Sunday, May 15, 2016

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."

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

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. 

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. 

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?


  1. It's so nice to see that HG is finally getting more exposure. I'm 25wks into my 3rd pregnancy with HG. Both my second & current pregnancy from day one is shadowed with fear, sadness & guilt for feeling that way. I'm a lucky HG survivor as I only was hospitalized 4-7x each pregnancy & can to a degree manage it with Zofran(which has it's own set of fear & guilt). There are so many that have it so much worse needing pick lines or feeding tubes. I try to keep that in mind as I'm hanging over the toilet, garbage can, sometimes steering wheel or work desk. I understand how some women would never get pregnant again. After my second I said that but this one, SURPRISE. Others dont understand how a woman could be so devastated at hearing shes pregnant, people don't understand the trauma. It's women like you, foundation's like HER, & even the Duchess Kate who are so brave tho shine the light on this for the world too see. Thank you for sharing, I know it's not easy but you make it easier for women like myself too deal with it. Support is paramount even just reading stories like yours to know you're not alone & not crazy or a drama queen(I've been called called both even from my first OB) helps so much. You are brave & strong and I hope you know appreciated by me & I'm sure countless other HG sufferers & survivors. Thank you just thank you!

    1. Heather- Thank you so much for your thoughts, words, courage, and encouragement. You are a warrior!

  2. I am currently in search of ways to recover from PTSD after HG, 2 and a half years after my pregnancy. I had dreamed of having a large family and wanted to have another amazing birth like my first (thankfully our birth was fantastic), but as time went on I became crippled with fear about falling pregnant again. It is so heartening to hear I am not alone and to find there are health workers out there who do understand and do want to help. Thank you for this post, I feel stronger for having read it. X

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