Information for Midwives and Nurses

Nausea and Vomiting in Pregnancy and in particular, Hyperemesis Gravidarum is a challenge for both mothers suffering and the midwives caring for them. Below is some information for Midwives about how they can help women with this debilitating and devastating condition both in the community and as in patients on ward.

Physical care

• Encourage appropriate medication. Medication is necessary for severe HG and women should be reassured of the need for safe, effective treatment.
• Watch for signs of dehydration, (Ketones are not a sign of dehydration)
• Refer to a physiotherapist to minimise the effects of atrophy from prolonged bed rest if needed
• Ascertain the level of sickness by asking what foods and drinks have been tried, what has helped/what has not and taking a thorough history.
• Encourage her to fill in a daily diary to look for a pattern
• Reduce sensory stimuli and triggers as far as possible - In particular odours from food, perfumes, coffee and so on but also lighting and noise levels, motion and general interruptions to rest. 

Food

• Ask for permission before discussing food and before mentioning food names in case it triggers nausea
• Do not challenge what she is or is not eating/drinking; anything is better than nothing (within current recommended guidelines).
• Refer her to this website for information on eating and drinking and coping strategies as well as for support for both the mother and her partner

Emotional support

• Listen to her: loneliness and isolation may well be a major part of her distress.
• Alleviate any guilt and reassure the mother if she has been unable to take prenatal vitamins. 
• Consider signs of psychological illness as a result of the condition and refer to the perinatal mental health team as appropriate
  • PSS also have a specialist HG Counselling service that is available for anyone who is currently suffering or has experienced HG in the past. 
• Remind her to take the pregnancy one day at a time and that the HG will end, even if that is not until delivery.
• Remember that recovering from HG takes time and that there may be a long-term impact on both mother and baby.

In-patient care

• Women admitted to hospital with hyperemesis gravidarum should be in a side room so as to reduce sensory stimulation.
• Measure legs and prescribe TED Stockings to reduce the risk of Deep Vein Thrombosis.

General advice

• Avoid recommending "morning sickness cures" to an HG sufferer; she will have been told innumerable times to try crackers and ginger. It may undermine confidence in healthcare professionals as well as adding to her feeling of isolation. Many sufferers of hyperemesis report that the suggestion of ginger instils feeling of anger and hopelessness
• Remember that pregnancy sickness is not always a ‘good sign’.
  • There are many cases of women whose HG has continued despite later discovering that the foetus died weeks earlier. Unpublished evidence has shown that women with HG likely to suffer miscarriage (see www.hyperemesis.org/HER-Research).
  • Furthermore remember that many women with HG suffer so badly that they consider termination as their only remaining option.
• Those with prolonged illness and inadequate medical care - e.g., those with greater than 10 per cent loss of pre-pregnancy body weight or those who fail to gain weight for two consecutive trimesters - are at increased risk of serious complications such as pre-eclampsia and pre-term labour.
  • A referral should be made to an obstetrician or assessment unit to check for signs of Intra Uterine Growth Retardation.

For more information, Essentially MIDIRS journal published an article written by PSS Trustee, Dr Caitlin Dean about how midwives can help women with Hyperemesis. Access the full text of the article.