A fortnight after seeing these two pink lines, I began to feel unwell. Blaming for a hurried dinner after my late return from the hospital – I was a junior doctor at the time and still am – a tightness prevailed where my lower back meets my stomach. By morning, I had an appetite, although I had not touched alcohol in weeks. In a patient’s bed, I suddenly tasted something sour. I ran to the ward barrier. Holding my hair behind my face, I cried out in shock at how violently I was sick. Food and then acid and then air. Leaning against the wall, with my knees trembling, I wiped my mouth with a paper towel that absorbed almost nothing. It was the last time I would be at work for more than two months. Pregnancy is not a disease. Expectant mothers are not sick. But this does not mean that the common symptoms are not pathological. Up to 90% of pregnant women feel ill and 35% may need clinical help for nausea and vomiting. In medical school, hyperemesis gravidarum was covered in one or two slides. I remember hoping it would never happen to me. Known to its victims as HG, overexertion is an “excessive” disease. It is estimated to affect 2% of pregnant women. This statistic excludes many whose days are marked by nausea, stinging and vomiting, but they never find the diagnosis or support they need. Even if we use this conservative estimate, of the 700,000 women giving birth each year in the UK, 14,000 will be overweight. After premature birth, vomiting is the second most common reason for every pregnant woman who needs a hospital bed. The damage can be horrible: the drums burst. bleeding glands; critical dehydration; vitamin depots were looted. Urine contains ketones, an indicator of starvation. To assess severity, clinicians use a tool whose name resembles misogyny: the PUQE (unique quantification of indirect vomiting in pregnancy). Meanwhile, parents are offered reassurance that their babies are doing just fine. The history of medicine for the fetus as a “parasite” offers a relaxing idea that this scavenger will get what it needs from its host. However, a study published in 2021 shows a fivefold increased risk for young babies of gestational age by mothers who have HG, a more serious effect on size than amphetamine, cannabis or maternal tobacco use. In these children, there are higher rates of autism, mental health problems and neurodevelopmental retardation. Some embryos never reach this stage. Up to one in seven women with hyperemia resort to an abortion, which is harshly called “therapeutic termination”, while more than 50% consider it. These are wanted, beloved babies. Ask a doctor why nausea and vomiting start in the first trimester, why hyperemesis can continue for months and why it recurs in over 75% of future pregnancies and may seem shifted. Why is women’s health so low on the agenda that these extreme symptoms are reduced, mistreated and misunderstood? “My body kills babies,” said Dr. Marlena Fejzo, sitting at her Los Angeles home as the sun shines through the half-closed blinds. In 1999, she was a postdoctoral fellow working at UCLA studying genetic markers of multiple sclerosis. Then she became pregnant. In the first few weeks she vomited so hard her doctor arranged for intravenous fluids to be given at home, while an antidote to the disease, ondansetron, was injected into her veins on a four-hour basis. Even this powerful drug, originally developed for patients receiving chemotherapy, did not cause any symptoms. Fejzo’s retired parents came every day to provide nursing care, clean the bedrooms and thoroughly check her ketones for urine. Fezo’s bones began to dig into the mattress. With the slightest twist of her head, a spiral of vomiting began. After 10 weeks in bed, she started bleeding and lost the baby. It was a tragedy that became a call. “The severity of overdose is not understandable unless you have been through it yourself,” says Fejzo. “The only way people who have not done it can understand it is if they think about it while they are over the toilet. These 30 seconds before a person vomits and thinks he is going to die. This is how women with HG constantly feel. ” Fejzo returned to work in the laboratory six weeks later, injured by the loss of her daughter, but determined to save other women from this pain. “I want to do a genetic study on gravity overload,” Fejzo said at a group meeting. “I want to find the cause.” Her boss laughed. I did breathing exercises. I bought a miniature Tens to wear at the nei guan pressure point inside my wrist. I ordered every ginger product I could find (ginger tea! Ginger cookies! Gingerbread cookies!) Every tincture and sting failed. I called my doctor to tell her I was not working. Vomiting was not the worst part – I was full of nausea. I was prescribed a brown glass bottle of white tablets. She was kind, suggested I take cyclizine and wrote me a note for a fortnight. Eventually I returned in person, aware that I was vomiting in public. I explained my condition to another doctor. He insisted on three antiemetics at the same time: cyclizine, prochlorperazine and ondansetron. When I said I was wary of more drugs, he told me to “disengage my academic brain.” But I had read a paper linking ondansetron to fetal lips and palates. The European Medicines Agency has recommended that it not be used during the first trimester. This was unfortunate, as ondansetron is the most effective drug for the disease of pregnancy from a small range of bad choices, helping the symptoms in half the women. The association between ondansetron and oral clefts is actually minimal. There is a 0.03% increase in risk compared to babies who are not exposed to ondansetron. This is an additional three slits per 10,000 births. But as I kept the prescription, I could not see these numbers the way I would as a doctor. I was another lost patient. My belief that medication could keep both me and my baby safe. “Why are women’s health so low on the agenda that these extreme symptoms are mistreated and misunderstood?”: Dr. Kate Womersley. Photo: Robert Ormerod / The Observer As with so many drugs, antiemetics such as ondansetron and cyclizine are not licensed for use in pregnancy and, when prescribed, patients are at risk. In the late 1950s and early 1960s, thalidomide was licensed to treat pregnancy disease. Within two years, the drug’s terrifying effects on skeletal development in the first trimester became apparent when babies were stillborn or with delayed limbs. Researchers and pharmaceutical companies were burned. Pregnant women have since been found to be excluded from drug trials and, therefore, from the evidence base that such trials produce. But these results are essential for their guidance, protection and reassurance. I was convinced that my baby’s safety was more important than my discomfort. I now realize that our needs could not be separated so easily. My body was the place where she and I lived, and it would leave its mark on her as well. I returned to work in the middle of the second trimester when I stopped vomiting all day. But the nausea was constant. My salary had been cut in half. If I were not at work, I would jeopardize my maternity leave earnings. I was going to start a job in obstetrics. Here, I was hoping for understanding. But patients with HG had a low priority. They had to pass the toast test to be discharged home – hold down a slice without returning it. Dry white triangles are pinched or untouched on the discs. “Almost half of the women in the ward are overweight,” I said impatiently to one of my elders. “Is there nothing else we can do for them?” “What you need to remember about overdose,” she said, “is that most of it is….” I had not seen this gesture since school. These women are crazy. Her hand told her everything she knew not to say out loud. “Didn’t you feel sick when you were pregnant?” I asked. “The less I worked, the worse it was. “I had surgery,” she replied. She picked up her phone. The discussion was over. The exchange reminded me of a recorded lecture given to me by a medical student two years ago while researching maternity insurance in the United States. I found the attached email again. “This is usually what we see in people with hypersensitivity,” the clinician told her audience, looking at a sea of laptops. “They are so serious that they have to be admitted to the hospital. Usually something psychosocial happens. Either they do not want to get pregnant or they do not have support at home. Or some such situation “. Then the kick: “And often they do not want to feel better.” I could not shake the barbarity of this idea as I walked to my car that night, stroking my blow. I wanted, more than anything else, to be pregnant. But I was indignant with my body. How dare he do that to us? How dare he not be able to cope? As Dr. Fejzo searched for the cause of the overdose, she knew that for many experts the answer was already clear: everything is in the minds of women. Medicine tends not to trust symptoms that are difficult to diagnose, difficult to measure, and difficult to treat. Nausea is all three. When the “disastrous vomiting of pregnancy” was first described in the medical literature by the French obstetrician Paul Dubois in 1852, hysteria was used to explain many female complaints. A collection of scientific articles from 1980 reports …
