This is one remarkable story...up until I heard this story, I didn't think there existed a worse pregnancy than mine. But whilst mine was an emotional challenge, Kim truly deserves accolades for making it through a physically gruelling and emotionally exhausting 37 weeks, suffering from hyperemesis gravidarum and more.
Hyperemesis gravidarum (HG) is not morning sickness. It is a condition of pregnancy involving extreme nausea and persistent vomiting which causes dehydration, electrolyte imbalances (and associated complications), weight loss and has a hugely detrimental effect on quality of life. Kim is bravely sharing her experience with HG, but importantly she also reflects on how those of us who might know someone with HG might be able to help.
Please note, there is a trigger warning for this story, involving extreme sickness, hospitalization,
prenatal mental health, and threatened pre-term labour.
The day my husband and I found out we were pregnant was one of the happiest of our lives. I vividly remember the moment the test came up positive – I was shocked and did two more tests right away, because I couldn’t believe that we were actually pregnant. It took us quite a long time to conceive, and the months of disappointment had conditioned me to expect a single line!
That day I booked a doctor’s appointment to get bloods taken and the pregnancy confirmed. I was only about 2 weeks pregnant, and hadn’t even missed a period yet. We were thrilled, and when I started to feel bad nausea at around 4 weeks, my excitement only increased as this confirmed that the pregnancy was going well. I nibbled my crackers and prepared to wait it out.
But the nausea didn’t go away. In fact, it intensified significantly. By five weeks, I was vomiting violently at least 10 times a day. I assumed this was normal, and tried all the ‘remedies’ – sea sickness bands, acupressure, dry crackers, and ginger in all its forms. Nothing worked, so off I trotted to the GP for medication. By six weeks, my vomiting had increased to 20+ times a day and I could barely crawl out of bed. I lost almost 7kg within a week. At seven weeks, I had my first hospital admission. After a 4 hour wait in ED, I was finally admitted with severe dehydration; I was given 4 bags of IV fluids, chemotherapy-level anti-emetics, and a diagnosis of hyperemesis gravidarum. That ED was to be my second home for the next few months!
The first trimester of pregnancy is renowned for being exhausting and wrought with morning sickness. But as one of my friends once said, “Calling HG morning sickness is akin to calling a typhoon a spot of rain”. My husband and I had never even heard of hyperemesis gravidarum (HG) before, and we were thoroughly unprepared for what it would do to me. The first trimester of my pregnancy was a blur of bone-deep exhaustion; extreme, unrelenting nausea; vomiting up to 50 times a day; trial and error of numerous medications; endless bags of IV fluids and ED admissions; and desperate hope that the sickness would go away.
The guilt I felt was horrible. I was forced to use up most of my sick leave from work, and felt that I should be able to just suck it up. I couldn’t keep down the nutrients I felt my baby needed. There were almost zero foods that I could stomach, and my body was seriously suffering from malnutrition. Side effects to my medications were horrible, and taking pregnancy vitamins was a laughable concept. I felt trapped in my own home. To my shame, I found myself wishing I weren’t pregnant, wishing that all of this would just disappear.
Almost worse were the comments that I received from others. If someone tells you they have HG, please listen to them. Believe them. Don’t tell them they’re fine. Don’t compare your own morning sickness, or that one time you got food poisoning for 12 hours. It is not the same.
Some of the comments I received included:
“Just stop thinking about it.”
“It’s all in your head, just think positive and you’ll feel better.”
“I had morning sickness too, it sucks but it passes.”
“Well you’re past 12 weeks so you mustn’t still be sick.”
“It’ll stop at 12 weeks… 15 weeks… 18 weeks… 20 weeks…”
“Just be thankful that you’re pregnant at all.”
“You shouldn’t be taking those medications, they’re bad for the baby.”
“Have you tried ginger?”
The typical remedies for morning sickness are generally ineffective for HG. Ginger does not work. It took a long few months of trial and error before I found a combination of medications that worked together to ease my nausea and vomiting slightly. I was still constantly nauseous, still vomiting multiple times a day – but I could perform the barest essential functions, and keep down a small number of foods. I was finally (slowly) getting better!
I moved into the second trimester exhausted, sick, but optimistic that the worst of the HG – the “death zone”, as HG sufferers call it – had passed. I still became dehydrated very easily, the medication I required to keep myself and my baby alive caused extreme constipation, and I still required a number of hospital admissions – so life was far from easy. However, our little baby was miraculously healthy and growing! Given how malnourished I was, this was a huge relief.
Then, at 24 weeks, I started experiencing intense abdominal pain. After a gruelling six hours or so, it was still getting worse – so up we trotted once again to the maternity ward. The diagnosis: I was experiencing threatened pre-term labour. This was scary. My baby was barely ‘viable’, and I was given steroid shots for the baby’s lungs in case the baby was born prematurely. I was transferred to a specialist hospital 3 hours away from home. I spent just over a week at this hospital, and despite the support of my friends, family, and my wonderful husband, it was a very lonely and anxious period. Thankfully, the contractions ceased and my cervix remained long and closed, so I was allowed to go home on the condition that I used progesterone pessaries for the remainder of my pregnancy.
At around this time, I was also diagnosed with symphysis pubis dysfunction (SPD) – or severe pelvic girdle pain. This is a stabbing or aching pain that occurs in the hips and groin, making it difficult to sleep and move – particularly walking long distances, up and down stairs, getting out of cars or beds, etc. I developed a pregnancy waddle very early on! I was referred to a physiotherapist, and began seeing her fortnightly to help with my pain. I received deep tissue massages, went to hydrotherapy sessions, and had my lower back rock-taped constantly. Between the HG, SPD and labour risk, I was now taking a total of 15 different types of medications per day, and it was starting to take a toll on my body. But my baby was still safe and thriving, and we started to see the light at the end of the tunnel.
We were on the home stretch! I was still vomiting a few times a day and constantly nauseous, but I could eat a greater variety of fatty and carb-y foods. There were no more signs of labour. Then, at around 27 weeks, I had my first gallbladder attack. For those who have never had a gallbladder attack, it feels similar to what I imagine a heart attack is like. It was considerably worse than my labour contractions! I quite honestly thought I was dying, and I took my first ambulance ride to hospital. An ultrasound confirmed that my baby was okay, but my gallbladder was packed with stones. The following morning, I was sent home with a script for endone in case I had another attack. The attacks kept coming. The endone barely took the edge off. I was referred to a dietician to discuss gallstone and HG-safe foods, and I immediately cut all fats and oils from my diet. Unfortunately, as my HG ‘safe foods’ were mostly fatty, this resulted in a minute number of foods I could eat without triggering either a gallbladder attack or exorcist-style vomiting episode. Soon I was on a diet of purely jelly, watermelon, and microwaved potatoes.
And still, the attacks kept coming. They slowly went from once a week to once every 3-4 days, until from around 32 weeks, they were occurring every 1-2 days. I became too scared to eat anything for fear of another attack, and I had many more trips to ED. It was around 33 weeks that I had the most challenging night of my pregnancy, and my mental health was suffering. I had been okay for a few days, and my cousin was visiting for the first time during my pregnancy. I took all my medication and we cooked rice paper rolls for tea (no oils, fats, sugar, or any triggers!). I thought I would be safe for one night. But at around 8pm, the familiar burning feeling started again, and built up to a full-blown attack – the worst yet. I was on the ground on all fours, I couldn’t move, I couldn’t stop heaving. Tears were streaming, and endone + paracetamol made no difference whatsoever. I couldn’t believe the pain. My husband called an ambulance, and the paramedics assessed me at home (I couldn’t talk and was struggling to breathe from panic). They were concerned I may be going into early labour, and regardless I needed some hardcore painkillers - so I was loaded up into the ambulance again. I got to hospital (I was not in labour) and was given morphine and fentanyl, which abated the pain somewhat – but they triggered my HG, and I began violently vomiting. I could not stop, and I started to get really scared by the stuff I was bringing up. My previously strong pelvic floor couldn’t withstand the strength of each vomit, and my self-esteem was at rock bottom. I vomited every few minutes for about 6 hours straight. I actually begged the ED doctors to just put me into a coma for the remainder of my pregnancy - I wish I had been joking! Needless to say, they refused. But I did (finally) ask for some mental health support, and began to see a support nurse every couple of weeks until the end of my pregnancy.
The gallbladder attacks continued, and I had many more trips to hospital. My symphysis pubis dysfunction worsened, and I ended up using crutches for much of the last three weeks of my pregnancy. I was starting to hit breaking point, and my obstetrician brought up the possibility of an induction. I jumped at this. My body felt like it was falling apart, and I needed this baby to come out. Eventually, at 35 weeks, the obstetric team agreed to induce me, and we set an induction date for 37 weeks + 2 days. This was such a game changer! Finally having an expiry date on my suffering made a huge difference to my mental health. I could count down the days! Those final two weeks were the best of my pregnancy, as I finally started to feel some excitement (and fear of the birth). I knew that an induction at 37 weeks came with risks and the probability that the baby would not be in a good position for birth yet, so I started preparing. I spent all of my time on a gym ball, hand expressed 250ml of colostrum, and did everything I could think of to help get my baby into position and ready to be born.
Kim on the day of her induction
My husband and I went to the hospital to be assessed and have cervidil tape inserted to dilate my cervix enough that my waters could be broken. The lovely midwives set us up in the birth suite that was to be ours until our baby was born, and we made ourselves as comfortable as possible. Around 4 hours later it fell out, and as I was now 2cm dilated, the obstetrician decided not to put it back in. The following morning, the obstetrics team broke my waters, and we got started! Contractions started almost immediately, and within half an hour or so I decided to use the shower for pain relief. That was where I spent most of the next few hours! Eventually the pain got extreme and I asked for some morphine. I was told that I needed my dilation checked first – this was enough for me to decide I didn’t want the morphine just yet! Another half hour later and I decided that it was worth the internal – only to be told that I was almost 8cm dilated, and it was too late for morphine. I was shocked! After my recent gallbladder attacks, I was expecting the contraction pain to get much worse than this. I panicked a little and asked for an epidural instead. The midwife said that it may be too late for that too, but she was kind enough to send for the anaesthetist anyway. Some time later, the anaesthetist arrived – at the same time as I had a huge urge to push, and the midwife said she could see the baby’s head! After 40 minutes of pushing, my beautiful, tiny boy was delivered by my brilliant student midwife and was placed on my chest! It was exactly 4 hours since my waters had been broken, and I couldn’t believe that my baby was here and my pregnancy was over. The relief I felt was incredible. The first thing I said was, “Is it over? It’s done?” shortly followed by, “Is he okay?” He was more than okay. For a 37 week baby, he was exceptional. All his APGAR scores were 9 or 10. He started breathing (and screaming!) immediately. He made his way towards the breast. He was a tiny 2.78kg, and he was red and squished and covered in vernix – but I had never seen anything so wonderful. I couldn’t stop grinning. I received the injection to deliver the placenta, and the moment it was out, all of my nausea completely disappeared. I felt well again! I had a small second degree tear, but barely felt a thing while I was being stitched up. It was one of the happiest moments of my life! I felt such relief that my sickness was gone, and so grateful that the birth had gone smoothly and quickly. We felt like the luckiest people on the planet. Within half an hour or so I’d gotten up and had a shower, and an hour later we were relocated to the maternity ward with our tiny, perfect little bundle. We named him Asher David Clayton, and he was born at 13:31 on the 21/12 – our little palindrome baby :) He is now 9 months old, and is the happiest little darling!
I had my gallbladder removed at 2.5 weeks post-partum. It was a surprisingly tough surgery and recovery, but I no longer have any lingering problems. I can eat whatever I want, and I am medication free and healthy again! While we want Asher to have a sibling, the thought of being pregnant again still scares me, and I have some PTSD symptoms with certain triggers. It is extremely likely that I will get HG again with any subsequent pregnancies, so whilst we hope to have a second baby someday, at the moment we are enjoying life with our gorgeous little wombat.
Baby Asher surrounded by the medicines needed by mum Kim to survive her pregnancy
I would also like to mention something that made my challenging pregnancy journey considerably better – I had an amazing student midwife follow my pregnancy from around 20 weeks. She came with me to numerous appointments, answered my questions and concerns at all hours of the day, visited me in hospital, and campaigned on my behalf to midwives and obstetricians when I was either too weak or too upset to do so myself. She was by my side for the duration of my labour, and delivered my baby boy. If you are pregnant and considering having a student midwife follow your pregnancy, I strongly recommend it! They are a wonderful source of support and encouragement, and I know that I would not have coped anywhere near as well without the constant support I received from Alison.
Kim's student midwife Alison, who followed her through the pregnancy journey, birth and postpartum.
I hope you've enjoyed reading Kim's story of her challenging pregnancy. It is tough to read in sections, but thankfully there is a really positive birth experience and outcome. Like my own story (link below to read), it highlights once again that trauma can occur any time for any reason - it is not limited to caesarean birth or long labours. Kim is lucky too that she had support to get through the pregnancy, and acknowledges the importance of advocacy - something her student midwife assisted her in when she was suffering during pregnancy. I will also put links below to my blog posts on continuity of care (including how student midwives can ensure you have continuity of care, and how this alone can improve outcomes) as well as an article on perinatal mood disorders, such as the decline in mental health that Kim experienced in pregnancy. Please don't hesitate to comment below or get in touch if you have any comments for Kim or questions for the midwife.