As a doula, you are a non-medical support for pregnant, birthing, and postpartum families. While you are not a clinical provider, it is important you are familiar with common medical issues which impact the people you work with. Understanding hyperemesis gravidarum (HG) is important so you can provide evidenced based support to clients suffering from HG.
If you are familiar with medical terminology, hyperemesis simply means excessive vomiting. Gravidarum refers to pregnancy. However, HG is more than just vomiting.
While morning sickness impacts 50-90% of pregnancies, HG impacts just 0.5-2% of pregnancies. Morning sickness is considered a typical symptom of pregnancy. Medically, morning sickness is referred to as nausea and vomiting of pregnancy or NVP. HG is not a typical pregnancy ailment and always requires professional medical support.
As a doula, being familiar with symptoms of HG can help you in providing your clients with support, resources, and the information to self-advocate for adequate treatment.
What is Hyperemesis Gravidarum?
The HER Foundation is a leading expert in hyperemesis gravidarum. They explain it as unrelenting nausea and/or vomiting which leads to a loss greater than 5% of pre-pregnancy weight, symptoms which interfere with daily activities, and dehydration leading to the production of ketones.
However, if you ask someone who has experienced HG, they will describe it in a way which paints a greater picture of what it truly is. HG is truly life altering. It takes good things, gives bad things, and ultimately changes families.
The simple ability to stay hydrated, a basic need for physical and even mental wellbeing, is quite nearly impossible with HG. Many with HG cannot even eat, and if they can, the food immediately comes right back up. It can ruin teeth, steal time from children, ruin careers and finances, and in severe cases it can even lead to the loss of the pregnancy.
As a doula, if your client mentions any of the following symptoms, you should strongly encourage her to speak to her provider and be insistent about treatment:
- Inability to drink enough
- Frequent vomiting
- More than 24 hours without keeping food down
- Dark, foul-smelling urine
- Severe nausea impacting her ability to care for herself (e.g., unable to shower)
- Ongoing dizziness, especially if it leads to fainting (should seek help immediately)
- Feeling of ongoing vertigo
- Overall inability to function most of the day
Is HG That Much Worse Than Morning Sickness?
Morning sickness is highly inconvenient and uncomfortable. Some might lose a couple pounds and occasionally struggling with staying well hydrated. However, with typical morning sickness, there’s an ability to function decently, just at a slower pace.
With HG, there’s an inability to function well, if at all. One woman who experienced both NVP and HG as morning sickness being getting sick, washing your face, and then going about your day, but HG as getting sick and never being able to function without feeling as if you’re about to collapse.
While some call HG severe morning sickness, it is truly far beyond morning sickness.
Things such as ginger, crackers, eating before getting out of bed, none of those things work for HG. It is not a normal pregnancy side effect; it is a medical condition in need of treatment. As a doula, the best thing you can do is encourage a client to seek medical care and never push NVP remedies.
What Are The Effects Of HG?
Untreated or undertreated hyperemesis can lead to miscarriage, and in 10% of HG pregnancies even termination for medical reasons as not everyone receives proper treatment.
HG also often impacts future family plans as parents cannot fathom repeating such a difficult ordeal no matter how much they desire more children.
HG can lead to:
- Suffering strong phantom odors
- Weight loss with ongoing metabolic issues
- Depression and anxiety
- PTSD
- Side effects from needed medications
- Ongoing gastric issues and damage
- Dental problems
- Food issues
- Painful treatments with risks such as PICC lines
- Relationship difficulties
And that is only a partial list. When treated properly, some cases of HG respond well to treatment. Often, women are undertreated or not taken seriously. In rare cases, there is no relief with treatment, only basic management.
Where Can One Get Help With Hyperemesis Gravidarum?
As a doula, you are non-medical and cannot give medical advice. However, you can provide resources, especially if a client is undertreated.
Some are never prescribed medication even after losing over 10% of their body weight, some fight for necessary fluids and some are erroneously told termination is their only choice. If you have a client in that situation, refer them to these websites:
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...