Please note that I talk a little bit about a psychotic and self harm episode in this post, so don’t read on if it might cause any problems for your condition.
There’s so much I want to write about, so much I want to share, that I almost can’t get the thoughts out coherently to write something that is a) sensible and b) legible. But something that affected this pregnancy so badly has been on my mind.
Staring into the mirror today, I wanted to write about diet, exercise, pregnancy, bipolar, and all the links between it. This was inspired by the row of acne that had appeared seemingly overnight on a person who has never struggled with it ever before. But I want to have more of a think about that post as I firmly believe diet plays a HUGE part in having a negative impact on modern day living.
But not today because that requires thought and some good research to back up my theory.
I am thinking of depression today. I’m not feeling low emotionally; actually pregnancy and impending motherhood, combined with not having to drag myself to a job I hate every day, has meant I’m probably mentally the well-est I’ve ever been these last few weeks. It’s a lovely feeling. But I’m bone-gnawingly tired. It eats away at every single atom of my being. Pregnancy tired is like nothing I have ever experienced before.
Combine this with struggling with hyperemesis which, for the ease of writing I’m going to refer to as HG throughout the rest of this article, it’s been a massive hit of physically sick as a dog, mentally unable to think straight and exhaustion combined with insomnia.
So, what is HG quickly? It stands for Hyperemesis Gravidarum which is an extreme form of nausea and vomiting in pregnancy (NVP). NVP is very common, and around 70-80% of women will experience it in some form. With HG, however, it is relentless nausea and vomiting, with women experiencing sickness 10-12 times a day as normal and unable to keep any liquids or solids down. 1 in 100-150 women will need hospital admission as they are so severely dehydrated or malnourished. Just to reiterate, that is NOT morning sickness! Morning sickness also subsides by around week 12 of pregnancy, whilst HG persists in varying forms throughout pregnancy and, sometimes, even after birth for a few weeks.
HG affects 1%-3% of women in pregnancy according to the excellent support network in the UK, Pregnancy Sickness Support. Think of all those women all round the world having babies – a quick Google says around 130 million a year – and then think, of that around 4 million are wrapped around a bucket for most of that time, unable to do much apart from suck on an ice cube.
I’m part of a thread on Mumsnet which has been a life saver. The wonderful women of the Hyperemesis thread, run by a quite marvellous mother hen who ensures there is always a support space for mums to be to hear from others and just have a moan. Other posters generously share wisdom on medication and what to do to get through to the
somewhat pigheaded medical community what women need to do to get treatment.
It’s hard to explain the toll this has on you. Don’t be sucked into the marketing bullshit of pregnant women serenely eating lettuce and drinking smoothies whilst doing Tai Chi in Hyde Park on a misty morning, playing with their children and running marathons. I know you exist somewhere you lucky things, but it is not really like that when you have HG. You LOSE weight. I actually shrunk in my first trimester which was alarming enough. You cannot eat a thing. Your tastebuds change on a daily basis and I was devastated to not be able to enjoy a Ribena any more; it was like something had died in my mouth. The thought of going near toothpaste or a toothbrush is retch-inducing so you’re at risk of cavities due to no dental hygiene for several months. One poor woman tore a face muscle vomiting, another developed an abcess and several of us pulled stomach muscles with the force of our sickness.
And this goes on for pretty much NINE months. Some women are unmedicated. Doctors refuse to administer even the most basic antiemetics. I swear to god if one more person in my family had recommended ginger to me I was going to cut them out of my life. Women are told by supposed medical professionals to change their diets or buy sickness travelling bands, wtf???
There is a persistent lack of understanding that medicine is ok in pregnancy so long as it is monitored. There are horror stories of women being so sick that they are in hospital being advised to have an abortion because there is nothing safe to give them and their baby. Which is, quite frankly, rubbish.
I was very fortunate. Around eleven weeks I couldn’t cope any more and went to my GP who immediately prescribed me a front line, commonly used drug called Emesafene, essentially an antihistamine with vitamin B6 after checking it didn’t interact with my thyroid medication and lithium. Now, this is in the Netherlands so if you want to know what might work in your country or what to ask your doctor about there are the usual links below. Whilst I was working I took two a day and it just about powered me through the day, along with probably far too much diet Coke and Nutella sandwiches, along with sipping ice cold tap water (I went off bottled water!) which was all I could eat or drink. It didn’t really ease up until I stopped working and was able to properly rest.
What has any of this to do with bipolar or depression you may wonder? Well, consider the impact that has on your body. I’m one of the fortunate ones who a) got a GP who knew what to do and b) got medication that worked. You’re permanently feeling like you’re about to puke or doing the deed itself. Your body is very weak and you’re trying to at least keep down your pregnancy multivitamin so the baby develops ok. You’re off work and potentially with an unsympathetic employer so you are worrying about that. You’re unable to get out of bed or, if you’re lucky, you’re lying on the sofa, unable to see friends or family as you are in effect housebound. And chances are you have a GP who tells you to buy a packet of Ginger Nuts and you’re saving your precious energy stores to battle with them on your next visit to beg to even try some of the basic medication that is available and within the NICE guidelines. And you’re worried about the impact all of this has on your growing baby.
Stress + HG = high chance of prenatal depression. Prenatal or antenatal depression affects as many as 1 in 10 women. A dear friend of mine had it severely for most of her pregnancy. Recently we discussed on our thread how having hg was impacting on our moods. We all felt that we had been so low at several points, plus the stress of having to battle with the establishments both medical and work related, meant that most of us had had some form of depression at some point. This had taken its toll on partners and those inspiring women who were on baby no 2 or even 3 and had young children who were being impacted as well.
Stress + HG + bipolar = high chance of prenatal depression + serious chance of bipolar episode. I should know as I narrowly dodged this bullet.
Because of my bipolar and the fact I’d had a miscarriage, my very nice GP in all good faith referred me to my local hospital. Neither I nor she realised at the time that all my care would be transferred to the main university hospital in the city and be led by the perinatal psychiatric team. I’d gone to see her to get an increase in my thyroid medication which was duly done, and off I trotted to the local hospital expecting to be told I’d be scanned from around 8 weeks when there would be the best chance of seeing the foetal heartbeat. To my bemusement and slight fear/paranoia, I was told they wanted to see me immediately and I would be scanned from six weeks onwards. This totally freaked me out, and I didn’t know then that they had no experience of dealing with patients with psychosis or bipolar or any form of mental illness.
My scan at six weeks showed not much, but that all looked quite normal. My scan at 7 weeks was a different story. I had by this point seen the perinatal psychiatrist and been told I would be switching hospitals, but that there shouldn’t be any harm in going to the last planned scan in the meantime. How wrong we all were. I was told by the dumb bint calling herself a doctor that my lithium was just for my ‘mood’, my blood pressure was too high (I had just come off a flight from London after being away for a work event and had sat in the waiting room for an hour and a half as they were so delayed), and that my bowel was too full for her to see anything on the scan. She then went onto say that she couldn’t tell if it was a ‘good’ pregnancy, there had been no growth and that I should be prepared to miscarry and to come back in a week. Bye bye and out the door in 5 minutes DH and I were pushed.
To receive news like this when you are full of pregnancy hormones is horrendous enough for any woman. If you add to the mix the chances that person can have a major psychotic episode then it’s pretty devastating. I went home numb. I couldn’t sleep. And I started to hallucinate in the middle of the night, punching my middle as I wanted it ‘out of me’, that this ‘dead foetus’ was spreading intense black all throughout my body. I could feel it skittering over my skin like a million black bugs. It was enveloping me, choking me and I needed it gone. I was scratching at my arms, scratching at my stomach and fortunately hadn’t managed to hit myself that hard in the lower abdomen before sanity in the form of DH stopped me.
Thank my stars that DH woke up and sat with me for the rest of the night. Poor man had to deal with the news himself, as well as the fact that his wife was convinced she had been taken over by seeping black death.
We went back the next day as I wanted a pill to ‘get things going’ and have the black death out of my system. I was convinced the baby was not to be. The doctors refused to see me, said there had been slight growth and everything still looked on track to be fine, it was just too soon to see a heartbeat. I stood there in this reception area in floods of tears, unable to understand why people couldn’t make it all go away. So I refused to go back there and had received my appointment to see the specialist gynaecologists and thyroid experts at 13 weeks. I would wait until then. I managed to see my psychologist that day who calmed me down, and also my regular psychiatrist who both were wonderful and talked me around.
I decided that my body would tell me what was right and wrong. If it was not meant to be then I knew from painful heartbreaking previous experience what would happen. And that my body would take care of it. I hoped I hadn’t harmed it, and was creating elaborate schemes in my head to get back at the stupid consultant who had left me in such turmoil. Equally, if the baby was actually growing, then I would wait and see what my consultant had to say at the next appointment.
In the meantime, my HG kicked in. Massively. My GP whom I wept all over when prescribed my medication, couldn’t understand why I was so worried as they had, he felt, been wrong to scan me so early. The fact that I had such awful symptoms that were getting worse rather than better was, he said brightly, a good sign!
Those six weeks were the darkest things had been for me for a very long time. I had no idea if my baby was ok or what was in me. I could barely move without needing to be sick or experiencing such nausea. I couldn’t sleep properly in case my death demon came to visit me in the night so was exhausted. I had to drag myself into work, and then tell them, well before I was ready to do so as I was so sick. I hated everything, and mainly hated myself. And I didn’t want that negativity to be passed onto my baby. I was worried about my lithium impacting the foetus. I worried my thyroid would fail again and the baby wouldn’t be. Such anti energy. It’s not good for us.
Obviously things turned out fine. I cried the whole time waiting for the doctor and cried when DH explained what happened. Actually I cried all day and it didn’t sink in really that all was ok until I reached my 20 week scan and saw a normal, healthy baby. To this day I can’t look at the scan screen without looking at DH first for him to tell me it is ok.
First trimesters are the worst. They don’t have to be. There are so many women who are just in raptures about their baby and sail through pregnancy. But for us with HG it is a long, long road to nine months and pregnancy is terribly tough. We can’t wait to give birth and get our bodies back. For those of us with bipolar as well, we can’t wait to be able to bring our brains back from the brink. I’ve teetered several times and it is only through the strength of my DH and finding fun things to focus on such as my dog that I’m still here.
Please don’t underestimate the impact of pregnancy sickness on your mental health. Make sure you go armed with information so you can get the medication you need to stop the vomiting. Taking care of yourself physically and mentally when pregnant must be your main focus. If that means stopping work like I did, then do so. Nothing is more important than being very, very nice to yourself. In the wise words of the Hypermesis Support ladies, this shall pass.
Pregnancy Sickness Support
Pregnancy Sickness SOS
PANDAS for pre and postnatal depression