Hyperemesis Gravidarum – The pregnancy Voms

Hyperemesis Gravidarum – The pregnancy Voms

“Aah Phoebes, you have that wonderful pregnancy glow. Glow … that is sweat! You throw all morning and see how you glow” – F.R.I.E.N.D.S

That unmistakable wave of nausea is commonly one of the earliest signs of pregnancy. It can be bitter sweet, as no one really likes to feel nauseous, but when pregnancy is your goal, it is really exciting. 70 -90% of women experience nausea and some vomiting in the first trimester. The cause of nausea in pregnancy is not completely understood, but does appear to be linked to the production of Human Chorionic Gonadotropin (HCG) hormone. Nausea usually starts at around 4-8 weeks and subsides around 12-14 weeks.

For around 5% and up to 20% of these women, this will continue throughout the pregnancy. Hyperemesis Gravidarum (HG) is the most severe form of nausea and vomiting in pregnancy, associated with ketosis, weightloss, dehydration, electrolyte and acid imbalances, and nutritional deficiencies. Severe cases may need hospitalisation. Women that are more likely to develop HG: developed symptoms in previous pregnancies; have menstrual migraines; develop similar symptoms taking oestrogen (birth control); experience motion sickness; and have GI problems such as ulcers or reflux.

Your obstetrician or midwife will usually start by trying natural nausea prevention methods such as Vitamin B6 and Ginger, eating smaller frequent meals, and dry food such as crackers. Drinking plenty of fluids to stay hydrated. Now, pregnant moms that I have given this advice to move from sarcastic, to nuclear, and then often to defeated. I asked some of my mom’s to tell me about their experience:

I have been pregnant twice and in both my pregnancies I have suffered terribly from nausea and vomiting. It started around 8 weeks and continued throughout the pregnancy. With my first I lost 10kg, and with the second it was 7kg. I felt nauseous all the time and certain smells and foods would set me running to the toilet. Nothing worked, I tried everything. My doctor even put me on medication but to no avail. I was open to all advice, I would have tried anything to stop it. Donna Matthews

Severe cases may require hospitalization. Pregnant women who are unable to keep fluids or food down due to constant nausea or vomiting will need to get them intravenously. Medication is necessary when vomiting is a threat to the mother or child. Majority of mothers try avoid medications at all costs during pregnancy, so usually if a pregnant mom is asking for medication, she really is desperate.

I was very excited when I found out I was pregnant with my first daughter, sadly that excitement was very soon replaced with nausea and vomiting which lasted all day. It started at about the same time that I began to suspect that I was pregnant and worsened as my pregnancy advanced.  I told my Gynae at time that I was suffering from severe morning sickness and could barely keep any food down. I was given Asic tablets and told to eat small meals regularly, this did not help one bit. The gynae would not give me anything stronger as she was unsure of what effect it may have on the baby. I was unable to go into any shop which stocked meat of any form as the smell made me vomit and I regularly had to leave a trolley full of groceries and run. My husband and I turned vegetarian for almost 6 months because I could not cook any meat.  My work was compromised, some days I only managed to get to work around midmorning and many days I had to call in sick. I vomited for a full 39 weeks and was totally exhausted and despondent by the time my C-section date arrived.  I suffered from exhaustion and postpartum depression for a long time after my daughter was born and I think a lot of it could be linked back to the hyperemesis. It took us 6 years to work up the courage to go through all of that again despite people telling me that the next time might be different. When I found out I was pregnant with my second daughter I made the Dr redo the blood test 3 times just to be sure as I was slightly nauseous, but not vomiting, however by week 7 the vomiting had set in again. When I was 10 weeks pregnant I was hospitalised for 4 days because I could not keep anything down and was becoming dehydrated. When I was discharged my Gynae prescribed Zofur which reduced the vomiting to mornings only, however the nausea remained. We finally got the vomiting under control around the 20^th week of my pregnancy, even though the nausea was never controlled and I struggled to eat many things. I felt a lot better and had far more energy going into the birth the second time around and am coping much better in the weeks following the birth. I had many people giving me advice about what worked to reduce their morning sickness, including ginger suckers, teas and small meals. None of this advice was helpful as none of it worked and I got progressively more frustrated and despondent. Hyperemesis is debilitating and frustrating and I don’t think that women who truly suffer from it are taken seriously, I mostly felt like a hypochondriac when I told people how terrible I was feeling. I will definitely not be having any more children as I cannot go through those months of vomiting again. Meagan Mansell

Medications that are commonly used:

Antihistamines such as Diphenhydramine or Meclizine, these commonly cause drowsiness.

Other anti-nausea medications such as promethazine and metoclopramide are available for use. Zofran (Ondansetron) is commonly used to help with HG. Zofran blocks the actions of chemicals in the body that can trigger nausea and vomiting.

The way that medications are used can improve efficacy.

-          Changing medications abruptly and frequently is counterproductive

-          Scheduled dosing improves response, rather than taking when needed.

-          Wean slowly after a few weeks of stability and adequate nutritional intake

-          Medication may be needed until delivery

Complementary treatments can be used such as acupuncture, acupressure, and hypnosis. These have been helpful for certain women.

Many of the moms worry how the HG will affect the baby. Although the pregnancy may be long and tedious, nausea and vomiting of pregnancy is typically not associated with adverse pregnancy outcomes in the absence of severe malnutrition or weight gain <7kg. There is strong evidence that women with nausea and vomiting in early pregnancy have a lower rate of miscarriage than women without these symptoms. Larger follow-up studies are needed to determine whether HG has long-term effects on offspring.

There are others that have HG and they are usually your best resource, even if it is just to know that you will survive it.

 

www.HelpHER.org

info@HelpHER.org

facebook.com/HERFoundation

twitter.com/HGmoms

I Don't Have Enough Milk

“I Don’t Have Enough Milk”

By Samantha Crompton BNURS SACLC

New mothers are often overwhelmed with the insecurity that they will not be a good mother, that they will not do everything right. Over the years our confidence in the ability of our bodies to grow, birth and nourish our babies has been stripped from us. I often hear mothers say that they don’t have enough milk, and I always try and find out why they are saying this.

“The first milk is not enough, I need to top up until my milk comes in”, the milk coming in is an unfortunate term as it implies that there was no milk to begin with which is untrue. Despite mothers knowing the many benefits of colostrum, when they hear that it is measured in teaspoons and not tens of mls, they often think that can’t be enough for my baby, surely I must top up.

 A newborn with a stomach capacity of around 20ml translates into a feeding interval of around 1 hour. This is in line with gastric emptying of human milk and neonatal sleep cycles. Larger feeding volumes at longer intervals may therefore be stressful and the cause of spitting up, reflux and hypoglycaemia. (Bergman 2013)

 

Colostrum is low in fat, and high in carbohydrates, proteins and antibodies. Natures first vaccine. It is easily digestable, and has a laxative effect on baby helping to pass early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice. Colostrum has an important role to play in babies gastrointestinal tract. A newborns intestines are very permeable. Colostrum seals or paints the GI tract mostly preventing foreign objects from penetrating. Small frequent feeds are all your baby needs, and your breasts will begin to produce mature milk increasing in volume as your baby grows. It is often not that our baby is feeding too often and not getting enough in these early days, but more that our expectations of how often baby needs to be fed are misdirected.

“My baby feeds all the time, my milk must be low or not strong enough”

Firstly it is good to know that frequent nursing is normal and expected in the early months. Most newborns need to nurse 8-12 times a day. It is needed to reduce engorgement in early days, nourish growing baby with a small stomach capacity but needs to double weight by 5-6 months, and to establish a good milk supply.

 SUPPLY = DEMAND. (Every formula bottle decreases demand therefore supply leads to vicious cycle).

Nursing is not only about nutrition, safety & security are basic needs. They just need mom, lots of kangaroo care in the first 6 weeks.

Managing expectations, it helps when the parents understand growth spurts or frequency days. I usually get the crying phone call at 2 weeks old. This is good baby suddenly turned on you and the lack of sleep caught up. Nature designed these frequency days to increase our milk supply to keep up with the growing demands of our baby. Your baby can feed every hour for 2-3 days and then usually returns to normal feeding patterns. They are difficult but if you are prepared for it mentally and physically. Adjusting expectations is the best way to cope. Once you consider frequent nursing in this time to be the norm and not a problem it will make life easier. Prioritise your to do list – List things that have to be done in the week and list things that can wait.

“When I pump, I am only getting ..ml’s”

Pumping is a good way to see how much milk you can pump. A baby that breastfeeds well can get much more milk out than you could ever pump. How much milk you can pump out depends on many factors. It is not unusual to have to pump 2-3 sessions to get enough milk for 1 feed. Pumped milk while breastfeeding full time is extra milk. It is normal for output to vary from session to session and day to day. Other things to consider:

-          Are you using the appropriate pump for the stage of nursing and the amount of pumping that you are doing. It is extremely difficult to pump colostrum with an electric pump. In early days hand expression is much better than any pump on the market. If you are pumping for a full day away, you may need a double electric pump to keep up.

-          Is the flange on the pump the correct size. Sometimes switching to a larger flange or getting the correct sizing makes all the difference.

-          How old is your pump?

There is also the lost art of Hand Expression. It is extremely important to  learn how to hand express. No need for electricity or batteries, hands are always with you. A number of my mom’s that battle to express using pumps get much better results when using hand expression or manual pumps.

How do I know that I really have a low supply?

As moms we tend to stress ourselves more than we need to. We obsess about knowing how much milk baby is getting. Let baby tell you how much milk he is getting.

-          The number of wet nappies your baby produces.

-          Weight gain problems such as a flat or dipping growth trajectory.

-          Consult with qualified SACLC or IBCLC lactation consultant

There are many factors that can cause a low supply, but it is not all doom and gloom, and the answer is not always come in a tin or a pill / supplement. We need to find the cause of your low supply and address the problem. Discuss these technicalities with a skilled lactation consultant and together you can find the right solution for you.

Samantha Crompton

BNURS RN RM community psych

South African Certified Lactation Consultant

Certified Preggi Bellies Instructor