Coping strategies

The key for the hyperemesis sufferer is rest rest rest!  Hyperemesis gravidarum is an episodic condition with frequent periods of recovery and relapse. The temptation when you do feel better is to rush around to catch up with the jobs that you couldn't do when you were too ill, but this is a sure-fire way to cause a relapse. Don't think you're somehow weak because you can't so much as do a bit of housework before having to take to your bed again, this is absolutely classic, and most HG sufferers will recognise this. If it's your first baby, just lie on the sofa and enjoy not vomiting for a change. If you have children, do everything in your power to sort out childcare - rely on relatives, nurseries and friends. Don't feel guilty about needing help, you are very ill, and you would not be expected to carry on as normal if you were undergoing treatment that causes similar symptoms, such as chemotherapy. The house may be a tip, there may be a washing mountain and the kids/your partner/work may have to fend for themselves for a while but if you push yourself, your vomiting will get worse. If you have HG, you need to give yourself a break and know that normal service is not applicable.

Many people find that sensory stimulation such as noises, moving visual images or bright light, strong smells and even the movement of air from an open window can all trigger vomiting and/or nausea. Knowing your triggers and trying to avoid them at all costs may be the only way to reduce nausea, which is notoriously difficult to manage with medication, even if the sickness is under control. You may consider changing your household and hygiene products to non-scented versions and creating a room in the house just for you where you can have some control over your environment.

Strong aversions to various foodstuffs and food smells are common in most, if not all of those suffering HG. For some, the slightest thing will trigger nausea, including even the sight of food or hearing someone talking about it. Many people find that once they have thrown up a certain food, they cannot bear the sight of it again until the HG improves. For some an aversion can have such a strong association that they still cannot eat certain things even after the pregnancy. Cooking smells are often unbearable so avoid cooking as much as possible and make sure that windows are open, and you are far from the kitchen while it is going on.

Feeling tired or doing too much can have a big impact on how sick you feel, so try to take regular naps and get to bed early enough for a full 8-hour sleep and try not doing more than your body can handle.

It can be difficult to stay hydrated when experiencing sickness, and even water can become very intolerable but try to drink an absolute minimum of 500ml a day.

Avoid dehydration by trying some of the following tips:

• Sucking ice cubes – these can be made of juice or water, whatever is more tolerable
• Sipping very slowly through a straw
• Bottled mineral water may be more palatable than tap water
• Having ice lollies
• Flat fizzy drinks can often be easier to keep down
• Try freezing half a bottle of mineral water and then topping up with fridge cold water, this keeps the water freezing cold for hours which is easier to drink for some people
• Seeing if you can manage foods with a higher water content such as watermelon, cucumber, oranges and grapes

If this doesn't work and you become dehydrated, then be prepared for a hospital admission. Don't try to fight it - if the GP says you need to be admitted you must go. Not getting treatment can lead to serious complications for you and baby. An intravenous drip and having antiemetics injected can give you days/hours of respite that are so important not only to your physical welfare but your mental wellbeing too. 

People with pregnancy sickness often find that the list of food and drinks that they can keep down is very small and not at all from the healthy options. Some even find that eating vegetables and some fruits causes immediate vomiting in the peak stages, making it even more difficult to follow a healthy diet. You may find sweet and salty foods i.e., sweet drinks like lemonade, and eating crisps, are more likely to stay down than healthy foods. Although, it is important to follow current guidelines regarding avoiding certain foods which may contain harmful bacteria such as paté, liver, soft cheeses, and undercooked eggs.

An empty stomach can exacerbate nausea so snacking little and often and keeping snacks nearby may help with symptoms.

If you can tolerate small quantities of food and fluid, then try to fortify what you do eat and drink.

Fortified Milk: Add 4 tablespoons of milk powder to 1 pint of full cream milk. This milk can then be used for drinks that you find tolerable such as milkshakes, hot chocolate, or smoothies, or use it on cereal or in puddings, porridge, or jellies.

Snacks: Try to always have snacks available in the house so that as soon as you feel able to eat something you can. Snack bars or cereal bars, crisps, crackers and so on.

Fortify Meals: If you are managing to eat small amounts at your mealtimes, then try to add calories to your meal by fortifying with hard or pasteurized cheese, butter, crème fraiche, margarine, meat and so on.

Lactose Intolerance/Dairy Allergy/ Dairy Free/Vegan: Fortify your meals, snacks and drinks using pulses, (silken) tofu, avocado and dried fruits. Already fortified cereals, bread, unsweetened soya, rice, and oat drinks can be bought from the supermarket. Seeds and nut butters can also be added to meals and snacks as well as snacking on whole nuts (please avoid if allergy present). Cook and prepare any food using olive oil, coconut oil, avocado oil, or flaxseed oil.

If you feel you may be depressed, have anxiety, or suffering more than you are able to manage emotionally then speak with your GP and ask for a referral to the perinatal mental health team.

• Contact us to be matched with a peer supporter who has been through HG themselves and can understand how debilitating this condition is. Text support from a HG survivor can be absolutely invaluable at getting you through each day and helping you feel less alone.
• Avoid thinking ahead more than the next few days. Torturing yourself with 'I have 20 weeks of this left to go' is not helpful. Take one day at a time and at the end of the day acknowledge that you have one less day to get through.
• Lying alone in bed or on the sofa can make you feel isolated. If you’re able to watch TV then watch your favourite films or series, or perhaps something new. If watching TV makes you nauseous, try radio or audiobooks instead. You may find music therapeutic instead, or adult colouring-in books, findng something which can entertain you in those moments of relief will help with the isolation and boredom.
• Having friends who can come over for a while and just be around will help a lot with the loneliness that many people feel. If you are okay to talk on the phone, call friends or family to keep you company.
• Becoming informed as possible on the treatments you can take can go a long way in feeling in control of your condition rather than having the condition control you.

Excess saliva is a very common part of HG, but it isn’t often talked about. It can be overwhelming and distressing to deal with, especially if you are dealing with unhelpful comments. There are some things we can suggest trying which may help, often people just need some coping tips as there is sadly very little medication available for this symptom.

• Ask your GP for an antacid called omeprazole, some people find it helpful in reducing the amount of saliva to some degree. It can also help with nausea and retching
• Carry a spit cup or cloth around with you so that you can get rid of the saliva without swallowing
• Sucking on strong flavoured sweets can help with the taste in your mouth that comes as part of HG

A complication of spitting out excess saliva can be dehydration. If you are experiencing any symptoms of dehydration, then please let your healthcare professional know as soon as possible.

During periods when you are able to get out and about, or perhaps you have gone into work, then there are some things you can do to be prepared. There are two main aims, first to avoid vomiting, second to cope with it if you can't avoid it. Below are a few tips to help you get through the day.

• Always carry something to eat with you. What this is will depend on what you are able to eat at the time, but suggestions include bananas, cereal bars, nuts, dried fruit, bread, crackers, sandwiches and crisps.
• Eat more when you are hungry, not necessarily at scheduled breaks or usual times. Often you will spend most of the time too nauseated to eat, then hunger will strike very quickly. This is your window of opportunity to eat something and if you miss it, you may well be unable to eat anything again for the rest of the day.
• Reduce smell triggers by carrying with you an essential oil you can tolerate, you can put a few drops on a tissue and smell it periodically to mask other smells, or even put a few drops inside a face mask and wear it. If you have severe smell triggers then you could wear a nose clip, like those used for swimming, it may feel extreme, but it can block out all scents and give you some much needed relief.
• Sudden vomiting is a hazard of HG, so it is advisable to be prepared. You may not always be somewhere with a toilet or sink, or you may vomit while on the way there. Keep an emergency kit on hand, which includes a bag for vomit (tried and tested suggestions are airline type paper bags and jiffy bags and nappy bags), wipes, tissues, plastic bags for disposal and a bottle of water for mouth rinsing afterwards.