When morning sickness is all day sickness

Macy* lay in prone position, with her head hanging over the edge of the bed, right above a plastic bucket. She could not remember when she last got out of bed, used the toilet, took a shower or even brushed her teeth. She lay waiting for death. She summoned the last ember of strength she had left and called her mother. She did not want to die alone.

Macy’s mother was mortified to hear her daughter sounding so weak. She grabbed her purse and ran out of the office. Half an hour later, she had her daughter bundled up in a blanket, speeding off to the hospital, leaving a riot of angry motorists in her wake.

At the emergency department, Macy was wheeled to the acute room. The nurse rang a bell summoning the resuscitation team and within seconds, Macy was surrounded by a team of nurses, doctors and phlebotomists. Her mother kept pacing up and down the corridor mumbling a prayer for her only child.

Within two hours, Macy was stable and able to talk. She kept apologising for her stinking breath but no one appeared particularly concerned. Her mother was allowed into the room to sit with her. The nurse put a green oval bowl next to Macy and gave the two some privacy.

Angry concern

Macy summoned a sheepish grin and apologised to her mother for ruining the great surprise. She went on to wipe the bewilderment off her mother’s face by announcing that her mother was clearly expecting one fierce grandchild.

She took great pleasure in watching the array of emotions playing on her mother’s face; from bewilderment to amazement, then excitement and back to angry concern. She scolded Macy for taking so long to call for help and being home alone in such a delicate state. Macy responded by throwing up bile into her green bowl, followed by a prolonged minute of intractable retching.

Macy was nine weeks pregnant. She had been dating Andy* for a decade.  They started dating in campus. Their families were close and it was no surprise to anyone that they had ended up dating. Andy’s father was quite firm and insisted that they both graduate before settling down to start a family. Macy’s mother, having lost her husband when her daughter was six, really wanted grandchildren.

The couple moved in together the day Macy completed her master’s degree and a few weeks later they conceived. A week to her graduation ceremony, Macy found herself in the hospital trying very hard not to throw up her baby.

Andy had travelled for work and was due back in two days. Macy had taken Friday off from work to see her obstetrician for antenatal care.

Symptoms

She mentioned the excessive nausea and vomiting she was experiencing and the doctor reassured her and prescribed some pills. She got back home in the afternoon and despite taking the medication, she would not stop vomiting. She woke up several times that night to vomit and by morning, she had brought a bucket to the bedside. All through the weekend, the vomiting did not stop. She thought of going to the hospital but was unable to move.

Macy gave up on food and stuck to sipping water and diluted orange juice which would last all of five minutes in the stomach before coming right out. In addition, she would not stop forming excessive saliva which she was unable to swallow as it tasted cold and salty. By the time her mom was getting to her, she was dry as a bone, with ashen skin and cracked lips.

She was admitted to the wards and the lab results started trickling in. Her kidneys were not happy, neither was her liver. The dehydration and forced starvation had taken their toll. The ultrasound confirmed that baby was doing well despite the hostile conditions it was growing in.

Macy remained on intravenous fluids to hydrate her, medication to control the vomiting, vitamin supplementation to prevent complications and injections to prevent development of blood clots in her veins since she was mostly confined to bed.

Despite nausea and vomiting being a common pregnancy symptom, hyperemesis gravidarum represents the most severe form. This occurs in two per cent of pregnant women, commonly setting in from week eight to nine of pregnancy and resolving from around week 13 to 14. In a small number, it may last the whole pregnancy.

Nausea and vomiting

The nausea and vomiting is thought to occur as a result of the pregnancy hormone, human chorionic gonadotropin, made in the placenta and theorised to be a protective mechanism for the baby against toxins that may cause harm in the delicate phase when the baby’s organs are formed.

It is more common in first pregnancies, in younger women (below 30), those carrying multiple babies, those with abnormal pregnancies (molar pregnancies), the obese moms and those with a family history of hyperemesis gravidarum, especially if the woman herself caused the condition in her own mother.

The nausea and vomiting is accompanied by weight loss and ketosis (increased breakdown of body fat as an energy source since there is no oral nutrition). The extreme dehydration can cause kidney injury, dangerously low blood pressure and heart complications. The ketosis leads to liver complications while lack of vitamins can cause brain complications and even loss of sight.

Macy was in the hospital for a week before she could hold down food. She had developed a whole new level of respect for her mother.

Treatment

Although treatments that are commonly used for morning sickness, such as eating dry crackers in the morning or consuming a bland diet, may be recommended for women with extreme morning sickness, they may not be effective on their own because of the severity of the condition.

Medical treatment may include:

● A short period of not eating by mouth to rest the gastrointestinal system

●Intravenous (IV) fluids

●Vitamin and nutritional supplements

If necessary, the woman might also receive medicine to stop the vomiting, either by mouth or through an IV. The doctor might recommend eating foods with ginger or taking vitamin B6 supplements to help alleviate nausea. The following can also help:

●Consuming a bland diet

●Eating frequent small meals

●Drinking plenty of fluids when not feeling nauseated

●Avoiding spicy and fatty foods

●Eating high-protein snacks

●Avoiding sensory stimuli that can act as triggers

Additionally, if a woman is feeling anxious or depressed as a result of her condition, talking to a therapist or counsellor might help her cope with her feelings.