Well the thought of a Hyperemesis free pregnancy turned out to be too good to be true and a scan today showed that the baby hadn't developed and the heart had stopped beating. We're sad but we had been realistic to the possibility. So now we're faced with the rather unpleasant process of miscarrying it over the next few days. Sadly miscarriage in early pregnancy is very common; this is my second as I lost one before conceiving Alfie, but it doesn't effect our chances of conceiving again and we are not deterred from wanting our third child to complete our family.

On the plus side at least I didn't endure weeks of sickness before loosing it, which has just happened to a poor woman I have been supporting recently... 6 weeks of the worst Hyperemesis Gravidarum I've ever heard of; ruptured oesophagus, jaundice from a failing liver and hair loss, only to loose her baby girl at 12 weeks. Devastating!

Anyway, I will still blog about any treatments and developments I read about and also about some of the women I'm in contact with suffering at the moment. And will let you all know when our journey starts again... I never thought I would wish for nausea but last night I did and I expect I will when I get my next positive test... HG is a bitter sweet condition!

Well the good news is that there was a heart beat present on the scan. The explanation for the lack of current sickness is that according to the scan I'm only 5 weeks... which means I had a positive pregnancy test before I was actually pregnant... if you can figure it out then let me know!

Well so far I'm feeling well... very well! After some nausea and general yuckiness between week 4 and 5 and some adjusting to the pre-emptive meds I have for the last few days been feeling particularly well. You'll be thinking 'Yay! Thank goodness for that'. Sadly for Rob and myself the profound impact Hyperemesis Gravidarum has had on us in the past does not allow us such optimism. Hyperemesis is not morning sickness and each pregnancy is not different, if you've had hyperemesis once then there is a massive chance you'll have it again and potentially worse.

I just wanted to quickly blog about the various support networks currently available for Hyperemesis sufferers because since yesterday I have been facebook messaging and texting a young woman in the North of England who is currently in hospital with hyperemesis gravidarum and has torn her oesophagus from vomiting. She is on a ward, not in a side room and it is noisy, bright and smelly... all triggers for hyperemesis!!! She is feeling so low that she wants to die rather than go on suffering and to top it off people keep suggesting she eats ginger! She is in a terrible way and just feels like no-one understands... the reality is no-one can understand unless they have been through it which is why sufferers supporting each is so crucial.

If you find this blog and are suffering with Hyperemesis Gravidarum, perhaps it's not yet diagnosed and it's being called Severe Nausea and Vomiting in pregnancy or you are the partner/mother/friend of someone suffering... there is support out there:

www.helpher.org has fantastic information about everything, there is a section for Mothers, family and friends and for healthcare professionals. There are also forums on there for support.

Www.pregnancysicknesssupport.org.uk is the UK version and is the charity which I am most hoping to raise awareness of.

On facebook there are two main groups:

the UK support group is called Hyperemesis UK and the URL is http://www.facebook.com/search.php?q=wwoof&init=quick&tas=0.6090943993372939#!/pages/Hyperemesis-UK/197019263655727

and the larger international one is called Hyeremesis Gravidarum (when its more then just morning sickness) and the URL is http://www.facebook.com/search.php?q=wwoof&init=quick&tas=0.6090943993372939#!/group.php?gid=2587175083

There are also similar groups on Facebook for Austrailia and Ireland.

So things have happened somewhat quicker than expected this time and it turns out I'm already pregnant! We are a little freaked out about it at the moment but we do feel ready for it.

I've started on the Promethazine as I have had nausea from literally the day I turned 4 weeks... which worries me immensely as I was 6 weeks before hyperemesis struck with both the boys.

So I said last time that I would tell you about the other ways we've been preparing. There is a variety of alternative therapies available which I don't doubt can help greatly with normal morning sickness but for me simply don't cut the mustard when it comes to full blown Hyperemesis Gravidarum.

In my previous pregnancies I have tried homoeopathy, reflexology, hypnotherapy and cranial osteopathy without benefit. I have however found potential benefit from acupressure in the form of wristbands, which I have on now and won't take off until I have delivered the baby (2 pairs so I don't need to take them off in the shower/bath) and I will probably need a fresh set after a couple of months as the elastic loosens on them. The benefit I get from them is more psychological than anything - "Have you tried travel sickness bands?" "Yes - see!". I can't be accused of not trying to help myself!

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.