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Support is Vital

"The support I received over the past 6 weeks helped get me through what has been the toughest time of my life. Having someone who really who really understood the condition give advice helped us through and crucially, at times, gave me really useful information I didn't get from my own medical practitioners. In my experience, HG is such a debilitating and lonely struggle, the more support you get the better chance you have of surviving it" - Lisa, from London.

HG Facts

Hyperemesis Gravidarum rarely ends at 12 weeks of pregnancy. It typically improves in the middle of pregnancy, but symptoms often last until birth. 

Termination of Pregnancy

Below you will find some information on considering pregnancy termination for HG and how to go about getting an abortion in Ireland, if that is what you decide to do. There is no right or wrong answer: someone else in your same situation may make a different decision, and that is okay. No-one can go through with the pregnancy for you and so it is your decision whether or not to continue it.

UK research suggests:

While we don’t have exact figures for Ireland, we do know that some HG patients terminate because of the condition:

Professor Higgins said many of the women find themselves in a very “dark place”. She said she knows of women who have contemplated suicide, “which is a horrible thing to think of at the time of your life, which is meant to be a joyful time in life”, she said.

Some women she knows have unfortunately chosen not to continue with their pregnancy, she said. - TheJournal.ie, Feb 2023

In other countries, HG patients were sometimes told that they should terminate and try again as HG was random. We now know that HG has a genetic basis and a high recurrence rate, so this is not true and is not an evidence-based strategy to avoid HG. If you have HG in this pregnancy, or have a history of HG, and are considering termination, you are probably weighing up lots of different factors, like:

  1. How far along you are
  2. What treatments you have already tried, and any you haven’t tried yet
  3. Your health now (both mental and physical), and how it may be affected by continuing the pregnancy
  4. Any other children you have, and their needs
  5. Your financial situation and support from partner, family and friends 

 

“HG made my pregnancy horrendous and almost unbearable. I considered termination for a very much wanted pregnancy.... I was extremely depressed. I lost all sense of who I was.” - Lizzie

 

Accessing HG treatment 

If you are considering termination because of HG, and you would otherwise continue the pregnancy, the first priority is to make sure you are getting the correct treatment. If you feel that your healthcare team have not been supportive and proactive with HG treatment, or are not taking your condition seriously, please ask for a second - or third! - opinion from a senior doctor experienced with HG. 

Some patients find the dieticians or perinatal mental health team are helpful when navigating treatment, and you can also complain to the hospital’s Patient Liaison team. 

“I was still struggling severely with HG at 17w and told the [hospital] that I was thinking about going to England for a termination. They sprang into action and put me under [another doctor] who advocated for me and said he would sign off to have a termination done here [in the hospital in Ireland]. They then gave me a high daily steroid dose as a last resort. Luckily this worked for me, but if it hadn’t been for [that doctor] standing up for me, and me finally feeling like I was being listened to, I would have gone to England.” - HG patient, Dublin. 

Legally, HG patients can fall between two stools: it is easiest to access a termination under 12w, but at that point you may not have tried all possible treatments and may still be hoping that HG will ease in later pregnancy (as it does for many!). After 12w, access is only through hospital and the legal criteria become much more difficult to meet.

 

How to get a termination: Under 12w of pregnancy

In the Republic of Ireland, termination is legal under 12 weeks of pregnancy for any reason. However in practice, because of the legally-mandated three-day wait between requesting a termination and having one, and the practicalities of getting medications/hospital access, you will need to request a termination by 11w4d at the latest, and the earlier the better. 

You will need to have two appointments with a doctor: the first to request a termination, and at the second - three or more days later - you can take the pills (see below for info on surgical terminations). The first appointment can happen over the phone or online. 

It is important to remember that you don’t need to tell the doctor why you want an abortion; they don’t have to agree with your reasons! All they need to know is that you want a termination and that you are under 12w. If they do not offer that service, they must refer you to someone who will, or you can call MyOptions to find a service near you. 

Community Care: Some GPs offer medication abortion (abortion with pills) up to 9w. You can find a GP or family planning centre through the MyOptions service. If you need a surgical procedure, you will be referred to the nearest hospital which offers that service (NB: not all maternity hospitals offer termination yet so you may be referred to a different hospital other than the one you are registered with). 

Secondary Care: Between 9w and 12w, you will need to be referred in to hospital for either a medical or surgical abortion - again a GP or family planning centre can refer you in. 

NB: there is a 1-2% risk that a medical abortion does not work; if so and you are then past 12w, you are not legally eligible for a surgical abortion. Please ask your healthcare team about this risk, and any additional risk factors you have as a result of HG e.g.: medication abortion can increase nausea; dehydration makes blood clots more likely. 



Over 12w of pregnancy

Termination of pregnancy is legal under only three grounds at this point in pregnancy: 

  • A risk to the life or health of the pregnant woman (Section 9); 
  • A risk to the life or health of the pregnant woman in an emergency (Section 10); 
  • Where there is present a condition likely to lead to the death of the fetus before or within 28 days of birth (Section 11) 

Practically speaking, if you need a termination after 12w it would only be allowed under Section 9 or 10. And it’s also likely that you will need to have tried all available treatments before termination would be done. Second-trimester surgical terminations are specialist procedures and are not offered in every hospital; you may need to be referred to a higher-level hospital.

If you request a termination and the doctor does not agree, you are entitled to a second opinion. You are also entitled to request a HSE review. Some patients find the perinatal mental health team are a good support and help you advocate for what you want: there is one in every maternity unit (though perinatal psychiatrists are not available in every unit). 

If you have requested a termination due to HG and your hospital are not supporting you, please contact us

Here is the link to the clinical guidance document on Section 9 & 10 from the Institute of Obstetricians and Gynaecologists:  it is aimed at doctors, not patients, but still useful for reference or to send to your healthcare team. 

 

Outside of Ireland

Some patients may find it easier to travel to get an abortion rather than navigate the Irish system. If so, we recommend you contact Abortion Support Network, a UK-registered charity who have over a decade of experience helping clients from Ireland and elsewhere in Europe to travel to the UK and other countries. They can advise on clinics, locations, and travel arrangements. If you are not an Irish citizen and need a visa to enter the UK, it may be better for you to plan to travel to the Netherlands or another European country - ASN will be able to advise. They may also offer grants towards the procedure and travel costs if necessary. 



Further resources & recovery:  

  • Irish Family Planning Association. As well as abortion services and information, they also offer online and phone counselling, both to help you make your decision and to process afterwards.
  • MyOptions HSE service which directs you to local abortion providers as well as non-biased counselling and support services. 
  • Information from the HSE on what to expect after abortion
  • Leanbh mo Chroí (child of my heart in Irish) is a support group for those who have ended a pregnancy because of a poor diagnosis, either for the foetus or the pregnant person. 
  • Pregnancy Sickness Support page on pregnancy loss including miscarriage, stillbirth, ectopic pregnancy, molar pregnancy, termination of pregnancy, and neonatal death