This post if for family and friends of women suffering hyperemesis gravidarum who don’t really know what is happening to their friend but would like to know more so they can help and support them… because that’s what family and friends do right… help and support each other!

Now I know that the very last thing you would want to do to someone you love and respect is hurt them or say cruel things to them, things which might harm your relationship with the woman. But you see the problem with hyperemesis gravidarum is that it is surrounded by stigma and misunderstanding and saying the wrong thing, no matter how kindly meant, can really truly hurt your friend. I’ve covered what not to say here and here so familiarising yourself with those would be a great start.

But what can you actually do to help? Well, there are two aspects to helping… the first is simply trying to understand the condition and the second is offering practical support to the sufferer – the person you love and respect and want to help, remember.

First - A bit about HG...

Hyperemesis Gravidarum is a serious complication of pregnancy. It is NOT morning sickness, it’s similarity with morning sickness ends when then sufferer can’t eat or drink, can’t move for retching, gets dehydrated and starts losing weight. If you had morning sickness in your pregnancy and therefore think you know what she is going through then stop yourself right there... you don't. HG is a whole different ball game! Whilst pregnancy itself is not an illness and the vast majority of pregnancies are normal and healthy, there are in fact a number of very serious illnesses that can be caused by pregnancy, many of which were commonly fatal in the past and occasionally still are now. Hyperemesis gravidarum is one of those. 

In addition to the extreme nausea and vomiting there are a range of other symptoms which characterise HG. These include but are not limited to:

• Extreme fatigue and lethargy (this can be a symptom of hypocalcemia which happens when you are dehydrated and throwing up all the time)

• Extremely heightened sense of smell which is also warped so nice smells can smell awful

• Excessive saliva, which not only increases dehydration but is unpleasant and embarrassing

• Headaches

• Depression, from the severe ongoing symptoms, the isolation, concern over work and also a physical side effect of calcium deficiency as mentioned above.

HG is relentless… the nausea, which can feel like you’ve been poisoned, goes on and on and on, every minute of the day and night. Once the pregnancy hormone relaxin kicks in many women will find they wee when they throw up adding to the humiliation and the need to stay within the house. And then there is the emotional distress of having missed out on the pregnancy they were expecting, looking forward to, excited about.

What are some of the challenges of HG for your friend?

You would think that a condition that can have such serious impacts would be taken very seriously by doctors and midwives. Yet because this is a condition shrouded in stigma and old wives tales your friend may actually be finding that half the battle isn’t the condition itself but trying to get treatment and help for it… half the battle is simply being believed! Which is a strange place to find yourself when, as an adult, most of us take being believed for granted. If I hopped into A&E and said I thought my leg was broken and I was in a huge amount of pain the doctors would likely believe me, give me pain killers and send me for an X-ray. So it can come as quite a shock to find yourself dismissed and not believed and this is a major challenge for HG sufferers.

Another challenge is the social stigma of taking medication in pregnancy and the fear we have drilled into us about it. Most of us embark on our pregnancies hoping for natural healthy pregnancies… we give up wine and avoid every possible toxin from cigarette smoke to household cleaning sprays, we embrace organic food and don’t dye our hair and it’s all part of the initiation to motherhood… the idea that we go without for our children and do whatever it takes to ensure optimum health for our precious bundles. And so, to be faced with the awful situation of developing a complication of pregnancy which means you can either risk your baby’s health by becoming dehydrated and malnourished or you can take medication to get symptoms under control… it’s worse than a rock and a hard place!

So what can you do to help your friend?

1. Advocate for her with others… challenge the notion that she’s exaggerating, remind others that she’s normally tough and well and not prone to drama. Don’t just let the gossip slide and definitely don’t perpetuate it.

2. Help her make informed decisions, which in turn will reduce the anxiety about the decisions. Look for reputable sources of information such as Pregnancy Sickness Support, the HER Foundation and NHS Choices. Don’t forward her nonsense links about risks or other random medications or fear mongering pictures of babies affected by Thalidomide.

3. Offer practical help. Could you do some shopping for her or pop round and clean the house? If she has kids could you take them out while she rests or bring round some quite activity packs for them?

4. Support her via text/email/facebook etc. a regular message in the evening saying “Well done, that’s another day done that you don’t have to do again. One day closer to the end” would make a HUGE difference to someone whose days seem to drag like months and who feels like the end is just so far away.

5. Remember it’s not about you… If she doesn’t reply to your texts or doesn’t want you to come round then don’t take it personally or get stroppy about it… realise that the reason your friend is withdrawn is because she is so so so ill and if anything that means you should text more without expecting replies. She may get too sick from typing on her phone and she may not want you to visit if she’s worried about throwing up and wetting herself in front of people. She will appreciate your support and express that when she can.

If you’ve read this and learned something about how to support your friend then please do comment below or if you’ve supported a friend through HG and have other tips to post then let me know. It’s always nice to hear from people how haven’t’ suffered but “get it” and supported their friend.

If you had a friend who really supported you and helped you when you needed them then print out one of my HG Hero Certificates for them!

For more posts on how to help a friend with HG check out theses from my archive:

10 tips to help a friend with HG

What not to say to a woman with HG

De-bunking the Myths

Mental Health and the Legacy of Hyperemesis Gravidarum

Today I have an important guest post for those of you recovering from hyperemesis gravidarum, or for those in the thick of it who want to focus on the future and what you can achieve once you've survived this endurance. Susie's story is inspirational, it's positive and rewarding. Please read it and show her the support of the HG community which she is supporting with her abiding endurance.

A test of endurance - By Susie Nicholas

Five years ago I was pregnant with my second child and suffering from hyperemesis gravidarum (HG) for a second time.

I was extremely ill, plagued by the constant vomiting and nausea that characterises HG and which all HG sufferers will recognise. The day-to-day tasks we all take for granted - washing, getting dressed, making a drink, cooking the tea, washing the dishes - became an enormous effort for me, an effort which was often just too much for me to bear. I was unable to care for my older child, relying hugely on friends and family to fill the void left by my absence as a mother. At that time, my days were mostly spent bed-bound or, on a good day, lying on the sofa too ill and weak to leave the house. The frustration and guilt that came with being so useless and utterly reliant on others was immense.

Fast forward five years and it is a very different story. I am on the verge of doing something that I never in a million years imagined possible. Tomorrow I will be taking part in my first ever triathlon to raise money for Pregnancy Sickness Support.

I am honoured to now be a trustee of the charity and so I know all too well how vital it is that we, the HG community, raise funds to enable the charity to continue the work it does to support sufferers and to improve the medical care they receive.

Nine months ago I decided that I would embark on a challenge to raise money for the charity. I wanted the challenge to be just that - something a long way out of my comfort zone and something that I would never have even contemplated before HG. The idea of doing a triathlon came into my head and, strangely, seemed to be the obvious choice.  

After suffering from HG for three very long and tough trimesters, it seems fitting that I will be putting myself through the three gruelling disciplines that make up a triathlon - a swim in open water, followed by a cycle and finally a run. Individually, the three disciplines would be hard enough, but put them together and it is a whole different ball game.

A triathlon is known as one of the top endurance sports. It requires perseverance and stamina, not just during the event itself but also in the training. Until last year I was woefully unfit having not done any proper exercise for 20 years. I have had to train hard for months to get myself ready for this challenge.

It is certainly no exaggeration to say that hyperemesis gravidarum is also a test of endurance. It is a test of endurance to get to the end of each day, each week, each month. Week nine in particular sticks in my mind. I had already been ill for several weeks and week 40 seemed like an eternity away. It felt as though I had a mountain to climb but I didn't know how big the mountain was or how long it would take to reach the summit.

But that's where the similarities end. This time I have chosen to put myself through this, I have not had it forced on me against my will. This time I am in control. I have decided to take on this challenge simply because I can. Being so ill during my pregnancies has made me appreciate my health. Now that I feel well, I have resolved to make the most of it and not waste the opportunity.  In contrast to the dark days of HG I am feeling healthy and enjoying being active ... and I feel great!

So, if you are suffering or have recently suffered from HG, hold on to this thought: it may take some time, but you will feel well again and your body will heal. And when it does, don't waste the opportunity. Do something amazing and show HG that you will not be beaten!

If you would like to sponsor me, it's not too late! 

Click here for my fundraising page

Thank you!.

If you would like to read more about my progress towards my first triathlon, I have been blogging about it over on my own blog, Diary of a Charity Chick. 

Pregnancy is a strange phase of life… it seems that as soon as you get that little blue line everyone and his dog has nonsense advice and ludicrous old wives tales about the condition you’re in… from whether your bump “looks like” a boy or a girl to advice about not raising your arms above your head or the cord will wrap around the babies neck…

And if you are unlucky enough to get a pregnancy related condition then your experience really does become public property for anyone and everyone to know best about!

And that‘s how it is with hyperemesis gravidarum, a serious and complex condition which everyone, except the doctors, seem to be experts on!

So, I'm here to do some myth busting about HG and get some of the facts out there instead... 

Myth 1: Pregnancy isn't an illness

Correct, pregnancy itself isn’t an illness but there are numerous illnesses which can be caused by pregnancy. Hyperemesis Gravidarum is just one of them. Other illnesses which are caused by pregnancy include Gestational Diabetes, Molar Pregnancy, Ectopic Pregnancy, Symphysis Pubis Dysfunction, Eclampsia, Anaemia, Obstetric Cholestasis and Acute Fatty Liver of pregnancy. Most of those, including hyperemesis can be life threatening.

Myth 2: You'll be fine at 12 weeks

Whilst this is true for regular morning sickness as experienced by 80% of pregnant women during normal and healthy pregnancies, it is not true for women with hyperemesis gravidarum, which is rarely over much before 20 weeks. Many women, even if they see an improvement around 20 weeks, will still be experiencing symptoms by the time they give birth. It’s unhelpful and unfair to harp on about how much better she’ll be at 12 weeks and it will only increase her feelings that no one believes her and they all just think she’s got morning sickness. Much better to look ahead to what support you can offer over the coming months.

Myth 3: The baby will be just fine or it's a good sign

When it comes to regular morning sickness there is a slight correlation between experiencing symptoms and having a reduced chance of an early miscarriage. But we’re talking about a reduced risk… not a dead cert for a healthy baby! Given that 1 in 5 pregnancies end in miscarriage, even if having pregnancy sickness halved that risk (which it doesn’t!) you would still have a 1 in 10 risk! Now when it comes to hyperemesis gravidarum, unless it is effectively managed and treated then there is an increased risk of miscarriage due to the dehydration and malnutrition which characterise the condition. On top of this there is a very high, 1 in 10 chance that the baby will be lost to a therapeutic termination as severe symptoms put the mother's health, family and home at risk.

If HG is poorly managed as the pregnancy progresses there is an increased risk for the baby of placental problems, inter-uterine growth restriction and even death. Plus there is increasing evidence that malnutrition and dehydration can have a long term impact on normal infant development.

So basically… No the baby will not always be fine!

Myth 4: If you don't think about being sick you won't be

And if you don’t think about your diabetes you can eat all the cake you want!! Hyperemesis gravidarum is not a psychological condition; it is biological. We don’t fully understand the mechanism at play but it involves genetics, prostaglandin E2 and hCG and the complex relationships they have on other things like thyroid and digestion. This myth is particularly tenacious and dangerous as it is used as an excuse to leave women without necessary treatment and to treat them cruelly.

Myth 5: It's only 9 months, you'll be fine when the baby comes out

Sadly for many women HG doesn’t end when the baby is born, particularly if their condition has been poorly managed and anyway, 9 months is a hell of a long time to be sick all day every day. Many women are left with long term problems with their oesophagus and digestive system, torn muscles and other physical scars. Many more women are left with emotional scars as HG has robbed them of their physical and mental health. I’ve written more on that here with details of where to get help. It’s particularly poignant this week as the HG Community lost a member to a terminal mental illness.

Myth 6: It must be a new thing as it wasn't around in my day!

Often heard from generations above ours and from older midwives particularly, this is utter nonsense! There are Egyptian records indicating hyperemesis as far back as 4,000 years years ago. Hippocrates wrote of the condition a Roman physician documented it in the early second century. Until early last century it was considered a biologically based illness to be taken seriously as it was the leading cause of death in early pregnancy.

So no, it’s not new and it’s not just fashionable now… women have always suffered it and until a complete cure is determined they will continue to suffer it, but hopefully with greater awareness about treatments and support they will suffer less severely and not think they need to just put up in silence with it.

Myth 7: You can't take medication because it will harm your baby

About 50 years ago a drug was marketed as a cure all for pregnancy ailments, from insomnia to sickness. It was called Thalidomide and sadly it caused devastating harm to the growing foetus if taken between days 35-50 of pregnancy. At the time doctors did not believe that things the mother ingested would have an impact on the foetus and it was this drug that made everyone realise that it in fact does matter if mums smoke, drink, take drugs and so on while pregnant. Since then there has been a big black cloud over taking anything during pregnancy and the stigma is so strong that many doctors still advise terminating a healthy baby rather than risk prescribing drugs which a quick search for evidence would show is safe and effective. So you see the tragedy of Thalidomide is far from over. The drug is still claiming infant’s lives and causing devastation to families, not just affected by HG but all sorts of conditions which can be safely treated in pregnancy but are not, out of fear. For more information about the safe and effective treatments for HG please see the Pregnancy Sickness Support website.

Myth 8: Ginger helps hyperemesis gravidarum

Now I’m not going to get into a debate about whether or not ginger helps morning sickness… I’m not talking about morning sickness, or even moderate pregnancy sickness… I’m talking about hyperemesis gravidarum. And guess what – Ginger does diddly squat to help it! In fact, recent research I’ve done with a colleague actually showed it caused significant harm, not just by making symptoms a lot worse and causing pain to vomit but by alienating those who suggest it and adding to the woman’s isolation and feelings of being utterly misunderstood. When it’s suggested by a doctor or midwife then it’s been found to utterly destroy the patient’s confidence in their professional abilities… so just don’t suggest ginger!

If you like my blog and appreciate the work I do to raise awareness for hyperemesis then please could you click on this link and nominate me for the Outstanding Contribution category at the MAD Blog Awards. Nominations close on Monday 20^th July 2015, so do it quick. Thanks x

Click here to nominate me now!