Why people who experience severe nausea during pregnancy often go untreated

After a miscarriage and a roller coaster of fertility pills, Mineka Furtch didn’t let the thoughts of morning sickness bother her before she finally became pregnant with her son.

But when the 29-year-old from suburban Atlanta was five weeks pregnant in 2020, she started throwing up and couldn’t stop. One day she held down an orange. Other days nothing. Furtch’s sick days used up her paid leave, and she eventually had to resort to unpaid medical leave. She remembered that her doctor had only had morning sickness and she said she would get better.

By the time Furtch was 13 weeks pregnant, she had lost over 20 pounds.

“I fought hard to have this baby and I fought hard to protect this baby,” Fulci said.

Now, Furtch’s son is 18 months old and heading into the second trimester of his unplanned new pregnancy, he’s once again suffering from severe nausea and vomiting.

The nausea associated with morning sickness is common in early pregnancy, but some women, like Furtch, have long-lasting symptoms and need to see a doctor. However, the condition is often misunderstood or downplayed by doctors and patients themselves, resulting in no treatment or inadequate treatment.

Mothers said they didn’t care because they couldn’t afford the drugs or doctors didn’t take them seriously, fearing the drugs would harm their unborn babies. If left untreated, symptoms can become difficult to control and such delays can become a medical emergency. You may.

“Most women realize this isn’t normal until they finally go to the ER and say, ‘Most of my friends have never been to the ER.'” Researching and raising awareness.

There are many unknowns about what causes nausea and vomiting during pregnancy. Studies have shown that genetics play a role in its severity, with hyperemesis estimated to occur in up to 3% of pregnancies. However, there are no clear lines to distinguish between morning sickness and hyperemesis, nor consistent criteria for diagnosing morning sickness, and MacGibbon says its impact is underestimated.

According to broad estimates, at least 60,000 people (perhaps more than 300,000) go to the hospital each year in the United States for pregnancy-related dehydration or malnutrition. Millions of people go to walk-in clinics or do not seek medical care.

Its impact ripples through all aspects of human life and the economy. One study estimated that the total annual economic burden of severe morning sickness and hyperemesis in the United States in 2012 was more than $1.7 billion in lost jobs, caregiver time, and medical costs.

The research for this article was personal. I was pregnant and by week 5 she was vomiting 5-7 times a day. My primary care physician in Missoula, Montana asked the obstetrician’s medical team pregnancy-related questions but didn’t see me until my first prenatal appointment more than a month later. On the advice of an on-call nurse, I tried over-the-counter supplements and medications to help ease my nausea.

I couldn’t stop vomiting. Almost a month after the symptoms started, brown rice was the only thing I could endure. I thought it would.

The following week, after I fasted for 24 hours, a remote on-call doctor prescribed anti-nausea medication. Now into the third trimester of pregnancy the nausea remains, but the symptoms are manageable and continue to improve.

For this story, I spoke with a woman who was unable to hold down solids and was unable to drink water before she received an IV for hydration. It can be difficult to determine if

“There’s no number like, ‘Okay, I’ve vomited five times, so I’m meeting the criteria,'” said Dr. Manisha Gandhi, vice president of the American College of Obstetricians and Gynecologists, which helps determine obstetric clinical practice guidelines. “The important thing is, ‘Are you abstaining from liquids? Are you allowing anything by mouth?'”

Gandhi says in her experience, only a minority of patients experience severe symptoms, with most peaking around eight or ten weeks’ gestation. She said it is standard for doctors to ask if a patient has felt nauseous during the first prenatal visit, and that patients should be called if the problem occurs before then. Treatment is gradual, involving dietary changes and taking natural supplements such as vitamin B6 before considering prescription anti-nausea drugs.

The first prenatal visit varies, but can be done 10 to 12 weeks after conception, once the fetal heartbeat can be seen. JaNeen Cross, her worker and assistant professor of perinatal social at Howard University in Washington, D.C., says there are gaps in the care of women in early pregnancy.

“This is followed by nausea, sickness, bleeding, and enough time to think, ‘Is this normal?'” Cross said. “And assuming people have access to providers.”

Barriers to care include whether you have insurance, can afford your copays, are raising children, and are taking paid time off to see a doctor.

According to a report released by the Centers for Disease Control and Prevention, about two-thirds of black patients in the United States saw a doctor during the first trimester of pregnancy in 2016, compared with 82% of white patients. Overall, about half of those who had to pay out-of-pocket did not have an early pregnancy check-up.

Cross would like to see more services and resources built into the community. That way, as soon as we know someone is pregnant, we can connect them to support groups, community health workers, or programs that do home visits. It’s about believing that the treatment is safe.

Some of that mistrust may be rooted in the 1950s and ’60s. The morning sickness drug thalidomide has caused thousands of babies to be born with severe birth defects. Studies have shown that current anti-nausea medications used during pregnancy pose little, if any, risk to the fetus.

Helena Schwartz, 33, of Brooklyn, New York, was on an IV at home before she was six weeks pregnant with her first child because she could not abstain from food. She was helpful for about 2 days. Then her body started rejecting her food again, and Schwartz said her doctor, who soon helped her, prescribed her anti-nausea medication. As her symptoms worsened, she left the medication off for three weeks.

“I was afraid I would hurt the baby,” Schwartz said. “I waited until it became impossible”

Even with a diagnosis and a supportive medical team, people like Schwartz experience extreme symptoms during pregnancy and are slow to heal.

As for Furch, the prescription medications she used in her first pregnancy weren’t enough to relieve symptoms this time around.

Her new obstetrician takes her symptoms seriously, but at times she faces obstacles to care. bottom. When her doctor prescribed a course of medication as a back-up plan, her insurance initially refused to cover the cost. So she vomited about 8 times a day.

Since starting the prescription medication, she can usually keep her diet to some extent. But she’s still having bad days and she had to go to the hospital again to get an IV in late December.

She is due to give birth this spring. After that, she will see the doctor again and have her tubes tied.

“Birth is nothing compared to ten months in hell,” Firch said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of the three main operating programs of KFF (Kaiser Family Foundation), along with policy analysis and polls. KFF is a donated non-profit organization that provides information on health issues to the public.

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