Hyperemesis is Serious Business, Whether You’re a Princess or a Pauper

Hyperemesis is no stroll in the palace park. Kate may be a princess, but she is also human. Women of every race, class, and income level face risks in pregnancy and put their bodies on the line every time they get pregnant. The only differences between the princess and the pauper are that one has proper food, nutrition, and care and the other has none.

Kate Middleton

As you might imagine, virtually every news outlet still located on planet Earth has covered the fact that Princess Catherine, Duchess of Cambridge, is officially pregnant. A feeding frenzy of press coverage on the royal pregnancy has been virtually guaranteed since the day she and Prince William got engaged.

But unlike those princesses in the fairy tales, Princess Kate’s pregnancy is so far neither easy nor uneventful. An announcement from the Royal Family stated that she was hospitalized with hyperemesis gravidarum, which the American Pregnancy Association explains as “a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Mild cases are treated with dietary changes, rest and antacids. More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line (IV).”

Major news organizations are not widely known for their effective treatment of women’s health issues, and so it’s not been surprising to me that many have reported Kate is suffering with a “bad case of morning sickness.” Others have been downright rude and ignorant. Gawker’s Caity Weaver, for example, wrote that “hyperemesis gravidarum [is] what they call regular old morning sickness when you are a princess.”

I beg to differ.

Unless I am missing something, I am no princess; otherwise, my butler has been missing in action for quite a while and my diamond tiaras are nowhere to be found. I suffered from hyperemesis in both of my pregnancies. I assure you it has no relationship to the quaint notion of saltine-crackers-and-ginger ale morning sickness we all think about if and when we think about morning sickness at all. Really, it doesn’t.

From the very day of the six-week mark in my first pregnancy, I began to throw up. I never stopped. I vomited until there was nothing left to throw up, and then I would keep vomiting, resulting in sustained convulsing dry heaves. And this was day two. If I took a sip of water, it came right back up. If I tried to drink plain broth, same thing. Pregnancy vitamins? No way. If you have ever had a really, really bad case of food poisoning and gotten to the point where you were begging God just to let you die, you have a sense of what I am talking about here. But food poisoning lasts at most a few days. Try nine months like that.

In my case, within a couple of days of my “hyperemetic episode,” I was unable to walk around; when the dry-heave convulsing became literally painful, I was taken to the hospital for intravenous (IV) fluids. In that first pregnancy, I spent a cumulative total of five months in the hospital or at home in bed on IVs, with home health aides, catheters, nausea medicine, and the rest, unable to eat enough to sustain myself and tethered to IVs. I lost more than 30 pounds. (That made for great jokes *after* the baby was born, about how I never realized that all I needed to do to lose weight was to get pregnant.)

I was virtually unable to work for the better part of five months of my pregnancy, because I became so weak that walking up and down stairs—and some days lifting my head off the pillow at all—was difficult and made me excruciatingly tired and dizzy. When I did go places, we brought my IV bag. And the IVs only worked to keep me hydrated as long as I had them in; take out that IV, and I would go back into convulsive vomiting and lapse back into serious dehydration. I was six months pregnant and still on IVs before I could sip chicken broth or drink what oddly enough I most craved, Diet Pepsi, and hope to keep some down. When I expressed (constantly) to my doctor my concern for the baby, she reassured me: “Don’t worry. You came into this healthy and well-nourished. Its not the baby that is in danger right now, it is you, because the baby is feeding off all your reserves and you have nothing with which to replenish yourself.”

My daughter arrived as a healthy, alert 8-plus-pound baby. And, much to my obstetrician’s shock, I went through it all over again with my son.

Like Kate, I was lucky. I had a job I could keep; disability insurance; health insurance; and help from my then-husband, who had to take off work to change the intravenous fluids and take care of me. I had contraception to plan my pregnancies, great medical care, a wonderful Ob-Gyn, and the reassurance, even when I did not believe it, that my babies would be okay. Kate may have it worse or better than I did medically, but either way she is suffering from a potentially serious complication of pregnancy. And, what is more, she is going to be expected to “perform” for the cameras some time very soon, putting more pressure on her as a woman dealing with a serious condition in early pregnancy. The very thought of mixing cameras with hyperemesis makes me sick all over again.

The treatment of Kate’s condition by at least some media outlets as just another bout of morning sickness is at least in part a failure to really understand and report on pregnancy as anything other than a fantastic event, a tug of war between “choice” and anti-choice movements, a struggle to *get* pregnant, or a major social drama (think teen pregnancy).

Missing is an examination of just how dangerous pregnancy can be, and how dependent the lives of pregnant women are on access to good nutrition, good medical care, and good support systems. This same reality was illustrated in a different but tragic way in the case of Savita Halappanavar, who died last month in an Irish hospital because doctors refused to terminate her pregnancy at 17 weeks even though it was clear she was miscarrying and even after it became clear she could not survive unless in fact they terminated the pregnancy, quickly. They let her die.

But it is a reality played out every day in places throughout the world in which papparazzi have no interest. More than 350,000 women die each year from complications of pregnancy and unsafe abortion. The malnutrition, anemia, and other health conditions rampant among pregnant women worldwide are contributing factors. Cultural, economic, and social discrimination mean that both women and girls are exceptionally vulnerable to poverty and are less likely than men and boys to have  adequate food intake. Iron deficiency anemia, for example, contributes to 20 percent of all maternal deaths worldwide. One study conducted by UNICEF in Samburu, Kenya revealed that 60 percent of the pregnant women were malnourished, and even so, they still gave up shares of their food to make sure they could give more to their children.

Data show that HIV-positive pregnant women are more likely to be malnourished than their HIV-negative counterparts, a serious problem in regions like Africa where women make up the majority of those infected with HIV. Lack of emergency obstetric care is one of the leading factors in high rates of maternal death and illness throughout Africa, Asia, and Latin America. And in regions where under-nourishment in pregnant women is widespread, infants are far more likely to be born at low birth weight, a risk factor for neonatal deaths, learning disabilities, mental, retardation, poor health, blindness and premature death in infants.

So if I were a woman with hyperemesis in, say, rural Kenya, Nigeria, or Uganda, the outlook for me and my baby would have been dramatically different than it was in fact for the middle class United States me, or than it is for Kate (barring, of course, any other complications with her pregnancy). There would have been no IV fluids, little rest, and likely no extra resources to assist me. I might have died, along with my baby, and even if I had survived, my daughter would have a higher risk of dying and far poorer prospects in life.

Kate may be a princess, but she is also human. And as human beings, women of every race, class, and income level face many risks in pregnancy. What Kate—and Savita before her—have reminded us is that women put their bodies on the line every time they get pregnant. I wish Kate all the best. But the only differences between the princess and the pauper in this case are that one has proper food, nutrition, and care and the other has none.