief in sight other than delivery. As scary as it's been for me the days where I can't even keep down a sip of water, I've had success in treatment, and many others don't. And morning sickness just doesn't compare, having been in both situations myself.

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