Hyperemesis gravidarum: Severe nausea during pregnancy but no vomiting?

Morning-sickness-hyperemesis-gravidarum

by Kat de Naoum |
Updated on

Hyperemesis gravidarum (HG) was up until recently simply passed off as acute morning sickness. The word ‘hyperemesis’ itself literally means ‘a lot of vomiting’, but there is actually another side of HG – if you’re experiencing severe nausea during pregnancy you could in fact have hyperemesis gravidarum without vomiting.

For fear of dehydration, a lot of women who experience HG are hospitalised, sometimes more than once during their pregnancies, and put on IV drips. Many others, however, are turned away or dismissed for seemingly ‘not being ill enough’.

If you're going through HG or something similar, it can feel scary, but with more awareness and information spreading, you do have options for hyperemesis gravidarum treatment and management.

What is hyperemesis gravidarum?

Hyperemesis gravidarum affects up to 2 per cent of pregnant women; in about half of these cases, the symptoms subside around the 21-week mark, but unfortunately, in others, symptoms can last right up until – and even during – labour. When morning sickness starts, you may not be aware that it isn't normal to feel as bad as you do, but if does continue into the late stages of pregnancy and beyond, you'll need medical support.

With HG vomiting provides no relief whatsoever, as opposed to when you are drunk, hungover or have food-poisoning and vomiting makes you feel immensely better. With HG, you only continue to feel just as sick as you have been even after vomiting.

If, like most women with HG, you’ve called your doctor, exasperated, because you can’t see straight from all-day nausea and can’t believe this is your life now, you’ll inevitably have had to deal with the predictable question, and the only thing that seems to matter to them:

“How many times have you vomited today?” If your answer is anything under 10, you may feel like you’re being shrugged off. While it’s understandable – as what your doctor cares about is whether you have managed to retain any sort of liquids, nutrients, and electrolytes in your system because if not, you could become dehydrated and risk the health of your baby – even if you’re not vomiting ‘enough’ you could still be showing signs of HG and be at risk of dehydration, so it’s important to know the symptoms.

What are the symptoms of hyperemesis gravidarum?

Everyone will be different, but if you're trying to figure out if you have hyperemesis gravidarum, here are the most common symptoms to look out for and take note of.

• Severe, or prolonged nausea
• Intense and frequent vomiting
• Dehydration and reduced urination
• A lightheaded, dizzy feeling
• Some weight loss
• Dark yellow and strong smelling urine

Will hyperemis gravidarium harm the baby?

HG can make you feel very unwell, but it's unlikely to harm your baby if treated effectively.

However, if it causes you to lose weight during pregnancy, there is an increased risk that your baby may be born smaller than expected (have a low birthweight).

Can you have hyperemesis gravidarum without vomiting?

Yes, it is possible to have hyperemesis gravidarum without vomiting all day long. Plus, even if you’re only vomiting once or twice a day while experiencing extreme unrelenting nausea, it can still leave you dangerously dehydrated.

Vomiting can be triggered by a range of things, including being hungry, brushing your teeth, eating, not eating, talking, breathing, moving… If you eliminate these factors, the vomit can be stopped from escaping your oesophagus, but that doesn’t mean that you don’t feel physically sick.

In some cases, the patient manages to hold down the vomit (some credit it to a strong stomach or literally just clamping the back of their throats shut all day), but that’s not to say that the vomit isn’t right there at the back of the throat ready to come out at any given moment. In these instances, the patient has incapacitating, debilitating, continuous nausea that prevents them from having any sort of normalcy.

Hyperemesis gravidarum and depression

Depression and severe psychological stress have been found to be a direct consequence of hyperemesis gravidarum. The same study that found this notes that “patients with HG during pregnancy should be evaluated with respect to mood disorders as much as their medical conditions. Psychiatric counselling may be helpful in patients with HG to assess the anxiety and depression degree and provide optimal management, care and support for these patients.”

The HER Foundation says, “Many HG women describe the illness as something no one can truly understand unless they have endured it themselves. Instead of the joy every pregnancy should bring, HG women spend most of the 9 months suffering in silence unable to eat or simply keep water down.”

So when a medical professional simply shrugs off what you’re going through as ‘normal’ just because you aren’t vomiting much, it can really be a blow to one’s psyche.

The funny thing is, most HG sufferers can agree that the actual act of vomiting isn’t as bad as the nausea itself. And we can’t just lie in bed and wait for months till it’s all over. The guilt and stress you may have for not being able to carry on with your daily life only serves to make matters worse.

It isn't easy, but you're not alone. There are a range of pregnancy support groups available who will be able to offer you advice and get you the help you need.

If you want to talk to someone who has been through HG, you can contact Pregnancy Sickness Support's help section. They have a support network across the UK and can put you in touch with someone who has had HG.

How to alleviate the symptoms of hyperemesis gravidarum

When it comes to the physical symptoms of hyperemesis gravidarum, there are a few ways to help with the symptoms that you can do yourself. Of course, talk to your doctor about your symptoms and take any medication they prescribe, but feeling proactive can do the world of good when you're not at your best.

Eating more regularly but in smaller portions can be incredibly helpful. To make this simple change, make sure your meals are as odourless as possible and remain fairly plain to avoid inducing the nausea. Food with a heavy fat content may be best to avoid as well. Toast, crackers, rice, and oatmeal are all good foods to stick to. There are many foods you can eat with morning sickness that could work for you too.

There are couple of things you can purchase that may help your feelings of sickness. Certain teas like ginger tea and green tea (there are many herbal teas you can drink while pregnant) are also good for soothing nausea. Travel sickness aids such as pressure-point wristbands that may also help.

When it comes to the mental side of hyperemesis gravidarum, removing as much stress from your life as possible will really help. You may not be able to get rid of the nausea and vomiting, but you can seek out and, hopefully, end the triggers that won't be helping. This may require a slight lifestyle change, and prioritising some things over others, but it will be so worth it for your mental and physical health.

Rest as much as you can and make sure you stay hydrated. You should be doing this during pregnancy anyway, but it will help to alleviate your hyperemesis gravidarum symptoms.

Hyperemesis gravidarum treatments

The good news is that in recent years people are starting to take acute morning sickness and hyperemesis gravidarum more seriously. Research is constantly being done, and breakthroughs are being made. There is no cure for hyperemesis gravidarum yet, but there are medicines that can be used in pregnancy, including the first 12 weeks, to help improve the symptoms of HG. These include anti-sickness (anti-emetic) drugs, steroids, or a combination of these.

You may need to try different types of medicine until you find what works best for you.

If your nausea and vomiting cannot be controlled, you may need to be admitted to hospital. This is so doctors can assess your condition and give you the right treatment to protect the health of you and your baby.

Treatment can include intravenous fluids, which are given directly into a vein through a drip. If you have severe vomiting, the anti-sickness drugs may also need to be given into a vein or a muscle.

Until such time that a safe cure-all is discovered, there are a few things you can do:

• Be informed. Read everything there is to know about HG. Know what you’re dealing with. “Education is power,” says Ann Marie King, co-founder of the HER Foundation. “Telling a HG women to eat crackers, try ginger or sea-bands shows your lack of knowledge of HG.”

• Don’t let your doctor or anyone dismiss your discomfort just because you are not physically vomiting over a certain amount per day. You deserve to be taken seriously and your suffering merits attention.

• Look into the treatments available, bring these up with your doctor and even ask to be admitted into hospital if possible.

• Don’t keep it inside; talk to someone – other mums, your family, friends, a therapist. You don’t have to suffer in silence. Reach out to fellow sufferers in forums for information on what helped them or even just to get an understanding and sympathetic ear.

Kat de Naoum is a freelance writer based in the UK and Greece. She has written for many publications, and, as an advocate for female empowerment, loves to write about women’s issues, and helping fellow mothers feel supported and less alone.

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