Last Updated:
July 05, 2007

What does Hyperemesis Gravidarum have to do with Allison today? By Kimber Wakefield MacGibbon, RN
HER Foundation

Many are asking why the media is reporting on Allison's pregnancy complications as if they still have an impact on Allison. How can that be true? Hyperemesis gravidarum is a disease of pregnancy that typically ends on or before delivery. So, can that be influencing her now, a year and a half after delivery? My answer is unequivocally yes.

HG is a pregnancy disease that impacts many women for years after delivery, and sometimes for life. It's not necessarily the physical effects that continue for so long, but the emotional scars. Too little research has been done on HG to identify the long term effects on both mother and child. However, it can obviously be said that HG is a very serious disease since women still die from it. Others may suffer permanent neurological damage due to malnutrition and dehydration. Autopsies of women with HG show signs of starvation and organ damage. The adverse effects of HG typically last at least until week 20 of pregnancy, and cannot be reversed in just a few weeks.

For Allison, HG persisted throughout pregnancy preventing her from gaining more than 10 of the 45 pounds needed to sustain a twin pregnancy. Consequently, one of the twins had a low birth weight with reflux, and Allison had chronic preterm contractions for weeks before delivery. Children born to mothers with HG have a greater risk of chronic disease in adulthood, as well as neurologically-based learning, emotional and behavioral disorders. A mother's sacrificial love is crucial to these children's success.

To understand how HG affects women, imagine yourself enduring months of food poisoning or a stomach flu. Just a few days would leave you weak, tired, sore, and miserable. The sleep deprivation, lack of food, constant nausea, vomiting of bile and blood, isolation, exhaustion, weakness, powerlessness, and pain are often overwhelming, weakening emotional and cognitive functioning.

Due to ineffective care, HG causes devastating debility and results in 25% of pregnancies being therapeutically terminated, while others are lost to stillbirth, miscarriage, and premature birth. Women may be unable to work for some if not all of their pregnancies; and their lives are put on hold. Women like Allison do not feel pregnant or enjoy their pregnancies; they feel sick and miserable and pray to die to end the suffering.

Few realize the incredible impact of starvation on the brain and body. Obviously there is fatigue and weight loss, but there are also profound changes in mood and mental capacity. Confusion, difficulty with decision making, and lack of focus can be debilitating. Sleep deprivation exacerbates these issues and recovery does not occur until there are months of consistent sleep and normal weight, a challenge for new mothers.

For about half of women with HG, their symptoms will subside by mid-pregnancy, others are not so lucky and have to endure HG until delivery. Further, many women like Allison are not diagnosed until they are severely ill and well beyond the first trimester. Only then do they get the aggressive care they need. She vomited blood for about six months, eroding her throat and stomach, and was barely able to eat for most of her pregnancy. She was not gaining weight and weighed less going into her eighth month, than before pregnancy. Finally, she was given the correct diagnosis of severe HG and critical IV nutrition, yet her labs still showed severe hypoglycemia and low protein levels. She was totally depleted and at this point, completely dependent on others for her basic needs. Her delivery admission papers confirm she was also severely dehydrated. Then she had life-threatening bleeding after delivery and was diagnosed with severe anemia and hypothyroidism. Her body was devastated and recovery would take time.

Women with severe or prolonged HG like Allison, enter the postpartum period depleted emotionally and physically, not to mention extremely vulnerable. Consequently, they are predisposed to depression, anxiety, and post-traumatic stress syndrome, as well as adjustment difficulties. The constant demands of newborn care, which are much greater with twins, results in deterioration of the mother if she does not have adequate support. Unfortunately, no one evaluated her support before she was discharged, nor did anyone monitor her for postpartum mood disorders, despite the many risk factors. She was simply sent home with few instructions and no resources to call for help.

The collapse of Allison's social support network during pregnancy, a surgical delivery with life-threatening complications, and the strain of caring for twins while trying to recover made life overwhelming to say the least. Imagining herself as capable mother and preparing for their homecoming were practically impossible in her debilitated state. This is ultimately what lead to the discussion of adoption - utter exhaustion, and fear she would not survive or recover. With no alternatives offered, she was desperate for respite and acquiesced to the only solution presented at that moment.

On average, a woman requires 5-8 months for recovery from HG. Obviously more severe or prolonged cases take longer, sometimes years. Some never fully recover. The residual food aversions, stomach ulcers, and metabolic changes impede women from restoring vital nutrients and normalizing their weight. Allison has worked to become stronger and recover from her pregnancy. She still struggles to regain some of the weight she lost and overcome anemia due to the strain of the ongoing litigation and residual food aversions. In time, she will return to the strong woman she was previously.

Pictures of Allison prior to pregnancy show a vibrant, physically fit woman who loves children. After pregnancy, she was a mere 110 pounds, very emaciated and exhausted. When I met Allison in January 2006, she was six months postpartum, and just a shell of a woman. Her body was frail and she weighed maybe 115 pounds, her few smiles were forced, and her emotions were very raw. Her health and overall disposition confirmed the devastation of all that she had endured. Over time, I have watched the protracted litigation, separation from her twins, and enormous legal expense slowly crush her. She has lost nearly everything, including the precious twins she nearly died twice giving life to. My fear now is that the disempowering effects of incarceration and more litigation will deplete the emotional and physical strength she has worked to regain.

Let me emphasize that Allison is NOT an unstable woman that presents a danger to anyone. In the midst of her incarceration, she is concerned about the strain on her supporters, and for the welfare of a child she has cared for often over the past few years while the mother was in rehab. This woman has been battered by this protracted custody battle, loss of freedom, financial devastation, and never-ending attempts to permanently sever her relationship with her twins. Few could endure all of this and survive. She is a very strong and courageous woman who loves her children very much. Ending this litigation, empowering her with freedom to return to work, and granting her the opportunity to restore her relationship with her twins will ultimately lead to her recovery and resumption of a normal life.

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