The Troubling History Of Treating Hyperemesis Gravidarum

This week, Slate covered a troubling topic: women whose serious pregnancy-related health concerns are dismissed by physicians, putting both the mother and fetus at risk for more severe complications. The article focuses specifically on Hyperemesis Gravidarum.

Many women experience nausea and vomiting at some point during a pregnancy. What distinguishes Hyperemesis Gravidarum (HG) from morning sickness is the severity and frequency. A woman suffering from HG can experience severe nausea, vomiting, weight loss, dehydration, damage to organs, and pregnancy complications. Despite the fact that HG  was a major contributing factor to maternal death before the 1950s, it has a history of being poorly understood and dismissed by the medical community. 

As late as the early 1900s, the root cause of HG was thought to be psychological: women who were unhappy to be pregnant were thought to be “manifesting” physical symptoms. A 1905 article in the Journal of Obstetrics and Gynecology stated that “Hysteria is the principal cause of hyperemesis. Vomiting first commences when such women realize that vomiting is expected of them … an unwelcome conception may be a cause.” At the time, treating HG involved abortion, leeches, the drug thalidomide (which infamously resulted in babies born with limb deformities), cocaine, mercury, and an injection of the woman’s husband’s blood.

In the 1950s, using intravenous fluids to treat HG significantly dropped the death rate. However, the belief that the condition was fabricated still persisted among the medical community. A 1955 article  in Psychiatric Quarterlytheorized: “Nausea and vomiting have been considered an unconscious manifestation of oral rejection of the fetus, a repudiation of femininity, self-punishment, and punishment of the father.” Women who suffered HG were thought to be those with a “compensated schizoid character formation,” and HG was less likely in women who are “stable, happily married, and desirous of having a child.” During this time period, the treatment—although less harmful than thalidomide, cocaine, and mercury—was still ineffective and included ideas such as”use a little psychotherapy,” and “send them home to their mothers.”

Much more about HG has been learned in the following decades (in fact, Duchess Kate Middleton was hospitalized multiple times with the condition, an event which received extensive media coverage). The medical community is correcting its view of HG, but there are still some persistent misbeliefs. As recent as 10 years ago, peer-reviewed medical journals were theorizing that HG was a means of “avoiding sex” or  “an unconscious wish to orally expel the fetus.” The author of the above-cited Slate article, along with other women profiled in the piece, had to deal with physicians who were dismissive of their symptoms and were hesitant to provide even basic remedies, such as anti-nausea drugs. The horrifying outcomes of untreated HG included detached retinas, burst eardrums, and torn esophagi from the violence of the vomiting, brain damage caused by vitamin B1 deficiencies, and children born with neurodevelopmental delay.