The pills on our tongues

Drugs. Probably, no definitely, the last thing a pregnant woman thinks they will have to consider during their first trimester. When I first found out I was pregnant, I made a plan. I was going to start swimming everyday to keep my body healthy, help to keep my tone and to enjoy a new exercise, like I was going to enjoy this new chapter of my life. I was going to eat more vegetables and drink smoothies and generally look after myself.

Woman plans, god laughs. Instead at 11 weeks pregnant I was begging my GP to give me drugs, anything really, just to get me through Hyperemesis Gravidarum.

If you are reading this and you have had or are currently suffering with HG, then you will understand exactly what I am talking about. If you haven’t then maybe this is the post that will help you to finally understand what HG is. It’s SO bad that women who wouldn’t have considered taking an aspirin or paracetamol during pregnancy are asking for off license medication so they can survive.

Last week, I spoke with Dr Gillian Ostrowski, a GP from London who practices in Battersea. She is a three time HG survivor and advocator for women with HG.

I asked her why GP’s are still so reluctant to prescribe anti-sickness medication in pregnancy and she was very honest with me. Which was nice, for a change, to get some real answers. She said that GP’s are still terrified to prescribe anti-sickness drugs in pregnancy. Why? Thalidomide, the legacy that keeps on giving. Its over 50 years since we found out that Thalidomide caused foetal abnormalities. Most of those babies died, but those that did survive were left severely disabled. Marketed as an anti-sickness and nausea drug for the first trimester until it was recalled in 1961.

I can’t imagine how it would feel to know you played a part in such devastation. As a GP your entire purpose is to help not to harm. So I understand this reluctance.

This was over 50 years ago though, a lot has changed since then medically, we now know for example, because of Thalidomide, that medications do transfer from the woman to the foetus via the placenta. This was previously unknown or presumed not to.

So what is a HG sufferer to do? Firstly, if you can get access to medication then you are a step further a long than a lot of women. At this point you should be able to have an honest and open conversation with your GP. I am not a doctor, so my opinion is exactly that, just my opinion, but at this point your GP should be mentioning the following:

  • There are what are called “first line” medications that you can take that have a lot of safety data around them. These are antihistamines and phenothiazines. One of the most common of these prescribed to HG sufferers is Cyclizine. Again there is a lot of safety date around these types of drugs and the Royal College of Obstetricians & Gynaecologists in the UK have said since 2016 that these should be offered to women.
  • Combinations of these drugs should also be used to manage symptoms.
  • Here’s the important one. IF symptoms are persisting and your health is deteriorating (physical and mental) there are “second line” medications that should be offered. These drugs are Metoclopramide and Ondansetron. Both these drugs are currently deemed as safe. However, it would be fair to say that there isn’t as much safety data for these second line treatments.

If your GP simply says “there is nothing I can do” Get another GP immediately or contact the Pregnancy Sickness Support charity, because that is not the case.

If you want to read the 2016 Green-top Guidelines from the Royal College of Obstetricians & Gynaecologists for yourself you can do here.

I took all of the above and only Ondansetron worked for me. I have been very honest about this, so will do so again here, without it, it is very likely I would have terminated my pregnancy.

I was satisfied with why Ondansetron is off license (basically because it hasn’t been tested on pregnant women, because what woman would volunteer to test any drug??) and I weighed up less safety data information at my disposal against a termination.

Until funding for research in to drugs prescribed for women suffering with Hyperemesis Gravidarum is seen as important, we will never be able to say 100% that a drug is “safe” to be used. That’s a fact. But if the Royal College of Obstetricians & Gynaecologists deems second line medication to be safe as of today. That’s good enough for me, as the alternative didnt’t bare thinking about.