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Hyperemesis is no stroll in the palace park. Kate may be a princess, but she is also human. Women of every race, class, and income level face risks in pregnancy and put their bodies on the line every time they get pregnant. The only differences between the princess and the pauper are that one has proper food, nutrition, and care and the other has none.

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

As you might imagine, virtually every news outlet still located on planet Earth has covered the fact that Princess Catherine, Duchess of Cambridge, is officially pregnant. A feeding frenzy of press coverage on the royal pregnancy has been virtually guaranteed since the day she and Prince William got engaged.

But unlike those princesses in the fairy tales, Princess Kate's pregnancy is so far neither easy nor uneventful. An announcement from the Royal Family stated that she was hospitalized with hyperemesis gravidarum, which the American Pregnancy Association explains as "a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Mild cases are treated with dietary changes, rest and antacids. More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line (IV)."

Major news organizations are not widely known for their effective treatment of women's health issues, and so it's not been surprising to me that many have reported Kate is suffering with a "bad case of morning sickness." Others have been downright rude and ignorant. Gawker's Caity Weaver, for example, wrote that "hyperemesis gravidarum [is] what they call regular old morning sickness when you are a princess."

I beg to differ.

Unless I am missing something, I am no princess; otherwise, my butler has been missing in action for quite a while and my diamond tiaras are nowhere to be found. I suffered from hyperemesis in both of my pregnancies. I assure you it has no relationship to the quaint notion of saltine-crackers-and-ginger ale morning sickness we all think about if and when we think about morning sickness at all. Really, it doesn't.

From the very day of the six-week mark in my first pregnancy, I began to throw up. I never stopped. I vomited until there was nothing left to throw up, and then I would keep vomiting, resulting in sustained convulsing dry heaves. And this was day two. If I took a sip of water, it came right back up. If I tried to drink plain broth, same thing. Pregnancy vitamins? No way. If you have ever had a really, really bad case of food poisoning and gotten to the point where you were begging God just to let you die, you have a sense of what I am talking about here. But food poisoning lasts at most a few days. Try nine months like that.

In my case, within a couple of days of my "hyperemetic episode," I was unable to walk around; when the dry-heave convulsing became literally painful, I was taken to the hospital for intravenous (IV) fluids. In that first pregnancy, I spent a cumulative total of five months in the hospital or at home in bed on IVs, with home health aides, catheters, nausea medicine, and the rest, unable to eat enough to sustain myself and tethered to IVs. I lost more than 30 pounds. (That made for great jokes after the baby was born, about how I never realized that all I needed to do to lose weight was to get pregnant.)

I was virtually unable to work for the better part of five months of my pregnancy, because I became so weak that walking up and down stairs -- and some days lifting my head off the pillow at all -- was difficult and made me excruciatingly tired and dizzy. When I did go places, we brought my IV bag. And the IVs only worked to keep me hydrated as long as I had them in; take out that IV, and I would go back into convulsive vomiting and lapse back into serious dehydration. I was six months pregnant and still on IVs before I could sip chicken broth or drink what oddly enough I most craved, Diet Pepsi, and hope to keep some down. When I expressed (constantly) to my doctor my concern for the baby, she reassured me: "Don't worry. You came into this healthy and well-nourished. Its not the baby that is in danger right now, it is you, because the baby is feeding off all your reserves and you have nothing with which to replenish yourself."

My daughter arrived as a healthy, alert 8-plus-pound baby. And, much to my obstetrician's shock, I went through it all over again with my son.

Like Kate, I was lucky. I had a job I could keep; disability insurance; health insurance; and help from my then-husband, who had to take off work to change the intravenous fluids and take care of me. I had contraception to plan my pregnancies, great medical care, a wonderful Ob-Gyn, and the reassurance, even when I did not believe it, that my babies would be okay. Kate may have it worse or better than I did medically, but either way she is suffering from a potentially serious complication of pregnancy. And, what is more, she is going to be expected to "perform" for the cameras some time very soon, putting more pressure on her as a woman dealing with a serious condition in early pregnancy. The very thought of mixing cameras with hyperemesis makes me sick all over again.

The treatment of Kate's condition by at least some media outlets as just another bout of morning sickness is at least in part a failure to really understand and report on pregnancy as anything other than a fantastic event, a tug of war between "choice" and anti-choice movements, a struggle to get pregnant, or a major social drama (think teen pregnancy).

Missing is an examination of just how dangerous pregnancy can be, and how dependent the lives of pregnant women are on access to good nutrition, good medical care, and good support systems. This same reality was illustrated in a different but tragic way in the case of Savita Halappanavar, who died last month in an Irish hospital because doctors refused to terminate her pregnancy at 17 weeks even though it was clear she was miscarrying and even after it became clear she could not survive unless in fact they terminated the pregnancy, quickly. They let her die.


But it is a reality played out every day in places throughout the world in which papparazzi have no interest. More than 350,000 women die each year from complications of pregnancy and unsafe abortion. The malnutrition, anemia, and other health conditions rampant among pregnant women worldwide are contributing factors. Cultural, economic, and social discrimination mean that both women and girls are exceptionally vulnerable to poverty and are less likely than men and boys to have  adequate food intake. Iron deficiency anemia, for example, contributes to 20 percent of all maternal deaths worldwide. One study conducted by UNICEF in Samburu, Kenya revealed that 60 percent of the pregnant women were malnourished, and even so, they still gave up shares of their food to make sure they could give more to their children.


Data show that HIV-positive pregnant women are more likely to be malnourished than their HIV-negative counterparts, a serious problem in regions like Africa where women make up the majority of those infected with HIV. Lack of emergency obstetric care is one of the leading factors in high rates of maternal death and illness throughout Africa, Asia, and Latin America. And in regions where under-nourishment in pregnant women is widespread, infants are far more likely to be born at low birth weight, a risk factor for neonatal deaths, learning disabilities, mental, retardation, poor health, blindness and premature death in infants.


So if I were a woman with hyperemesis in, say, rural Kenya, Nigeria, or Uganda, the outlook for me and my baby would have been dramatically different than it was in fact for the middle class United States me, or than it is for Kate (barring, of course, any other complications with her pregnancy). There would have been no IV fluids, little rest, and likely no extra resources to assist me. I might have died, along with my baby, and even if I had survived, my daughter would have a higher risk of dying and far poorer prospects in life.

Kate may be a princess, but she is also human. And as human beings, women of every race, class, and income level face many risks in pregnancy. What Kate -- and Savita before her -- have reminded us is that women put their bodies on the line every time they get pregnant. I wish Kate all the best. But the only differences between the princess and the pauper in this case are that one has proper food, nutrition, and care and the other has none.

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Comment Preferences

  •  This is what so many people don't get (13+ / 0-)

    when they think of pregnancy. They don't see it as a serious health condition that presents risks for the mother.

    •  Exactly, and not to forget: (5+ / 0-)

      Pregnancies create permanent damage to a woman's body. The leading cause of osteoporosis in women (and also why they are so disproportionately affected by it compared to men) is that a pregnancy, over its whole course, drains your calcium reserves which can never be restored and uses it to build up the embryo/fetus's own calcium levels. The amount of calcium a baby drains from the mother is irrevocably depleted by as much of 1/3rd of the original amount (!) - and that's something specialists have only discovered a few years ago.

      Baby Development

      During pregnancy, the developing baby drains the mother of many resources, including calcium. Your baby needs as much calcium as possible for proper growth and development of bones, muscles and blood clotting abilities. For these essential needs to be met, the baby starts pulling the calcium from your body. You run the risk of poor teeth and brittle bones.

      Then one has the gestational problems that affect tens of millions of women in the United States alone that don't stop after pregnancy and can last for the rest of their lives like diabetes, blood pressure problems, extreme fatigue, depression, not to mention the effects of eclampsia (life-threatening condition that can induce tonic-clonic seizures and coma that happen during pregnancy but are not due to preexisting or organic brain disorders), asthma, thyroid conditions, several kidney diseases, an assortment of neurological problems, Gestational trophoblastic disease (pregnancy-related tumors), etc. etc. etc.

      Those idiots who seem to think pregnancy is a walk in the park are absolutely infuriating - they should be able to feel the "bliss" of being pregnant when their spouse is. They're the reason why besides Papua New Guinea, Liberia and Swaziland the US is the only country in the world not to have paid maternal leave, for example.

      Sorry, rant over! ;)

  •  Mrs. Polecat had to take Zofran, it was so bad. (7+ / 0-)

    At least it is available as a generic, now anyway.

    She lost weight during the first 4 months, each time.

    Happy little moron, Lucky little man.
    I wish I was a moron, MY GOD, Perhaps I am!
    —Spike Milligan

    by polecat on Thu Dec 06, 2012 at 11:43:40 AM PST

  •  My niece had this... (8+ / 0-)

    and she survived, albeit with much help. Her daughter was not perfect, and had some developmental issues, primarily neurological/physical that have lasted since her birth. At 13, she is essentially normal and shows no signs of her difficult path.

    Following her pregnancy, my niece vowed to not have another pregnancy. She has stuck with that vow, and is quite happy to have only one child.

    My sincere, heartfelt sympathies to all women who have this.

  •  Thank you for the diary. (4+ / 0-)

    It is of serious use both to policy wonks who look at Rs saying pregnancy is 'normal' and doesn't involve risks, and, in another case, to me directly.

     My DiL had a beautiful eight pound boy on Thanksgiving, but something was off with the blood pressure. Someone here had posted on post partum eclampsia, which was the first time I had heard about it, and it turned out that that was what ailed my DiL so that I saw from the posting how serious it was and could do some research and therefore could  ask the right questions about the diagnosis, and therefore use the grandmother's spot to lobby for the care required for DiL  for that, even if it left her in bed for a month the way pre partum eclampsia did in four pregnancies out of six for me and my Sis, and her goofball husband, my son, trying not to copy the plastic tag attached cooking his father my beloved, had to do when I was down and what we shall politely if not quite truthfully call his housekeeping.  

    I hope this diary will help people understand the problem it describes is real and a risk, and permit more of them to ask their obgyns about it and what proper care is, and insurance companies to stop fussing about covering it. This is important, and the post about it is a goooood thing, a proper and necessary counterbalance to all those Righties who think babies drop from Heaven or are brought by the stork and create no health and life risks to the mothers who carry them which sensible men should consider. .

  •  Great diary. (1+ / 0-)
    Recommended by:
    Catte Nappe

    That is one condition I never heard of.  I admire your courage in having a second child after experiencing that.  

  •  Pregnancy is difficult and dangerous. (2+ / 0-)
    Recommended by:
    Cassandra Waites, 2thanks

    Even in the best of circumstances. It infuriates me when people talk about it like, "Oh, so, it's just almost a year of your life, suck it up."

    We don't force people to undergo major trauma for any other reason that can save a life. We applaud it if they do, but we don't make them. It's great if you want to donate a kidney or bone marrow or the like. But this pretense that it's easy and painless and no sacrifice doesn't exist as it does for pregnancy.

    www.stacysmusings.wordpress.com

    by Magenta on Thu Dec 06, 2012 at 02:16:50 PM PST

  •  Thanks for more attention to HG (2+ / 0-)
    Recommended by:
    Catte Nappe, Cassandra Waites

    Hyperemesis gravidarum is a deadly serious condition. My daughter suffered through it during two pregnancies. Even with aggressive treatment (especially during the second, which was worse), she was risking her health and life every day she continued.

    We read everything available in the medical literature about diagnosis, treatment and prognosis for the baby and the mother (I do medical research for a living.) Sound hard? Not as hard as you would think - there is pathetically little serious research and there are virtually no clinical trials in this area. Shocking when you consider that 80-90% of women experience some degree of nausea during pregnancy, and about 1 in 200 actually have HG.

    It gets worse. My daughter was risking her life to have a much-wanted baby, but some doctors told her the whole thing was psychosomatic. The closest hospital told her they would not terminate the pregnancy even to save her life.

    And the venal and/ or ignorant men (for the most part) in the press and the right-wing clown car cannot tell the difference between a little queasiness and being close to death. Or between the life of a cluster of cells without a nervous system and the life of a grown woman with a husband and parents who have loved her for many years, and a child at home who needs his mama.

     

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