When is morning sickness considered hyperemesis gravidarum? And can you have it without vomiting?

by Kat de Naoum |

Thanks to Kate Middleton’s battle with this affliction, hyperemesis gravidarum (HG) has garnered awareness around the world giving sufferers a little well-deserved sympathy.

Up until recently, it was simply passed off as acute morning sickness. It was obviously not enough that author, Charlotte Bronte, most probably died from HG; according to Wikipedia, she “is often thought to have suffered from hyperemesis gravidarum. She died in 1855 while four months pregnant, having been afflicted by intractable nausea and vomiting throughout her pregnancy, and was unable to tolerate food or even water”. In fact, hyperemesis gravidarum is so unbearable that around 1000 sufferers a year choose to terminate their pregnancies because of it. Yes, it is a very serious matter.


Hyperemesis gravidarum affects up to 2 per cent of pregnant women; in about half of these cases, the symptoms subside around the 21-week mark, but unfortunately, in others, symptoms can last right up until – and even during – labour. For fear of dehydration, a lot of these women are hospitalised, sometimes more than once during their pregnancies, and put on IV drips. Many others, however, are turned away or dismissed for seemingly not being ill enough.

If, like most women with HG, you’ve called your doctor, exasperated, because you can’t see straight from all-day nausea and can’t believe this is your life now, you’ll inevitably have had to deal with the predictable question, and the only thing that seems to matter to them:

“How many times have you vomited today?”

If your answer is anything under 10, you may feel like you’re being shrugged off. “You’ll be fine,” “Try to rest,” “Try some ginger tea,” “Take a walk,” “Stop thinking about it,” and other such gems that will make you want to rip your hair out.

Although hideously annoying, it’s understandable that all your doctor cares about is whether you have managed to retain any sort of liquids, nutrients, and electrolytes in your system because if not, you could become dehydrated and risk the health of your baby and that is your doc’s first and main concern. Your discomfort, unfortunately, isn’t. If you have managed to ingest even a minimal amount of food and liquid, your baby is likely getting all the nutrients it needs and that’s good enough for your doctor, even if it means that you are left feeling like death on a stick.

Women who don’t vomit the expected 10+ times per day can actually end up feeling bad when asked that question because, sure, as we are constantly reminded, there are other women who vomit 40 or more times per day, but that fact alone doesn’t make your pain and discomfort any more bearable. “I was embarrassed when I was landing in the ER for fluids and had to say I had only vomited once or max twice in a day,” says Hypermumofthree. “But all in all, I had held down only 16oz (450g) of liquid.”

Can You Have Hyperemesis Gravidarum Without Vomiting?

When thinking of hyperemesis gravidarum we usually bring to mind Emily Rose from The Exorcist with a limitless supply of vomit. After all, the word “hyperemesis” itself literally means “a lot of vomiting,” but millions of mums everywhere, in their debilitating, immobile state, with the suppressed vomit that has been rising in the back of their throats every waking hour (and even during sleep), would tell you otherwise. There is actually another side of HG and you can in-fact have hyperemesis gravidarum without vomiting.

Believe it or not, it is possible to have hyperemesis gravidarum without vomiting up all day long. “Extreme unrelenting nausea is real, is HG, and yes, can get you dehydrated enough for your veins to collapse like mine were,” continues Hypermumofthree. “Don't be embarrassed! I usually only puked once a day.” Wikipedia says, “A small percentage rarely vomit, but nausea still causes most (if not all) of the same issues that hyperemesis with vomiting does.”

Consider this: vomiting can be triggered by being hungry, brushing your teeth, eating, not eating, talking, breathing, moving… If you eliminate these factors, the vomit can be stopped from escaping your oesophagus, but that doesn’t mean that you don’t feel physically sick with every fibre of your being. In some cases, the patient manages to hold down the vomit (some credit it to a strong stomach or literally just clamping the back of their throats shut all day) but that’s not to say that the vomit isn’t right there at the back of the throat ready to come out at any given moment… all… day… long. In these instances, the patient has incapacitating, debilitating, continuous nausea that prevents them from having any sort of normalcy.

Not to minimize the Duchess’s plight in any way, but we imagine that Kate wouldn’t really have had to lift a finger during this whole horrendous ordeal, as opposed to most of us who would still have to hold down our job, do household chores and perhaps even care for our other children whilst simultaneously wishing we were dead. If you think this sounds extreme, for most women suffering from hyperemesis gravidarum, it really isn’t.

Hyperemesis Gravidarum and Depression

Depression and severe psychological stress have been found to be a direct consequence of hyperemesis gravidarum. The same study that found this notes that “patients with HG during pregnancy should be evaluated with respect to mood disorders as much as their medical conditions. Psychiatric counselling may be helpful in patients with HG to assess the anxiety and depression degree and provide optimal management, care and support for these patients.”

The HER Foundation (Hyperemesis Education & Research Foundation) says, “Many HG women describe the illness as something no one can truly understand unless they have endured it themselves. Instead of the joy every pregnancy should bring, HG women spend most of the 9 months suffering in silence unable to eat or simply keep water down.”

So when a medical professional simply shrugs off what you’re going through as “normal” just because you aren’t vomiting much, and perhaps even makes you feel like you’re making much ado about nothing and hints that you should be feeling blessed instead of complaining all the time, it can really be a blow to one’s psyche.

The funny thing is, most HG sufferers can agree that the actual act of vomiting isn’t even the worst part; the relentless, debilitating, all-day nausea is. One pregnant woman says, “I am a HG sufferer myself (diagnosed in hospital at 7 weeks) and the constant unrelenting nausea is by far worse than the physical vomiting (which is so severe it makes my throat bleed).” When you have HG, days seem like months, you’re physically incapacitated, and God forbid you have anything else to do all day rather than just lie in bed and wait for months till it’s all over. The guilt and stress you may have for not being able to carry out your duties only serves to make matters worse. In any event, vomiting provides no relief whatsoever, as opposed to when you are drunk, hungover or have food-poisoning and vomiting makes you feel immensely better. With HG, you only continue to feel just as sick as you have been even after vomiting.

Need to talk to someone? Here’s how to get help when you need it

You are not alone

At times when all you can do is lie in a dark, deathly silent room because any form of light, noise or movement could trigger a vomit attack, you might be inclined to risk it just to try to connect with someone else who could perhaps understand or knows what the hell is going with your body. That’s where the mum’s forums come in handy. It’s most probable that any questions you want to ask have already been asked before by some other poor desperate suffering pregnant woman somewhere around the globe.

“Is it possible to have hyperemesis without actually vomiting?” asks one mother from Aberdeen. “The reason I ask is that for the last few weeks I have had 24/7 nausea - not mild either. It's been completely debilitating. I can't face food most of the time and have lost 6-7 pounds in 3-4 weeks. Certain foods (vegetables mostly) make me gag when they're in my mouth and after I have eaten, my tummy is gurgling and grumbling and I often feel worse. Not eating doesn’t really help either. If I'm hungry I feel even sicker. I spend most of my days feeling like I am about to throw up and my mouth even fills with saliva sometimes which I know from past bugs means I'm about to be sick but nothing happens. I wake up in the middle of the night with that lurching feeling of needing to be sick but again, I'm never sick. Between that and needing to pee during the night, I'm constantly shattered.”

Thankfully, even though some doctors might not agree that women who don’t vomit tonnes every day have HG, there are myriads of women who know exactly how this feels.

“I only vomited three days (not consecutive) my HG pregnancy,” says Ann, “but that didn't mean I wasn't extremely nauseous. I lost 10 pounds in my first trimester but was able to gain it back plus more. I would spend days and nights on the bathroom floor because I was on the verge of vomiting but it never happened. It was the darkest days of my entire life. I didn't feel like a person anymore… Now at 26 weeks, I am still nauseous most of the day but I find it more bearable. I consider myself lucky that I don't actually throw up but at the same time it's hard for people to realize just how sick you feel since you have no physical signs.”

Some other responses include, “I really sympathise as I had the feeling just before you're sick 24/7. It's good you've got treatment as I left it and by 12 weeks I couldn't stop dry retching and was completely exhausted and dehydrated as I couldn't physically get anything down. I lost 3/4 of a stone.”

“I had extreme nausea the whole 9 months, on Zofran, hospitalized twice, lost 20 lbs in first trimester, still down 4lbs just before delivery, managed to somehow to have a 10+ lb baby, and NEVER vomited,” continues Ann. “I just felt so sick all the time that I couldn't force myself to eat. In fact, when I did eat my stomach would feel like I had intense food poisoning. I had to stop working because all I could do was lay down. I always felt self-conscious about telling people I didn't vomit because I thought they would think I was making it up. It would really help to hear there is someone else out there with an experience like mine as I am beginning my third pregnancy and just started on Zofran today which by the way just takes a bit of the edge off for me.”

A common denominator in all the stories online is that women are not getting the support they need with this disease. “I left feeling unsupported, extremely sick and quite down,” says one sufferer. “I was sent home from hospital with no help,” laments another. However, women are coming together to support other fellow sufferers. “Don't discount how you are feeling,” says Terri. “Being nauseated is HORRIBLE, especially when it is unrelenting.”

If the reason behind the lack of support from medical professionals is simply the name pertaining to “a lot of vomit,” then we’re sure all vomit-less HG sufferers will gladly sign a petition to rename it “hyper-nausea” or “hyper-help-me-now.” Whatever its name, women who are suffering need support and understanding.

How to live with Hyperemesis Gravidarum

The good news is that in recent years people are starting to take acute morning sickness and hyperemesis gravidarum more seriously. Research is constantly being done and breakthroughs are being made. Until such time however that a safe cure-all is discovered, there are a few things you can do:

• Be informed. Read everything there is to know about HG. Know what you’re dealing with. “Education is power,” says Ann Marie King, co-founder of the HER Foundation. “Telling a HG women to eat crackers, try ginger or sea-bands shows your lack of knowledge of HG.”

• Don’t let your doctor or anyone dismiss your discomfort just because you are not physically vomiting over a certain amount per day. You deserve to be taken seriously and your suffering merits attention.

• Look into the treatments available, bring these up with your doctor and even ask to be admitted into hospital if possible.

• Don’t keep it inside; talk to someone – other mums, your family, friends, a therapist. You don’t have to suffer in silence. Reach out to fellow sufferers in forums for information on what helped them or even just to get an understanding and sympathetic ear.

• Contact the UK Pregnancy Sickness Support group. There are tonnes of information on their website, an online support forum, a volunteer support network and even a helpline you can call.

Have you suffered with Hyperemesis Gravidarum? Share your story on Facebook or Twitter.

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