Nausea and vomiting in pregnancy (NVP) affects up to 80% of pregnant women in the first trimester (Goodwin, 1998). A recent systematic review has shown that normal pregnancy sickness may offer a reduced risk of miscarriage and improved pregnancy outcomes, even when severe enough to warrant first-line medications (Koran et al, 2014). However, one in 100/150 pregnant women's symptoms develop into hyperemesis gravidarum (HG) (Goodwin, 1998).
Both severe NVP and HG are underappreciated conditions and insufficient care and treatment can lead to poor pregnancy outcomes and complications for both mother and baby (Bolin et al, 2013). Women can become house or even bed-bound, feel isolated, fearful, guilty and even depressed (Swallow, 2010). Furthermore, women can face difficulty advocating for themselves to receive adequate treatment, they can face discrimination in the work place for absence and relationships with relatives and friends can suffer due to a lack of understanding about the condition (Sykes et al, 2013).
The charity Pregnancy Sickness Support (PSS) has pioneered a peer support network of volunteers who provide one-to-one support for sufferers during their pregnancy. They also provide information, education and support to the health professionals caring for those with HG or NVP.
Volunteer support network
The volunteer support network (VSN) has been operational for 3 years and has successfully provided support to hundreds of women and their families. Women often contact the VSN at their most desperate, when many consider termination to be their only remaining option. Once contact is made, either via the helpline service or the website contact forms, a member of PSS staff contacts the woman to complete a needs and risk assessment and provide her immediate information to better manage her symptoms. If the sufferer would benefit from one-to-one support, a volunteer is matched based on geographical location and other factors.
Volunteers have all been through HG themselves. They are interviewed, referenced and receive online training before they can support women in pregnancy. The charity has other volunteer roles in which people who have not suffered can support the work of the charity.
The service has a number of safety net systems in place to protect both women and the volunteers and ensure the integrity of the support relationship. All the volunteer activity, including peer support, is covered by the charity's indemnity insurance and professionals referring women to the network can feel confident in the integrity of the service.
In addition to the support network the charity provides an online forum, information leaflets and web pages for sufferers and their carers and useful charts to aid with self-management.
Evaluation of the charity's work has found that referring women to be matched with peer supporters can reduce isolation, improve mental wellbeing and increase a woman's ability to advocate for herself. The information on the charity website about coping strategies for NVP was found to significantly improve the quality of life for women suffering (Saleh and Sykes, 2014).
How can PSS help midwives caring for hyperemesis patients?
HG can be a frustrating and difficult condition to treat. Unlike the more common and milder forms of pregnancy sickness, which can be improved with self-help techniques such as eating little and often and resting as much as possible, HG is rarely managed entirely with such measures and antiemetics are needed to control symptoms.
The website provides a useful resource for health professionals caring for the HG patient and includes:
Education and training opportunities
PSS is keen to promote education and awareness about NVP and HG and are happy to help hospitals and Trusts develop their staff training. The charity's doctors, nurses and midwives are happy to attend teaching sessions and expert patients are able to come to talk about their experiences.
2013 saw the second national conference about HG and there is a large conference planned for 2015 which will bring together researchers, health professionals and sufferers.