The nurse came and drew the blue curtains around my bed as I continued to violently retch and vomit for the third or fourth time that day. Hunched over the grey cardboard bowl, I managed to catch a glimpse of the lazily disguised disgusted look on her face before she disappeared behind the other side of the curtains.

It was my first pregnancy and despite only being five weeks into it, the days had elongated and blurred into a dark miserable episode that felt more like five months. The closest thing I could equate it to was a continuous bout of norovirus with no end in sight.

I had been hospitalised for the third time in about a fortnight with unrelenting nausea and violent episodes of vomiting, and the medical professionals didn’t quite know what to do with me. I didn’t know at this point that I had hyperemesis gravidarum, a debilitating condition that affects approximately 2% of pregnancies and is characterised by severe nausea and vomiting. It isn’t your average morning sickness. The extremity of the symptoms often leads to dehydration and malnutrition, and in some cases gastrointestinal damage too. Alongside this are the myriad of mental health issues that can arise like depression and PTSD (post traumatic stress disorder), and in some cases, women abort their pregnancies because they simply can’t cope.

When the nausea had first started, I thought nothing of it. Everyone knows about morning sickness – around 70-80% of women suffer from it and it’s even purported to be a sign of a healthy pregnancy with some studies suggesting it lowers the risk of miscarriage (1). I put it down to genetics as my sister had suffered from extreme nausea in her last pregnancy.

It was only when my mother-in-law, a mother of four herself, pointed out that my nausea wasn’t normal that I decided to go to the doctors and have it checked out. She accompanied me to the GP surgery where I spent the majority of the waiting time in the toilets because I couldn’t stop retching. The extremity of the nausea was dizzying and overwhelming beyond anything I had ever experienced before but I was still in reasonable spirits at this point, clutching to the notion that it was all part of the process of being pregnant.

I reminded myself of the hadith, “No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls a Muslim, even if it were the prick he receives from a thorn, but that Allah expiates some of his sins for that.” [Sahih Bukhari]

When we were eventually called in for the appointment, the doctor asked me if I had tried ginger biscuits and dry crackers – I had, as well as homemade kahwa (2). She relented and prescribed me some mild antiemetics with the disclaimer that whilst they are generally known to be safe, there is always a risk in pregnancy when you take any type of medication. We went home and I tentatively took the tablets with encouragement and reassurance from my mother-in-law, expecting a sense of relief, but it didn’t come. The nausea continued to worsen and the vomiting was increasing in frequency. By the second or third day I was vomiting 12 times a day; my stomach was completely empty and my oesophagus was burning from bringing up bile. I was utterly exhausted from each episode as my body violently convulsed with the pressure and force of the vomiting. In those moments, I realised the complete lack of control I have over my body; a vastly complex and amazing vessel gifted to us by Allah that we often take for granted. We’re accustomed to it functioning and doing what it has to do every day, but only in moments of illness do we truly realise the immense blessing of good health.

Stupefied as to why the medicine hadn’t worked and desperate for some relief, my husband and I made our way to the hospital and waited patiently in the waiting area. Yet again, I spent half of the time in the toilets trying to disguise the sounds of my violent vomiting. This would turn out to be a routine in the next few admissions to the hospital during the coming weeks. Disappearing to the toilets in desperation, exhaustion and shame – not wanting to become a spectacle in the small, harshly lit waiting area.

When I was eventually seen by the doctor, the ginger biscuit question reared its head again. Some might deem it to be an innocent question but there is a subtext here, usually laden with an assumption that you haven’t explored avenues of self-help and are probably exaggerating your symptoms. It’s common for HG (3) sufferers to be met with this line of questioning leaving scope for further feelings of alienation and depression to develop in an already distressing situation.

I was administered fluid through an IV drip to rehydrate me and given stronger antiemetics that finally gave some respite from the persistent vomiting, but the overwhelming nausea remained. It was a welcome relief but would end up short-lived as the symptoms would worsen again once I returned home after a few days.

We developed a routine for the next few admissions. Waiting in A&E after days of increased vomiting, the inevitable ginger biscuit questioning, eventually given IV fluids and antiemetics, staying a few days on a ward and then being sent home with oral antiemetics whose effects would only last a few days at most before it became unbearable again. And thus the cycle would repeat.

It was only after I read the discharge note on my last admission that I discovered that what I was suffering from had a name – hyperemesis. I tried to research and find out more to help myself manage the symptoms. The doctors said it should curb off after the first trimester but I discovered that it can stay for the entirety of the pregnancy and it did, but fortunately, the severity of the symptoms lessened for me. There are instances, though, of women suffering with extreme sickness throughout their pregnancy.

Desperate not to be hospitalised again and feeling like a burden on the system, I intensely supplicated and turned to Allah seeking relief and ease. Eventually, I was able to manage the symptoms at home by staying heavily medicated on complete bed rest for approximately six weeks. Even minimal movement like walking a few metres to the bathroom could induce an episode of extreme vomiting, so I had to be very careful. My husband became my main caregiver and pillar for support. The severity of it did lessen after the first trimester but the nausea stayed for the whole pregnancy with recurring episodes of severe vomiting if I over exerted myself in any way. My day-to-day activities became limited and subdued. It was a depressing and isolating time that inevitably caused a great effect on my mental health too.

Many women are often reluctant to pursue avenues for treatment because of a fear that it may harm the baby and this is completely understandable. I was in that position myself. Although some women manage to get through without medicating, it’s essential for healthcare professionals to relay accurate and empathetic information to sufferers to help them make informed decisions on what route to take. There are a number of pathways to treatment available in a tiered system of medication starting with IV fluids and vitamin therapy that builds into stronger options like antiemetics which research has so far shown to have minimal risks in pregnancy.

More than 80% of women will suffer from hyperemesis in their subsequent pregnancies too (4) and I became a part of this statistic. I was better equipped to advocate for myself the second time round through the help of a UK based charity that supports HG sufferers called Pregnancy Sickness Support. They helped me to draw up an action plan as soon as I found out that I was pregnant, which I preemptively took to the GP should the hyperemesis develop again. This included details such as not having to do multiple A&E admissions with long waiting times whenever I needed IV fluids and gaining access to treatment more quickly.

Fortunately, there was a lot more information and help available online in comparison to when I was pregnant last time, and even the hospital had implemented a policy of direct access to treatment specifically for HG sufferers including a private room to administer IV fluids and medication. I also discovered private help groups on social media sites that had thousands of other women from around the world who were suffering from hyperemesis. This peer support turned out to be an invaluable resource in helping me to cope but the strands of PTSD emerged and whilst my physical symptoms were actually less severe in my second pregnancy, the mental toll of reliving hyperemesis turned out to compound the original trauma from the first pregnancy.

As with most illnesses, a woman’s experience of hyperemesis will be subjective to her individual presentation of it, so there’s no one size fits all answer on how best to treat it, but every woman should be offered adequate resources and knowledge to help her to get through this debilitating time.

When I reflect back on hyperemesis, it was a deep condition of helplessness and desperation, leading to a realisation of a true state of reliance and slavehood before Allah. My body had become a fragile vessel that I had to handle with kid-gloves in fear of it literally erupting into violent episodes of illness, and whilst I was overtly relying on the medication to help keep the hyperemesis in control, I became fully cognizant that the Source of healing was beyond the chemical formulas I was ingesting. It’s a reality that most of us are aware of; that everything is in Allah’s control, but in our innately human state of forgetfulness, we can easily lose sight of this in our daily life. It sometimes takes moments of extreme tribulation to be reminded of it.

References

Flaxman SM, Sherman PW. Morning sickness: a mechanism for protecting mother and embryo. Q Rev Biol. 2000 Jun;75(2):113-48. doi: 10.1086/393377. PMID: 10858967.
A traditional hot beverage made with different ingredients, usually for medicinal purposes, in many ethnic households
Acronym for hyperemesis gravidarum
Recurrence Risk of Hyperemesis Gravidarum. J Midwifery and Women’s Health. Mar-Apr;56(2):132-6 (2011)

Rehnaz M

Hyperemesis Gravidarum: How This Rare Condition Impacted My Pregnancy