Hyperemesis and Breastfeeding – What You Need to Know

by Caoimhe Whelan, IBCLC www.latch.ie

If you are currently pregnant and suffering from hyperemesis gravidarum (HG), the chances are the condition is causing you to feel fatigued, low in spirits or perhaps even depressed – all of this on top of the physical symptoms of HG and the various other pregnancy challenges that women experience.

Every day can be a struggle. It might be hard for you to believe that you will feel normal again and that your body will once again be your friend, such is the unrelenting and overwhelming nature of HG. It might also be hard for you to mentally prepare for the birth of your baby and breastfeeding him or her. But if you are considering breastfeeding, this is what you need to know:

1. You CAN breastfeed after HG!*

Even though it might not feel like it right now, both your body and your baby are currently preparing for breastfeeding. Despite the hyperemesis, you body will still go through the normal hormonal changes to ensure that you will be able to produce milk for your baby. This is called ‘lactogenesis 1’ and involves the proliferation of milk producing cells in the breasts and the production of several different hormones for milk production. And while all this is happening, your baby in utero is learning all he needs to be able to feed at the breast when he arrives, for example how to find the breast, how to suck, swallow and coordinate feeding. 

*Please note: There are some conditions that affect a woman’s ability to breastfeed and
make enough milk for her baby, but HG is not one of them.

2. Having HG will not affect the ‘quality’ of your milk

Very often mothers who are experiencing HG worry that they will not be able to produce nutritious milk for their babies. Because of the struggles they are having keeping food down themselves, they find it hard to imagine how it will be possible for them to make ‘good’ milk. But there is no evidence for this. You body synthesises milk from constituents in your bloodstream, rather than the contents of your stomach, so you will make milk for your baby that has the perfect balance of fats, proteins, carbohydrate and nutrients. Your milk will be perfect for your baby.

“Because I was vomiting so much throughout the pregnancy and only wanted to eat fizzy jellies I was convinced that my body wouldn't produce "the right breast milk" that it wouldn't be nutritious, or my body wouldn't produce any milk! How could it with a diet of Fizzy jellies?! I also thought that if baby vomited from a breastfeed I passed on vomiting to her. Both irrational thoughts but that went through my mind I was hormonal.

I think hypermesis can cause a fear of vomiting. Even know if I feel nauseous I'm worried I will start to vomit causing a cycle of worry about baby not getting enough. I think this fear can take over for some women and make them give up breastfeeding altogether.”

Emma, breastfeeding mum to baby Keela

3. You cannot pass HG on to your baby through your milk

It might seem like an irrational fear, but when you are at a very low ebb, feeling unwell and miserable and struggling to believe that you will make it to your due date, sometimes fears like these can become magnified. But rest assured, your baby will not ‘catch’ hyperemesis from you or from your milk.

4. Your ability to breastfeed should not be affected by medications you are taking for HG

Whatever medications you are taking will not interfere with your body’s ability to make milk. The placenta is an excellent filter. And even if you need to need to be treated with anti-emetics or other medications for time after the birth of your baby, you will still be able to breastfeed. Most medications are safe to take while breastfeeding, and your medical support team will advise you on this.

5. Breastfeeding can help you heal and bond with your baby

Quite often, breastfeeding can be perceived as more work, or some added ‘extra’ thing to do. But actually, breastfeeding is just the normal, physiological way to feed your baby. And when it’s going well, it can be whole lot less work than preparing formula and sterilising feeding equipment. What breastfeeding can offer you is an opportunity to rest, recover from the previous months and to bond with your baby while those around you can help with other tasks such as preparing meals, housework etc. Breastfeeding is not just about food. It is about cuddles and skin-to-skin contact, and about your baby feeling secure and safe. When you are breastfeeding, certain hormones flow in abundance and can hugely impact your mood and sense of wellbeing. Oxytocin, the hormone needed for your milk to let down, helps you to feel calm and connected and to bond with your baby. It also helps to lower stress hormones. And prolactin, one of the hormones involved in milk production, can help you to feel relaxed and sleepy (which helps you to go back to sleep after night feeds). It’s probably also worth mentioning here that breastfeeding lowers the risk of post-partum depression in new mothers.

“I didn't enjoy either pregnancy due to feeling ill and exhausted all the time. I also found it difficult to bond with my unborn babies due to feeling so sick all the time.

I wasn't going to breastfeed either of them but despite some initial soreness after my first baby I breastfed her until she was 10 months (she didn't want to breastfeed one night when she was 10 months old and never looked for a breastfeed again). I am currently feeding my second child who is six months old. She was a month early and I felt breastfeeding would be the best for her. After my experiences of sickness I have found breastfeeding a great way of bonding with my children. It's also been a positive physical experience between us after my not so positive physical experience of pregnancy. It has also enabled me to rest after two difficult and physically hard pregnancies.“

Ruth, breastfeeding mum to baby Rosa

Tips to help prepare for breastfeeding

So, there are lots of reasons to breastfeed! If you do decide it’s for you, here are a few tips for helping to ensure you get off to a good start:

• Talk to your healthcare team (midwives, GP, obstetrician) about your intention to breastfeed, and that you would like to have as much help as possible after the birth to achieve this. And talk to them about any concerns or fears you have around being able to breastfeed, or about the possibility of the HG lingering after your baby is born.

• Ensure that your partner and family know that breastfeeding is important to you. There are lots of things they can do to help such as taking a breastfeeding class with you, minding your baby while you get some rest, preparing meals, doing grocery shopping and doing jobs around the house. 

• Attend a breastfeeding class – This is a great way to learn about breastfeeding in the early days, what is normal, how to know if breastfeeding is going well etc. Maternity hospitals usually run them, and check out support groups (below) and Doula Care Ireland as well.

• Investigate local support groups – Cuidiu, La Leche League and Friends of Breastfeeding groups love to see pregnant mums at their groups. Most women come away from a group like this feeling a little bit more confident about breastfeeding their baby. Some groups also do virtual/online support if it is difficult to leave the house or hospital.

• If you encounter a problem, help and support is available - know that if you encounter a difficulty with breastfeeding in the early days (such as pain, or a feeling of being overwhelmed), you can ask for help in the hospital, from your Public Health Nurse or GP, you can phone a voluntary Cuidiu breastfeeding counsellor or La Leche League leader, or available of the services of a lactation consultant working in private practice. Sometimes breastfeeding can take a little while to get established. It is a new skill that both you and your baby will learn together. So do reach out if you need help.

What if you are breastfeeding an older infant while you are pregnant with HG?

This depends on the age of your older child and what medications you need for HG. Generally, it is not recommended that lactating parents of premature babies take Doxylamine (one of the active ingredients in Cariban/Nuperal) as it could have a sedating effect on them.  However, older breastfed babies and infants are at a much lower risk of being affected by Doxylamine, especially if they have started taking solid food. If you are nursing your infant and start taking Cariban, monitor them for any side effects such as drowsiness or irritability and discuss any concerns you have with your GP. Here are some resources to discuss this: 

• The Trash the Pump and Dump website states that taking Doxylamine is NOT an indication to pump and dump (ie continue breastfeeding) 
• The Drugs and Lactation Database (LactMed) says that larger doses of Doxylamine can cause drowsiness in babies and could potentially affect milk supply if it has not already been well established, however, the milk supply of mothers nursing older babies is unlikely to be affected  -  
• E-lactancia categorises Doxylamine as high risk for breastfeeding or lactating parents due to its sedative effects and advises against its use by mothers of preterm babies and babies less than one month of age. -  

Information on other drugs used in the treatment of HG and their safety when breastfeeding can be found on Wendy Jones’s website.

“I breastfed my firstborn till he was 17.5 months and was forced to make the decision to stop because I was around 12 weeks pregnant with my second and was diagnosed with hyperemesis gravidarum. It was such a sad moment for me because I wanted to feed him till he was at least 2 and resented this pregnancy. However, survival was what mattered, and I had to look after myself and somehow the instinct that keeps mothers going also made me decide for the best at that point.

Hyperemesis was a new thing for me because I had not been touched by this on my first pregnancy. It took over everything, my life as a mum of a toddler, my life as a wife and my work life because I was on sick leave for weeks and weeks - something that had never happened to me in the 10 years I had been working! I was so weak and felt so lonely and depressed. I remember going to a Cuidiu meeting and telling the counsellors there how bad I felt about stopping to feed my little man... And it was so good to receive a hug and to cry... It was something I did a lot. I was an expat in Ireland at the time and therefore had no family around... My mother came over for five weeks and took care of myself and my family, which was really a blessing but I was so depressed and annoyed with myself at the time that I did not show her my appreciation at that moment... I hated myself for being pregnant again while my little boy was so young and still needed me so much... I felt like I had betrayed him... I remember going to my appointment in a satellite clinic and the midwife said I needed to go to the hospital to be admitted and to get some fluids... I was admitted to hospital twice and again felt like I was leaving my son behind... It was a nightmare. Breastfeeding another baby was the last thing on my mind. At around 20 weeks though, I started feeling a bit better, I would be sick fewer times and things took another turn as I read the 25th week. I was able to hold food. And my energy levels started going up.

When my little girl arrived at 41+5 weeks, I did not question whether I would breastfeed her or not because I had done this with my first. But I had so many doubts about having enough supply and dreaded the weighing with the Public Health Nurse (PHN) because I was certain that I did not have enough milk. In fact, before the birth, I remember asking the dietitian if I needed to do anything to make sure I had a good supply! As with my first, it was the most natural thing to do that was to feed my daughter! Her birth was quick and she was determined as I would discover over the months !!

And as I grew more confident, the doubts of not having enough supply subsided and became just a distant memory. Even the whole hyperemesis episode was quickly forgotten because it is amazing how birth and breastfeeding and seeing how my body was strong while I had hit the bottom - can be empowering! What our bodies do during pregnancy and even after to create and maintain life is just a miracle and I feel so blessed to have had a healthy baby despite everything that happened because of hyperemesis. My son fed a few times while I was feeding my baby and I was so happy that he was able to do this again... I cherish the time when they both fed... It is a real blessing and gives me so much satisfaction. My daughter is 16 months old today and is still breastfed. No end date in sight! Trust your body and your instinct... They will guide you to the best place for you and your baby.”

 Breastfeeding mum of two, Farzana.