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22 April 2015

UK: Better support needed for women with severe pregnancy sickness, charities urge

Difficulty obtaining swift treatment and support for severe and debilitating pregnancy sickness means some women feel they are left with no option but to end otherwise wanted pregnancies, the charities British Pregnancy Advisory Service (bpas) and Pregnancy Sickness Support (PSS) have warned.

And despite raised awareness of the condition through coverage of the Duchess of Cambridge’s experience of Hyperemesis Gravidarum, many women also still feel the decision to terminate is one stigmatised and judged by those who feel it is “just” morning sickness, a perception which only adds to the distress of ending a wanted pregnancy.

The two pregnancy charities have together surveyed more than 70 women in the UK who had experienced Hyperemesis Gravidarum and undergone abortion. While many of the pregnancies were not planned, the overwhelming majority were wanted. 

Women are often expected to either tolerate their symptoms or terminate their pregnancy. Nearly half of the women surveyed described difficulty obtaining appropriate medication, with specific treatments refused. In particular, women reported being denied some of the more effective treatments because of concerns about cost but also the impact on the foetus, even though there is a broad body of evidence indicating these treatments are safe. This suggests that nearly 60 years on from the Thalidomide disaster, some doctors remain hesitant about offering pregnant women medication, and women in turn anxious about whether such drugs are safe in pregnancy.

However there are a number of treatments now available for severe pregnancy sickness, and clear guidance from NICE’s Clinical Knowledge Summaries on what can safely be offered to women which provides the reassurance healthcare professionals and women need. As well as alleviating the suffering such sickness causes women, early treatment in the community may prevent sickness leading to serious illness and dehydration, which requires hospital admission. While some community-based treatments are more expensive than others, all are cheaper than a hospital stay for dehydration. 

There is no medication that can completely alleviate symptoms for all women, and many women will know abortion is the right option for them when faced with an HG pregnancy. But no woman should be left for her symptoms to deteriorate to the point that she feels abortion is her only option in an otherwise wanted pregnancy, and any woman who wishes to try other treatments before terminating must be given the chance to do so.

Caitlin Dean, chair of Pregnancy Sickness Support, said:

“Most pregnant women expect “morning sickness” and are willing to tolerate severe symptoms before seeking help, so by the time she is presenting at the GP or hospital, staff can be confident that her symptoms need to be taken seriously and likely need treatment. The severity of the condition should not be underestimated and the risks and complications of not treating it need to be appreciated. We may not have a cure for HG yet, but we can do much more to support women earlier with the range of safe and effective treatments available. Women should not be expected to choose between tolerating dangerous levels of sickness or terminating a wanted pregnancy before all treatment options have been explored.”

Clare Murphy, director of external affairs at the British Pregnancy Advisory Service, said:

“Any woman who needs an abortion should have straightforward access to one. No woman should ever feel stigmatised or judged for doing what is right for her and her family. But misplaced concerns about the impact of medication on the foetus should not prevent a woman accessing the care she needs to continue a wanted pregnancy.  Women who need medication must be able access this, safe in the knowledge that abortion is there as a back-up should they not sufficiently ease her sickness and enable her to get on with her life.”

Read the full report, I could not survive another day, here.