Preparation for Pregnancy. part 2: The Care Plan
Well sorry for the short absence folks, I've been gallivanting around Yellowstone National Park in America still riding the no-more-HG high two years on from my final bout!
Now down to business. As promised, I'm going to discuss preparation and planning for hyperemesis gravidarum in the next few blog posts (bar something topical arising). Once you've made that hard decision, as discussed in a previous post, the next crucial thing is planning how the hell you're going to survive the dreaded nine months you need to endure to get your precious bundle of joy, aka the End Goal.
As I sat on the floor of the wood cabin we are staying in on a Montana farm this evening, gently stroking the forehead of my third and final End Goal in an attempt to get the, ahem, little monster, to sleep next to her equally monstrous (and still awake) End Goal Siblings, I thought about this post and the order in which I should discuss the different aspects of preparation. The way I see it there are three main aspects to preparation and planning for hyperemesis gravidarum. The first, which I will discuss in this, already long winded post, is about your medical care and pre-emptive treatment. The second is practical considerations and the third is emotional support – I'll address these later two over the next week or so.
This blog originated after my husband and I had made the difficult decision to have a third baby despite hyperemesis gravidarum. The condition from my husband was that I do more research than I did for number two and that we are better prepared than before. So I did and you can read that story way back in the archives from 2011. That pregnancy was better than the previous two by about a thousand miles, entirely down to careful preparation and planning, which is why I now harp on about it so much!
So here is the key... if your GP is rubbish and won't make a pre-emptive plan (like mine was), then switch doctors, switch practices if needs be, but find a doctor who is willing to make at least a basic plan in advance. The doctor I found in a practice in the next town along was brilliant (Dr Tullberg of Carnewater Practice in Bodmin). Empathetic and kind, she was all for being pro-active and having a plan in place. She knew I had read plenty of research and could tell I knew all about the various treatments. She believed me when discussing what had and hadn't worked before and listened to me regarding what was personally tolerable.
Together we made a plan for which drugs to try and when, which we were both happy with, ie. I was happy with the medications and side effect and she was happy to prescribe them based on current evidence. Also planning when to move onto the next 'level' of treatment and at what point admission to hospital would be deemed necessary. She weighed me and took bloods so she would have 'base lines' to compare to and aid decision making. And she made note of which adults she could discuss my condition with (ie. My husband, the nanny we employed and so on). After all this she told me she would discuss the plan with the other doctors at the practice as she only works three days a week and would ensure they all knew there was an agreed plan to follow. The plan was fully documented on my electronic medical notes.
When I finally got pregnant we re-noted my weight etc. as it had altered (by that I really mean increased) since the plan had been made and she reminded the other doctors about the plan. I was also able to communicate with her via email, which when sick is really quite convenient.
The pregnancy was drastically better than the first two, I was still pretty sick, housebound and miserable. But I got downstairs almost every single day, I ate and drank almost every day. I had one very brief spell in hospital when a down hill spiral happened quickly at 17 weeks and I hadn't managed to get on top of it but that was it. During that pregnancy we moved house and I worked on and launched the current Pregnancy Sickness Support website and support network... whilst pregnant from my sick bed. In my first two I couldn't even consider looking at a computer screen let alone populate an entire website and I couldn't get out of the house let alone move house!
“So what was this wonderful plan?” I hear you plead...
Well after the End Goal arrived safe and sound, the wonderful Dr Tullberg and I set to work formalising the plan we had made into a more accessible plan for others to use. Doctors don't like a lot of paperwork so it's as short as possible but accompanying it is a worksheet for you to do before you approach a doctor so you have your own head clear about how you want to tackle the hyperemesis and there is a sheet with all the references and additional info needed to back up the care plan. Remember to approach your doctor with empathy for how tough their job can be, the responsibility of prescribing in pregnancy and so on. Your aim should be to build up a 'team approach' rather than going along to 'demand' what medication and treatment you want. But if the doctor is very dismissive then forget them and try another. Switching practices is easy so don't be put off.
The Care Plan and accompanying documents are available to download and print from the Pregnancy Sickness Support website by clicking here. It will also be available in the book I have co-authored with PSS colleague Amanda Shortmanalong with lots more information and tips about planning for hyperemesis gravidarum, which will be available to purchase this Autumn. It's called Hyperemesis Gravidarum – The Definitive Guide so keep your eye out for it and watch out for my next post about the practical considerations for hyperemesis gravidarum.