For some women, pregnancy is a grave struggle

By Tomoeh Murakami Tse
The Washington Post

Wednesday, November 12, 2008 1:41 PM CST

NEW YORK — I found out I was pregnant on an early December morning last year and, for two days, went about my routine in a euphoric trance: a grin on my face, elbows out slightly to guard my belly from the crush of commuters and holiday shoppers. I daydreamed about turning the guest room into a nursery, of taking prenatal exercise classes and bonding with other moms-to-be.

But I wouldn’t get to do any of those things. By the sixth week of my pregnancy, I was vomiting so much I was spitting up blood. Dehydrated and dizzy, I landed in the emergency room at week nine. In my 20th week, I started receiving nutrition intravenously.

What I had was hyperemesis gravidarum, a severe form of pregnancy sickness characterized by persistent nausea and vomiting as well as significant weight loss, often more than 5 percent. It occurs in about three to 20 of every 1,000 pregnancies, hospitalizing more than 30,000 women a year in the United States, according to studies and government statistics.

Women with the condition can suffer from dehydration, malnutrition, electrolyte imbalance and, in severe instances, neurological disorders, spleen tearing, kidney failure and lung collapse. Before intravenous fluid treatment became available, it was not uncommon for women to die from hyperemesis. It can affect the unborn baby, too: Some researchers have linked the condition with restricted fetus growth, preterm delivery and low birth weight.

No one knows exactly what causes nausea and vomiting in pregnancy, but elevated hormone levels are widely thought to be at fault. Multiple studies have found that women with hyperemesis have higher levels of human chorionic gonadotropin, a hormone unique to pregnancy, and thyroxin, a thyroid hormone, than women with less-severe nausea and vomiting, said Roberto Romero, chief of the perinatology research branch at the National Institute of Child Health and Human Development. At higher risk are women who are carrying twins, had the condition in a prior pregnancy, have gastric disorders or are prone to motion sickness; so are women whose mothers and sisters experienced hyperemesis, suggesting that genetic predisposition plays a role, Romero added.

“It’s extremely debilitating,” said Marlena Fejzo, a geneticist and researcher at the University of Southern California who has studied hyperemesis. “It’s most devastating for women who end up aborting. Many women decide to change their plans for having another child. A lot of them adopt or don’t have more children.”

My ordeal began three days after learning I was pregnant, when I woke up in the early morning with a queasy feeling in my stomach. As I lay in the darkness, the sensation grew stronger until I could no longer ignore it. My mouth went dry and in the next instant filled with saliva. As the contents of my stomach rose, I crawled over my husband, Archie, and headed for the bathroom. I retched loudly several times, then vomited.

Unpleasant, I thought, but no big deal. Plenty of friends had told me about morning sickness. It was just something most women had to put up with during the first few months of pregnancy, a small price to pay for the ultimate joy that lay ahead.

Evolutionary biologists have proposed that nausea and vomiting in pregnancy are nature’s way of protecting the fetus from food-borne toxins in the critical first trimester, when major organs are formed and the fetus is still small enough to live off the mother’s stored fats. This seemed to fit with research showing that women who experience morning sickness have lower rates of miscarriage, and I took comfort in that.

So I slogged along, throwing up everywhere: in trash cans on subway platforms and in the bathrooms of the white-glove hotels, law firms and Wall Street banks that I visited as a New York-based financial reporter for The Post.

I tried everything that the pregnancy books suggested: Salted pretzels. Ginger slices. Jell-O. Acupressure. My mother, who lives in Tokyo, sent pickled plums and other Japanese remedies. My mother-in-law brought herbs from Taiwan.

But nothing seemed to help. Soon, I was vomiting 10 to 12 times a day. I lost 12 pounds, my 5-foot-3 frame falling to 96 pounds. When there was nothing left to regurgitate, I threw up gastric fluid, tinged with blood from my inflamed stomach.

I frequently became severely dehydrated. One day in January, Archie came home and found me so wobbly that he rushed me to the emergency room, where my fluids were restored intravenously.

Doctors prescribed anti-nausea medications: first Reglan, then Compazine suppositories, both of which prevent dopamine, a neurotransmitter, from stimulating receptors in the brain that cause nausea. They didn’t do much. Next came Zofran, a relatively new drug used to combat nausea in chemotherapy.

The round-the-clock nausea was paralyzing. The cruel thing was that vomiting, unlike the times I’ve thrown up because of the flu or a jerky cab ride, provided no relief. As my condition worsened, I spent all my time at home, lying as still as possible in bed, heaving on the bathroom floor or writing articles at the kitchen table with a bucket at my feet. I stopped seeing friends, since I could no longer do the things we enjoyed together: dining out, rollerblading, going to church.

I had lost control of my body and, worse, I had lost control of my life.

For Archie and me, the lowest point came at an appointment with the obstetrician during a difficult stretch at the beginning of my second trimester.

Overbooked, he was a very busy man, and we often had trouble asking questions during the rushed appointments. That day, there was a particularly long wait of two hours, which I spent throwing up. We contemplated heading to the emergency department next door but stayed because the nurse, seeing I was too dehydrated to give a urine sample, thought the doctor would admit me for treatment. But he declined, saying I should feel better in a few weeks — and then he was gone.

It was getting late, and we couldn’t shake the feeling that he just wanted to go home. As I lay on the exam table clutching Archie’s hand, I told him I wasn’t sure if I could keep going. Both of us were exhausted, and on that chilly February day, my Aug. 7 due date seemed so far away.

Something had to change. We started asking close friends to stay with me. They sat by my side, late into the night, and rinsed out my bucket when necessary, giving Archie a break. Still others helped us look for a new doctor, realizing the stress of my medical care arrangement. In retrospect, we should have switched sooner, but neither of us had ever had serious medical problems — I didn’t even have a doctor — and we didn’t know any better.

Whenever I became too dehydrated, the new doctor, Ricky Friedman, and his partner arranged for me to receive intravenous fluids at home or had me admitted to Mount Sinai Medical Center. There, I was pumped with fluids and anti-nausea medication and met with a nutritionist. I was even seen by a social worker, who made sure there were no underlying psychological issues, such as an eating disorder, causing me to reject food. I told her that there were few things I loved more than eating.

At 20 weeks, with my body still below pre-pregnancy weight and producing ketones, a sign of starvation, Friedman ordered a nutritional line inserted in my arm. Ketones themselves can cause nausea, worsening the problem. “It sort of feeds back on itself,” he said in an interview. “If we can interrupt that cycle, we might be able to make you feel better.”

The nutritional tube, which reached to just above my heart, provided the calories and vitamins that I and my growing baby needed. From then on, I spent 14 hours a day connected to a five-pound bag of milky liquid, which I wheeled on a cart from my bed to the bathroom to the kitchen table. Every week, a nurse took blood samples so that my endocrinologist could use them to adjust the contents of the bag, such as adding potassium when my levels fell.

As the spring thaw gave way to longer days, I vomited less and found I could keep down certain foods (a potato, ramen noodles and, strangely, extra-sharp cheddar cheese) around lunchtime. I gained weight. Archie and I could feel our baby kicking, stronger each day, which gave us great comfort. The finish line, we felt, was within reach.

Early in the third trimester, the pregnancy threw us one more curveball. With the fetus crowding my stomach, I started getting acid reflux, a common problem in pregnancy, which reaccelerated my vomiting. As the weeks went by, the condition worsened. So at 38 weeks, I checked into Mount Sinai to induce labor.

I threw up for the last time about 20 minutes before the arrival of my son, at 2:54 a.m. July 25. He weighed 5 pounds 12 ounces and was in excellent health. I held him, he looked up at me and the euphoria from December came rushing back. I didn’t think about the months in between. The nausea vanished almost immediately.

That morning, a nurse who had taken care of me during my hospitalizations popped in and asked if I felt like breakfast. It was eggs and sausages, pancakes, cereal and fruit salad. I planned to save half for Archie, who had fallen asleep on a pullout chair. But I couldn’t help myself.

I ate the whole thing.

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