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After HG

Support is Vital

"The support I received over the past 6 weeks helped get me through what has been the toughest time of my life. Having someone who really who really understood the condition give advice helped us through and crucially, at times, gave me really useful information I didn't get from my own medical practitioners. In my experience, HG is such a debilitating and lonely struggle, the more support you get the better chance you have of surviving it" - Lisa, from London.

HG Facts

Hyperemesis Gravidarum rarely ends at 12 weeks of pregnancy. It typically improves in the middle of pregnancy, but symptoms often last until birth. 

Preparation for an HG Pregnancy

This page focuses on the practical things you can do if you have decided to try for another pregnancy after HG. Click here for information on recurrences, and questions to consider if you are thinking about it or unsure. 

There is not a lot of research on HG recovery and pregnancy after HG to guide us yet, so the below is based on both what we do know, and our own practical experience. Not all of the information below will be relevant or possible for you - consider what makes sense to you and your individual circumstances. Please discuss medical options with your own doctor. 

Not all pregnancies after HG are planned of course, but there are still steps you can take to help make another pregnancy more comfortable. 

 

When should you try again?

There can be a lot of pressure from friends, family and random members of the public about “when are you having another one?” - it’s no-one’s business but yours, and there are no “wrong” timings! If you have had fertility treatment or pregnancy loss, it can be particularly painful to be asked. 

The general guidance on how long between (full-term) pregnancies is 12-18 months between the birth of one baby and the conception of another - to reduce the risk of premature birth and low birth weight. Your risk of these complications go up with HG, so with a history of HG, leaving a gap longer than 12m may be a good idea. It may allow you more time to physically recover, especially if you lost a lot of weight or had complications as a result of HG. If you are breastfeeding your older child, that’s another factor to consider.

Practically speaking, many HG survivors find it easier to think about another pregnancy when their child at home is more independent e.g.: is out of nappies, can play independently, or is at school. Mentally, it may be easier to use a long-acting reversible contraceptive (LARC) such as an IUS, IUD, injection, or implant until you are definitely ready to try again, as their failure rates are lower than other types and you don’t have to make a decision about them frequently (e.g.: taking a pill every day, using a condom every time you have sex, etc. More information on the free contraception scheme is here.)

"I've had hyperemesis with each pregnancy. I don't think I prepared mentally for my second pregnancy to be honest, and the impact hyperemesis would have on me. My first child was 18 months and it took a great toll on my mental health. I waited 3.5 years before getting pregnant again, I had to mentally prepare, and also ensure I had the right supports in place, medication-wise. Having a bit more time in between pregnancies and preparing for the likelihood of another hyperemesis pregnancy made all the difference. So while the hyperemesis is maybe worse, I've coped much better in my third pregnancy." - Marie*

Your health 

Do you feel physically and mentally recovered from pregnancy? Are there any lingering health issues - mental or physical - that you’d like resolved or stable before getting pregnant again? When you have HG, you are in survival mode: so consider getting routine health to-dos like dental checkups and smear tests (if due) out of the way before trying again. 

In Ireland, folic acid and Vitamin D supplements are recommended for everyone for three months before conception, if possible. Some people need higher doses of folic acid - you can read more here. This is particularly important if you are likely to struggle with taking folic acid in early pregnancy. 

Depending on what you are currently eating, how long it has been since your last pregnancy, and how severely your hyperemesis affected your food intake during your last pregnancy, you may benefit from taking additional prenatal supplements. Some maternity hospitals may offer a pre-pregnancy dietitian service for HG, but if not, a list of dietitians working in private practice is available here: https://www.indi.ie/find-a-dietitian.html

 

Taking medication to prevent HG

It’s not a guarantee, but there is some evidence that taking medications as soon as you know you are pregnant can help reduce your risk of developing HG, or make it less severe than before. You can also start taking medications at the first sign of nausea/vomiting even if it doesn’t meet the criteria for HG yet: 

A Canadian study comparing women with NVP (PUQE score  of  13  and above)  who  took  pre-emptive  antiemetics  before  pregnancy  or  before  the  onset  of  symptoms  with  those who did not, reported a lower recurrence rate of HG….There  was  also  a  significant  improvement  in  the  PUQE  score  of  NVP severity compared with the previous pregnancy in the pre-emptive  group.  Women  who  have  experienced  severe  NVP  in  a  previous  pregnancy  may  benefit  from... commencing antiemetics before or immediately at the start of symptoms in a subsequent pregnancy - RCOG guidelines, section 8.3

The medications in the studies above were doxylamine/pyridoxine (the same as Cariban) or not specified. However if Cariban did not work for you in a previous pregnancy, it is reasonable to start with a second-line medication. 

"Due to the clinical guidelines given to me from this page, I started meds the minute I got a positive test and I didn't vomit once and had minimal nausea. I was a functioning human being. Compare that to my first horrific journey where I had to beg for meds at 16 weeks as no-one would listen to me!" - Ciara*

 

Finding a supportive doctor 

A knowledgeable and supportive GP can make a huge difference to your experience: they are your most accessible doctor in early pregnancy when HG hits. 

If you have private health insurance, or can pay out of pocket, a consultant obstetrician can also be accessible in pre-pregnancy and in early pregnancy. If you don’t have private health insurance yet, you need to have signed up for 12 months before they cover any pregnancy costs. 

Questions for finding a supportive healthcare provider: 

  • Do they know the 2021 consensus definition for HG?
  • Have they read the latest HG guidelines? (HSE guidelines and RCOG guidelines)
  • Are they happy to prescribe medications for you before pregnancy, or from the start of pregnancy? 
  • Can they explain to you how HG is assessed and managed in your maternity hospital? 

Ultimately, you want a doctor who takes HG seriously, understands the complications and the toll it can take on you, and is willing to work with you to find treatments that will help you. Consider making a pre-conception appointment with a GP to discuss the above: you should leave feeling supported not dismissed. If not, keep looking!

It’s also a good idea to give permission to your doctor to discuss your care with your partner or someone else you trust, in case you aren’t able to during pregnancy.

My first HG pregnancy was horrific. I couldn't access Cariban, and then I couldn't afford it. My daughter stopped growing and was born tiny, and I was left with several health problems afterwards. It took years for me to feel like I was ready to get pregnant again.
 
This time, I was given medication by my GP to take preemptively and then Cariban at 6 weeks. Even at its worst, it was easier than the first time. And this baby is measuring right where she should be. My second pregnancy (although still very difficult) has been a night and day difference to my first, and has been very healing for me.
 
 - Trish, support group member. 

 

Household work

It’s usually easier to do this planning before pregnancy, as depending on your HG symptoms you may not be able to think about food, be in the same room as children and/or pets, look at screens, or move around your home much. 

  • Sit down with your partner - or whoever you live with - and write a list of everything you do for the household in a typical week: childcare; laundry; food shopping; cooking; cleaning; pet care; paying bills; etc. 
  • Write down who will manage each of those tasks if you are unable to in pregnancy.
  • Does your partner/other members of the household know how to do everything on the list, where everything is kept, contact numbers, passwords, etc.? Writing these details down in a shared document can be helpful so others can refer to it without asking you when you are sick. 
  • Can friends and family help with any of these routine tasks, or help you pay for external help like a cleaner/babysitter/dog walker/meal deliveries? Some families find it helpful to batch cook and store meals in the freezer. 

 

Workplace Issues

If you are employed, check your workplace policy on sick leave, long-term sick leave, and pregnancy sick leave. Citizens Information is a good source of general information on sick leave and what you are entitled to during pregnancy. 

If your partner is employed, it’s also a good idea to check if they have any extra leave entitlements if you need extra care. Unfortunately state Carer’s Allowance doesn’t apply to HG as the sick person needs to “require full-time care for at least 12 months”. 

If you work in the public service, and need to be hospitalised with HG, you may be entitled to Critical Illness Protocol benefits - more details here. This can be claimed retrospectively. 

 

Preparing for Hyperemesis Gravidarum Worksheet

This is a detailed care plan to help you work through with your GP/Consultant.

Hyperemesis Gravidarum Care Plan

This last document can go into your Patient Held Maternity notes and a copy can be scanned for your GP/hospital notes so that all the doctors in your practice can access it and so on. 

Book Recommendations

The book Hyperemesis Gravidarum: the definitive guide may be useful for you and your support people to read before planning another pregnancy (UK-based information).

The memoir High Risk by Dr Chavi Karkowsky (US-based) has a chapter on HG and its history in medicine. 

 

Books for kids

If you have kids at home, it can help to prepare them for what HG looks like. Members in our support group recommend the following books to read with children: 

How to be an HG Hero by Caitlin Dean. Caitlin is the Chair of Pregnancy Sickness Support. 

Mama Has Hyperemesis Gravidarum (but only for a while) by Ashli McCall. 

 

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