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Obtaining Treatment

It is the unfortunate case that the provision of treatment for HG is extremely patchy and many GPs are not up to date with current treatment methods. There is often a strong reluctance to prescribe medication to pregnant women. This reluctance is largely a hangover from the thalidomide disaster in the 1960s when babies were born with deformities after their mothers were given thalidomide for pregnancy sickness. In addition, GPs may be unwilling to prescribe unlicensed medicines. If a GP has no specialist knowledge of the condition or wrongly assumes that no drugs are safe, then the patient may be refused treatment.

This situation should improve with the publication in June 2016 of
the RCOG "Green Top" guidelines for the treatment of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum. The guidelines are available via the RCOG website RCOG GTG 

Tips to maximise your chances of obtaining treatment at your first GP visit.

- Never go alone to see the GP, always take your partner, relative or friend to help advocate for you. It is very difficult to get your point across when you are ill and your advocate will be able to back up how sick you have been.

-  Make sure the GP is fully aware that this is more severe than ‘normal’ morning sickness and that you are having difficulty carrying out your normal duties.

-  Tell your GP that you have already tried other strategies such as eating little and often, avoiding triggers, ginger, sea bands etc and that these measures do not work.

-  Point out to the GP that the RCOG guidelines recommend that mild NVP should be treated in the community with antiemetics, and that antiemetics are safe and effective.

-  Ask your GP to look at the healthcare professionals section of the PSS website PSS HCP Resources

-  For a few days before seeing the GP make a note of how much weight you have lost and how much you are eating and drinking and tell them.

Tips for obtaining treatment if your GP refuses to prescribe medication

If your GP still refuses to medicate, or they will only prescribe a small range of medications that you don't find effective, then:

-  Ask for a referral to a hospital consultant obstetrician (OB). It is more likely that an OB will have experience of managing HG and have knowledge of which drugs are safe to use in pregnancy.
-  If possible, see another GP.    
-  If you remain untreated and become dehydrated, you can have yourself admitted to A&E for IV fluids and ask to be seen by an OB while you are there. 

-  Call your local maternity hospital and ask if there is a consultant who treats HG or if they have an HG clinic. If they have an early pregnancy unit  this is usually the best place to make initial enquiries.  Some maternity hospitals have special arrangements so that women can self refer and have themselves admitted directly onto a gynaecology ward, rather than going through A&E. Also, if you are under an OB, they may have an arrangement where you can go directly to the hospital and say that your consultant has authorised you to self refer. In this way you will get quicker treatment as in A&E as you will initially see a general emergency doctor rather than an OB and you may have to do lots of explaining and cajoling to get your treatment. 

-  Call pregnancy sickness support on 024 7638 2020 and ask if they know of a doctor in your area who is willing to treat with medication. PSS Contact Us

Importance of prompt intervention in the management of HG
It is now acknowledged that HG should be treated quickly before symptoms deteriorate. Studies have shown that prompt intervention is more effective than later. A 2004 study compared two groups of women one in which women took antiemetics at the first symptoms of NVP, the other in which women waited until symptoms were more advanced before taking therapy. The authors conclude:

The pre-emptive group was improved significantly compared to the control group (P = 0.01). Pre-emptive symptom management appears to be effective in preventing severe NVP in general, and HG in particular. Women who have experienced severe NVP in a previous pregnancy may benefit from taking antiemetics before, or immediately at the start of symptoms in a subsequent pregnancy.

Koren G and Maltepe C, Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. Journal of Obstetrics and Gynaecology 2004 Aug;24(5):530-3.

The importance of asking for treatment is pointed out in the following article. Because most GPs and midwives do not bring up the subject unprompted, the patient herself must bring it to their attention.

If a care provider is unaware of a condition, they will not offer therapy. Women are aware that nausea and vomiting are common symptoms in pregnancy and may assume there are no treatments available and, therefore, no reason to raise the issue with their care providers. It is essential for care providers to ascertain if a woman is suffering from NVP and offer therapy. Asking questions about the effects the NVP is having on different aspects of their quality of life helps guide therapy and validates the condition for the woman. Waiting for the condition to become severe enough to result in weight loss and electrolyte disturbances, risking maternal and fetal health, does a disservice to women and society in general when safe therapeutic modalities are available.

Lane CA, Nausea and vomiting of pregnancy: a tailored approach to treatment. Clinical Obstetrics and Gynecology 2007 50 (1): 100-11