What does Hyperemesis Gravidarum have to do with Allison today?
By Kimber Wakefield MacGibbon, RN
Many are asking why the media is reporting on Allison's pregnancy
complications as if they still have an impact on Allison. How can that be true?
Hyperemesis gravidarum is a disease of pregnancy that typically ends on or before
delivery. So, can that be influencing her now, a year and a half after delivery? My
answer is unequivocally yes.
HG is a pregnancy disease that impacts many women for years after delivery, and
sometimes for life. It's not necessarily the physical effects that continue for so
long, but the emotional scars. Too little research has been done on HG to identify
the long term effects on both mother and child. However, it can obviously be said
that HG is a very serious disease since women still die from it. Others may suffer
permanent neurological damage due to malnutrition and dehydration. Autopsies of women
with HG show signs of starvation and organ damage. The adverse effects of HG
typically last at least until week 20 of pregnancy, and cannot be reversed in just a
For Allison, HG persisted throughout pregnancy preventing her from gaining more
than 10 of the 45 pounds needed to sustain a twin pregnancy. Consequently, one of the
twins had a low birth weight with reflux, and Allison had chronic preterm contractions
for weeks before delivery. Children born to mothers with HG have a greater risk of
chronic disease in adulthood, as well as neurologically-based learning, emotional and
behavioral disorders. A mother's sacrificial love is crucial to these children's
To understand how HG affects women, imagine yourself enduring months of food
poisoning or a stomach flu. Just a few days would leave you weak, tired, sore, and
miserable. The sleep deprivation, lack of food, constant nausea, vomiting of bile and
blood, isolation, exhaustion, weakness, powerlessness, and pain are often
overwhelming, weakening emotional and cognitive functioning.
Due to ineffective care, HG causes devastating debility and results in 25% of
pregnancies being therapeutically terminated, while others are lost to stillbirth,
miscarriage, and premature birth. Women may be unable to work for some if not all of
their pregnancies; and their lives are put on hold. Women like Allison do not feel
pregnant or enjoy their pregnancies; they feel sick and miserable and pray to die to
end the suffering.
Few realize the incredible impact of starvation on the brain and body. Obviously
there is fatigue and weight loss, but there are also profound changes in mood and
mental capacity. Confusion, difficulty with decision making, and lack of focus can be
debilitating. Sleep deprivation exacerbates these issues and recovery does not occur
until there are months of consistent sleep and normal weight, a challenge for new
For about half of women with HG, their symptoms will subside by mid-pregnancy,
others are not so lucky and have to endure HG until delivery. Further, many women
like Allison are not diagnosed until they are severely ill and well beyond the first
trimester. Only then do they get the aggressive care they need. She vomited blood for
about six months, eroding her throat and stomach, and was barely able to eat for most
of her pregnancy. She was not gaining weight and weighed less going into her eighth
month, than before pregnancy. Finally, she was given the correct diagnosis of severe
HG and critical IV nutrition, yet her labs still showed severe hypoglycemia and low
protein levels. She was totally depleted and at this point, completely dependent on
others for her basic needs. Her delivery admission papers confirm she was also
severely dehydrated. Then she had life-threatening bleeding after delivery and was
diagnosed with severe anemia and hypothyroidism. Her body was devastated and recovery
would take time.
Women with severe or prolonged HG like Allison, enter the postpartum period
depleted emotionally and physically, not to mention extremely vulnerable.
Consequently, they are predisposed to depression, anxiety, and post-traumatic stress
syndrome, as well as adjustment difficulties. The constant demands of newborn care,
which are much greater with twins, results in deterioration of the mother if she
does not have adequate support. Unfortunately, no one evaluated her support before
she was discharged, nor did anyone monitor her for postpartum mood disorders,
despite the many risk factors. She was simply sent home with few instructions and no
resources to call for help.
The collapse of Allison's social support network during pregnancy, a surgical
delivery with life-threatening complications, and the strain of caring for twins
while trying to recover made life overwhelming to say the least. Imagining herself
as capable mother and preparing for their homecoming were practically impossible in
her debilitated state. This is ultimately what lead to the discussion of adoption - utter exhaustion, and fear she would not survive or recover. With no alternatives offered, she was desperate for respite and acquiesced to the only solution presented at that moment.
On average, a woman requires 5-8 months for recovery from HG. Obviously more
severe or prolonged cases take longer, sometimes years. Some never fully recover.
The residual food aversions, stomach ulcers, and metabolic changes impede women from
restoring vital nutrients and normalizing their weight. Allison has worked to become
stronger and recover from her pregnancy. She still struggles to regain some of the
weight she lost and overcome anemia due to the strain of the ongoing litigation and
residual food aversions. In time, she will return to the strong woman she was
Pictures of Allison prior to pregnancy show a vibrant, physically fit woman who
loves children. After pregnancy, she was a mere 110 pounds, very emaciated and
exhausted. When I met Allison in January 2006, she was six months postpartum, and
just a shell of a woman. Her body was frail and she weighed maybe 115 pounds, her
few smiles were forced, and her emotions were very raw. Her health and overall
disposition confirmed the devastation of all that she had endured. Over time, I have
watched the protracted litigation, separation from her twins, and enormous legal
expense slowly crush her. She has lost nearly everything, including the precious
twins she nearly died twice giving life to. My fear now is that the disempowering
effects of incarceration and more litigation will deplete the emotional and physical
strength she has worked to regain.
Let me emphasize that Allison is NOT an unstable woman that presents a danger to
anyone. In the midst of her incarceration, she is concerned about the strain on her
supporters, and for the welfare of a child she has cared for often over the past few
years while the mother was in rehab. This woman has been battered by this protracted
custody battle, loss of freedom, financial devastation, and never-ending attempts to
permanently sever her relationship with her twins. Few could endure all of this and survive. She is a very strong and courageous woman who loves her children very much. Ending this litigation, empowering her with freedom to return to work, and granting her the opportunity to restore her relationship with her twins will ultimately lead to her recovery and resumption of a normal life.