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Hyperemesis gravidarum and my mental health

Charlotte & Henry
Charlotte with her son

By Charlotte Howden

Trigger warning: this piece contains graphic descriptions of hyperemesis gravidarum (HG) as well as mentioning suicidal thoughts. You can call the Samaritans on 116 123 or email jo@samaritans.org.
This article is based on Charlotte’s experience of HG but it’s important to remember that everyone’s journey is different. Please take care when reading and if you need further support please refer to our Urgent Warning.
If you are currently suffering with HG in the UK, please speak to your GP and reach out to Pregnancy Sickness Support charity. Motherdom is not responsible for the content of third party websites.
This content is for general information purposes only and is in no way a substitute for medical advice or treatment. You can see our full Disclaimer here.

I have spoken extensively about the physical breakdown of my body when I was pregnant with my son and suffering from hyperemesis gravidarum. But I found it very hard to talk about what I went through mentally. Hyperemesis gravidarum (also referred to as HG) is a severe pregnancy sickness condition that affects 1% of pregnant women, according to the charity Pregnancy Sickness Support (PSS). PSS lists excessive vomiting and nausea, weight loss, and dehydration among the possible symptoms. In my case, I vomited up to 30 times a day (I think I usually lost count) and when nothing was left to throw up, I would expel bile and acid from my stomach. It sounds traumatic, doesn’t it? It was. Thankfully, just before my 20-week scan, I was prescribed medication that enabled me to physically return to around 70% of normality. I was able to eat and drink and it stayed down. All was well! I was better – heavily medicated – but better.

Except that I was not.

During those 20 weeks I had become heavily depressed, and I had suicidal thoughts on most days. When you have nothing else to do but lay alone in a bed, your thoughts consume you.

Returning to normal (on the surface) conversations soon turned to how big my bump was getting, the gender of my baby and names. No one asked me how my mental health was.

And so, I remained isolated with my mind. I no longer had suicidal thoughts but now I wanted my son to be born early. I was wishing the days away, turning down invitations to see people, avoiding being near other pregnant women and would Google how early a baby could be born and survive.

Of course, my son was nearly two weeks late. When he finally came, I felt an incredible bond with him instantly. I was obsessed with him and sailed through early motherhood.

A recent study from Imperial College London in which just over 100 women with HG took part in, found that they suffered from much higher rates than normal of antenatal and postnatal depression. 49% had probable antenatal depression and 29% had probable postnatal depression. The study also concluded that there is a ‘large effect relationship between HG and antenatal anxiety’.

When my son was born, I showed no sign of the baby blues or depression, no red flags in the postnatal period at all. And yet, how could anyone believe that I was okay?

The Royal College of Obstetricians & Gynaecologists state in The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum Green-top Guideline, that ‘practitioners should assess a woman’s mental health status during the pregnancy and postnatally and refer for psychological support if necessary’, for women diagnosed with NVP (nausea and vomiting of pregnancy) or HG. This is a great step forward.

However, many women who I have spoken to told me that they felt their mental health was an afterthought or not appearing on health providers’ radar at all.

In the first two years of my son’s life, I was being held hostage by the legacy of HG and no one saw it. I now know that I was suffering with postnatal anxiety most likely triggered from my trauma, a normal response to an abnormal situation.

My anxiety took over my life. Every single day was spent analysing and planning for risk and danger. I was convinced that something awful would happen to either my son or I, and the only person who could prevent that from happening was me. The pressure of that was so overwhelming that eventually I would simply stop going anywhere that I deemed as dangerous.

I was out of the perinatal period when I realised that I needed to get help. Long NHS waiting lists meant that I had to privately pay for therapy. In two short sessions I had an explanation for my anxiety, an empathetic stranger had drawn dots that I just wasn’t able to realise. Put simply, HG was a traumatic experience for me and my mind was reacting to this. 1% are low odds, right? Almost impossible? But I am that 1% and so now anything that I might have previously passed off as unlikely to happen was a reality.

I did three sessions of talking therapy with a counsellor and in those 3 short hours, I was able to join up the dots of my trauma and the affect it was having on me and I was advised to find a way to process what I had been through.

So, in 2018 I embarked on a two-year journey presenting and producing the world’s first documentary about HG. Throwing myself into this condition, researching it, listening to, and interviewing brave women who had battled it or who were currently suffering with it, enabled me to do that. This project was as much about me processing my trauma as it was about validating women’s experiences, showing them that they are not alone and shining a spotlight on a condition that so few really understand.

I was also very lucky to work with Dr Hannah Wilson, a Clinical Psychologist during this project. She said something to me that will live with me forever: ‘anxiety is a normal way for your body to respond to an abnormal situation’. This was the first time that I had heard someone put the emphasis on my hyperemesis being abnormal, and not me.

It was tough road, but I did it. Sick – The Battle Against HG was released on Prime Video in the UK and US in September 2020. It’s also on Vimeo here.

I am not sure if it’s the quickest way to process trauma, or in fact the best way, but it taught me one thing: that however long the journey takes doesn’t matter. It’s starting the journey that’s important. With each day, I have started to feel physically lighter, I know that I am not alone, and I now have coping mechanisms to help me manage my anxiety.


10 Top tips for coping with hyperemesis gravidarum from Pregnancy Sickness Support:

The content below is for general informational purposes only, and is in no way a substitute for medical advice or treatment. You can read our full Disclaimer here.

  1. If your pregnancy sickness symptoms are far worse than you were anticipating then speak to your GP. If you don’t feel that you are being listened to, then try another GP or contact Pregnancy Sickness Support for information about how to seek help.
  2. Think of what you would say to a friend in this situation about seeking help. Do the same for yourself.
  3. If you are diagnosed with HG, accept that you have a serious illness and this is not a ‘normal part of pregnancy’.
  4. Rest! It can be hard to accept but you do need to rest.
  5. Eat whatever you can manage and don’t feel guilty if that’s crisps and toast. A calorie is a calorie regardless of where it comes from. Pregnancy Sickness Support can give you more information about how to fortify food and add nutrition. You can see the NHS advice on what’s safe to eat in pregnancy here.
  6. If you are not weeing much, or having dark yellow and strong-smelling wee, seek medical advice. You can read more from the NHS on dehydration here.
  7. Use unscented soaps, detergents and cleaning products if smells are a problem, and low foaming toothpaste if brushing your teeth is triggering.
  8. Try listening to audiobooks or relaxing podcasts to pass the time, particularly if reading or watching screens triggers symptoms.
  9. Try to avoid thinking ahead more than the next few days. Take each day at a time.
  10. Contact Pregnancy Sickness Support for ongoing 1-2-1 peer support and more information about coping strategies.

This article was reviewed by Dr Claudia Pastides and edited by Anna Ceesay.

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Urgent Warning

Some of the material you read on this website is potentially upsetting. Or you may read an article that makes you realise that you are struggling more than you thought.

If you need further support, please speak to your GP or another healthcare professional within or outside of the NHS. If you are seeking help outside of the NHS, make sure you see someone registered with an appropriate professional body.  There is also lots of information available online via MIND or the NHS website.

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