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Info for midwives

The following is an extract from an article called 'Hyperemesis gravidarum: how midwives can help' from the journal The Practising Midwife from 2008. The section transcribed below gives advice to midwives in how to deal with patients with HG.

  • Reduce stimuli and triggers as far as possible - eg, lighting and noise levels, odours, motion and interruptions to rest.
  • Listen: loneliness and isolation may well have featured heavily during the course of the illness.
  • Watch for signs of psychological illness and refer for assessment as appropriate.
  • If possible, refer to a physiotherapist to minimise the effects of atrophy.
  • Ask for permission to discuss food and before mentioning food names.
  • Ascertain the level of sickness by asking what foods and drinks have been tried, what has helped/what has not.
  • Be careful if recommending morning sickness cures to an HG sufferer; she will have been told innumerable times to try crackers and ginger. It may undermine confidence in the healthcare professional. 
  • Do not challenge what she is or is not eating/drinking; anything is better than nothing.
  • Refer to HER (Hyperemesis Education & Research www.hyperemesis.org) for a list of foods, drinks and vitamins that may work.
  • Watch for signs of dehydration; refer for medical assessment as appropriate.
  • Alleviate any guilt and reassure the mother if she has been unable to take prenatal vitamins.
  • Remind her to take the pregnancy a day at a time and that the HG will end.
  • Remember that pregnancy sickness is not always a ‘good sign’. There are many cases of women whose HG has continued despite later discovering that the fetus died weeks earlier. Unpublished evidence has shown that women with HG likely to suffer fetal demise (see www.hyperemesis.org/HER-Research).
  • Encourage appropriate medication.
  • Those with prolonged illness and inadequate medical care - eg, those with greater than 10 per cent loss of pre-pregnancy body weight or those who fail to gain weight for two consecutive trimesters - are at increased risk of serious complications such as pre-eclampsia and pre-term labour. A referral should be made to an obstetrician or assessment unit to check for signs of Intra Uterine Growth Retardation.
  • Remember that recovering from HG takes time and that there may be a long-term impact on both mother and baby.

Excerpt taken from Farrell N., Hyperemesis gravidarum: how midwives can help. The Practising Midwife 11(7) 2008