In the hours before the royal baby was born and international media gathered in front of a London hospital with nothing much to say, many references were made to the bad “morning sickness” from which the Duchess of Cambridge suffered from early in her pregnancy. At the time, commentators had even ridiculed Middleton for not toughing it out, dismissing it as non-news. What Middleton suffered from was not mere morning sickness, but hyperemesis gravidarum (HG). It apparently better for the royal mother, but as Ashli Foshee McCall points out, women can suffer the symptoms of HG through 20 weeks and even birth.
“It’s not uncommon for a woman who learns she is suffering from HG for the first time to spend hours waiting in the ER, only to receive a two-hour IV session and be sent home where she repeats the cycle within a couple of days,” McCall says, describing her own experience and the testimony of others. “Often, for patients with more severe forms of HG, this happens multiple times before they are given their initial hospital stay, and many end up with blown veins and the unnecessary discomfort of exacerbated symptoms from excessive trips in the car and too much stimulation. Many times HG does not abate until the 20th week or even until the baby is born, so this illness can be extremely expensive to treat and often takes a toll on the woman’s spouse, their marriage, their existing children, their relationships with other relatives, and friends.”
Ashli Foshee McCall is a stay-at-home mom who has battled hyperemesis gravidarum four times. She is author of the book Beyond Morning Sickness and hosts a resource website for women suffering from HG.
KJL: What can a woman who is reading this now, whose doctor dismissed her concerns, who really truly knows she has something much different than morning sickness, do?
McCALL: Women who feel they are not getting the care they need should make every effort to get a second opinion and change doctors where necessary. This is imperative in cases where the doctor suggests that it is “all in your head,” declares that “‘morning sickness’ is a normal part of pregnancy,” or is obviously allowing the insurer to dictate the course of treatment. Surprisingly, many doctors are not very knowledgeable about HG. Unless such a doctor is willing to obtain a rapid education on the treatment protocols or consult with an experienced specialist, it might be in the mother’s best interest to find a more knowledgeable doctor who can offer optimal care.
It’s a good idea for the HG sufferer to seek the opinion of a doctor outside of the practice she is currently with. But it’s often hard to know who has had the most experience treating HG, and who the most compassionate and skilled doctors are. Current and former sufferers offer their recommendations via websites such as beyondmorningsickness.com and helpher.org. The woman might also ask a friend or relative to research the ob-gyns on her insurer’s providers list, starting with those who are certified in maternal-fetal (high-risk pregnancy) medicine. Often simply googling a doctor’s name with the term “hyperemesis” will reveal a news item indicating he has treated the disease or written about it in a medical journal or other publication.
KJL: Why should people be concerned, beyond feeling bad for a woman who doesn’t have the same resources?
MCCALL: Women with limited resources may be the most likely to suffer complications or even terminate wanted pregnancies because of HG. In many states, Medicaid does not cover basic treatment options, such as a Zofran pump or home health care. In such cases, the woman often finds herself making “revolving door” visits to the ER and ultimately succumbing to intense suffering and prolonged debilitation.
Even pregnant women with adequate insurance may be at risk. In the darkest days of the disease, abortion is a tempting and seemingly irresistible “solution.” Busy, indifferent, or incompetent doctors may be all too ready to suggest or even promote termination, often with the added encouragement of friends, relatives, and the insurer.
KJL: Having suffered from this yourself, leading you to have an abortion in your first pregnancy, why would you ever have another child? Wouldn’t getting pregnant be the last thing you would ever want to do?
MCCALL: My first pregnancy was horribly mismanaged. While it was an unplanned pregnancy, it was a wanted pregnancy, but my physicians believed that the HG was somehow a physical manifestation of pregnancy rejection.
I had lost roughly 14 percent of my total body weight, had liver dysfunction, was jaundiced, and began experiencing hallucinations by the 14th week and still didn’t have even continuous fluids. I only had a prescription for medications that didn’t work. When I demanded to be hospitalized, I was told that the hospital was not a hotel, and I did not have the choice to be admitted. There were several physicians in this practice, and I had been seen by them all, so I assumed this was the only treatment available for HG. It was not enough. I woke up one morning and snapped.
I wanted my child, not the HG. I needed help my doctors refused to give me. I didn’t believe I had a choice. Ultimately, the second-trimester abortion of my child was a nightmare far worse than HG. I sustained permanent physical and emotional damage from the devastating experience.
I combed through medical-journal articles looking for information that would explain how the happiest event in my life was reduced to the worst event of my life; I wanted answers. They were there: life- and health-sustaining medical treatments had been available but they had not been afforded to me. Knowledge was power. Knowing more about the illness and its necessary treatments enabled me to know what to ask for and when. I learned how to interview doctors in an effort to find one who I felt would most likely properly treat HG. This knowledge gave me the confidence I needed to try again for another child. I looked forward to having children my whole life. I believed I could fulfill my desire to have children if doctors would only give me the option of necessary medical treatments. And I was correct. My two children are living proof of that.
KJL: You consider yourself pro-life now, against abortion? Why would you restrict other women from having the choice to do what you did during your first confrontation with this condition?
MCCALL: Mothers who are battling HG are doing so for their children; they do not want abortion. Abortion only becomes an issue when others infringe on their choice to have their children. For example, worried friends or family members may suggest that the mother is going to die and just needs to “take care of it.” And we have heard from moms whose physicians were not giving them the necessary care but who did recommend abortion as a means to end the symptoms. Abortion reduces the risk of lawsuits stemming from a woman’s care and ends “wearisome” repeated entreaties from a patient who “refuses” to get well.
In my fourth pregnancy, my medical-insurance caseworker called me up in the hospital and tried with all her might, through fear-mongering, to convince me to abort my baby. In my first pregnancy my dad tried daily to convince me to abort my baby. Like a mantra he would repeat, “You can’t lose your job,” and he would constantly tell me my baby was going to be “messed up.” I think well-intentioned people don’t realize that it’s actually antithetical to the goal of being supportive to encourage a mother to abort her child when she is trying to preserve her child’s life and her relationship with said child. The actual supportive thing to do is to help her achieve her goals, and sometimes that takes a lot of time and effort. I happen to think women are worth it.
Abortion is the easy way out — for everyone else. But it actually abandons a sick mother who does not desire to be separated from her child. I did not want to end the life of my child, and no matter how successful my other pregnancies were, my experience with abortion will cast long shadows over the remainder of my life. I don’t want another expectant mother to be blindsided by HG and end up like me. That’s why I wrote Beyond Morning Sickness: Battling Hyperemesis Gravidarum, and why all our volunteers work so hard to serve other sufferers who write to us at beyondmorningsickness.com. We all understand we must never forget the women who come after us; we must never let them suffer alone. They must see our success and know without a doubt that it can be their own.