Most women expect to experience nausea and vomiting in pregnancy which is commonly called morning sickness even though it occurs any time of day or night. It is often a welcome sign for women who have been trying for a baby and many women see it as a rite of passage through pregnancy. Therefore it is not often that women complain or ask for treatment for "normal" pregnancy sickness.
If you think your symptoms are severe enough to be looking for help and support then you probably have moderate-severe pregnancy sickness, or hyperemesis gravidarum. Some signs that you might need treatment and help with your symptoms are:
If you are vomiting more than five times a day for more than five days
If you are not eating and drinking normally because of the nausea and/or vomiting. Food aversions can be normal - but not being able to keep down most foods or liquids is not.
If you are struggling with basic day-to-day activities like showering, leaving your home, working, and looking after your family
If you have lost weight, particularly if you have lost more than 5% of your pre-pregnancy weight
If you are getting dehydrated
If you fit any of these criteria - you do not have to fit all - and lifestyle techniques like eating bland foods, eating little and often, and resting haven't worked, then you should seek help.
Where to get help
You can check your PUQE (Pregnancy Unique Quantification of Emesis and Nausea) score by going to p8 in the clinical guidelines. This rates your nausea and vomiting over the previous 24h on a scale from 3 to 15. The guidelines suggest IV fluids and/or medication may be appropriate for scores over 7.
Check out our guide to making the most of your healthcare appointments here.
Most people begin suffering symptoms of hyperemesis gravidarum at 5-6 weeks pregnant, before they have had their initial Booking Visit in the Maternity Hospital (usually at 12-14 weeks.) For this reason, your first port of call for help or diagnosis of HG may be from your GP or ED, before you have had any routine contact with midwives and obstetricians.
People suffering from hyperemesis may need to tell their employers sooner than they had planned, especially if they need time off work.
If your symptoms are causing you to feel low, do not hesitate to contact your GP or midwife for support.
General Practitioner (GP)
Depending on the severity of your symptoms your GP may prescribe anti-nausea medication. These medicines are safe to use during pregnancy.
Often you may need to to give a urine sample and undergo a physical examination to test for signs of dehydration. If you are showing signs of dehydration, your GP may refer you to the Emergency Department.
Your GP can also support you during your pregnancy as part of the Combined Care Antenatal Scheme.
Emergency Department (ED)
Depending on where in the country you live, you can attend the ED in your local hospital or you can attend the ED in a specialist Maternity Hospital (Dublin, Cork, and Limerick). Here is the HSE list of maternity units.
The midwives and doctors will assess you and determine whether you need IV fluids and/or medications.
You can attend the ED with a referral letter from your GP (this is free.) You can also attend the ED without a GP letter; standard hospital charges will apply.
Midwives can give advice over the phone, for example in the Emergency Department of the Maternity Hospital. If you are taking part in midwife-led care, such as the Domino schemes, your midwife can assess your symptoms and refer you to an obstetrician or into hospital.
For people on the public schemes, you won't usually have a scheduled obstetric visit until at least 12 weeks; if you have a private obstetrician they may be available to you earlier in pregnancy. If you attend Emergency you would usually see a non-consultant hospital doctor (NCHD) initially who will be able to prescribe the most common treatments and will call in a more senior doctor if required.
Please note: if you need Cariban, under the current HSE process, only a prescription from a consultant obstetrician is eligible for reimbursement (medical card, drugs payment scheme). Watch this space for a more detailed guide to accessing this!
We have a private peer support group online: it is a place to get practical tips, ask about others' experiences, or just to share your experience with people who understand. Click here to request to join (please note, it is limited to HG patients and survivors, not healthcare providers or carers).
We also offer general information on Instagram @hyperemesisireland and Twitter @hyperemesisie