May is Hyperemesis Gravidarum Awareness Month. As a therapist with lived experience of mild to moderate hyperemesis gravidarum (HG), I know firsthand how incredibly invisibilized and dismissed this condition so often is, so I wanted to share a little bit about what it is and some “do”s and “don’t”s about how to respond to people struggling with HG.
HG is a severe, debilitating form of nausea and vomiting in pregnancy that significantly interferes with a person’s medical stability, daily functioning, and/or emotional well-being. At the mild to moderate end, HG may look like constant, unrelenting nausea that impairs a person’s functioning and mental health but does not necessitate hospitalization or result in risks to the pregnancy. At the severe end, it often results in significant dehydration, malnutrition, and electrolyte imbalances that can be life-threatening to both the pregnant person and the baby.
Even in its mildest forms, HG can be an incredibly traumatic experience. It is a debilitating illness that affects every area of life. For me, it’s not just the physiological symptoms of HG that caused trauma, but also the intense minimization and dismissal of my condition that I faced from so many people around me. One of my favorite things to do as a therapist is to turn my own pain and struggles into something that can validate others. So without further ado, here are some of my least favorite things that were said to me about HG, why it’s not helpful to say them, and some things that are actually helpful to say.
The Don’ts
Variations include:
-If I ever had HG, I’d just be so grateful I was pregnant.
-Just be grateful you’re pregnant.
-Some people can’t have kids. Aren’t you just so happy that at least you can get pregnant? Our problems often seem so minor when we step back and look at the bigger picture!
Why this isn’t helpful: You can be extremely grateful to be pregnant, and also extremely debilitated by a terrible illness. Both things can exist. People with HG deserve to have their struggles validated and heard, and being told to just be grateful can feel very dismissive. It also feeds into the idea that to be a good mother or parent, you need to feel grateful 100% of the time, and any struggles mean that you don’t love your children enough. Adding parent guilt/shaming to someone’s severe nausea isn’t kind.
Variations include:
-I’m so happy to hear you’re still this sick!
-This shows there’s a good kind of sick.
Why this isn’t helpful: When I experienced my first miscarriage, my body continued the pregnancy for weeks after my baby had already died, meaning I was still extremely ill for a long time despite having miscarried. So no, it is not reassuring to “still” be sick, and comments like this can be very dismissive of people who have had symptomless miscarriages. There are also so many ways to get reassurance or medical confirmation that a pregnancy is progressing, like ultrasounds and blood work, that don’t cause long-term suffering or harm. We can support pregnant people in getting reassurance without implying that it should come at the cost of their well-being.
Why this isn’t helpful: While this can be true in the end, this phrase often minimizes the experience that someone with HG is going through right now. It implies that their suffering and potentially life-threatening symptoms are okay because they’ll result in a baby. Like the first comment on this list, it reinforces the narrative that motherhood/parenthood is all about self-sacrifice - that any suffering a parent goes through is justified as long as it benefits their child. No matter how much a pregnant person deeply wants their baby, it is still not okay or fair to be so debilitated by unrelenting illness.
Why this isn’t helpful: It’s highly likely that people with HG have tried all of the go-to, very commonly recommended steps for managing pregnancy nausea. But even the mildest form of HG is much more severe than morning sickness, so it usually does not respond to behavioral or dietary changes. Medical intervention is typically needed. Suggesting dietary or over the counter remedies often discounts the seriousness of the illness.
Why this isn’t helpful: Prescriptions require doctors to write them, so if someone has been prescribed a medication during pregnancy, you can be confident that they’ve discussed the risks and benefits with their doctor. Medical professionals are often hesitant to prescribe any medication during pregnancy because it is difficult to study the long-term effects of taking a medication while pregnant. So you can rest assured that if a medical professional has prescribed someone you know a medication during pregnancy, they believe the benefits outweigh the risks. Perhaps more importantly, this line of questioning can imply that you care more about the baby’s well-being than the pregnant person’s. Both are important, and people with HG are doing their best to protect both.
Why this isn’t helpful: First of all, if you are keeping yourself and your baby alive while navigating a horrific illness, you are parenting already; you are a parent. HG parents are already doing so much labor to care for their baby just by staying afloat while sick. Just because the baby isn’t externally visible to others doesn’t mean the baby doesn’t exist - for HG parents, the existence of the baby is extremely real. Second, there are unique challenges and joys of the newborn stage for every parent, and I don’t at all want to minimize the challenges. But for people with HG, there is often very little if any joy to be found during symptomatic periods of pregnancy, as the symptoms are unrelenting.
Variations include:
-At least you might lose some weight!
-I wish I had what you had so I could lose some weight.
Why this isn’t helpful: Weight gain and fatness aren’t bad in general. Weight gain is especially important in pregnancy, and malnutrition is especially dangerous during this time. Let’s stop reinforcing the idea that thinness is worth pursuing at all costs.
Just to be clear, if you’ve said any of these comments before, it doesn’t make you a bad person (except for that last one…if you’ve said that, you might want to do some self-reflection). These comments are often well-intentioned and said out of concern for the pregnant person or the baby’s well-being, or out of excitement about the pregnancy and a desire to focus on the positive aspects. My hope is that this article can help offer a different perspective and help you understand why those comments might have the opposite effect than you intended.
If you’re wondering what to say instead, below is a list of comments and questions that generally are helpful to someone with HG:
1. I’m so sorry you are going through this. This is so horrible and unfair.
2. Do you want to share more about what you’re going through? It’s also okay if you don’t want to talk about it.
3. However you feel about your HG is valid. It doesn’t mean you love your baby any less or that you’re not grateful to be pregnant.
4. Can I bring you a meal/help with cleaning or childcare sometime this week?
5. Are your medical providers taking this seriously and working to address it? If not, would you like any help looking for providers who have experience with HG?
6. Have you been able to get any time off and/or accommodations you need at work? If not, would you like any help gathering documents you need to file or any other information you’ll need to share?
7. I believe you.
8. You are already such a great parent and your baby is lucky to have you.
If you are struggling with HG or have experienced it in the past, please know that you are not alone and your feelings are valid. Please feel free to share this blog post with anyone in your life who could benefit from some guidance around what’s helpful vs. unhelpful to say. For more information about HG including treatment and support group options, please visit the HER Foundation website. And if you are in need of therapeutic support to cope with the mental health effects of this experience or the trauma of past HG, please don’t hesitate to reach out to me.