Hyperemesis Related Post Traumatic Stress Disorder (PTSD): Morning Sickness It's Not

It's an alien and a parasite. It makes me tired and weak. It's complicated my whole life. I resent it. I have no idea how to take care of it. I'm the anti-mother. ~The Waitress, 2007

Trusted Nurse Midwife Friend: "So, when are you going to get past this HG thing and have some more kids?"

Me: "Oh! I'm not. I can't. I can't get past it at all. As much as I love my child, and as much as I love being a mother, I can't begin to imagine having to go through that again, especially while caring for a toddler. All three of us would suffer. My husband may be OK. {giggle} Nope. I can't imagine. I couldn't put my family through that. I'm open to adoption though."

My Hyperemesis Gravidarum Story

A Pregnancy Fit For A Princess

I really do not mean to perseverate over my experience, but even after 3+ years, I cannot get beyond it enough to desire another pregnancy. I did not have a life-threatening pregnancy. My child's health was never at risk, but still... I would not mind revisiting the muscle aches, heartburn, constipation, shortness of breath, bladder urgency, fatigue, or even the 23 hours of unmedicated labor, that I experienced with my first pregnancy; but to have to suffer through that unrelenting nausea, vomiting, and lethargy, moment after moment, for weeks on end, is too much to imagine. Just after the birth of my daughter- you know when everyone immediately starts asking about baby #2- I joked about not being emotionally stable enough to endure a 2nd pregnancy. I always laughed, but now as a postpartum doula, I support many moms who have had birth trauma that leads to postpartum mood disorders. The more that I read about their complex and sometimes debilitating emotional state, and the more that I listen to their stories, the more I see myself in their struggle. Because I had an otherwise healthy pregnancy, a birth with minimal intervention, and a perfect child born at 40 weeks, I never considered that I was in the birth trauma crowd, or was at risk for pregnancy related depression or anxiety. I was wrong. I have slowly come to realize that I had post-traumatic stress disorder (PTSD) related to my hyperemesis gravidarum (HG). Yep! That's really a thing!

In the 1930s, Dr. Freud's popular psychodynamic theory was applied to women with HG, which resulted in physicians viewing mothers as mentally ill women with a subconscious rejection of the fetus, as if the she were literally trying to throw the baby up. It was further speculated that the mother's illness was related to broken relationships, broken homes, marital distress, depression, anxiety, abuse, resonating disorders, hysteria, sexual dysfunction, poor self-confidence, poor coping skills, and good ol' stress. The treatment of HG during ths time included isolating the mothers and leaving them to rot in their own vomit, without bowls or buckets, and without any assistance other than the regular presentation of more food, which every HG mom knows is the very last thing that is wanted. Later, intravenous fluids were used as a treatment, so while fewer women were dying as a result of HG, those who survived were still being mistreated. Although there have been additional medical advancements in the treatment of HG, these psychological factors continued to be cited as the source of nausea and vomiting through the 1990s, which means that even relatively young doctors, treating mothers today, learned this archaic information in medical school. Many are still telling mothers that they are just stressed or anxious. That's pretty scary. 

Fortunately today, there are more humane ways of treating HG... even though I was terribly isolated, because I could neither predict, nor recover from my nausea, vomiting, and simultaneous incontinence; and I did mostly, OK always, clean up my own vomit and urine, because it either happened while I was working alone, or overnight, when I did not want to wake my hardworking husband- especially after that time that he accused me of just wanting attention. I cringe to think about that even now, but he didn't know. He had never heard of HG (neither had I), and none of his six older sisters had ever experienced it, so there was no known source of empathy. The repeated need for IV fluids helped him to understand my need for help better, along the way. Zofran was the only way that I survived. Fortunately, my pregnancy occurred before the claims the drug causing birth defects. I really feel for those HG moms who had to suffer under that fearful shadow. 

“What was really significant to me was that women with extreme morning sickness who took Zofran reported fewer miscarriages and terminations and experienced higher live birth rates,” Fejzo said. “Taking this medication helped them get through their pregnancies and gave them their desired outcome, a live birth.”
Marlena Fejzo, PhD

Zofran Update

Today, it's clear that psychological factors do not cause HG, but they can definitely be the result of HG. An expectant mother who is violently ill throughought the day, to the point of ejecting blood and bile, having constant leakage from her eyes, nose, hoo-ha, and mouth (a condition called ptyalism), is going to be at risk for antepartum depression, postpartum depression and anxiety. Many women with HG are placed on bedrest, and many others should be. Those who are on bedrest are often too sick to journal, scrapbook, chat, or e-shop, like mothers who are resting for other conditions. Any mother who is too sick to work outside of the home or care for her children could very likely feel guilty; and her inability to contribute to her home, could create an additional strain on her marriage and finances. Insomnia and black-outs are common with HG. Emetophobia, or the fear of vomiting, creates even more anxiety and can lead to panic attacks. The fear of dying or actually wanting to die are very real thoughts for HG sufferers. Some medications even offer suicidal ideation as a side effect. Imagine that? 

I can remember being so sick on the day of my baby shower. It took me forever to pull myself together and get out of the house, but friends, including the hostesses had traveled 3 and 4 states away to honor me. I had to get it together. I was late for the shower, and they were irritated. I couldn't bring myself to complain about how I was feeling on that day. Who wants to be Debbie Downer at her own baby shower? So, I arrived when I could, and sadly, those relationships were strained as a result, leading to more isolation. One of the friends had incredibly survived HELLP and a subsequent premature delivery, and the other had never been pregnant. There was no easy way to explain this inescapable hell that happens to fewer than 5% of pregnant women, and typically results in a healthy birth. No way. 

I can also remember suffering in silence because my blood pressure and blood sugar were not at risk. My uterus was in a great space, my baby was growing well, and her heart rate was active. What did I have to complain about, when as an occupational therapist with NICU experience, I saw both mothers and neonates at far greater health risks? What I know now is that HG was tortuous and it robbed me of the joy and happiness of a major life event. It was miserable, it was traumatic, and it was a kind of loss. I was felt helpless, hopeless, withdrawn, and even ambivalent about the birth of my child, which of course brought on even more feelings of guilt, shame, and fear. Naturally, this experience puts HG moms at risk for depression, anxiety, and post traumatic stress disorders. 

Post traumatic stress disorder is caused by a single traumatic event, like a rape, assault, or natural disaster, but it can also be caused by prolonged exposure to an extremely stressful situation, like foster care, domestic violence, and hyperemesis gravidarum. Symptoms include disturbing thoughts, dreams, hallucinations, and feelings related to the event. They also include mental distress, physical distress, avoidance of related situations, and alterations in thought patterns, lasting for longer than a month after the event. Even though the nausea and vomiting are finally relieved at birth, when HG survivors have PTSD, they have an actual fear of getting pregnant, which may be extreme enough to avoid sex or rush into permanent birth control. How stressful is that on a marriage, especially one in which the mother was probably not ever excited about having sex during pregnancy? This avoidance could lead to yet another loss; this time, that of a larger family that was hoped for before HG reared its ugly head. A father, wanting to "try for a son", may become resentful of his HG survivor partner, who has absolutely no desire to become pregnant. Likewise, that mother may become resentful of her husband for pressuring her to do so. She may also become strangely resentful of her child or children who "caused" these horrible feelings of body and mind. 

Kate Middleton's Ongoing Condition Much Worse Than Morning Sickness 

Flashbacks, hallucinations, and panic attacks are signs of PTSD with HG survivors. Food anxiety can also appear during the postpartum period. Moms who have not been able to eat for 6-10 months, may experience a continued aversion to food, or overeating, similar to someone who was starving at some point. Both extremes are dangerous to the mother's health and her child's well being, especially if she is breastfeeding. The symptoms may show up at anytime after the birth, and may become especially exacerbated if a subsequent pregnancy does occur. Hyperemesis is typically present in and may be progressively more severe with each pregnancy. It does not usually abide by the "every pregnancy is different" rule. 

Physicians are doing a better job of identifying postpartum depression. There is a greater understanding and more empathy around this group of hormone related mental illnesses. Health care providers are even getting better at referring mothers who have had traumatic births to psychological care. Unfortunately, PTSD related to HG is less recognized, considered, diagnosed, taken seriously, or treated. PTSD can be terminal, but it is very treatable when symptoms are identified and help is sought. It's existence, severity, or impact should never be underestimated. Some survivors experience life long anxiety, especially around needles, hospitals, and medical procedures. Others are anxious and resentful around glowing mothers, as they continue to feel cheated by their dark pregnancy. These feelings intensify anytime HG is dumbed down to extreme morning sickness or a survivor's story is invalidated. 

For More Information, Visit Help HER

In order to minimize PTSD symptoms, at any phase, mothers should be able to rest and relax without guilt or additional stress. Any mother who has had a stressful pregnancy, or traumatic birth, should consider hiring a postpartum doula, in order to help with the transition of motherhood. She should also consider establishing a relationship with a psychologist or counselor who could screen for and treat any depression or PTSD. A strong, observant, and knowledgeable circle of support is vital.

So, while I am not into a position to move beyond my traumatic hyperemesis experience to the point of having another child, as a birthworker, I am eager to help mothers who have survived hyperememsis and want to live their best lives beyond that experience. If you need help, please reach out. You do not have to suffer in silence. You do not have to suffer alone.

What is your experience with Hyperemesis Gravidarum?

Living With Lupus... As A Mother

We may run, walk, stumble, drive, or fly, but let us never lose sight of the reason for the journey, or miss a chance to see a rainbow on the way. -- Gloria Gaither

Pregnancy and motherhood come with their own set of challenges. From impossible fatigue to seemingly endless aches and pains, new mothers experience a wide array of symptoms that can make the whole mom thing less than fun. However, when those common symptoms are exacerbated by the pain, inflammation, irritation, respiratory distress, and suceptible immunity of lupus, there are many other factors to consider, for mothers, her child, and her circle of support.

What Is Lupus? 

Lupus is a chronic autoimmune disorder, wherein damaged cells of the immune system attack healthy cells of multiple systems, leading to inflammation, joint pain, and skin rashes, in addition to kidney, heart, lung, nerve, and liver damage, in severe cases. Digestive issues and anemia are also areas of concern. All over, and usually, symmetrical joint pain is often the first sign. There may also be a common "butterfly" rash across the face, along with other skin irritations, sensitivities to the sun, and mouth ulcers. In fact, the entire integumentary system may be affected in the form of scaly skin, brittle nails, and patchy hair loss. Another symptom is unrelenting and debilitating fatigue, often with a low-grade fever. Lupus shares many symptoms with rheumatoid arthritis, fibromyalgia, Sjögren's syndrome, and other autoimmune conditions. A battery of lab tests and history help to diagnose lupus. Women are 10 times more likely to get lupus than men, and women who are African-American, between the ages of 20-40, and related to someone with lupus, are more more likely to get the he incurable condition, than other groups. The symptoms of lupus come and go, present themselves one at a time, altogether, or in any combination, and can be treated by addressing its multiple symptoms with corticosteroid pills or cremes, NSAIDs, and antimalarial medications. People living with lupus are at an increased risk of developing heart disease and having a stroke. 

Lupus- What Is It? 

Lupus and Fertility 

Lupus alone does not create issues with fertility. During the preconception period, a woman with lupus should meet with a rheumatologist, perinatologist, and a pediatric cardiologist, in order to discuss risks and options for both mother and child, including finding a hospital that specializes in specialized infant care. Hopeful mothers should adopt and maintain a healthy lifestyle in order to minimize lupus-related symptoms. Women who conceive while symptoms are in remission are less likely to have complications during pregnancy. While fewer than 50% of lupus pregnancies have complications, all pregnant women with lupus are considered high risk. Planning pregnancies while living with lupus is important.

Lupus and Self-Care 

Lupus and Pregnancy

The pregnancy complications associated with lupus include an increased risk of miscarriage, still birth, prematurity, preeclampsia, and HELLP syndrome.  In order to monitor and decrease these risks, more frequent doctors' visits are necessary and eventual bedrest is likely. All pregnancies are different. Some will require treatment early on to adjust medication levels, while others require frequent monitoring after the first trimester, in order to check for blood clots, blood pressure, fetal growth, and offer reassurance, often via ultrasound. The physiological demands of pregnancy can often place extra stress on the mother's heart, liver, and kidneys. Expectant mothers and their partners should be extra vigilant about lupus flares. Although they are rare during pregnancy, they often appear as exaggerated signs of pregnancy, including fatigue, joint swelling, fluid accumulation, skin changes, and hair changes. Just as in a normal pregnancy, nutrition, weight management, and rest are essential for an optimal birth outcome.

Neonatal Lupus

Most babies born to women with lupus are born healthy, when full-term. Those that are born prematurely, are at risk for the same heart, lung, digestion, and growth complications as other preemies. In very rare cases, the newborn can have neonatal lupus, which may mimic mom's symptoms of skin rashes, anemia, or liver problems. These symptoms usually go away after a few months and do not cause permanent damage. If a newborn presents with a heart condition related to neonatal lupus, the prognosis is more concerning. 

Autoimmune Disorders and Breastfeeding 

Breastfeeding and Postpartum 

Lupus itself does not prevent breastfeeding and since lupus is not contagious, it cannot be passed to the baby through breast milk. However, new mothers may still experience breastfeeding challenges. For example, if the mother was very sick or medicated at the end of her pregnancy, she may have difficulty producing milk right away, especially if the birth was premature, as nearly 50% of lupus-pregnancies are. In this case, be patient, seek assistance from a lactation professional (early and often), continue to express milk, be available for kangaroo care, and ask for donor milk. A pre-term infant may have developmental challenges that make breastfeeding complex, but also very important. Along with the numerous well-known benefits of breastmilk, the milk of a mother with lupus, has properties that may help decrease the risk of the infant developing lupus later in life. In addition to utilizing the services of a lactation consultant, a new mother with lupus may 
consider hiring a postpartum doula to help manage physical recovery, baby care, and home care. As mentioned earlier, symptoms may be surpressed during the pregnancy, but the stress of motherhood could contribute to a flare up after the birth, especially if the child is fragile, or when the mother returns to work. 

15 Reasons To Call A Lactation Consultant 

Nutrition 

Nutritional choices neither cause, nor cure lupus, however, healthy food choices are an integral part of the overall treatment plan, especially during pregnancy. As a general rule, the diet should be well-balanced, anti-inflammatory  consisting of vegetables, fruits, oily fish, and limited amounts of whole grains, lean poultry, and beef. Avoiding the major inflammation causing foods, is as equally important. The goal of nutrition is to reduce inflammation and other symptoms, maintain strong joints and muscles, minimize side effects of medications, maintain a healthy weight, and reduce the risk of heart disease. 

Foods That CAUSE Inflammation 

Mental Health and Self-Care

Like many chronic illnesses, depression and anxiety are a risk for those living with lupus. The unpredictable pain, in combination with the emotional stress of coping with daily obligations, can often be too much to bear without intervention or support. It is vital that a self-care plan includes stress & pain management, regular exercise, a balanced diet, social support, rest, and regular mental health assessments. 

If you know a mother who is living with lupus, reach out to her and offer a bit more support than you have been, regardless of the age of her children. She's probably more tired than the average mother. If you know a woman with lupus who is trying to conceive, check in with her to make sure that she's making healthy choices the majority of the time. If you are a mother living with lupus, know that we think the world of you, we are cheering for you, and we support you and your amazing self. Take care. 

The Myriad of Emotions Associated with Mother's Day!

Each year, I reflect with gratitude on Mother's Day 2012, when I had recently left my corporate health care job in order to focus on my own women's wellness business, full time. It was on that day, while celebrating my own mother with my nieces, that immense nausea and fatigue led me to the drug store, where I purchased a digital pregnancy test, and moments later, learned that I was indeed getting ready to be a mother myself. I experienced a tremendous range of emotions right then. Today, as I celebrate my fourth Mother's Day (tee-hee), I am still grateful. I am blessed to be able to spend another Mother's Day with my own mother and to be around aunts and cousins who are also mothers.

At the same time, I am filled with a deep sadness for those longing for and missing their mothers because of loss, including my parents, my husband, my siblings, several of my closest cousins, and too many friends. I send sweet thoughts to those whose mothers are ailing with physical or mental disease, as well as to those who cannot travel to see their mothers because of distance, expense, inflexibility, brokenness, or conflict. 

As a birthworker, I spend Mother's Day sending love and light to those whom have lost children. I send miracles and blessings to the mothers of unborn children, still born children, and those struggling with infertility. I am thinking of those mothers who have had to bury an infant, child, adolescent, or an adult child. I am sending patience and forgiveness to mothers whom have lost their children to incarceration, addiction, or other destructive decisions. My heart goes out to the mothers whom have had forced or elective abortions. May the guilt, fear, pain, shame, grief, or isolation of these losses be transformed into peace, healing, power, inspiration, and possibility. 

                                                         An Open Letter To Mothers

I have so much compassion for the moms who have to work too many hours and too many jobs to see their children, just so that their basic needs are met. I feel for moms who have to drop their infants off with strangers at a daycare at 6 weeks because they can't afford to be off work another day. I feel for single mothers, mothers without support, those with strained interpersonal relationships, mental illnesses, or physical limitations- moms who just need a 
few more resources, and a lot more hugs. 

I stand in awe of the mothers who are mothering other mothers' children. To the foster and adoptive mothers, grandmothers, aunties, big sisters, family friends, teachers, mentors, and next door neighbors who have stepped in to mother, she it was impossible, unreasonable, or unsafe for the birth mother to be a mom, I salute you. We support the often misunderstood and lonely experience of the mother of children with special needs. 

15 Inspirational Mother's Day Quotes 

Mother's Day is an emotionally complex day. My hope is that wherever and whenever moms need to be celebrated, elevated, appreciated, supported, remembered, prayered for, or fought for, they are, each of them, today and every day. 

Happy Mother's Day!