Hands up if you’re a busy working woman or mother of young kids and can be bothered to try and get a GP appointment for anything less than “really seriously ill”.
No, nor me, it’s such an effort. Especially when you’re feeling nauseous and are vomiting your guts up and your sense of smell is like a bloodhound and noise makes you feel worse.
First, you must get through on the phone to make the appointment, justifying your need to the nosy receptionist and then dragging your poorly, puking body down there with your humiliating sick bowl, to sit in a miserable waiting room with a tinny radio, noisy people and various smells assaulting your senses.
But you figure it will be worth it because, surely, this isn’t normal? You were expecting morning sickness, prepared for it, even looked forward to it a little, but this can’t possibly be morning sickness? A doctor will know what’s wrong and will give you something that might make you be able to function again, right?
Except that when 72% of the women in a study published this week went to the effort of getting a GP appointment for abnormally severe pregnancy sickness they were dismissed with nonsense remedies, suggestions to simply drink more or just rest (because resting for the average adult of child-bearing age who has a job, responsibilities, bills to pay and kids to care for is so easy).
The resulting problem is that these women go home and deteriorate because they have a condition which is not going to miraculously improve the next day or even the next week if she’s early in the pregnancy. At the very best she might start to improve around 12 weeks but that could be six weeks away yet and she’s likely to get worse before that as symptoms peak between nine to 11 weeks. So, instead of some basic medication, which has decades of safety data behind it, they’re sent home to get worse and worse until they need hospital admission, possibly via ambulance.
This is because of the misconception that all women only experience a bit of morning sickness, just some women make more of a fuss than others. Calling Hyperemesis Gravidarum (HG) morning sickness is like calling Tuberculosis (TB) a bit of a cough. Morning sickness is a normal, often welcome, part of early pregnancy which women expect and tend not to moan about. HG is a serious complication of pregnancy which can ultimately be fatal. Women dying from it is rare now, thanks to modern medicine, but it’s not unheard of, and when you include the other potential complications caused by HG such as developing lesions in the brain, thromboembolisms, not being able to keep down medication for conditions like epilepsy, cardiac arrest and the mental health impact the severity can start to be appreciated. Even the most standard complication of dehydration can kill an adult within 3-6 days. So yes, sometimes ambulances are required for this life-threatening condition and its life-threatening complications.
But they wouldn’t be necessary (or at least rarely so) if women were believed in the first place, properly assessed, treated with evidence-based medication and where required referred to the appropriate hospital department. Suggestions of “just try to drink more” when you’re crippled with constant raging nausea and everything you swallow is coming back up are wholly inappropriate as “medical advice”.
One of the biggest and frankly bizarre problems is the refusal to treat women unless they have ketones in their urine even though ketones have nothing to do with pregnancy sickness or HG and don’t show if a patient is dehydrated. There is no other medical condition in the world where, when faced with a clearly dehydrated patient, a healthcare professional would test for ketones to “prove” that she was sick enough to warrant giving IV fluids or medication.
HG is rare and at the very severe end of the pregnancy sickness spectrum and even with early treatment women may end up with frequent hospital visits and multiple GP appointments. However, there is a large group of women for whom hospital visits and repeated GP appointments could be avoided altogether if basic level medication were provided appropriately when she’s first saying the sickness is worse than she was expecting (because as I said, we all expect a bit of sickness). This would not just save the NHS millions but would reduce the vast suffering and the financial, social and emotional burden on women and their families.
Thankfully, things are changing, albeit slowly, and it’s worth bearing in mind that the research published this week was conducted before the introduction of national guidelines. The recent BMJ guidelines will hopefully give GPs the confidence to treat pregnancy sickness proactively as well. But in the meantime, can we please stop calling it morning sickness and suggesting ginger?