Last week I flew to sunny California to attend the International Colloquium for Hyperemesis Gravidarum (otherwise known as HG or severe pregnancy sickness). Supporting people through HG is a passion for me because I have been there and the lack of support I experienced honestly wounded my faith in humanity. But it is also a condition that I love to research and write about because it is emblematic of so many of the issues that scupper mental health during pregnancy and parenthood.
Because HG is so extreme (the nausea and vomiting are really beyond imagining if you haven’t been there) societal beliefs and assumptions that often hide in the shadows, making us feel rubbish about ourselves but just evading our conscious awareness, are thrown into the spotlight. The ICHG gave me the opportunity to hear the latest developments in the quest to understand the causes of HG and how to support people through it better, medically and nutritionally. It was wonderful to hear what the experts had to say, and to talk to them about our study into mental health and HG, but it left me thinking about all the ways women experiencing HG get hurt by our beliefs and assumptions. I have a feeling it is going to take me a few weeks to get my head around everything I learned at ICHG so over the next few weeks I’m going to bring you a post each week talking through a topic we talked about there. The first one is a cultural belief/assumption that all of the HG survivors (including me) talked about with fervour.
You should look after yourself during pregnancy
At first glance, this seems straightforward. From the moment you use an online baby name finder and your data is sold to “babycorp” you are flooded with emails telling you exactly what you should eat and when for optimal baby development. I remember devising ambitious but careful exercise regimes and freezing smoothies with the exact nutritional requirements for the entire first trimester in handy cubes. Of course, I took it for granted I was NEVER going to miss taking my pregnancy multi-vitamin. Then week 5 came, HG struck me down and my poor baby bump was fed on nothing but the occasional ice lolly and a salted cracker for the next 12 weeks. It didn’t get much better after that, I think I managed to add the occasional Coke, scoop of ice cream and a piece of toast into the mix in the third trimester but they didn’t stay down long.
I 100% knew this diet was bad for my baby and bad for me. In fact, I was begging for help whenever I saw a midwife or doctor. But no one gave me any help (other than a few drugs that didn’t work) and I could not keep any food, or multivitamins, down. So that was reality for me and my baby. I know that this is true for most of the women battling through HG. Not only do you have the excruciating symptoms of an all-consuming illness to contend with but you also have the sense that you are breaking your own rules and disappointing everyone around you.
So what should we be doing differently? Well, first we can stop assuming that pregnant women need more education about what they should (and shouldn’t) eat. Everyone should receive some advice when they first register their pregnancy but beyond that we should probably stop believing that telling women who say they can’t eat anything to try a “diverse range of foods” is in any way helpful. I learned at ICHG last week that nutrition in prgenancy IS really important and that poor nutrition is probably leading to some of the difficult outcomes of HG. So, if we know it is important we should be offering real support to achieve it. There were examples of this being done through IV supplementation, delivery of anti-emetic (anti-sickness) medications through IVs and through tube feeding. These treatments are often not offered to women because the belief that they simply need to be “look after themselves” is so strong that doctors, nurses and midwives never consider other options.
HG is not the only condition in pregnancy that makes sticking to the “look after yourself” rule hard. It is hard to “look after yourself” when you have multiple children, an absent partner, are living in poverty, are juggling many jobs, have complex health needs, are living with addiction or care for someone with a disability (to name just a few). People with a more straightforward path might lack empathy for many of these situations because they simply can’t imagine a world in which you don’t have time, money or skills to organise taking a prenatal vitamin but if there is one thing I have learned about mothers over my ears as a perinatal psychologist, it is that if they can they will. If they are not doing something they know would be beneficial to the baby it is because they cannot do it and we need to look at the barriers they face and come up with creative solutions that address those rather than judging them.
We need to challenge the belief that women should look after THEMSELVES in pregnancy and instead think about how we can all look after them better.
If you are struggling with judging yourself harshly or you are troubled by how others may be judging you please know you are not alone. The ICHG was full of HG survivors and each of us had multiple stories to tell of feeling shamed by others for the things we did to survive. I remember vividly an older woman knocking my bottle of Coke out of my hand in the hospital canteen (I was in the third trimester and attempting to work that day). She told me I was killing my baby. I wish I had told her I had been sick 9 times on the way to work and lack of calories was the biggest threat to my baby. But I was so pregnant and sick I just vomited from the stress and cried, partly from anger at being judged but mostly from the deep shame I felt that I wasn’t the kale swilling yoga-mum I thought I was going to be.
If we want to free ourselves and our daughters from the shame we have to spread the message of shared responsibility for health in pregnancy, mental and physical so share this article with your support network. You can also find me on Instagram @thepregnancypsychologist where there are plenty of shareable posts and reels to educate your friends/family/health professionals with!
Self-help when you are feeling the shame
If you need a “pick me up” yourself I have an exercise for you to try today. It is based on the principles of Compassion Focussed Therapy and involves imagining a compassionate person responding to you with understanding, strength and a commitment to alleviate your suffering. It is astounding what receiving compassion from another person can do to calm our nervous system and allow us to rest, digest and think more clearly about our situation. We are lucky that our human power of imagination allows us to access some of the healing power of compassion through imagery. Practising in this way also means we find it easier to show ourselves compassion when we find ourselves in a difficult moment. I wish I had built up my self-compassion muscle a bit more before I had to deal with the woman and the Coke bottle. I’ve adapted it from Paul Gilbert and Michelle Cree’s principles so please do go and read their work if you like this approach.
Start by getting yourself into a comfortable, supported position. If you are struggling right now that might be lying on your side but if you feel well enough an upright, strong position with your feel pushing into the floor will help you feel alert but grounded. Try to adopt a slight smile as you close your eyes or allow your gaze to settle on an object of focus.
Now take some soothing breaths down into the belly. As you breathe in imagine a coffee plunger sending the breath down so your breath inflates your abdomen rather than your chest. We are going to try breathing in a particular rhythm that some people find soothing. In for 4, holding for 4, breathing out for 4 and holding for 4. Try it with me but if the pace isn’t right for you just concentrate on breathing in a way that feels good to you, making sure you fully empty your lungs each time you breath out slowly.
Breathe in 2,3,4, hold 2,3,4, out 2,3,4, hold 2,3,4
Now the body is feeling more relaxed and the soothing system in the body has had a chance to engage I’d like you to imagine a person or being that embodies strength, wisdom and kindness to you. They understand that we didn’t choose our brains or the world we live in, they are non-judgemental. They are also strong and committed to helping you through your distress. This could be a real person you have known who has shown you these qualities or it could be a character from fiction. It could be a spiritual being, an animal or a creature you have made up entirely.
What is it wearing? What are the textures of its clothing? Skin or fur?
Spend a moment noticing how its posture and how it moves. How does it relate to you? Does it approach you? Does it show its kindness through reaching out to you or is there another way?
What is its facial expression? Notice how it looks at you and how that makes you feel
How do they sound when they communicate with you? How does their tone of voice make you feel?
Spend a few moments breathing in a way you find soothing, just enjoying the presence of your compassionate being. Know that even after this exercise is over they are there for you, ready to help you support yourself through difficult moments.
Now gently open your eyes and re-focus on your surroundings, take a little stretch and notice how that exercise left you feeling. Compassion is not always easy to receive, especially when we are used to judging ourselves harshly so it might not have been the easiest five minutes of your life but if you can commit to spending time developing compassion for yourself each day you will find the grip that the judgement of others has on your mental health will slowly loosen.
Next week I’ll be back here talking about our cultural belief that pregnancy complications are all the mother’s fault. There were some fascinating insights at ICHG into that one!
For now, look after each other!
Rosie
Ps. I know this can be tricky to navigate alone so if you would like some help showing yourself some more compassion please check out my therapy practice (www.knowyourmindconsulting.com) as we would love to support you through pregnancy.
Know someone who needs to read/listen to this? Please share, together we can improve support for pregnancy mental health.
Disclaimer - Before you go, I just wanted to add that if you're really struggling, then listening to podcasts or reading blogs isn't a substitute for good mental health support. Please know that if you're feeling really low, or anxious, or like your mental health is interfering with the way you live your life, It's a really good idea to speak to your GP in the first instance and try to get a referral to perinatal mental health so that you can access therapy and the support that you deserve for your mental health.
If you prefer to go private and see an independent psychologist, please do come and find me at knowyourmindconsulting.com where we offer specialist therapy to help you through a difficult time in your pregnancy or in parenthood
Thank you for the music!
Mindfulness ex backing track music: Soothing Serenade by UNIVERSFIELD -- https://freesound.org/s/719269/ -- License: Attribution 4.0
Intro music
After the flu by kjartan_abel -- https://freesound.org/s/611440/ -- License: Attribution 4.0
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