Advice for Medical Staff

Some women have experienced excellent treatment as in-patients when they have to be admitted for IV fluids, but care is patchy and can be sub-standard. A paper by Power et al published in 2010 reported results of a survey of women treated in Manchester and found some appalling attitudes of staff towards women suffering from HG which resulted in a poor standard of care for some of them. (See Power 2010 Understanding Stigma of HG)

The following notes describe what an HG sufferer would say to you if she could. It comes from the collective actual experience of women admitted to hospitals in the UK.

  • Please treat me with some compassion, I don’t want to be here and I’m not making myself sick just to get attention. 
  • Please listen to what I say and believe my symptoms. If I say I can’t eat or drink anything, it’s not because I’m just being difficult, it’s because I really can’t. 
  • Don't advise me to try ginger and to eat little and often. Everyone from the midwife to strangers in the street has told me this, I have tried it and it doesn't work. 
  • If I ask for a sick bowl but don’t produce any vomit, I’m not doing it just to annoy you, sometimes I dry retch but I never know whether I will actually produce any vomit or not so I am asking for the sick bowl just in case.
  • Please don’t ask me to order from the menu when I’m vomiting, I can’t think about food while I’m in the act of throwing up.
  • Please give me my medications at the time stated on my treatment plan, not an hour later because you’d rather just do all the meds on the trolley round. If I don’t keep a constant level of medication in my system, I will get ill again.
  • If I am asleep when I am due my medication, please wake me up for it.
  • Nurses, please record in my notes whenever I am sick so that the doctors don’t think I’m making it up when they do their ward round.
  • Please read my notes so that you don’t prescribe me medications that I have already tried and didn’t work.
  • Junior doctors, don’t wait half the day to get approval from the consultant to change/increase my medication. Please do it immediately as every delay further degrades my chances of improvement and condemns me to further hours of unbearable misery.
  • If I can manage to eat something, please don’t take the food off me after 20 minutes, it will take me a long time to eat it.
  • When I tell you I am hungry and can eat something, please give me food immediately, don’t make me wait till mealtimes because by then the nausea may have returned and I will have missed my opportunity to eat. HG sufferers have short windows of opportunity to eat and when it’s gone it may not come back for days.
  • This is not typical vomiting, I don’t require a 24 hours purge period as if I had had food poisoning.
  • If I advise you that I am difficult to canulate, and that canulas typically fail after 12 hours, please listen to this experience and plan around it. Your priority is to rehydrate me, not to use me as a teaching tool. Make a plan in my care notes to reasses the canula regularly in order that it can be replaced promptly should it fail.
  • If you can see bruising or a wound from a previous canula, regardless of when it was fitted, please do NOT attempt to site a new canula here

reference: Power Z et al., Understanding the Stigma of Hyperemesis Gravidarum: Qualitative Findings from an Action Research Study Birth 37 Sep 2010 p237