They say be careful what you wish for. When I first wrote about being pregnant after my miscarriage in the summer I said I was hoping that I would be more sick. At the time (about 5 weeks) I still only had nausea as opposed to vomiting too, and my pregnancy that ended in miscarriage never had developed sickness to the extent that my pregnancies with the boys did – so for me the sickness would be a reassurance.
Well by 6 weeks the vomiting had started, and for a couple of weeks I was able to cope with this. I was definitely reassured that I was vomiting several times a day, and although obviously not nice, somehow I could see past this and concentrate on why this was happening and what we would get out of it. I basically spent my days on the sofa, doing as little as possible. Friends from church and my mum very kindly stocked our freezer with meals cooked for the boys, so I didn’t have to cook and smell the food, and Tom took over doing all the housework that I would normally do. Every day I went to bed as soon as Tom got in from work, earlier at weekends, and napped whenever I could.
But by week 9, I was starting to feel completely exhausted from all the sickness – I was getting more and more dehydrated and malnourished. It also didn’t help that the boys were sick from a tummy bug that week, and I probably caught that too, though it was hard to tell when I was already so sick anyway. My mental strength was starting to crumble, and I found myself no longer able to focus on the good. I was also battling with the memory of only getting to 10 weeks in the previous pregnancy, and the anxiety surrounding this did not help. Finally in week 10, I decided enough was enough and I would go to my GP to get a referral to the hyperemesis day unit (HDU) at the Birmingham Women’s Hospital. My midwife had said a couple of times that if my sickness got really severe to the point of dehydration then I could be referred to the HDU and they could give my IV fluids.
Unfortunately the GP that I saw that day was not informed about severe pregnancy sickness. I explained how I was being sick up to 10 times a day, more if you include retching and spitting up stomach acid, how I was only weeing a couple of times a day and even then it was a dark-coloured trickle, how I had a headache, and how little I was eating and drinking. Her first suggestions were to try ginger, acupressure wrist bands, and eating more. Whilst these may have an effect for mild nausea, they really don’t help when the sickness has got this severe. I told her the only thing ginger did for me was burn my oesophagus on the way back up, and yes I had tried the bands earlier but found they made no difference, and believe me I would love to be able to eat more, but I can’t help that it just comes back up again, that is if I actually manage to chew it without retching. She did do a urine test, and in the tiny sample that I could produce, my ketone level was at 2+, which is a sign of dehydration, but she told me that the hospital would only admit me with a level of 3+ or more. I tried to explain that the hospital has a day unit and they wouldn’t necessarily admit me, but she laughed as I don’t think she liked that I was telling her information that she clearly didn’t know of. She then prescribed some medication, cyclizine, which I knew of as the first line of anti-emetic drugs that can be taken in pregnancy. I tried to tell her that this had done nothing for me previously when I had labyrinthitis (inner ear infection that gives you vertigo and nausea), and that I was concerned about taking medications in pregnancy. She simply brushed off my concerns like I was stupid and made no attempt to have a conversation with me about these. Plus she told me that they would just put really strong anti-emetics in a drip with fluids in hospital anyway, so I might as well try the oral ones first. This is downright false. I ended up in tears because I felt so awful but was getting nowhere in this appointment – she didn’t exactly have the bedside manner to deal with the crying either. So I left and went back home.
After the weekend I managed to get hold of my midwife, who said that she wasn’t aware that the ketones had to be at a specific level to be referred to the HDU. She was sorry that she couldn’t do a referral herself, but did suggest that I might get further by going to the walk-in centre that afternoon rather than my own surgery. So I tried this, and did end up getting referred to the hospital. Not that the GP there was any more clued up on severe pregnancy sickness, but he noticed that my heart rate was quite high, so phoned the hospital where he was told by an obstetrics registrar that ketone level wasn’t a good indication of dehydration, and that my heart rate clearly was. After a bit of a wait at the HDU, the doctor there decided that I was indeed dehydrated and prescribed a couple of bags of IV fluids. I had these in the evening and felt soooo much better, it was amazing! The thing I noticed most after a bag of fluids was that I actually had an urge to go for a wee – I hadn’t had that for a while, it had just been trickling out if I happened to try when I was in the bathroom being sick. After a nice long chat with an obs and gynae doctor, who clearly had a clue about severe pregnancy sickness and who actually listened to my concerns and entered into conversation about them, I agreed that I would try some cyclizine. They didn’t want to admit me, so I went back home and had a good night’s sleep when the drip was finished.
For a few days following this my sickness was much better, but then it started to get worse, and once again I became concerned about dehydration. I wanted to get this checked out before we were due to go away for Christmas at the weekend. My 12 week scan was booked in for the Friday at 9.30am, so on that morning I rang the hospital (who didn’t need a referral after I’d been in once) and they said to come in after the scan. Well as I said in my last blog post, the scan showed that I am expecting twins! Whilst this doesn’t make the sickness easier to bear, it does make it easier to understand – multiple pregnancies are associated with a higher level of hCG, an important pregnancy hormone, which is also thought to be linked to the cause of pregnancy sickness (though this is still not known for sure).
I was assessed at the HDU, and initially they said my dehydration wasn’t severe enough for IV fluids, but the doctor was slightly concerned about my high blood pressure and heart rate. I wasn’t too surprised by this myself, because I had been really anxious before the scan (due to my previous experience of not finding a heartbeat), then felt like I had been hit with a whole load of other emotions at the news of twins, and I always feel like adrenaline pumps through me when I’m out of the house at medical appointments, as I’m trying not to be sick and I build myself up to speaking to other people, plus I’d had to wait in the waiting room for quite some time before seeing the doctor as it was a busy day. She decided to do a full set of blood tests, to check for anything underlying that wasn’t obvious. That meant another 2 hour wait in the waiting room with sick bowls. In the end she decided that she wanted a cardiologist to give me a check up, because she didn’t think it was anything pregnancy related that was causing this, and that was the limit of her expertise as an obs and gynae doctor – my blood test had come back completely normal, except they were still waiting on the thyroid function one, which would come back in a few days. So I got admitted to the ward, to await a cardiologist.
He arrived more quickly than had been expected, and sat down to ask me questions and do an examination. His conclusion was that there wasn’t anything major wrong, as I didn’t have any symptoms other than the fast heart rate and raised blood pressure. He thought that it was simply the result of dehydration, sickness, the stress of waiting around in hospital all day, and the shock of twins – enough to send anyone’s heart a bit funny! He suggested that the ward did another urine test for dehydration, and it turned out that this one showed I would benefit from some IV fluids, so they put me on a slow overnight drip, whilst I tried to get some sleep on a ward with ladies who had recently had operations and were clearly struggling with pain and calling the nurses all the time! Thankfully my blood pressure and heart rate had come down to within normal parameters by the morning, and I felt much better for the fluids. The cardiologist had also said that he thought it would be a good idea to have a look at my heart more closely with an ultrasound scan, just as a precaution, though he didn’t expect it to show anything. So I had to wait for that to be done before they were happy to discharge me. As expected, the scan showed my heart was in good working order, and by mid afternoon I was on my way home, feeling much more relaxed than the day before.
That takes us up to the start of this week, and since then I have been relaxing at Tom’s parents’ house. We are staying for the week until Boxing Day, and the boys are thoroughly enjoying spending time with their grandparents, while Tom gets a good rest too, which I feel he definitely deserves after holding the fort at home for so long. I am able to rest all the time here, even more so than at home, and the difference it makes to my sickness is really noticeable. I am hoping that this week here, and then another week of Tom being off work and spending time with my side of the family up to the New Year will help me get back on track and stay out of hospital in January. I find the vomiting is a vicious circle – the more sick I am, the more sick I get, until I break the cycle with the IV fluids that give me a boost because I no longer feel the negative effects of dehydration for a while. By resting enough to not be sick so many times, it helps me stay out of this downward spiral. I also heard back about the thyroid function result from my blood test this week, and it is slightly over active, which is common in pregnancies with higher hCG such as multiples, and it can cause a fast heart rate. So we will discuss whether anything needs to be done at my twins clinic appointment next week, but as it’s not that bad it may be fine to leave it alone.
So here I am just at the beginning of the second trimester, incredibly thankful that I and the babies survived the first 13 weeks despite the horrendous daily life that I’ve lived in that time. Hyperemesis (= over sickness) gravidarum (= of pregnancy) or HG is NOT normal “morning sickness”, it is a potentially life-threatening condition that used to be the biggest killer of pregnant women in this country until IV fluids were introduced some decades ago. I feel nauseous in every waking moment, day and night, and my vomiting is worse in the afternoon and evening – something that people often tell me they find strange when they’ve only experienced (first or second hand) “morning sickness”. There isn’t actually a standard accepted definition of when pregnancy sickness becomes severe enough to be called HG, but it usually includes a loss of more than 5% of pre-pregnancy weight, inability to keep down food and drink, and the need for hospital treatment. I suffered with pretty severe nausea and vomiting in pregnancy (NVP) with the boys, but this time it has definitely been worse, further along the mild to severe continuum, and the term HG is appropriate. Not that it matters if it has a fancy name or not – any amount of nausea and vomiting that debilitates a woman in daily life should be taken seriously.
Unfortunately though, understanding of HG amongst health professionals isn’t as good as it should be. I was lucky that my midwife was on the ball and that Birmingham Women’s Hospital is one of the leading centres for HG treatment in the UK, with consultants who have a specialist interest in it. The same can’t be said about the GPs whom I saw. Many women experience much less satisfactory care than I have, and I see this on a daily basis when I connect with other sufferers on the Pregnancy Sickness Support (PSS) forum. This forum has been invaluable in keeping my spirits up when house bound for so long – I feel like I have made some new friends, all of whom know exactly what it’s like to go through this. I’ve also had great online support from a couple of friends outside of the forum who have suffered the same and who have been checking up on how I am. One day, when I’m feeling better, I hope to be able to give something back to PSS as a charity and help others who will go through this in future.
For now I am concentrating on getting and staying well, and preparing for two little ones to arrive with us in May/June!