“Triiing” went the text message alert on my phone as I cleared up the breakfast stuff and ordered the kids to get in their uniforms. I glanced at the screen... “I'm pregnant” said the message from my good friend, Sarah. She's married with one child already, an 18 month old and she loves being a mum. “Oh no” I think “poor Sarah” as I read the rest of her text. She's devastated, scared and she is beside herself trying to figure out how she is going to survive the next nine months. I know how much she desperately wants another baby and I want to congratulate her, but I can't, it would be insensitive, instead I reassure her that she is not alone and I'm here for her every step of the way.

You see for women with a history of hyperemesis gravidarum, no matter how much you want another baby, the reality is that the moment the test shows positive you feel like your world is crashing around you... nine long months of severe illness lay ahead. That exciting time that most women experience when they find out they are pregnant is replaced with a torturous wait to see just how sick they are going to be.

Instead of planning a healthy diet and shopping trips for maternity clothes, women with hyperemesis are planning how they will manage childcare if they are admitted to hospital, how their finances will cope with nine months off work, how their toddler will cope emotionally if mummy vanishes from view. And that is assuming they can afford childcare. How will they cope with a toddler at all if they are throwing up continuously for hours on end? What if they physically can't stop throwing up long enough to fix some food for their toddler, or change his/her nappy, or keep them safe?

It's a scary time to say the least and for me it was probably the most stressful time of the whole pregnancy... waiting to get sick.

And then in a perverse twist there is the emotion and stress involved in not getting sick. Because in reality women with a history of hyperemesis have an 86% chance of suffering again so while we can “plan for the worst and hope for the best”, the experience of not getting sick can be utterly nerve racking! It's why we all hope for a bit of “morning sickness” when we get pregnant for the first time, it's reassuring and makes you part of the secret early pregnancy club. But for women who develop hyperemesis gravidarum it rapidly turns into a nightmare not just for this pregnancy but for every pregnancy thereafter. You want the reassurance of a progressing pregnancy but knowing what's in store for you is utterly terrifying.

Returning to the ensuing text conversation I understood only too well the confusing mix of emotions my friend was experiencing. Having been through this particular period three times, one of which the sickness never came and the new life was not to be, I get the strange juxtaposition of the wanting-not wanting sickness causing an internal battle. I understand the overwhelming rush of plans running through her head about preparing nine-months worth of meals, thinking about childcare options, working out finances. I feel the profound sadness experienced looking at your beloved toddler and knowing how much you will miss them over the next nine months. And the confusion of emotion over how much you love them and that it was “worth it in the end” but that you don't know it will be again, questioning will you love another as much as you love them.

I thought about what practical things I could say at this point and I replied with reassurance that she can get through this and is not alone; I'm here for her and I know lots of other women are too. Prepare practically and try not to dwell on projections of what the next nine months might entail. Enjoy the next few days before the sickness kicks in. Enjoy the time with your little one, but prepare mentally for the separation; know that they will be okay and remember that they will have you back in nine months time along with a new sibling.

I am, of course, posting her out the HG calendar I've produced as ticking off the days even at this point can really help make the time seem shorter. Unfortunately I live a blinking long way away from Sarah so while I can't provide practical help with freezer meals and so on I will be texting regularly and phoning while she's still able to speak on the phone.

If you have a friend with a history of hyperemesis gravidarum who is at the point of embarking on another pregnancy then try to appreciate this challenging time of mixed emotions. Rather than comments about “You might not get it this time”, “think positively” or “well you know it's worth it now” try simply asking how you can help, what support she needs and think about what support you are able to provide. Try to appreciate that while you're excited for her and want to congratulate her, she is feeling scare and wondering if she'll be in hospital next week hooked up to a life saving IV drip. Cull the enthusiasm about the end product and appreciate that the news is akin to your friend telling you that she has a serious illness and will be battling treatment for the next nine month.

That's not to say you can't congratulate her, I'm sure she will appreciate that you are pleased for her. Just follow it up with an appreciation of the severity of hyperemesis gravidarum and the need to survive the next nine months. Save the bulk of the congratulations for nine months time when the double whamy celebrations of baby's arrival and the end of HG really are party worthy.

As I'm sure you've picked up from my frequent mentioning of it, I've co-authored a book all about hyperemesis gravidarum. It's called Hyperemesis Gravidarum – The Definitive Guide and in it there is a whole big chapter all about planning for a hyperemesis pregnancy. About 10,000 words on the subject, which is far beyond the scope of a blog post. So, the first practical thing you can do is wait until our book is out (hopefully by September but sign up for updates about it's progress on The Book page) and then buy it!

However, if you can't wait that long or are already embarking on another round of the long nine months then here are a few tips and practical things you can do to prepare for what lays ahead. For medical preparation and pre-emptive treatment see my last post (part 1).

First of all, get fit and healthy. Some women prepare by deliberately putting on a bit of weight so that they have some to lose but I would only recommend that if you are currently under weight or on the lower side of healthy. Ideally for an HG pregnancy you should be starting out at the upper end of a healthy BMI, around 23-24.9. Use this calculator to work out what you currently are. If you are currently a little overweight then I wouldn't worry too much before embarking on HG, but obesity (BMI over 30) is known to reduce fertility so it's a good idea to get down to a healthy weight. The fitter you are going into a tough pregnancy the better and hopefully you'll find it easier to recover from it after.

Secondly, prepare your household. The ideas I have for this are almost endless and could almost fill a whole other book! Look at the main factors you will personally struggle with and try to prepare for them.

• If you tend to do the food shopping and preparation for your family then could you set up online shopping delivery and stock you freezer with masses of pre-prepared meals for your partner to warm up?

• Are you the only member of the household that knows how to use your old washer dryer that the instructions have worn off from? Could you write out the instructions?

• Does your partner know where the vacuum bags and spare light bulbs are? Do you sort out paying bills and if so could they be done by direct debit?

• Will the car need an MOT/tax/insurance sorting while you are ill and if so does you partner know where all the details needed for that are?

• Stock up with unscented washing powders/soaps and so on.

• What help at home can you afford, if any, ie. A cleaner or a laundry service.

Thirdly, if you already have children then you need to address childcare. I know a number of women who simply can't afford childcare at all and therefore have to cope at home. Which is fine if they can, up to a point... what if you get admitted to hospital? Will your partner have to take time off work to look after them and if so will that cause a problem with their employer? So what's you're plan B...

If you have relatives nearby or can afford a nanny then great but if not then how about local nurseries or childminders, do they have long waiting lists or would they be able to accommodate a last minute booking? Do any families nearby have teenage children who can help with some babysitting at the weekends or after school (a cheap option for sure)? The key is to think about what options are available locally for your needs and budget so that you're not trying to come up with solutions whilst on your way to hospital.

As I said a the start, this is just the tip of the preparation pile and I could literally write thousands more words on the subject but these are certainly the main areas to address if you're at the preparing point now.

Next time... preparing emotionally and psychologically for hyperemesis gravidarum!