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"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.

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Expressive writing for women in recovery from HG


Michelle Nicholson PSS Conference Notes: Bristol, 14th May 2016

Michelle Nicholson Conference 2016 Slides from Pregnancy Sickness Support on Vimeo.

My name is Michelle Nicholson and I lived with debilitating nausea and vomiting in the form of HG throughout both of my own pregnancies and found it difficult to cope, practically and emotionally.
Years later as a qualified Psychotherapist, given the opportunity to conduct a research study for an MSc Dissertation at the University of Edinburgh, I chose to focus on pregnancy sickness from a psychotherapeutic perspective, with a view to improving emotional support services for women today and in the future.

As part of this MSc course, I was required to write a personal narrative about my own pregnancy sickness experience. Research already shows that expressive and reflective writing can help people heal, recover from and make sense of difficult or traumatic life events. For me, I was surprised by the vivid memories this kind of writing roused and the tears that flowed both in my writing and my reading back. I was even more surprised by how much personal insight and healing it enabled. And this left me wondering if other women who have survived HG might find it helpful to write like this too. And so the following research study was conceived. 

In 2015, I conducted the first study to evaluate the beneficial effects of writing therapy in the field of pregnancy sickness at the University of Edinburgh. Ten women with an age range of 32-48 years participated in this study and were recruited as Volunteer Supporters via the charity Pregnancy Sickness Support. All were hospitalised at least once with severe pregnancy sickness symptoms in the form of HG, lasting from 6 weeks to their entire pregnancy, with most recent pregnancies ranging from 1 to 9 years ago.Participants were invited to write reflectively about their former pregnancy sickness at home, for approximately 15 minutes on 4 separate occasions in the course of 2 weeks and then take part in a qualitative, semi-structured telephone interview of approximately one hour, to talk about how they experienced this writing process in terms of its uses and sufficiency.

Participants were invited to write as freely, deeply and openly as possible about their pregnancy sickness experiences, thoughts and feelings without worrying about spelling, presentation, or grammar. They were invited to write either without any guidelines, so whatever they felt they needed or wanted to express, or to choose from a list of 20 suggestions. Examples included: Write about your most vivid memories of pregnancy sickness; about the kind of pregnancy you felt you wanted but didn’t have; Write a letter to your pregnancy sickness; Write about who did and didn’t understand; Write about your pregnancy sickness as if it were an object or image; Write about how it is to be a pregnancy sickness survivor.

What the process of expressive writing can do for women who have survived HG
  • An opportunity to express the unspoken
Participants wrote about feelings and thoughts not previously shared with anyone:
“There’s so much that we’re not allowed to say, we’re not allowed to feel when we’re pregnant”;
“The writing gave me a lot of closure on a situation never talked about beyond physical symptoms at the time.”

  • Voicing the anger
Over half of the participants described their writing voice as angry, in particular towards health care professionals or family members who they feel could have provided them with better care at the time of their HG experience:
“Writing is quite a good outlet for my anger”;
“Writing gives you back the voice you didn’t have while you were pregnant to say what you wanted to say at the time.”

  • Validating the HG experience as real
There was a sense of participants using the writing process to realise and validate their feelings around their HG experience:
“I don’t think until you see the emotions on the page you can put a name to them or they become real”;
“Writing orders it so it’s not just a mess of emotions in your head, it’s a real thing that happened.”

  • Externalising/venting the lived experience of HG
Participants described how writing allowed them to externalise or vent something of their experience of HG:
“Writing kind of cleared my head a bit and settled my thoughts. Otherwise things just keep going round and round in my head”;
“It let me let things out that I’d buried.”

  • Forming a story about the HG experience
Participants were able to form a story about their experience in the course of their writing:
“It’s gone from start to end, I formed a journey over four writings”;
“I’ve been filling in gaps and almost gaining ownership of my story as well.”

  • Processing the experience of HG
Writing allowed participants to make sense of and process their experience:
“Writing is a really good way to get in touch with what you’ve been through and understand the magnitude of it”;
“There was actually relief in the writing because it was a debrief and there’d never been a debrief and maybe there ought to be.”

  • Increased sense of agency and control
Some participants referred to a sense of reclaiming control in their writing:
“I felt like an observer at times during my pregnancy like things were happening to me and I wasn’t in control of it. I felt like I was taking that control back in the writing”;
“When you’re that ill, you feel totally out of control of your own body. When you write it down it kind of makes you feel a bit more in control.”

  • Increased emotional proximity to others
Expressive writing left participants feeling more affectionate towards or appreciative of their loved ones: 
“That’s what I realised when I was writing. Because I was just so in my own little bubble of awfulness, and he did try, he did try” (about her partner);
“It made me feel like it wasn’t their fault that they didn’t understand” (about her friends).

  • Healing
Expressive writing promoted healing in some participants:
“After writing I always feel a physical release like my shoulders sagging and just letting feelings go”;
“It’s a bit of therapy, processing it into an order so it’s not just muddled in your head.”

  • Increased self-awareness
Expressive writing allowed participants to conduct their own self-research, as a method of self-discovery around their experiencing of HG and what it meant to them:
“Writing made me a bit more aware of my emotional side. I surprised myself with what I had to say”;
“Acknowledging the feelings that I had tried to ignore.”

  • A space for self
Expressive writing provided participants with a space for themselves to write for themselves:
“It was a nice way of having me time”;
“Finding your own kind of theme to the writing and what’s right for you.”

  • Increased empathy for other women with HG
Participants expressed a sense of the writing process impacting positively on their work as PSS Volunteer Supporters:
“Revisiting how I felt and what happened has helped me to support those ladies a bit better. It’s just reminded me of how awful it is, of what is helpful and what isn’t helpful”;
“It’s given me more of a feel for what the women I’m supporting are going through right now. Because it’s been a while, so it’s easy to forget.”

  • Expressive writing as a new resource
Participants expressed an openness to carrying on writing expressively for themselves after taking part in this research study as if they had discovered a new self-help resource:
“There will still be certain triggers even now, years later, which will affect my mood. I would consider writing it down now”;
“I had very traumatic labours so I might write about that as well.”

  • A space to reflect on the experience of inadequate emotional support
Participants reflected on the quality of emotional care they had experienced around their HG and in 9 out of 10 cases described this as inadequate:
“I had very little support and I don’t know how I coped. It was a living nightmare”;
“I don’t really feel like I was ever heard. And I really felt like people didn’t get it”;
“I just felt totally isolated. I know that more could have been done for me”;
“It’s quite an unseen illness. People don’t want to see it.”

  • A space to reflect on the notion of HG recovery as an ongoing process
Participants in this study reported writing about being left with: nausea still being triggered by certain smells/sounds; vomiting phobia; dental problems; guilt; irritability; difficulty being around other women’s ‘normal’ pregnancies; a sense of loss; post-natal depression; unresolved anger; and flashbacks.
They made a number of references to recovery from HG being an ongoing process and the lasting impact of the lived experience of it on their sense of self:
“People are always so surprised that it still affects me but it does”;
“It changed me as a person”;
“There’s still more there to think about and go through”;
“Years later I still have very vivid memories.”

Clearly HG is not something women instantly recover from and forget about the minute their symptoms cease or their babies are born.
All the participants in this study seemed to recognise the scope for further healing, recovery or processing around their HG experience.

To Conclude
This research study identifies a number of potential uses and beneficial effects of writing expressively about our former pregnancy sickness experience.
At the same time, there was also a clear recognition of the value of emotional support and women having their thoughts and feelings around their HG experience witnessed by empathic others post pregnancy, particularly when this did not occur at the time of their suffering.

As an experienced psychotherapist, some of the feelings and thoughts that my research participants shared with me left me wondering about the potential value of professional and specialist pregnancy sickness counselling as a safe space to further explore the sense of feeling unheard, unsupported, unseen and misunderstood that many women describe. 

As such I am currently in the process of setting up a specialist national telephone counselling service for women affected by any degree of pregnancy sickness, due to launch in September 2016. As far as I am aware, this will be the first specialist psychotherapy service of its kind in the UK. And as PSS Volunteers you would be most welcome to signpost any of the women you are supporting to me if you feel they might benefit from professional counselling support. I shall send out more information about this in the coming weeks.

To end, I would like to leave you with 2 questions to reflect on for yourself. I think it’s great that you are all doing such a wonderful job supporting other women with pregnancy sickness. At the same time I would encourage you to think about how you might continue to talk about or write about YOUR pregnancy sickness experience in terms of your own feelings and emotions?
And how might you take care of yourself in YOUR OWN ongoing recovery from pregnancy sickness?

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