Welcome Green Top Guidelines
In a sea of puke, pain and suffering comes a beacon of hope for women with Hyperemesis Gravidarum. The launch of the first ever Green Top Guidelines by the Royal College of Obstetricians and Gynaecologists is here today. These guidelines will provide a comprehensive and evidence based treatment plan for women who present with pregnancy sickness which is worse than the regular old morning version.
And I am thrilled with them! Okay so they have a couple of minor issues (such as suggesting ginger for milder "nausea and vomiting of pregnancy" symptoms) but they have done the absolute best they can with the available research currently out there.
You see there is something a little but special about these guidelines... The patient's voice is not only at the very heart of them but is running through the arteries, veins and capillaries. Three Trustees for the UK Charity Pregnancy Sickness Support (PSS) were on the Authorship of the guidelines and have worked tirelessly with an amazingly knowledgeable and compassionate team to make sure these guidelines will do what they intend to do... HELP WOMEN! On top of that dozens of PSS volunteers commented and gave feedback on early versions and those comments were listened to and incorporated! This is in stark contrast to the vast array of naff "research" and even the weighty systematic reviews which have been published over the last few years in which no one ever thought to ask women "What's it actually like to have HG and what outcomes matter to you?"
The lead author, Miss Manjeet Shemar of Birmingham Women's Hospital is a Trustee for the charity and a sufferer herself. Since her own experience, which despite being on of the country's leading ob/gyne's was utterly miserable, she has worked tirelessly to improve services and treatments for other women. She established the UK's first HG Day Unit where women can receive treatment in the day and return home to her family at night. She has helped a number of hospitals to establish similar services and she personally oversees the care of hundreds of women affected by HG each year. So, you see, she is ideally placed to ensure that these guidelines as as good as the possibly can be for the women, and indeed the clinicians who need them.
So why are they needed and what difference will they make I hear you ask?
Until now a common reason women are refused treatment is the simple fact there were no guidelines. None of the medications we have in the UK are licensed to use in pregnancy; that's not to say they aren't safe, just that the manufacturers don't want to take any responsibility! And so the onus of responsibility has always fallen on the shoulders of the prescribers... the doctor whose name is on the prescription. The Thalidomide tragedy may have been nearly 60 years ago now but the shadow it cast was long and many doctors (and women themselves) live in the fear that shadow creates. These guidelines are not suggesting any new revolutionary treatment, they are mearly lifting the weight of the responsibility off the doctors shoulders. They treatments the guidelines suggest have all been around for decades. Even ondansetron, which many doctors think of as "new" has had two full decades of use and the teenage children of its first prescribers, I'm sure, are exceedingly grateful!
These Guidelines will give doctors the freedom to prescribe without the feeling that they have to undertake their own thorough literature review for every case they come across! In fact, it does more than that... it liberates them to try a number of different options in a step-wise approach to find the right treatment for the individual woman, which is exactly what Pregnancy Sickness Support and I have been advocating for years!
But what if my doctor hasn't heard of them?
Gone are the days of women printing off top notch information from websites such as Pregnancy Sickness Support, feeling empowered approaching their doctor only to be crushed with a "I'm not doing that... anything off the internet is nonsense". Women are totally entitled to request these Green top Guidelines are followed and used for their treatment. Admittedly, doctors don't have to follow them but they would have to have a very good, evidence based, reason not to! These are the Gold standard and that is that and now they're out they'll be updated as new research and evidence comes out.
Another amazing thing is that it's not just UK women this is going to have a wonderful impact on... the RCOG Green top Guidelines are respected and used around the world and women in pretty much any country can access them and request they are followed... they may be resisted in some countries but most will be as pleased to see them as I am!
So there we have it... the first glimmer of light at the end of the tunnel... a few more years and the end of the tunnel will be in full view. And by the time our daughters are having their children we'll be stepping out of the tunnel all together.