Hyperemesis gravidarum: not your garden variety morning sickness

So the tabloids have finally broken the real news that yes, Will and Kate, everyone's favorite Royals, are really, truly, pregnant. This time it's for real! And wouldn't you know it, Kate is making headlines for yet another reason: because of her recent hospitalization with hyperemesis gravidarum.

HG is probably one of the most poorly
understood conditions of pregnancy,
and its sufferers sometimes find
themselves marginalized, ignored,
and made fun of or told to
"just suck it up." If you wouldn't
say this to a recovering cancer
patient, then don't say it to a
pregnant woman - who likely is
experiencing daily debilitating
and excessive vomiting and nausea,
weight loss and severe dehydration.
For more information, visit the
Hyperemesis Education Research
website at helpher.org.

Many pregnant women have suffered through it and can relate. Many of us, like myself, have not, and find just regular old run-of-the-mill morning sickness utterly a royal pain, if you'll excuse the pun. When I wanted a second child, two things worried me: the recovery (as I planned at the time to have another cesarean), and the morning sickness. I don't know what it is, but even while not pregnant, I cannot stand being nauseated. I crocheted a lot while pregnant and now, can't even think of crocheting because the thought of doing so makes me queasy. So Kate is probably pretty miserable right about now.

HG, as it's called, can be a nightmare for sufferers. Many women I've talked to or know suffered for months, sometimes the entire duration of the pregnancy. One friend was finally, to her great relief, hooked up to a Zofran pump (like an insulin pump) that helped her manage through the feelings of constant nausea, complete loss of appetite and many, many trips to the toilet. If you've ever suffered through a day or two of stomach bug, you know how easy it can be to get dehydrated. Now think how that would feel day after day, for months. 

When it gets bad enough, a hospitalization for IV fluids can sometimes be in order. In order to differentiate between it and just normal morning sickness, severity is a consideration: if your nausea and vomiting are especially bad, to the point of being able to keep nothing in your stomach, then you're probably the lucky winner. The author of this Washington Post article humorously noted (although probably not funny at the time, I'm sure):

"I have often told people that I knew my condition was bad when a helicopter flew over my home and instead of listening to its rumble to make sure it passed safely overhead, I thought to myself, 'Well, at least if it crashes into my apartment I won't have any more morning sickness.' Death would have been an improvement...I mostly slept, and carried a trash can wherever I went. All my husband wanted was an omelet, but the thought of eggs made me want to kill him."  

One of the women who commented on The Washington Post article said that her daughter had it - and was hospitalized for the better part of her first pregnancy. Unlike Kate, however, the traditional remedies (and we're talking the big guns here that you get only at the hospital) did not work. To top it off, she became pregnant again, only to have it worse than the first time, which resulted in TPN (total parenteral nutrition, a form of IV that basically gives you all of your nutritional needs in IV form. *insert completely horrified face here*.) That would basically make you never want to have any other children, ever again. (As a side note: I used to make that stuff for patients when I worked in a pharmacy, and it basically meant you were pretty sick.)

I was glad to see that it made news, though, because of one thing: this horrible, not-your-average-pregnancy symptom is often delegitimized by people who think it's just regular old puking and feeling yucky. They often say terrible things like, "Suck it up!" or "You're just doing it for attention!" Sadly, I've even heard things like that from labor and delivery nurses, one of whom basically said, "You were the one who wanted to have a baby, so deal with it." She didn't seem to believe that it could be debilitating. I asked on my fan page if anyone had dealt with it and if they could share their comments:

"It was debilitating. I had little to no support. I was told to eat crackers, sip ginger ale, and it would just stop. I vomited around the clock for close to 7 months. When it did ease and I could eat, I had lost a lot of weight and began to develop very severe pre-eclampsia...The comments which hurt the most were when I was told I was doing this 'for attention' and that morning sickness is "all in your head." I could have died, my son could have died. I *wanted* to have a baby. I *wanted* to enjoy being pregnant. Why in the HELL would I then bring such suffering upon us both for 'attention?' It caused a lot of heartache and created a rift in my family relations for a long time afterwards." - Rebekah

"I was unable to hold down water, let alone food. Even with meds I'd have to crawl into an E.R. once a week for IV meds and fluids....The worst is when the doctors don't want to believe you...not sure I could ever put myself through being pregnant again. Which sucks because I long for another child." - Noel

"Meds didn't work. I spent my whole day either throwing up or trying not to. I lost my job - had to be hospitalized for dehydration. I lost my baby as a result of being so sick...The comment that hurt the most especially at the end where I was still but knew the baby was gone was when everyone would say the baby would be worth it." - Robynn 

"I threw up daily around the clock for 88 weeks out of my three pregnancies...it was worse with each child. The puking and never-ceasing nausea is hard, but the time you lose being completely debilitated is the hardest part. Your children don't understand. Your mother-in-law doesn't understand or people think you are exaggerating. When people ask "How are you feeling?" you learn to simply say, "Hanging in there." Reading or looking at a computer screen might exacerbate it. Grocery shopping becomes a challenge - beat the clock before you hurl. Your ribs ache from dry heaving. You eat and eat because you are worried your baby isn't getting enough. Your partner stops being empathetic. It becomes "normal." You clean your own puke off the wall behind the toilet. There is no one to take care of you. You will have days where you will cry clinging to the toilet as you dry heave bile and over and over again say "I'm so glad my baby is healthy!" to keep your affirmations as positive as possible." - Green Births

"Green Births is totally spot on. Eventually no one around you cares or will even help. Honestly it's so emotionally, physically, mentally crippling. I feel so awful for my daughter who has no idea why mommy can't do fun things with her very often, the strain and stress it has put on all my relationships, I just feel miserable and helpless." - Aimee

"I was losing a pound a day. I had to leave university because I was constantly running out of class to throw up...most of my day was spent with my head in the toilet or laying on the sofa." - Catherine

"Favorite moments were pulling over to puke in front of a bunch of teens in town. Puking in my work car park and simultaneously weeing. Puking on my steering wheel because I couldn't get out in time. HG destroyed my life for 9 months." - Sian

What's really sad, is that for some women, hospitalizations are really the tip of the iceberg. For some, the meds do not work, and it's speculated that as many as 6,000 abortions a year are performed on women who are at their wit's end dealing with HG and just can't take it anymore. Honestly, if you are experiencing misery day in and day out for months on end and then someone comes along and tells you "just deal with it," wouldn't you be reaching the end of your rope, too?

Those who think it's "all made up" might need a little education as to what it actually is: that big-sounding Latin word might trip them up. Maybe they need to be shown? Who knows. If you were a cancer patient going through the rigors of chemo, would they dismiss you as creating drama and trying to attract attention to yourself and just "suck it up?" I highly doubt it.

My best to Kate - I hope she responds well to treatments and gets better soon.

More reading:
Our lady of hyperemesis gravid arum - The Washington Post

Tori Spelling and cesarean complications: why we need to hear about it

It seems like everyone wants to hear about celebrity baby gossip. And with Tori Spelling's recent birth complications in the news, it's something we should be hearing about.

At the very least, Tori Spelling's
post-cesarean complications could
be an important vehicle for raising
awareness about risks of c-section and
the importance of adequate
informed consent. 

As Spelling underwent emergency surgery for complications after her fourth cesarean, the media was slightly abuzz about why it's such a concern, as they should be. I was elated that finally, finally someone was beginning to question the high c-section rate and how repeat cesareans can pose dangers for women. Not that I would ever wish those repercussions on anyone, but to have it happen to a high-profile celebrity, someone who's face we recognize, whose births are highly publicized - is perhaps instrumental in getting our attention when it comes to a very important topic that few people seem to really understand.

I don't know about Tori and her marriage, don't watch her show, or know what her motivations are, but it sounds like she wants a large family. She is in the minority, as more women are stopping after two children and therefore are not often exposed to the risks of what that number of c-sections can do to the body. Whether it's one, two or four or more, it always carries risks - but obviously with four surgeries under your belt you're going to be exposed to more risk than someone who's only had two. It's unclear, though, whether women really 'get' why this is important to understand - because many of them spend much time digging Spelling for 'not using birth control' (even though someone commented that yes, she was using it, and yes, it did fail). Some speculate that she did initially consider a VBAC, but decided against it when her first and second births were also close together (which can bring additional risk).

Instead of bashing her for having lots of kids, not 'getting fixed,' etc. etc. it should make us question why she wasn't encouraged to have a VBAC after her first birth, especially if she wanted more children. Although close births do pose a unique set of complications when considering VBAC, this is probably one case where why her first cesarean occurred is important to know: did she have a medical condition? Was she 'too posh to push' or did she simply want to schedule the birth? Who knows. Preventing the first scar is key, but sometimes it's not that easy, especially if you aren't sure how many kids you want. It's hard to gear up for a future birth when you're barely finished with the first one, but knowing before you get that uterine scar just how it could impact future births is very important.

After the birth of her first son, Liam, Tori said this:

"I had a c-section...One of the biggest misconceptions is that celebrities have C-sections because it's easier. If I had a choice, I would not have. The recovery is much worse." 

To me, it almost sounds like her doctor was a "once a cesarean, always a cesarean" type of person. And while I'm sure there is some strong-arming going on when it comes to pleasing a celebrity client, these women are no different than we are: if a doctor tells you a VBAC is "unsafe, dangerous, and your uterus will shatter" then you are just as prone to believe it's true as any of us might be.

I'll never forget it: that's what Anna Nicole Smith reported that her doctor told her before the birth of her daughter, born by scheduled cesarean. That her "uterus would shatter," as if it's made of glass, as if one tiny contraction could forcibly blow the entire thing up like a bomb. I was so sad for her, because she naively believed him, much like any of us probably would have.

Some articles surrounding Spelling's complications ask an important question: are doctors doing enough to inform patients about the risks of cesareans? I was happy to see that headline, because I argue wholeheartedly that they're not. If you were scheduled for brain or open heart surgery, would a doctor simply tell you, "Everything will be fine, trust me! It's totally safe!" and walk away without so much as an explanation of the procedure? Highly doubtful.

I know my own physician, whom I saw for two of my three pregnancies, definitely did not. I still remember clearly our conversation prior to the birth of my first baby, who was breech: to his credit, he didn't schedule the cesarean until the week of my due date, but never went over any risks - if he did, I probably would have left the office that day in a panic instead of nervous excitement about the arrival of my child. Thankfully I did go into labor days before the surgery, which meant my baby (and most importantly, my body) experienced labor on its own, which is critical for future births. Yet I had no idea just how important that was at the time, because I was naive and very uninformed. No thanks to him.

When I became pregnant with my second child, my doctor gave me a 'choice' of what I wanted to do: the cesarean route, which I was already familiar with and had survived (isn't that a benchmark of just how casual our approach is to it?) or a VBAC, then proceeded to tell me that it could be dangerous and he'd had two women rupture on him. I decided the word 'rupture' sounded very unpleasant and I wasn't even going to consider it for a moment. Duh. What an idiot I was!

As my pregnancy progressed, I decided maybe having a VBAC wasn't such a bad idea. My primary motivation for choosing one was a) my baby wasn't breech and b) I wanted to avoid a potentially horrific recovery like I had with the first. I was terrified to tell him my intentions, because I had just three weeks until my due date. I stammered my way through our office visit, my husband at my side, while he proceeded to again tell me just how dangerous VBACs were and "I have one patient who's on her fifth cesarean!" I will never forget those words. That's when I asked him, "Well, what about this? That? Or this?" He had to concede that yes, those were definite risks to multiple cesareans. But reluctantly.

I know I'm not the only one. I've read so many accounts from near-panicked women that are on the eve of their inductions: "What should I expect? What do they do? Is this really necessary?" Something is clearly wrong with this picture. Either we trust our doctors too much, feel completely incapable of asking them questions, or they are completely inept at adequately informing their patients of risks and benefits to procedures. It shouldn't be a "don't ask, don't tell" policy; even if the patient says she has no questions, you should probably go ahead and tell her anyway. If she doesn't even know what to ask, then she's probably not even thinking about what could happen, what should happen, or what doesn't even need to happen.

I asked people on Facebook if they were induced or had cesareans, did their doctor cover the risks of the procedure? Of those that answered, all of them said "no."

It doesn't help that many doctors will discourage you from 'reading too much.' The internet be damned, because that means you're a religious follower of Ricki Lake and she only wants women to give birth in bathtubs. *eyeroll* Here, here's a copy of What to Expect When You're Expecting, now please - I don't have time to go over all the risks with you because there are none and it's perfectly safe so have a nice day. Does that sound like informed consent to you? Me neither.

So it's not a wonder Tori Spelling has had her fourth cesarean, and I don't think she should be blamed for it, either. Not because she's "old," or "a breeder," or any of those things. Stop blaming the person who just trusted her doctor, as you often blindly tell her she should. Start blaming the people who knowingly put vulnerable, often inadequately informed people at risk. Stop enabling the very system that allows this to happen.

Between a rock and a hard place?

A few weeks ago I went to an acquaintance's baby shower. She was due sometime in early March, but apparently was developing kidney problems as she got closer to the end of her pregnancy. She told me that doctors were concerned, and even though she had no swelling and no high blood pressure, protein was spilling into her urine and it had her doctors puzzled. Therefore they were considering inducing her two weeks before her due date.

I have to remember that often times my facial expressions are so easy to read, and I need to do a better job hiding my feelings. I probably looked annoyed? Concerned? Puzzled? Who knows. I try to remember, it's not my pregnancy, it's not my baby, it's not really my business. I asked if maybe she could go on bed rest and take a wait and see approach, but not really knowing the full scope of her problem, I wasn't about to offer too much advice. But in the back of my mind I thought, There is no way this is going to work. I felt so badly for her.

I asked her coworker about her yesterday, and he told me she'd had the baby. They tried to induce, it didn't work, and did the section around 4 a.m. He told me her mother had kidney complications, and I knew her mother had died a few years ago. I thought, What should she have done? She was put between such a rock and a hard place.

Ultimately, her baby was born healthy, and that's the best thing for everyone. I won't say "that's all that matters," because for many women the journey to having that healthy baby is very important, too. But I just wonder why they even bothered putting her body and her baby through all of that when they knew it wasn't going to work? Why kid her about entertaining the possibility of having a vaginal delivery?

That was her first lesson in the School of Childbirth, and I felt so badly for her, but even more so for not really being able to avoid it. I felt the same way with my last section. It's sometimes a daily struggle to not feel "ripped off" by the whole experience, and somehow come away from it positively and hope to help other women (without coming off as the "Pregnancy Police" or a "birth nazi" - I hate that term).

Maybe if she has another baby she'll have a chance for a "do over."