Hyperemesis gravidarum is a severe form of nausea and vomiting that impacts 2% of pregnant women. After having hyperemesis gravidarum in two pregnancies I’m sharing all my hyperemesis gravidarum treatment tips for other mamas who are currently in the thick of it.
What Is Hyperemesis Gravidarum?
Hyperemesis Gravidarum (HG) is a rare form of severe morning sickness that affects roughly 0.5-2% of all pregnant women, and is categorized by an extreme and persistent case of nausea and vomiting that often results in weight loss, dehydration, and electrolyte imbalance and in most cases requires medical treatment.
What Causes Hyperemesis Gravidarum?
The exact causes of hyperemesis gravidarum are not exactly known, but research shows us that it may be caused by the rapid change and rise in pregnancy hormones HCG and estrogen. While the reason why some women end up with this rare condition and others do not is unknown, the way a person’s body reacts to the steep increase in pregnancy hormones is the most likely culprit, especially given that symptoms often will improve when hormone levels begin to balance later on in pregnancy.
Who Is More At Risk For Hyperemesis Gravidarum?
- history of hyperemeis gravidarum in previous pregnancy
- history of migraines with nausea
- history of severe motion sickness
- multiple pregnancy
Hyperemesis Gravidarum Symptoms
It is important to remember that hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy that falls within the category of “morning sickness”. While many of these symptoms overlap with normal pregnancy induced morning sickness, they are more extreme and impact the health, well-being, and daily life of the person experiencing hyperemesis gravidarum in a more extreme way that often requires medical intervention.
- extreme nausea and vomiting
- nausea and vomiting that is consistent throughout the day and night
- nausea and vomiting that lasts beyond the first trimester
- significant weight loss
- difficulty eating and drinking
- extreme food aversions
- consistently missed meals due to nausea/vomiting
Hyperemesis Gravidarum Treatment Options
Every person who experiencing hyperemesis gravidarum is going to have their own unique experience, which will require their own course of treatment. But for many women the following treatment options may be necessary and helpful in reducing symptoms.
- IV Fluids are often needed as a hyperemesis gravidarum treatment as women can become dehydrated very easily, which can become dangerous to both the mother and baby
- B6 is an over the counter vitamin which has been shown to help reduce the symptoms of nausea and vomiting
- Unisom an over the counter sleeping aid when combined with vitamin B6 has been shown to help reduce the symptoms of nausea and vomiting
- Zofran a prescription medication can be prescribed to women who are unable to reduce their nausea and vomiting symptoms with the above methods and are having a difficult time staying hydrated and maintaining a healthy weight
- Ginger is an herbal root that has been researched to help reduce the symptoms of nausea and vomiting in pregnant women
- Rest depending on your work requirements or other children you are responsible for caring for at home, rest can be difficult for moms experiencing hyperemesis gravidarum, but lying down and resting has been shown to help reduce some of the symptoms of nausea and vomiting that can be exacerbated by lots of movement.
- TPN a form of IV nutrition that is used in extreme cases when hyperemesis gravidarum is so severe that it results in significant weight loss and malnutrition in the mother and requires IV nutrition
My Experience With Hyperemesis Gravidarum
When I first found out I was pregnant with my daughter I was beyond excited, and then when week six arrived I got hit with some of the worst nausea I had ever experienced. I had a long history of motion sickness and migraines, so feeling nauseous wasn’t something new to me, but this level of nausea was different. 24/7 the nausea was relentless, but was worst at night when I found myself also vomiting the most.
Quickly I found myself in a very debilitating cycle of extreme nausea and vomiting that made it nearly impossible to eat, drink adequate fluids, and work. Luckily, I work for myself so I was able to take time off without needing to explain my early pregnancy symptoms to an employer, but I often think about how impossible it would have been to maintain any type of “normal job” while my HG was at its worst.
For me, the severe nausea I experienced was the worst part of my HG, and often vomiting actually felt like a form of relief. Picture the worst motion sickness or sea sickness you have ever experienced. The kind that leaves you feeling pale, unable to talk, read, or look at your phone or computer, and makes you just want to put your head between your knees and will it to stop. Now imagine having that level of nausea 24 hours a day, 7 days a week, with no relief in site. That is what my experience with HG was like, and for me it lasted for about 20 weeks of my pregnancy.
With my first pregnancy I didn’t have my first prenatal appointment until 13 weeks (because we were in the very early days of the pandemic) and so I didn’t receive any medical help until that time. Looking back I wish I had advocated better for myself, because by the time I was actually able to meet with my midwife in person I had lost close to 10 lbs and was dehydrated.
Once I was able to start a nausea medication for HG my symptoms became slightly more bearable, and I was able to start keeping more fluids and eat small amounts of food with more consistency. By 18 weeks I was able to stop the nausea medication and by 20 weeks I was only experiencing occasional mild nausea — thank god.
When I got pregnant for the second time I braced myself for what I knew that I most likely had ahead of me. While everyone said that “maybe this time would be different” I didn’t think so.
This time I knew what to expect, and to reach out for help ASAP. While HG is more common in women who experienced it in a previous pregnancy, it is important to note that not all women who experience HG in one pregnancy will experience it again in another.
Unfortunately for me, that wasn’t the case, and just like my first pregnancy HG hit me with full force right at 6 weeks, only this time around I also had a 1 year old. This time I knew that I would need medical help to keep my HG under control, and I also just didn’t have the option of being as debilitated by this condition as I was before I had my daughter.
I take care of my daughter full time, while also fitting in work for my small maternal-child health business in the early mornings, nap time, and evenings. While I knew that my work would probably need to be reduced while I got through this second round of HG, I needed to be able to continue taking care of my daughter.
So for this pregnancy I began taking a nausea medication (unisom 25mg + 50mg of B6 once a day) I had before right at 7 weeks, but this time it didn’t end up doing anything, and I had even worse nausea and vomiting then I had with my first pregnancy. I got pregnant right around when my daughter turned 10 months, and was still breastfeeding her. The first 6 weeks I was able to continue breastfeeding without any issues, but then things started to really go downhill.
After receiving my first round of IV fluids for dehydration at 8.5 weeks, and balling my eyes out to my midwife about how I was supposed to take care of my daughter, my midwife decided to add a second nausea medication (zofran 4mg every 6 hours) into the rotation to see if that would help at all.*
The combination of the two medications ended being what made it possible for me to get through the day and stay better hydrated, but when my daughter turned 13 months I knew we needed to stop breastfeeding. I had a really lovely breastfeeding journey with her (I know this isn’t the case for everyone!) but trying to get through nursing sessions without vomiting was nearly impossible, and my state of dehydration made my milk supply completely take.
I’m sharing this part of my experience because I know there may be other mothers out there reading this in the same position, and the guilt I felt about stopping breastfeeding because of my pregnancy was tough for me. Luckily, our weaning experience went very well and it ended up being a much easier transition for both of us than I had thought.
While nights were still the hardest for me, I am truly thankful that my healthcare team was able to recommend a medication combination for me that made it possible to care for my daughter and keep my HG better under control. Because medication both times has been the only way I could manage my HG I really want more women to feel empowered and confident having conversations with their physician about their options.
What Actually Helped Reduce My Hyperemesis Gravidarum Symptoms
- Resting as much as possible — being up and active can make nausea and vomiting worse, but try lying down when you have a toddler to take care of. As much as possible when I would be feeling really sick my husband (who works from home) would keep an eye on our daughter so I could lie down, even 30 minutes at a time could be really helpful.
- Switching To A Prenatal I Could Tolerate — while my all time favorite prenatal is this one by Full Well, during the height of my HG swallowing pills just wasn’t possible without triggering vomiting and I couldn’t consistently stomach emptying the capsules into yogurt of apple sauce, so I switched to this chewable prenatal to get me by until I could start swallowing pills again. While this chewable has its limitations, the best prenatal is the one you CAN AND WILL TAKE, so I highly recommend trying a few if you are experiencing HG or if you are finding that your current prenatal is making you nauseous.
- 25mg of Unisom + 50mg vitamin B6 every 12 hours alternated with 4mg Zofran every 6 hours* — neither medication did much for me on their own, but combined after a few days they really made a big difference. This was honestly the only option that would truly calm my HG, keep my weight loss and dehydration under control. and make implementing some of the other strategies even possible.
- Frequent small snacks — eating frequently is one of the most common pieces of advice for HG but it can also feel nearly impossible when you are in a horrible cycle of nausea and vomiting. But it is true that having an empty stomach will make nausea worse so I would try to eat small bites every hour and space eating with taking sips of water or other fluid. My most common snacks were crackers, fresh fruit, rice cakes with a little peanut butter, scrambled eggs, and toast. In all honestly, I was really only able to do this with any consistency once I started my nausea medication regimen.
- Separating eating and drinking — eating and drinking together can make you feel more full, which can trigger vomiting and nausea. To help prevent this I would try and separate taking small bites of food and sips of water or an electrolyte drink to help keep me better nourished and hydrated without triggering vomiting episodes.
- Lemon Water — simply adding lemon to my water seemed to make it easier to get more fluids in, and calm my constant nausea.
- Lemon Ginger Tea — both lemon and ginger have been shown to help with reducing nausea and can help improve digestion, both of which can help someone with hyperemesis gravidarum feel a little better. While lemon-ginger tea never made my symptoms go away entirely, I did find that when I was able to tolerate fluids this was one option that helped to settle my stomach some.
- Ginger ale and Coca Cola — I am as far from a soda drinker as you will find, but both did help to settle my stomach in small sips when my HG was at its worst — and both ginger and cola have a long history of being used to treat nausea. So while I wouldn’t recommend making soda drinking a habit during pregnancy (or anytime) if I helps then give yourself permission to sip on some soda!
- Fresh fruit (banana, kiwi) — when my HG would feel out of control one of the only things I found that I could keep down and that would somewhat calm my stomach were bananas and kiwi (I know kind of random). I would keep these cut up on my nightstand and reach over to grab small bites during a rough night without even needing to take my head off the pillow.
- Time — while some women will experience HG throughout their entire pregnancy, most will begin to notice some relief with the end of the first trimester and almost complete relief by 20 weeks. With both of my pregnancies I found that by 15 weeks I was starting to feel a little better and could reduce my medication, and by 20 weeks my symptoms were mostly gone.
How To Know If You Have Hyperemesis Gravidarum?
While more than 80% of women will experience some type of morning sickness, hyperemesis gravidarum is not your average morning sickness so it is important to be able to identify the signs of something more serious.
- Your nausea and vomiting is impacting your ability to work, take care of yourself, or take care of others
- You experience severe nausea and vomiting the drastically impacts your ability to consume liquids and solids
- You become dehydrated and have a difficult time maintaining a healthy state of hydration
- Your nausea and vomiting impacts your ability to perform normal daily tasks
- You experience significant weight loss (with both pregnancies I lost more than 10 lbs in the first trimester due to HG)
How To Support Someone With Hyperemesis Gravidarum?
Something that many of us do when we are trying to support a friend or family member is try to relate to what they are going through by sharing or comparing a similar experience we had. While there may be times for this type of sharing, something I have been actively trying NOT to do is relate someone else’s experience back to my own when trying to show support.While well meaning, this often isn’t the best way to help, and instead simply listening and showing empathy can go a whole lot further.
I know that I still get triggered today by well meaning friends and family members learning about my experience with HG and saying things like “ugh morning sickness just sucks doesn’t it, I hated being nauseous!” or “my nausea went away around 12 weeks, there’s a light at the end of the tunnel for you” or “don’t all pregnant people get morning sickness, you’ve got to just push through it”.
While many of these comments may be well meaning I am here to nicely tell anyone who has not experienced HG to please stop comparing or pretending to understand what this rare prenatal condition feels like just because you yourself may have experienced some nausea or vomiting during pregnancy.
The person you are trying to support with HG is probably feeling like they can barely get through each day, has a severe and rare medical condition that can dramatically impact their physical and mental well-being, and more often than not probably feels like her experience is being minimized.
So please if you want to be there for someone with HG just check in on her and empathize with what she is experiencing, encourage her to seek medical help if you think she needs it, and maybe offer to watch her child a few days when her HG tends to be at its worst, or gift her a little care package or cleaning service! These small acts of support could really go a long way!
When To Seek Medical Attention
While more than 80% of pregnant women will experience some form of morning sickness, very few women (less than 2%) will experience HG, and each person’s HG experience will vary in severity and length. Some women will only experience HG during their first trimester while others will have HG much longer into their pregnancy. Some extreme cases of HG may even require IV fluids, TPN nutrition, and hospitalization to help protect the mom and baby.
If your day-to-day life is being dramatically impacted by the level of nausea and vomiting you are experiencing, if you are losing weight, finding yourself dizzy, and getting dehydrated then this is NOT your average morning sickness, and you need to seek medical attention immediately.
* This is not personalized medical advice, and I am only sharing what medicine combination worked for me for the purpose of helping other women bring up safe options with their healthcare providers if necessary. While this approach was appropriate for my personal case, it may not be appropriate for everyone. Always speak with your personal healthcare team before beginning any new medical regimen.