12.05.12

Prue Clarke on Her Battles With Kate Middleton’s Illness, Hyperemesis Gravidarum

Joy about Kate Middleton’s pregnancy has been tempered by worry that she’s suffering from hyperemesis gravidarum. Prue Clarke on what the Duchess of Cambridge faces—and her own struggles with the extreme variant of morning sickness.

I’m sad to say the news that Kate Middleton is in hospital with hyperemesis gravidarum or “HG” brought me a moment of comfort. Not for Kate, who is likely so focused on just getting through this horrible ordeal that she has little idea about the hubbub the news of her pregnancy has caused. She and Prince William reportedly were “very pleased” to be pregnant. As an HG survivor, I can assure you Kate feels anything but pleased right now.

But the news that such a high-profile mother-to-be is suffering HG brought me hope that perhaps it will bring more attention, understanding, and treatment to this affliction, which affects 1 to 2 percent of all pregnancies, and claims lives around the world.

HG first hit me when I was six weeks pregnant with my son and living in New York City. I’d spent a week getting used to this strange new idea that my husband and I were going to have a baby when suddenly one Saturday afternoon I was overcome with nausea. We realized it had to be morning sickness. We’d heard enough about that to expect some illness. But nothing suggested it would be like this. For the next three days and nights I barely left the bathroom. Eating or drinking was out of the question.

I was so newly pregnant, I didn’t have an obstetrician. By Tuesday morning, my husband called the first one we could find who could see us that day. But as I stumbled out of the cab, her office called to cancel so she could go attend to a difficult delivery. I burst into tears. I didn’t think I could survive another night.

The doctor stayed. She gave us two options: I could go straight to hospital to be rehydrated with IV fluids or try an anti-nausea drug that could ease my suffering. A drug? I’d spent my first week pregnant learning that there was pretty much no drug considered safe for the baby besides acetaminophen. Particularly in the first trimester. What about thalidomide? Wasn’t that a treatment for morning sickness?

The doctor couldn’t guarantee the drug, Zofran, would not harm the baby. Ominously, it usually was prescribed for cancer patients undergoing chemotherapy. But she also could not guarantee the nausea would stop if I were rehydrated. She couldn’t tell me how long I’d be in the hospital. HG, like morning sickness, eases in most women by 12 weeks, but in some it could last the whole pregnancy. The idea of suffering this nausea another day, let alone another 34 weeks, was untenable. I felt I had no choice. I took the drug.

Zofran pulled me back from the brink. Within an hour of taking it, I felt well enough to eat. I still felt nauseated 24 hours a day, but I was no longer desperate. I lived by the clock. Every four hours as the drug wore off, the nausea heightened again. Eating regularly was essential. All the home remedies for morning sickness—ginger tea, pressure bands—proved useless. Eventually, I got some relief from expensive acupuncture appointments. But it was not covered by insurance. The one consolation was that sickness is a sign of a healthy pregnancy. But I was so miserable, I found it hard to feel joy in that.

It was far too early to tell anyone we were pregnant. Most people wait until 12 weeks, and the risk of miscarriage (one in four pregnancies) has passed. But we had no choice. As Christmas approached, I had to say no to every holiday celebration. As my freelance-journalism deadlines piled up, I had to tell my editors I was struggling to leave my bed.

I found little sympathy. An estimated seven in 10 pregnant women suffer morning sickness. No one I knew had been confined to her bed, nearly incapable of functioning, for weeks on end. People expect you to buck up and deal with it. They offer a constant, insistent advice that what worked for them will work for you. I was just lucky I didn’t have to report to an office every day.

A CNN story at the time reported that a woman had terminated her pregnancy because of morning sickness. Friends were shocked. I had sympathy.

Week 12 came and went with no improvement. A once-niggling background fear that I would be one of the unlucky few who had HG for nine months began to look very real.

Finally, in Week 16, the sickness lifted. The rest of the pregnancy was uneventful, and I gave birth to a beautiful, happy little boy.

Perhaps the silver lining of Kate’s suffering now will be a wider appreciation of the debilitating impact of HG on its victims.

As the years went by, the guilt did not subside. We watched constantly for any sign our son might have been hurt by the drug. Was his reluctance to engage other children due to Zofran or just a symptom of being 2?

Friends didn’t help. Most were shocked that I had resorted to a drug.

In the first year, I swore I would never do it again. As my son grew, I knew we wanted another child. People tried to assure me two pregnancies were never the same. But everything I read said women like me, who got seasickness, altitude sickness, motion sickness, were more likely to suffer HG. It wasn’t until my son was 3 that I was mentally ready to go through it again. By then I was 38 and we were almost too late. It took two rounds of IVF before we were, luckily, pregnant again. Any more children were likely out of the question.

By this time we had moved to London, where the attitude to drugs in pregnancy was different. I begged my IVF doctors to give me a prescription for Zofran in case the IVF worked and I couldn’t get to them before the HG hit. They refused. A nurse told me, in a disparaging shot at the U.S. medical system that I was to hear repeatedly, “We don’t just hand out drugs here.”

The sickness started more gradually this time. By Week 8 it was getting worse. The IVF doctor gave me a one-week prescription that cost a staggering £300. Eventually, my GP relented and I got Zofran, free. The U.K.’s National Health Service makes drugs free for pregnant women—hardly a generous move, given that few people take drugs during that time anyway. I’m now 27 weeks pregnant with a little girl. The HG lifted at about 20 weeks this time. For now, finally, I feel I can begin to put HG behind me.

During both bouts of HG, I’ve thought constantly of the women in Africa, where I run a media development NGO. There is no Zofran available to them. Most wouldn’t know of or be able to afford the IV treatment that is helping Kate now. I’ve been disappointed to read reports of Kate’s hospitalization that claim “before 1950 women used to die” of the dehydration caused by HG. No one keeps numbers on how many women die of HG in the developing world, but experts agree many women are dying of it now.

Perhaps the silver lining of Kate’s suffering now will be a wider appreciation of the debilitating impact of HG on its victims. Perhaps, too, there’ll be a closer examination of the drugs that can treat it and that might give those who take them more peace of mind. And perhaps there’ll be a bigger effort to identify victims in the developing world and stop them and their babies from needlessly dying.