Preparing for Pregnancy
I am a bit of a hippy at heart and when I got pregnant for the first time I was so excited about having a healthy, natural, glowing pregnancy. I would not take medication or drink any alcohol, caffeine or unnatural colours/flavours etc. In preparation for the pregnancy I had cut right back on the alcohol and had been taking all my prenatal vitamins and so on.
Then Hyperemesis Gravidarum struck! By week 7 I admitted defeat and agreed to take some cyclizine; an anti-histamine which has been around for donkeys years. I was too ill to look up any research about the drug I just had to go with it. By week 8 I was admitted to hospital and receiving medication intravenously (IV) and had no idea what they were giving me. This caused huge distress as I was already confused from dehydration and drowsy from the cyclizine I really was in no fit state to provide informed consent and had no idea what was going on.
This scenario is exactly what I am trying to avoid this time. Obviously the first time we didn't know in advance that I would be ill but the situation in the second pregnancy was little better because although I knew about the medication and was happy to take it, having read all the available research out there, the GP's were throwing doubt into my mind and trying to manipulate me into not taking them, against the consultants advice, which one even admitted was down to prescribing budgets; “I have one of the lowest prescribing rates in the county”. It is very hard to advocate for yourself or to make informed decisions and choices when you are in the throws of an horrific sickness like hyperemesis, compounded by medication that causes drowsiness but doesn't improve symptoms. Self advocacy for hyperemesis gravidarum sufferers is near on impossible.
So... I have changed GP and my new one was more than happy to make an action plan and set criteria for monitoring the effectiveness of the medication and boundaries for when to move on. She has read up on the safety of the treatments and is happy to liaise with my carers about my treatment (another battle in the past as there is a prejudice against the use of private midwives in some areas) or with specialists as required. Here is our plan, based on current research and what has worked for me before:
- Take B6 prior to pregnancy
- Take promethazine or cyclizine at start of pregnancy/first whiff of nausea
- If they don't control sickness then start metocloprimide
- If that's not enough then add in ondansatron (with laxatives for managing side effects, but I'll take her lead on this as I'm not sure what will work best for me)
- If needed then take out metocloprimide and add in domperidone (I found this combination quite good last time)
- once over 12 weeks then consider steroids (this is the only aspect she is not happy with as she feels the research doesn't look enough at foetal outcomes and I would probably need to go through the consultant; Ms. Watkins at Trellisk has been recommended as having a special interest in HG via Dr Roy Taylor who I contacted through the HelpHer website... a very helpful man!) I'll tell you more about steroid therapy in a future blog.
- What I do NOT want to try is Stemetil (sent me wakko!)
Criteria for moving on to the next step is vomiting >4 times a day and other measurable aspects such as weight loss; >5% total body weight loss will require intervention and dehydration; <500ml of urine in 24hrs needs admission for fluids (or hospital at home if available in my area) and altering the medication regime. I'll monitor my urine output with a measuring jug I bought and will keep a fluid balance sheet in the bedroom; my husband and midwife will be mainly responsible for this if I'm drowsy/confused etc. I have bought some ketosticks to monitor the presence of ketones (which your body produces when fat reserves are broken down; a sign of malnutrition) in my urine but I don't agree with it as a test really because I don't kick out ketones until I'm virtually dead whereas other people will have ketones in their urine after a few hours of mild dehydration; which is why urine output is a more accurate test.
I've also given my new GP permission to liaise with my husband, midwife and children's nanny (as there will be times that she will be the only responsible adult in the house) so she can discuss my care on the phone with them. My new GP works Monday, Tuesdays and Thursdays so she has documented the plan and will discuss it with the other GPs in case I need help on her days off. They are prepared for the fact I'll need home visits too.
The relief Rob and I feel at having this plan in place is just indescribable and having been in a consultation with a GP who didn't make me feel selfish and pathetic for being ill was a huge boost in my confidence to be able to make it through this pregnancy... I feel like we are a team and we have direction.
In my next blog I will tell you about all the 'alternative' ways we are preparing for this pregnancy.