When I found out I was pregnant for the first time, I immediately called my doctor to schedule an appointment. “I’m pregnant!” I told her, and then asked, “When can I come in?” Much to my surprise, she informed me that they don’t schedule appointments until approximately ten weeks. While that felt like a lifetime away, I acquiesced.

Within 48 hours of this conversation, I felt the nausea and fatigue hit me like a freight train, and while I felt ill, I did not know that I was experiencing something other than morning sickness. After weeks of not being able to eat or drink without getting sick, I was finally able to go to my first appointment with my OB after insisting that I was very sick and that I needed to be seen sooner than the 10-week appointment. 

“While I felt ill, I did not know that I was experiencing something other than morning sickness.”

It was May of 2020, so I went in alone. The appointment was quick, and the exam was painful — she recommended ginger, peppermint oil, and acupressure bracelets for the nausea. I’d already tried those things. I walked out with my first ultrasound, a picture of an indistinguishable little smudge that was indeed my growing baby. I held it together long enough to make the ten-minute drive home, hung the photo up on the fridge, and vomited into the sink.

I stayed in bed day after day. Then the days turned into weeks, and I felt guilty for not being able to rally. I was finally put on Raglan, Unisom, and B6, which helped me get by until my second trimester, when I started to feel marginally better, but was still vomiting regularly.

In the midst of my second trimester, I recall one particular conversation with my husband. We were sitting on our bed in the glow of the lamplight, the air heavy with what I’d been ashamed to admit for weeks — that I understood why a woman would consider terminating a pregnancy like this, even one she wanted, even under the most favorable conditions.

“I stayed in bed day after day. Then the days turned into weeks and I felt guilty for not being able to rally.”

There I was — a woman who knew I’d wanted to be a mother all my life, got pregnant on purpose, was happily married, employed with full benefits and a paid maternity leave, living in my own home and supported in ways many are not. And while I wasn’t considering it myself, I understood how feeling trapped in one’s own body and continuous suffering could lead someone to terminate even a desired pregnancy.

I didn’t know I had hyperemesis, and I didn’t know there was anything anyone could do about it. My doctors never mentioned it. And while the second half of my pregnancy was better than the first, I threw up even during labor, and was amazed to feel immediate relief upon giving birth.

My second pregnancy

I found out I was pregnant with my son on my 29th birthday. My daughter was a few months shy of turning two, and while I’d learned about hyperemesis and determined that I’d been undiagnosed the first time around, I’d hung my hopes on the premise that every “pregnancy is different.” Naive to the fact that the recurrence rate for HG is so high, I’d hoped that maybe this time I wouldn’t feel so sick — but it became clear very quickly that that would not be the case.

“I’d hoped that maybe this time I wouldn’t feel so sick — but it became clear very quickly that that would not be the case.”

It was early November, and prior to finding out I was pregnant, we’d planned to host an early Thanksgiving celebration with our friends. I remember we’d attended our niece’s soccer game that morning. By the end of the game, I’d thrown up in the bushes three times. I tried to hold out because I didn’t want to cancel our plans we’d all been looking forward to for weeks, but the repeated vomiting turned into lower back pain, and, feeling defeated, I told my husband we needed to go to the hospital.

We sat in the waiting room and finally I wept. My lower back ached, my kidneys screaming from dehydration. The nurses administered IV fluids, and while it did nothing for my nausea, it eased my kidney pain and general discomfort. Remembering my last pregnancy, I insisted on a prescription for the maximum nausea medication they could give me before we left.

We did leave with my meds in hand and arrived home to ten of our closest friends because I’d insisted they still come by and enjoy our potluck dinner without us. We walked into the backyard where they were all gathered around the fire and announced that I was pregnant, which they’d already figured out.

What is hyperemesis gravidarum?

Most of the time, when I say I had hyperemesis gravidarum during my pregnancies, people don’t know what that is. And I understand, because I didn’t either.

According to the Hyperemesis Education and Research (HER) Foundation, hyperemesis gravidarum is a pregnancy complication largely determined by genetics and is marked by severe nausea and vomiting that can lead to weight loss, malnutrition, dehydration, and debility, with possible long-term effects for both parent and baby.

“Hyperemesis gravidarum is a pregnancy complication … marked by severe nausea and vomiting that can lead to weight loss, malnutrition, dehydration, and debility.”

I spoke with leading researcher Marlena Fejzo, PhD, who made a point to clarify that HG is not morning sickness. She emphasizes, “It is not something you can power through — it is persistent, debilitating, and severe nausea and vomiting beginning early in pregnancy that results in dehydration and nutritional deficiencies if left untreated.” 

In an episode of “Informed Pregnancy” podcast, Dr. Fejzo shares how she herself experienced severe HG during her pregnancies, resulting in treatment that involved a feeding tube and, ultimately, in pregnancy loss. 

In addition to physical suffering, HG takes a psychological, financial, and social toll on families, and “it is the primary reason for hospitalization in the first trimester of pregnancy and the 2nd most common reason overall after preterm birth,” Dr. Fejzo says.

“In addition to physical suffering, HG takes a psychological, financial, and social toll on families.”

Currently, treatment for HG includes antiemetic medications, like Zofran, which the organization says is associated with small risks compared with untreated malnutrition, and early intervention is crucial. Many women decide not to have more children after experiencing HG, and one study found that HG was recurrent in 89% of subsequent pregnancies.

In the years since, Dr. Fejzo has dedicated her research to discovering the cause and potential treatments for HG. “Over the last decade we identified the greatest genetic risk factor for HG and the main mechanism. It is genetic and/or environmentally conditioned sensitivity to the rapid rise of a nausea and vomiting hormone called GDF15 that rises rapidly in early pregnancy,” she shares. 

Based on these findings, she is currently conducting a clinical trial at the University of Southern California to develop possible prevention measures for HG as well as consulting on a clinical trial in hopes of discovering a possible treatment.

How I’m processing my experience

With daily medication, I was able to function at minimum capacity until about 20 weeks when my symptoms improved. I remained on my nausea medication longer with my second pregnancy. Because my symptoms improved around halfway through my pregnancy, my case was considered mild, but an estimated 1 to 3 percent of pregnancies involve severe HG, and the true number is likely higher due to the condition being underdiagnosed.

In the years since being pregnant, I’ve been able to walk back through those long, hard months, to name the feelings I so desperately didn’t want to feel, and to grieve the parts of pregnancy and motherhood that I felt were taken from me. So much of it was a blur because I was busy trying to survive it. I’ve found a lot of healing in reprocessing pregnancy through therapy, understanding the importance of comfort and bodily autonomy, and not downplaying joy when it arrives.

“I’ve found a lot of healing in reprocessing pregnancy through therapy, understanding the importance of comfort and bodily autonomy, and not downplaying joy when it arrives.”

While HG is a physical illness, the compounding effects of it are what I remember most. I developed perinatal depression. After I gave birth, I felt so much physical relief, but I was still reeling, and it took me a long time to come to terms with the fact that I needed treatment for postpartum depression, too.

The hardest parts for me were the perinatal depression and the compounding guilt I felt for not enjoying pregnancy, not feeling connected to my baby, and feeling like I’d missed out on key parts of my daughter’s toddlerhood. I was ashamed of letting my daughter watch TV all day and for not being able to give her my full self. I felt guilty about our added expenses. I was ashamed of not being able to support our family in the ways I’d always been able to. It took a toll on my physical health, my mental health, my marriage, and my sense of self.

I think a question many of us are faced with when we are suffering is how bad is bad enough for this to count? At first I thought I was simply experiencing the morning sickness that all mothers went through, and that I was somehow less of a woman because I couldn’t handle it. Even for many years after learning about hyperemesis, I wondered if I could claim that I had HG when I’d never been officially diagnosed.

“I think a question many of us are faced with when we are suffering is how bad is bad enough for this to count?“

I wonder how much sooner I would have gotten support if I’d known none of this was anything to be ashamed of, and that I wasn’t to blame. No amount of holistic remedies or bootstrapping would have prevented it. What I wish I could go back and tell myself is this: You are not overreacting. You need support, and supporting yourself will in turn support your entire family.

My children are now three and five, and I have found my way back to myself. I feel well in my body, and if all of this has taught me anything, it has been to take such tender care of myself every day. And while for a long time this felt like an impossibility for us, and something I grieved, we are even planning for a third baby. With the experience, resources, and knowledge we now have, we are carefully putting together a support plan and systems in place that will nurture our family in this next chapter of our lives.

If you or a loved one is experiencing unmanageable nausea and vomiting during pregnancy, don’t wait to seek support. Here are some resources to get you started.

Resources for HG:

HER Foundation Resources
A nonprofit built for people living with hyperemesis gravidarum and the families and providers around them. Start here for treatment guides, clinical tools, and support groups, including one for HG loss.

Paid Research Study on Hyperemesis Gravidarum
USC researchers are looking for people ages 18 to 49 who had HG in a past pregnancy and plan to conceive again, to test whether metformin taken beforehand can reduce the risk of severe nausea and vomiting next time. Participants can earn up to $450, and the comparison group takes no medication and only completes surveys.

Donate To Support Pregnancy Research
Dr. Marlena Fejzo, the USC researcher behind the GDF15 discovery, is running a trial on whether metformin can prevent HG, and this page takes donations to expand it. Metformin is a generic drug with no profit motive for pharma, and she’s been denied seven grants, so reader gifts matter.

“Informed Pregnancy” Podcast
A weekly pregnancy and parenting podcast hosted by Los Angeles chiropractor Dr. Elliot Berlin. In its HG episode, Fejzo talks about her own pregnancies and what her research says about what causes HG and how it might be prevented.

Kate Arceo is a writer based in Southern California and the Community Manager at The Good Trade. She has a Bachelor’s degree in Communication Studies and has been reviewing sustainable home and lifestyle brands, as well as organic kids’ apparel and nontoxic cosmetics for the last ten years. In her free time you can find her hosting dinners on the back patio, reading a novel on the sofa, or sipping a latte at the local café. Say hello on Substack and Instagram!