A year ago I was newly pregnant and suddenly very, very sick. Within weeks of getting a positive pregnancy test, I was horribly nauseous all day, every day. At first, I did not recognize that extreme, unrelenting sickness was not normal morning sickness and that I would soon be diagnosed with hyperemesis gravidarum (HG).
You know, that thing Princess Kate had.
It completely upended my life, and for me it lasted all pregnancy.
I weighed less when I went into labor than when I got pregnant.
I’m six months postpartum (with a healthy baby!) and I am still recovering from my complicated pregnancy and months of starvation.
But I am one of the lucky ones. My hyperemesis was proactively and compassionately managed by great doctors. I had financial security and health insurance. We had a support network at the ready.
And I did not have hyperemesis in the middle of a pandemic overwhelming our medical system.
Obviously, the novel coronavirus, COVID-19, is creating many serious challenges for large swaths of the world.
And the medical system is trying to provide guidance and care to those currently pregnant. But articles available on pregnancy and coronavirus seem to target a more standard, low-risk pregnancy.
COVID-19, and the scarcity of food and medical attention it’s creating, poses special challenges for a small, but very ill group of women — people like me who suffer from hyperemesis or extreme morning sickness.
These women are navigating a triple threat of unknowns — being pregnant, ill, and socially distanced — all while trying to not vomit long enough to stay out of the hospital. Females are strong as hell.
So many of the keys to my hyperemesis survival are now no longer easily accessible to today’s pregnant women.
Very frequent doctor visits accompanied by my partner because I was too sick to go alone would be harder to come by today as we limit appointments only to the most essential, and as pregnant women are being asked to come to routine visits alone.
Almost a year ago to the day, I was admitted to the hospital for fluids and nutrients. I am considered lucky by hyperemesis standards because I only had one hyperemesis-related hospital stint.
What if I had to weigh the risks of dehydration and starvation with the risks of exposure to a novel virus?
And we have to talk about food.
Pregnancy food aversions are real and seemingly without reason, even in run-of-the-mill pregnancies. For those of us with extreme morning sickness or hyperemesis, finding a ‘safe food’ to eat is a relentless and quick-changing daily struggle.
It was hard enough to find something for me to eat when grocery stores were stocks and restaurants were open. My partner had to spend a long time wandering grocery store aisles trying to divine something for me to eat, an activity that would be frowned upon now, of course.
I did a quick grocery trip this week and was acutely aware of how nearly all of my personal safe foods were sold out as the masses descended on grocery stores to prepare (and hoard).
Even the fact that I am still taking stock of foods associated with my hyperemesis experience speaks to how fundamentally HG changes one’s relationship with food and grocery shopping.
My heart breaks for the women currently battling hyperemesis and hope there is something available for them to eat in the coming weeks.
I have been reflecting a lot on extreme morning sickness in the time of the novel coronavirus. I’m frequently sought out by friends looking for advice or insights as someone they love starts to experience morning sickness.
Hyperemesis and extreme morning sickness are unpredictable, and it is only now that I am postpartum and in recovery that I’m starting to process the lessons I learned from my long, literally nauseating experience.
Obviously I’m nobody’s doctor, but here is what I would tell myself or a newly pregnant friend if they were dealing with hyperemesis or extreme morning sickness today. Most of these ring true for normal life too, just with a little less emphasis on avoiding the hospital.
Of course if you cannot hydrate or stop puking, seek out medical advice from your doctor.
1. Be proactive and ask for help early
If pregnancy-related nausea is drastically limiting your ability to live normally, ask for help early. Starting anti-nausea drugs early helped me get diagnosed faster and kept me out of the hospital longer.
My 24/7 nausea set in before my first doctor’s appointment so I tried all the usual recommendations (ginger, crackers, etc.) and over-the-counter medicines (Unisom and B6) before I saw the doctor. Because I was able to give an exhaustive list of what hadn’t worked, we were able to jump ahead to prescription options.
My doctor believed being as proactive as possible was the best way to keep me out of the hospital. She readily gave me a hyperemesis diagnosis so I wouldn’t have problems with being taken seriously or accessing prescription medicines.
I truly believe this early intervention and a ready supply of Zofran (an antiemetic medication) reduced the number of hospital trips I had to make.
I still felt like I was dying and was most certainly starving, but I did not suffer through the endless puking cycles many hyperemetic women face.
2. Prepare to advocate for yourself
Not everyone’s doctor experience is going to go as wonderfully as mine did. Unfortunately, as many women know from past experience navigating our health system, sometimes women’s health issues are downplayed or not taken seriously.
You need to be prepared to advocate for yourself. Further, the newly pregnant may not even be seeing their doctor as regularly because of COVID-19 restrictions.
Start taking records of your illness now in case you need it later.
I did not weigh myself during early pregnancy and had no idea how quickly I was losing weight. I had lost 6% of my body weight without even realizing (I would ultimately lose over 10%).
The first time I was weighed during pregnancy was the appointment I got sent to the hospital, and my unrecognized weight loss was a contributing factor. Knowing your weight loss could also help get an HG diagnosis.
I also wish I had kept better records of what I ate and how much fluid I consumed in a day.
The rule of thumb from my doctor was to go to the hospital if you hadn’t kept anything down in 12 hours. It also helped to know my consumption data when having discussions with my doctors.
I was a bit of an anomaly in that I could eat and drink some without puking (thank you, Zofran), so I would have never hit the 12 hour criteria for I.V. fluids. But what I ate was still insufficient for my metabolism and I was wildly malnourished.
Guidelines are not one-size-fits-all.
I ultimately started self-monitoring my starvation with at-home ketone urine testing. You can pick these up at a drugstore for about $10. The tests I got had instructions on the packaging for how to read the strips, and I would do a test each morning.
3. There are more rehydration options than Gatorade or an E.R. trip.
Most people reach for a Gatorade and other sports drinks when they are dehydrated. For me, Gatorade was too sweet at the height of my hyperemesis.
Luckily, there are more options than sports drinks for oral rehydration. Other options include: Pedialyte, Nuun tablets, Normalyte, or broth.
I drank broth every day of my pregnancy (much to my chagrin by the end). I also really appreciated PediaLyte and NormaLyte’s flavorless, sugarless options.
There are also many recipes to make your own solutions, which you can adapt to fit your aversions.
The E.R. or hospital Labor & Delivery units are also not the only options for I.V. fluids.
The I.V. fluids I got at the hospital made me feel so much better, temporarily. If I were to do hyperemesis again, I would request I.V. fluid options like in-home infusions with a home health nurse, or regular I.V.s at an infusion center.
I didn’t ask for these when I was sick and I should have. These may be good alternatives to a hospital trip given today’s COVID-19 situation.
4. A few practical tips on puking
You probably are going to puke sometimes, even with the best medicine. There are a few things to keep in mind for after a puke session.
First, take it slow and easy on liquids and foods after vomiting. After I puked, I’d take small sips of liquid very slowly. I’d wait at least an hour before drinking anything substantial or trying to eat. Drinking too much, too fast could trigger another vomiting cycle.
After you puke, instinct tells you to brush your teeth but this actually rubs stomach acid into your teeth. If you are repeatedly puking, this may damage your teeth over time.
Instead, gargle with water with a little baking soda in it to neutralize the acid. After about 30 minutes, you can brush your teeth again.
I struggled with brushing my teeth without gagging or puking throughout pregnancy. Often, I could tell what kind of nausea-day I was going to have by how hard it was to brush my teeth in the morning. I found what worked for me was to brush quickly but more often throughout the day.
5. Connect online
I feel like a pro at social distancing because it doesn’t feel very different from the isolation I experience with HG. Hyperemesis is an isolating experience even in the best of times.
I did not feel well enough to see friends, could not go out to restaurants because of aversions and smells, and just generally was too weak to leave the couch.
I also craved the understanding of others living through hyperemesis and pregnancy.
I leaned heavily into online communities and believe these would also serve us well during social distancing.
On days when screens didn’t make me nauseous (which happens to some HG women), I spent a lot of time on subreddits for my due date month and my pregnancy complications.
There is a big and active hyperemesis Facebook group. The Hyperemesis Research Foundation, HER, has a great instagram (@hgmoms) that reposts stories from other girls dealing with HG.
I devoured so many women’s stories. I needed to not feel alone in this experience and am thankful to all the anonymous online women for sharing their lives with me in that way.
Paying forward this connection is a huge motivator for me writing this now.
6. Don’t doubt yourself
I spent my whole pregnancy wondering if I was sick enough.
I worried that I was not trying hard enough to eat and live.
I thought I was being dramatic.
I read about other people whose hyperemesis was so much worse so I felt I shouldn’t be considered ‘sick’ too.
But I was sick. I was very sick.
Just because someone else’s experience sounds worse, it doesn’t make you any less sick or deserving of care.
Don’t let self doubt keep you from asking for care that can improve your life and your health. Especially now, when ignoring your symptoms makes you more likely to end up in the hospital for fluids.
There is enough Zofran for all of us.
As a final note, there will be others who do not understand extreme morning sickness.
A lot of people had regular morning sickness or know someone who did. They may think they understand because of that.
They may downplay your experience.
They will suggest ginger.
Most people mean well, but don’t let others’ lack of validation keep you from believing your own bodily experience.
We are the one’s putting a face and a story to a women’s health issue that needs more awareness, research and funding.
Share your pregnancy experience, puke and all.