Nausea and Vomiting in Pregnancy and in particular, Hyperemesis Gravidarum is a challenge for both the sufferers and the healthcare professionals caring for them. Below is some information about how you can help sufferers with this debilitating and devastating condition both in the community and as in-patients on the ward.

• Reduce sensory stimuli and triggers as far as possible - in particular odours from food, perfumes, coffee and so on but also lighting and noise levels, motion and general interruptions to rest. Sufferers admitted to the hospital with Hyperemesis Gravidarum should be in a side room so as to reduce sensory stimulation

• Listen to them: loneliness and isolation may well be a major part of their distress

• Watch for signs of psychological illness as a result of the condition and refer for assessment as appropriate. Depression is not a cause of Hyperemesis but can become a symptom of it

• If possible, refer to a physiotherapist to minimise the effects of atrophy from prolonged bed rest

• Measure legs and prescribe TED Stockings to reduce the risk of Deep Vein Thrombosis

• Ask for permission before discussing food and before mentioning food names in case it triggers nausea

• Ascertain the level of sickness by asking what foods and drinks have been tried, what has helped/what has not and taking a thorough history. Encourage them to fill in a daily diary to look for a pattern

• Be careful if recommending "morning sickness cures" to an HG sufferer; they will have been told innumerable times to try crackers and ginger. It may undermine confidence in healthcare professionals as well as adding to their feelings of isolation. Many sufferers of Hyperemesis report that the suggestion of ginger instils feelings of anger and hopelessness

• Do not challenge what they are or are not eating/drinking; anything is better than nothing (within current recommended safe-food guidelines)

• Refer them to this website for information on eating and drinking and coping strategies as well as for support for both them and their loved ones

• Watch for signs of dehydration (Ketones are not a sign of dehydration)

• Alleviate any guilt and reassure them if they have been unable to take prenatal vitamins. Medication is necessary for severe Hyperemesis Gravidarum and sufferers should be reassured of the need for safe, effective treatment

• Remind them to take the pregnancy a day at a time and that the HG will end, even if that is not until delivery

• Remember that pregnancy sickness is not always a ‘good sign’. There are many cases of sufferers whose HG has continued despite later discovering that the foetus died weeks earlier. Furthermore, remember that many suffer from HG so badly that they consider termination as their only remaining option

• Encourage appropriate medication

• Those with prolonged illness and inadequate medical care - e.g., those with greater than 10 per cent loss of pre-pregnancy body weight or those who fail to gain weight for two consecutive trimesters - are at increased risk of serious complications such as pre-eclampsia and pre-term labour. A referral should be made to an obstetrician or assessment unit to check for signs of Intra Uterine Growth Retardation

• Remember that recovering from HG takes time and that there may be a long-term impact on both sufferer and baby

Suggested Nursing Care Plan

This sample care plan was developed by registered nurse and Pregnancy Sickness Support trustee Caitlin Dean for nurses and midwives to adapt to appropriate in their own professional environments. You can download a printable version here.

1. Reduce Nausea and Vomiting

• Ensure medication is provided on time to enable stable blood levels of anti-emetics

• Reduce sensory stimulation by providing a side room away from ‘smelly areas’, if possible, and ensuring staff are quiet and free from perfume whilst providing care

• Provide snacks when required where possible

• Review the effectiveness of medication and interventions daily or as required, using the PUQE-24 or HELP score tools

2. Correct dehydration

• Provide IV fluids as per the prescription

• Warm IV fluids to 37 degrees before administration, if possible. This is to reduce calorific loss from cold IV fluid administration

• Encourage oral fluids as and when they can be tolerated

• Provide information on suitable fluids for pregnancy and tips on getting fluids, for example, via ice blocks

• Monitor fluid balance input/output if appropriate

3. Prevent Further Weight Loss

• Encourage oral food intake where possible

• Provide information on fortifying food and fluid

• Ensure medication regime is controlling vomiting and nutrient loss. Adjust timings to maximise the ability to eat at mealtimes

• Provide snacks as and when they feel able to eat

4. Provide Emotional and Psychosocial Support

• Where available, discuss referral to perinatal mental health team for support with the psychological impact of HG and refer if appropriate

• Provide information about Hyperemesis Australia and make a referral to the support network if required

• Ensure they have an advocate for ward rounds with doctors if they are struggling to speak due to nausea and vomiting

• Ensure informed consent is obtained for all treatments, tests and procedures

• Provide written information about hyperemesis and any treatments or medication

5. Provide a Comfortable Environment

• Provide a side room where possible to reduce sensory stimulation such as smell and sound and reduce distress from public vomiting and episodes of incontinence

• Provide pressure-relieving mattress to reduce the risk of pressure damage from prolonged bed rest

• Ensure vomit bowls and urine samples are removed promptly and adequately empty receptacles provided