As those of you who have been through
it know it is very hard to advocate for oneself when you are barely
able to speak for throwing up. Hyperemesis Gravidarum can come on
very suddenly and in a matter of days take a woman from the happiest
moment of her life, when she got a positive pregnancy test, to the
absolute worse moment of her life to date when she hasn't stopped
being sick for days and is genuinely fearful for her life.
It can be overwhelmingly scary and with
such mixed emotions. Women can feel utterly lost and confused by what
is happening - surely this isn't “normal morning sickness”.
It's bad enough after a few days but after weeks and weeks of
unrelenting nausea and vomiting few women have the strength to talk,
let alone fight.
And that is where our partners can come
in. In this post I hope to give partners (and by partners I'm
referring to anyone in the main carer role, mothers, sisters, friends
etc.), some tips about how to advocate for the sufferer.
Doctors can be kind of scary can't
they? If you are not from a medical background then the chances are
you look up to doctors and all their knowledge and have them on a bit
of a pedestal. And rightly so - to a degree. They have been through
years of education and training. They must be cleverer than the
average person to have qualified and they know a damn sight more than
you about anatomy, physiology, pharmacology, how the NHS works and so
on. But they are not experts on EVERYTHING. They can't be, they are
human. And remembering that will help empower you to have a rational
discussion with them.
So, some practical tips for advocating
for your loved one:
Go in with a good attitude. Don't
assume that the doctor will be dismissive and don't assume that you
will have to “fight” for treatment. If you are reasonable then
they will have a hard time explaining why they are being
unreasonable.
Prepare yourself in advance. Take
notes in with you, in particular about her symptoms, your concerns
and any questions.
For example:
| Symptoms: |
How many times a day is she
vomiting?
How much fluid and food has she
kept down in 24/hrs?
How often is she weeing?
Has she lost much weight?
If she can't get down the stairs
for dizziness and vomiting then note that down.
Is movement, sound and smell triggering vomiting? |
| Your concerns: |
What are your main worries? That she is severely dehydrated?
That she has lost so much weight? That she is bedbound and
getting sores or at risk of DVT? That if you leave her alone to
go to work that she may fall down the stairs because she is so
dizzy and weak? That you are both going to lose your jobs over
this? |
| Questions: |
Is it safer to take medication or not? If she is not being
admitted now then at what point should you be concerned that she
needs to go to hospital? What signs and symptoms should you look
out for that things are more serious? What is the best route for
speaking to the GP, can you email or phone to speak to them?
Could you help by monitoring her ketones at home? Could the nurse
teach you to give her intramuscular injections of her meds for
times that she can't manage oral ones? Is there any other support
you can get with this? (well, you know the answer to that -
PSS). |
When you first go in, explain that
your partner is finding it difficult to speak due to the symptoms
and you would like to explain what's been going on. If he/she seems
put out then go on to explain that just getting to the surgery has
been a real struggle and she really would prefer you did the
talking. He can always confirm that with her.
Using your notes as above explain
that while you were both prepared for a bit of “morning sickness”
and know it's a normal part of pregnancy you really don't think this
severity is normal and you think she has Hyperemesis Gravidarum.
Explain that whilst you had hoped to have a nice natural pregnancy,
without medication and so on you really feel that she needs some
treatment as the symptoms are so severe. You understand they aren't
licensed for pregnancy but feel that when looked at from a
risk/benefit perspective you both think the time has come to accept
that she needs treatment.
Now assuming your doctor has
reacted really well and is being kind and pro-active, ask for a plan
going forward. He doesn't need to agree to more medication or
anything yet but he needs to let you know what symptom severity to
look out for and when to come back if things don't improve. If he is
sending you home rather than hospital then ask what he would like
you to monitor, ie. Fluid intake/output, weight loss, ketones in her urine - he can prescribe
ketosticks for this or you can buy them yourself online
Ketostix Reagent Strips Ketone - 50 strips
Hopefully by following these steps you
will develop a good working relationship with your GP and feel that
you have managed to help your loved one by getting her treatment and
support. But what if it doesn't go to plan as above. What if despite
your careful description of her symptoms and your concerns you are met with “It's normal” or “No medication is safe
in pregnancy”.
Well if the doctor is trying to claim
it is normal then ask at what point they would consider severe nausea
and vomiting to not be normal and what level of dehydration they
consider acceptable for a pregnant woman.
If they give you grief about taking
medication in pregnancy and claim it isn't safe and you might be
damaging the baby. Ask for the evidence base for such claims and
point out that there is far more evidence that not treating HG
effectively has greater risks for the baby and mother than treating
with medications for which there is no evidence of adverse foetal
outcomes (you might want to write that down).
Remember that GP's generally don't know
what the next patient to walk through the door is suffering with
until they sit down and tell them. HG is not particularly common with
many GP's seeing one or two cases a year and they can't keep up to
date with all of the research about every condition. So try to be
sympathetic to that, perhaps sign post them to the charity pages
about treatments and perhaps offer to give them some time to look
into the options, you could phone back in the afternoon or pick a
prescription up later.
Recognise too that getting the
treatment right can be a case of trial and error so always ask for
advice on how long to give the medication to work and what to do if
there is no improvement, or she gets side effects or deteriorates.
GP's can feel frustrated if a patient is expecting a cure from them
when there is no cure to give. Accepting that there is no cure, yet,
and that you need to look to “manage” the condition will help no
end.
The aim of the game is to build up a
team feeling with the GP make it clear you want to work with them to
help your partner and don't expect a quick solution from them.
Ultimately though, if you don't feel
you've been treated well or got the help you need then ask to see
someone else. Go out to reception and ask for another appointment
with someone else. If you have the strength and feel you have grounds
you could ask to speak to the practice manager or make a complaint.
But keep it in perspective. Getting help for you partner needs to
come first.
Don't forget, PSS have a helpline
number you can call, leave a message and one of the Charity doctors
will call you back: 024 7638 2020
I was empowered and
enabled enough to go through my second pregnancy to have Patrick.
