HG & Birth
You may be wondering how HG may affect your birth and the day you meet your baby. Depending on your health and your baby’s, some things may be out of your control: but thinking about what is most important to you, will help both your experience during, and how you feel afterwards.
- For some of us - particularly if your symptoms are still severe in the third trimester - you may just want the pregnancy to be over ASAP and a planned induction or c-section may sound best.
- For others, birth is a way to reclaim your pregnancy experience and get closer to what you thought you would have before HG; it can feel very important to get as close as possible to your own ideal birth and/or not feel medicalised. So this might mean opting for midwife-led care, planning a homebirth, or labouring at home for as long as possible. A HG diagnosis by itself shouldn't limit the choices available to you.
There is not a lot of research on birth experience and outcomes for HG patients: so the below is not evidence-based information but simply practical advice to consider. Discuss the information here with your doctor or midwife, and your partner and support team - taking your health, your baby’s health, and personal preferences into account.
As always, this does not take the place of medical advice.
HG Symptoms
Even if your HG has totally disappeared or is minimal by the end of pregnancy, nausea and vomiting can be a typical part of labour and birth, and so it’s still worth thinking about how you may handle that if it happens.
- Think in advance about what you’d like your providers/partners to do if you are nauseous or vomiting during labour/hospital admission - for example, some of us find a cold cloth or hand on the back comforting, others don’t want to be touched at all.
- If you have specific triggers like smells, discuss them with your team and put them in your birth preferences.
- Bring your safe foods and drinks with you.
Taking Medications
- Ask about continuing your usual HG medications, or adding others, to avoid or reduce nausea and/or vomiting during birth. Bring your medications with you to the hospital to avoid any delays in taking your meds.
- Ask about pain medication options during and after birth, as some have nausea and/or vomiting as a side-effect (e.g. gas and air, pethidine injection during labour, or morphine after birth).
- This is particularly important for c-section births where vomiting during surgery, or with a fresh incision, is something to avoid! Ondansetron is commonly given during c-sections to reduce nausea, so ask if that is suitable for you.
- If you do vomit (or sneeze or cough) after a c-section, holding a pillow to the incision can help reduce pain.
Fasting
You may be asked to avoid eating and/or drinking before a c-section or, sometimes, during induction. This can be really difficult with HG and make your symptoms worse. Ask about:
- Your personal risks if you eat/drink your usual foods while in labour: hospital policy is usually general, and your specific risks may be different due to HG.
- “Sip til send” where hospitals allow clear fluids for the hours immediately before surgery
- Being scheduled early in the morning, so that you have to spend as little time as possible with an empty stomach
- And taking extra anti-nausea medications, whether as tablets, injections, or IV.
"My HG was well-controlled by the end of pregnancy and so I didn't think it would factor into birth - and none of the medical team asked either. I had to have a c-section; because of other emergencies my surgery was delayed, and I had been fasting for over 16h by the time of the surgery. I had also been told not to take my usual HG medications that morning, and I was in so much pain afterwards that I couldn't eat. I got morphine for the pain, which made me more nauseous and, combined with the empty stomach, made me vomit, which made the pain worse. It was a vicious cycle that made my first few days of recovery so difficult, but could have been avoided with more consideration on how HG could impact me." - Lynn*
IV Access
If you’ve needed IVs in pregnancy, you may have a good idea of which are your “good” veins or most uncomfortable placements. If you’re likely to need IV access for birth - so particularly if you’re planning an induction, epidural, or c-section - put this in your written birth preferences or ask your provider to add it to your notes.
Antenatal Classes
Hospitals usually run their own antenatal classes (sometimes specific to a particular group e.g.: birth after caesarean). Ask if you can do an online version and/or bring a support person, if your symptoms might prevent you from attending in-person or you have to leave early.
An independent antenatal class can also be really useful to understand your options and go through things in more detail - if you find it difficult to attend in person, some organisations offer virtual or one-to-one classes. A doula (non-medical support person trained to support you) can also be a great support to you in pregnancy as well as during and after birth.
Advocacy
Talk to your maternity care providers about how HG might impact your birth experience. Make sure you have as much information as you need to make decisions that are right for you - you can request a birth preferences meeting or a longer appointment to allow time for this, beyond the usual antenatal appointment times.
- Continuity of care can be really helpful, so some of us opt for a private obstetrician, Domino/community midwife, or private midwife. However if these aren't accessible to you, there may still be continuity through the public service if you request it (e.g.: asking to see the same 1-2 doctors or midwives at your appointments; the perinatal mental health team may be helpful here). A doula can help too.
- Whatever type of birth you are planning, many of us are traumatised by inadequate treatment in earlier pregnancy. If you've had bad experiences in hospitals you may find it hard to trust the healthcare provider; or you may feel like you are unable to speak up even though you want to.
- Talk to your birth partner about your birth preferences so that they can support you. Your birth partner(s) should be ready and able to speak up for you, and familiar with what you do and don’t want: practicing beforehand can really help!
- You can add some dos and don'ts to your birth preferences, such as phrases to use or avoid.
Further Resources
HSE information on antenatal classes
Doula info: Doula Association of Ireland, Doula Care Academy, ITP Association for Doulas
