Information for Midwives and Nurses
Our Trustee Caitlin Dean recently had an article published about how midwives can help women with hyperemesis in the Essentially MIDIRS journal. To access the full text please click here.
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.
- 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. Women admitted to hospital with hyperemesis gravidarum should be in a side room so as to reduce sensory stimulation.
- Listen to her: loneliness and isolation may well be a major part of her distress.
- Watch for signs of psychological illness as a result of the condition and refer for assessment as appropriate. Depression is not a cause of hyperemesis but can certainly be caused by it!
- If possible, refer to a physiotherapist to minimise the effects of atrophy from prolonged bed rest
- Measure legs and prescribe TED Stockings to reduce the risk of Deep Vein Thrombosis.
- Ask for permission before discussing food and before mentioning food names in case it triggers nausea
- 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
- Be careful if 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
- 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
- Watch for signs of dehydration, check urine output for reduced volume and increased concentration. NB. Ketones are not associated with dehydration or severity of HG.
- Alleviate any guilt and reassure the mother if she has been unable to take prenatal vitamins. Medication is necessary for severe hyperemesis gravidarum and women should be reassured of the need for safe, effective treatment.
- Remind her to take the pregnancy a day at a time and that the HG will end, even if that is not until delivery.
- 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 foetal demise (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.
- Encourage appropriate medication.
- 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.
- Remember that recovering from HG takes time and that there may be a long-term impact on both mother and baby.
Farrell N., 2008 Hyperemesis gravidarum: how midwives can help. The Practising Midwife 11(7): 12-14