This article will talk about how I have continued breastfeeding with hyperemesis gravidarum. Hyperemesis gravidarum is a debilitating form of extreme morning sickness which affects 1-2% of pregnant women. If left untreated it can be deadly.

As well as the physical problems, one difficult aspect of having hyperemesis gravidarum is the absolute lack of support or sympathy most people have, including midwives and nurses. The two most common things I was told during all three pregnancies were “Have you tried ginger biscuits?” and “It’s just morning sickness”. When you have hyperemesis gravidarum, these stupid comments are not helpful and when you hear them enough, it starts to really get you down. Add breastfeeding and you get comments about how stupid you are. You do you.

If you are still breastfeeding when you fall pregnant again, you might be wondering how to continue breastfeeding your baby through this difficult time (or whether to continue). I was amazed there was no info about this online, so now I’ve been through it, I decided to write this article, although it’s taken a couple of weeks as, even though my latest HG has subsided, I’m still exhausted from throwing up so much. Also, I find it difficult to discuss this due to the trauma surrounding my first pregnancy (TW).

Choosing to stop breastfeeding completely is also an option for some. It wouldn’t have worked for us because my little one wouldn’t take a cup at all at the start of this pregnancy, although he now does.

My history of hyperemesis:

• Pregnancy 1: I was in and out of hospital, developed Wernicke-Korsakoff Syndrome (this is a life-threatening development of untreated or treatment-resistant hyperemesis gravidarum) and nearly died. At that point I couldn’t even keep down little sips of water, I was dizzy, confused, unable to walk more than short distances or stand up for long (these are symptoms of a medical emergency, get help if you develop these amid severe vomiting). The hospital were shockingly ignorant and negligent but my GP was really good about continually pushing the hospital to sort me out. I had to have an emergency TFMR without anaesthetic which traumatised me and I have never been able to come to terms with losing this baby.

• Pregnancy 2: It was so much less awful than pregnancy 1, that I didn’t even know I had hyperemesis gravidarum. I thought I had normal morning sickness until I got diagnosed at my first antenatal appointment by a very stern Chinese doctor who told me (through a translator) that I had to eat more for the baby because I’d lost 6% of my body weight. I was sick with this pregnancy until I was 21 weeks pregnant and only tore my oesophagus twice, and some days I could even get out of bed so I didn’t think I had HG. Given our previous terrible experience, I had stockpiled anti-emetics when I’d been in America. When I got the positive pregnancy test I thought I was prepared, but actually, I couldn’t swallow down the tablets and they tasted extra bitter (my tongue got over sensitive; they were usually tasteless, I was also using them for travel sickness) and made my nausea worse so I stopped trying them after the first two weeks. This pregnancy culminated in my healthy baby boy born late 2019.

• After he was born, problems that had been caused by my hyperemesis continued to manifest. You lose 300-500 calories per day from breastfeeding, which means that even if you eat normally, you will struggle to get back to a healthy weight after hyperemesis. I became clinically underweight a second time when he was about 8 weeks old and had to be referred to a dietician who put me on a weight gain plan. I had to fight really hard to get enough food in (and I wasn’t dealing with hyperemesis by this point). I’m not saying this to put anyone off breastfeeding after hyperemesis, but be prepared to eat a LOT of peanuts/peanut butter to get that weight back on.

• Pregnancy 3 (my current pregnancy): The hyperemesis gravidarum hit me like a shovel over the head at 6 weeks pregnant. I mostly couldn’t move from the sofa and struggled to care for my now-toddler (thankfully my husband was here to do it). In 8 weeks of HG my weight dropped to 7 stone from a comfortable 8.5. That’s 10% of my body weight. My BMI went from a comfortable 19 to a dangerously underweight 16. So it was becoming a matter of survival to eat and drink. My hyperemesis gravidarum has vastly improved and now, at 16 weeks pregnant, I’m only being sick 1-2 times per day, but more than that, I’m able to eat food. For me, the nausea and stomach cramps are always a bigger issue than the vomiting because they stop me eating, so I’m glad they’re gone now.

What happened to my breastfeeding when I got hyperemesis gravidarum:

• At the start of this pregnancy, I was feeding my 18-month-old baby about 5-6 times per day around the clock (he also ate solids but breastmilk was his main drink as he didn’t like his cup).
• My milk supply reduced. One boob gave up completely around 9 weeks pregnant.
• Boobs got sore. Feeding became agony again, akin to when my LO was newborn (undiagnosed tongue tie).
• Baby started self-weaning and signalling for his sippy cup, presumably because milk supply was so low.
• My baby got clingy as my milk supply reduced. More cuddles were needed and an understanding that he needed me to physically be nearer to him than usual, so I spent a lot of time lying down next to him while he played.
• It was very hard to stay hydrated anyway, but with breastfeeding on top, it created an added dimension.
• My stomach has shrunk (this is a known side-effect of anorexia, so God knows why doctors don’t know this can happen after hyperemesis gravidarum), making it impossible to eat full portion sizes now, two weeks after most of the vomiting has stopped, so I am trying to eat more but I physically don’t have the room to do it as well as I would like.
• Due to the amount of weight I had lost, and concern that I had a responsibility to the baby in my tummy as well as my one-year-old, I didn’t fight hard to continue the BF relationship as it was at the start. I unwittingly ended up doing “don’t offer, don’t refuse” to cut down the number of feeds, although I didn’t intend to wean him and I am still feeding him.
• Anti-emetics are generally unsuitable for breastfeeding. They’re also impossible to get hold of where I live.
• The maternity care here has so far been a bit primeval and no professionals have helped with the HG.
• At 16 weeks pregnant, I am still breastfeeding my baby once daily, for the first middle-of-the-night feed, and he drinks from his sippy cup for his second wake-up.

Tips for breastfeeding with HG:

• Focus on the connection with your baby, not the “how” to get that connection. Breastfeeding is more than just nutrition, and its the loss of connection as your milk supply dips that can make it so hard. Plenty of cuddles, gentle words, understanding and love for your LO, from you and from any other caregivers.
• Don’t guilt trip yourself. Whatever breastmilk your LO gets is better than nothing. Stress is bad for your pregnancy and it will also make your hyperemesis worse.
• Don’t be afraid to unlatch and regroup when you need to. Boobs are super sensitive during pregnancy.
• When boobs are sore, go back to basics and use Lansinoh or other nipple balm remedies such as ice compresses or cabbage leaves.
• Leave your bra off. No one is looking. If they are, they can get lost. I found this made a huge difference to the soreness and also improved my nausea a bit, along with having absolutely nothing around my waist (I started in maternity dresses at week 6 with Jellyfish because I had an ovarian cyst the size of my fist in there too and it was very uncomfortable).
• If you don’t have the energy for your usual breastfeeding positions, try and master feeding while lying on your side. Use any amount of pillows or cushions to get the positioning to work.
• I was too sick to work even from home. If you can, get signed off and get sick leave from your employer. If not, find out if you can claim welfare.
• Don’t do anything that isn’t urgent. Let it all go. The washing machine’s powder drawer will be fine if you don’t clean it for four more months.
• Don’t worry about forcing down the prenatal vitamins. In China, where I was pregnant with Jellyfish, women don’t use these (prenatal vitamins aren’t even sold in shops, nor are any other vitamins) and they produce healthy babies. Prenatals are much less important than we are told. Focus on hydration before anything else.
• Take little sips of bottled water or juice instead of gulping down a big drink.
• Keep track of how much water or juice you’ve drunk in a day by changing to a new cup when you finish. On very bad days I couldn’t finish a full mug of water.
• Between feeds, when you get a moment to yourself, I recommend relaxation with a meditation video. My favourite ones are yoga nidra, a type of yoga that focuses on mindfulness relaxation.
• I have found with all three of my pregnancies (all of which were HG) one specific food group was easier to eat than others. In my first and second pregnancy, carbs were what I could keep down (plain rice, plain pasta, plain bread), I struggled with protein and I developed a complete aversion to every green vegetable on the planet (and some colourful ones). In my current pregnancy, protein has been the thing that has stayed down (in small amounts).
• Don’t worry about what you’re not doing, not eating etc. You will make up for the lost calories/nutrition/prenatal vitamins later. Hopefully, your HG won’t last the whole pregnancy, but if it does, you will have to do a lot of extra eating after the birth if you’re planning to breastfeed your newborn.
• Ensure you get as much rest as you can, and don’t be afraid to depend on anyone else in your life (or get LO into daycare, if you can get him there. I was too sick to drive) to get you through this time.
• Don’t be afraid to put the TV on for your LO. It won’t ruin their development.
• When the hyperemesis starts to ease off (hopefully around 12 weeks, I hear this happens for some women), you will need to gradually build up to eating full-size meals again. Eating five meals a day is often recommended, but I find it’s hard to fit them in around a toddler and anyway, my stomach has rarely finished digesting the last small meal in time for the next one. Your mileage might vary so try eating little and often.
• If you can eat it, Bombay Mix (and similar mixes such as the barely-spicy London Mix) is about the most calorie-dense food I have come across at over 500 calories per 100g. Otherwise peanuts are also very good for calories, or peanut butter.
• Find a hyperemesis gravidarum support group e.g. on Facebook or one of the parenting sites (babycenter, mumsnet etc) if you think that will benefit you. Different groups have different group culture, so find one that works for you.
• Don’t panic if you get to the magical 12 weeks and your hyperemisis isn’t gone. Mine never is. I’ve never yet suffered with hyperemesis gravidarum for a full pregnancy.

THERE IS NO SHAME IN STOPPING BREASTFEEDING. I can’t stress this enough. But there is also no shame in continuing to breastfeed. Ultimately, you have to do what is right for both your babies and yourself. Good luck.