Pregnant women who suffer from extreme morning sickness are also at risk of severe mental health issues, according to a recent study.
Researchers from UK's Plymouth University examined the impact hyperemesis gravidarum (HG) has on a pregnant woman's psychological state, finding that it can be so debilitating that some women experience suicidal thoughts. HG, which is characterised by sustained and excessive nausea and vomiting, affects up to 1.5 per cent of pregnant women including Kate Middleton who has been treated for HG in all three of her pregnancies.
As part of their review, published in the British Journal of Midwifery, the team examined a wide range of published material dealing with the condition to assess its impacts on pregnant women. They found overwhelmingly that it negatively impacted a woman's ability to function in a range of areas at work and home.
From studies spanning more than twenty years, four main themes related to mental health and wellbeing were identified: social isolation, being unable to care for themselves and others (employment pressure, need to access additional childcare), negative psychological effects (depression, anxiety, guilt and loss of self), and a sense of dying, suicidal thoughts and/or termination of the pregnancy.
"One woman considered termination, another repeatedly asked doctors to induce labour early to end the sickness, and others mentioned the possibility of their own death; either fearing it or wishing for it," the authors explain, adding that given suicide is the leading cause of maternal death in the 12 months post-partum, it's a finding of particular concern and one requiring "rapid further investigation".
The review also included quotes from pregnant women who had suffered from the extreme nausea, shining a light on various aspects of the condition and its wide-reaching impact.
"I stay at home and it's between my bed and my rocking chair and the toilet and that's basically what my life consists of," said one sufferer. For many women, social isolation was a self-imposed strategy to manage symptoms - with loneliness occurring as a result. Fear of vomiting in public and the humiliation it would cause, was another reason women tended to isolate themselves during their pregnancies.
Other women reflected on their loss of "self" as a result of being so unwell, and unable to perform their usual roles as "mother, wife, employee".
"I want my life back; I am dying; I felt really not alive," one mum shared. "It's like I really don't exist anymore, and I am hyperemesis."
"It was so bad I was thinking about getting an abortion because I couldn't endure it anymore… I thought, 'This is not worth killing myself over'," said another.
As well as the psychological impact of the condition, the research highlighted that HG can also result in loss of earnings, financial hardship - and even loss of employment. Said one woman of her experience: "My office called because I couldn't come to work for a couple of weeks and told me that if I wanted my job I better get back to the office."
For some mothers, experiencing severe morning sickness resulted in having fewer children than they had originally planned. "That was another big factor in deciding not to have any more," said one mum, "because I thought I cannot even imagine having to look after a child when you're feeling like this."
The authors of the report say health professionals needed to be aware of the impact HG can have on women's lives, in particular their mental health. "Despite high quality research spanning more than 20 years, the effects of the condition are frequently underappreciated," they conclude.
"Health professionals can support women by enabling them to express their feelings and validating their experience.
"Referring women with symptoms to perinatal mental health services or peer support networks may be appropriate."
The authors also recommend that women are supported with help planning outpatient or at-home re-hydration services, "to reduce familial disruption," and that doctors "take an aggressive approach to anti-emetic therapy, (medication to manage nausea and vomiting such as Ondansetron) to control physical symptoms".
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