Hyperemesis Gravidarum (HG) is a severe complication of pregnancy in which women suffer extreme levels of nausea and vomiting and a host of other symptoms such as very heightened sense of smell, excessive saliva production, extreme fatigue and so on. The nausea and vomiting can cause dehydration and malnutrition and women are often rendered bed bound for weeks or even months on end due to the condition.
In a first pregnancy this can be hard enough to manage with work and so on but how on earth do women cope when they already have children, perhaps even a toddler at home?
Well the sad truth is that a lot of women are unable to have another pregnancy while they have a small child at home and inability to care for other children is a commonly reported reason for terminating an otherwise wanted pregnancy.
However, for many women with the right treatment and careful planning and preparation another pregnancy is do-able – And I’m going to tell you how.
Preparation, preparation, preparation!
For a lot of couples approaching reproduction they can just “come off contraception and see what happens”. But for women with a history of hyperemesis gravidarum it is far more important that you plan a pregnancy like a military operation. The condition has over 80% of recurring in subsequent pregnancies once you’ve suffered once so you need to be prepared and tackle it head on [1, 2]. If you don’t suffer then great, all you have done is waste a bit of time preparing and much of that won’t go to waste and will allow you to relax more often anyway.
In my book Hyperemesis Gravidarum – The Definitive Guide  there is a whole chapter on preparation and so I would recommend you read that and follow the plan. But in summary, there are two main aspects to preparation: A treatment plan with pre-emptive medication so that symptoms are got under control early and hopefully the severity will be reduced; practical matters such as childcare support and food for the family.
Getting early treatment
Early treatment is key to getting HG under control and when you have a toddler to look after it’s all the more important that you keep symptoms manageable. There are a number of medications which can be used safely in early pregnancy and there is more information about them on the Pregnancy Sickness Support website. 
Having a plan in place with a GP or hospital consultant also means that once you are sick and struggling to communicate you hopefully won’t have a battle on your hands to access treatment.
Planning in advance means you could arrange with the hospital to access IV rehydration as a day patient or even in some areas to have IV rehydration at home.
When you have a small child to care for these sort of arrangements can make all the difference as being admitted to hospital over night simply may not be an option.
There are a number of practical things you can do prior to pregnancy which will enable you to look after your toddler and cope better at home once you are sick:
- Prepare meals in the freezer and stock up on tins
- Set up online grocery shopping so you don’t have to manage a toddler and vomiting in the supermarket
- Stock up on household items like hoover bags, cleaning products and so on and source “scent free” products such as baby wipes and laundry detergent.
- Make a “Household Manual” so that if you do end up being admitted or needing family/friends to help at home they know where things are and how you like things done
- Develop your support network! Who is available to help with the toddler if you need re-hydration? Are there local friends who could help out with a meal once a week?
Occupying a toddler
Occupying a toddler while you are consumed by intense nausea and regular vomiting can be a daunting prospect and puts off a huge number of women from even attempting it. But again, with planning and preparation it is possible for most families.
In her excellent blog Adventures of Adam, Pregnancy Sickness Support Trustee, Emma Edwards, addresses how you can entertain a toddler while you are sick. She states that for the mum suffering HG, child based activities should:
* not need any preparation and for most of the resources to be found around the home
* not involve food
* not contain an odour (vomiting trigger)
* be mess free
* promote independent play
She has a whole section of her blog dedicated to suggested activities for the toddler at home with a poorly mum and the whole blog is an invaluable and inspiring resource.
Ask for help and accept offers
You don’t have to do everything on your own and it’s okay to accept help from friends. Have a list of things that you could suggest for when a friends says “let me know if I can help”… be ready… Instead of just saying thanks say “well actually…” and suggest what would be helpful:
- taking your toddler to the park for an hour
- taking your child to play group when they are going
- picking up some essentials from the shop or your prescription from the chemist
- dropping round some supplies for activities
- having your partner and kid over for tea one evening
- picking up older children from school
Most people are only too happy to help when directed.
Seek support for the long lonely nine months
Contact Pregnancy Sickness Support (PSS) and arrange for a volunteer to support you. Having someone to text and email will make a big difference to the isolation which can rapidly set in. You can also seek support on the PSS forum from other women who are going through the same ordeal at the moment. You’ll find further tips and advice on their from other mums who have been through it with toddlers at home.
Even if your partner is the most supporting person in the world, it will be different from them also this time as their attention and support must also be divided between you and your child and that’s okay. During my second pregnancy my husband and son really bonded and became a little team.
Often at the weekends I would feel quite left out as they went off on adventures together while I rested in bed.
By my husband focusing his efforts on our son my isolation was increased but that’s okay because he was looking after Alfie and because I was able to rest it meant that when they got home I would be able to spend a little more quality time with Alfie. So by sorting out your own external support through the PSS volunteer network you free your partner up to focus on the kids.
Tackle it as a team
Around half of the women we speak to through the PSS helpline have very supportive partners who alter their routines and schedules and help out as much as humanly possible. Hopefully you have one of these sorts of wonderful partners who tackle HG as a team… it’s your joint baby you’re growing after all!
Unfortunately though the other half of the women I speak to have a different sort of partner. It may not be that they are totally unsupportive, but many partners have demanding careers or simply don’t know how to help and lack confidence with their own toddlers. If this is the case in your household then you need to open communication, ideally before the pregnancy, about mutual expectations and practical matters of how they can help.
Sit down together and work out how you can rearrange you routines to make this pregnancy possible.
- Could your partner to get up 10 minutes earlier and make a packed lunch for your toddler and cut up some snack stuff?
- Could they do toddler night duties for you while you are ill? (yes they may be a little more tired at work tomorrow but it pales in comparison to a day with a toddler while suffering HG)
- Could they do the supermarket shop in the evening after work?
Look at your finances
A common comment for women with HG to hear is “well at least you can have children, you should be grateful for that” and it can be a very hurtful thing to hear, particularly if HG has limited your family or if you have conceived with fertility treatments! However, it does raise an interesting point about the “value” of pregnancy.
IVF can be hugely expensive and many couple go to extreme lengths to be able to afford treatments to enable a pregnancy. Yet when it comes to HG couples don’t consider spending money on “enabling a pregnancy” in quite the same way even though the end result is the same… a baby in your family!
So it can be helpful for couples to sit down and look at what they could afford in the short term to enable a pregnancy so that in the long term your family is extended.
- Could you afford for a teenager to help after school with some play time?
- Could you afford a cleaner or a laundry collection service?
- Could you afford for more childcare or a “mothers help”?
- Can you afford for your partner to take some extra time off work or could he arrange to work from home for some time each week?
The answers to those will be very individual and for some families the answer will be no to all of the above but if you can afford help then now is the time to use it!
Stay focused and keep things in perspective
I know only too well that it’s easier said than done but if you can focus on the end goal of having another baby in your family than it will be all the more rewarding to tick the days off as they go by. I also know how hard it is to have perspective on the situation when you are in it.
For a well person, particularly with small children 9 months can seem to fly by but when you are in the pits of HG every hour can seem to last a day, a day feels like a week and a week with HG feels like a month.
It’s very hard to keep a realistic grasp on time.
Try breaking your days, weeks and months into manageable chunks. When you wake up think only of the morning and focus only on that time. Then when it’s over give yourself a high five and think only about the afternoon and when your partner gets home from work high five you’ve survived. Then tick that day off, it’s nearly over and you never have to do that day again!
Focus on something that happens weekly, such as a certain TV program or arrange for a friend to visit once a week for an hours play date. It seems to make the weeks go quicker when there is a regular activity that comes around to look forward to.
Once you’ve passed a whole month have a mini celebration, it’s a big achievement!
- Clark S, Constantine M, Hankins G, (2012) Review of NVP and HG and early pharmacotherapeutic intervention Obstetrics and Gynecology International, Vol 2: Article ID 252676, 8 pages, [Online] http://www.hindawi.com/journals/ogi/2012/252676/
- Fejzo M, Macgibbon K, Romero R, Goodwin T, Mullin P (2011), Recurrence risk of hyperemesis gravidarum, J Midwifery Womens Health 56(2): 132-6
- Dean C and Shortman A (2014) Hyperemesis Gravidarum – The Definitive Guide.
- Dean C (2014) Helping women prepare for hyperemesis gravidarum. British Journal of Midwifery 22(12); 847-852