#277 | Hyperemesis Gravidarum with HER Foundation: A Matter of Life and Death

I need help. Either you're going to help me or I have to terminate. And they didn't bat an eye and said, well, we'll just go ahead and have you help you terminate it. It is the biggest regret of my entire life. It's a lot for me to speak that out to the public for everyone to know because it's not, it's not where I normally stand.

And what we see with Ashton here is that we see the trauma that comes from being sick. One of the things that's really hard for people to understand is say, when you have food poisoning, you vomit, you feel better. But that's not how it is. With hyperemesis you have hours upon hours of feeling like you're going to vomit. And many women sit in the bathroom, and they vomit to the point that they pass out. And you feel like you're suffocating because it doesn't stop and you can't breathe. She needed to terminate this pregnancy to survive. The mom wanted this baby, and she's denied the care she wants. And in desperation, she's making a decision that she doesn't want to make a decision about. And that all in of itself is very dramatic.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hello, I'm  Kimber Wakefield. I'm the Executive Director and co founder of the Hyperemesis Education and Research Foundation. I've been a nurse for over 30 years in the last 24 years I have worked with hyperemesis patients around the world. And we work to provide opportunities for advocacy, research and education of the HIV community, clinicians and the light public. hyperemesis gravidarum is severe nausea and vomiting and pregnancy. And it's not just morning sickness. It's something that causes more debilitating symptoms such as need to have bed rest and to get medical care. And it's extremely exhausting and traumatic, traumatic for families. And so we're going to be talking today with Ashton, who's here to share her story about her experience with hyperemesis gravidarum.

Yes, thank you, Kimber. My name is Ashton. I am a wife, mother, and also registered nurse. And I personally have experienced HGW, five times. And unfortunately, we've had losses with that. So I'm here today because I want I want to start moving the trend the other way around, I want to build education, I want mothers to know that they're not alone. And I really, really want our health care professionals to know that we need to do better, there's resources and education out there to properly and efficiently treat this condition.

Yes, it seems that a lot of times when a woman has HCG in pregnancy, it's sort of just written off as nausea and vomiting of pregnancy and it will, you know, likely get better. And if she's not gaining weight normally, then they call it H G, but they sort of still just provide the same solution. So we're going to be looking forward today to hearing from you guys about some of the latest research in H G. I mean, I think there's some groundbreaking research that's come out recently about identifying the source of HCG, which is obviously going to help tailor a treatment program because I don't what I think people don't understand about HCG is that it leads to serious psychological consequences for the mother. As you said, Ashton, it can even lead to pregnancy loss, or really, you know, dangerous conditions in pregnancy and it is not just nausea and vomiting of pregnancy.

Right. So I guess I'll just I'll dive into my my journey a little bit. So like I said, I've been pregnant five times. My first one, I will leave I did have HG but I wasn't diagnosed properly. I lost five pounds from Week Five to week 14. I couldn't keep water down. I did my best to advocate with my first my first pregnancy that I really think I have something going on and I was completely dismissed. You have to lose 5% Not five pounds. And it wasn't until I had a wonderful nurse midwife. I switched care at 33 weeks and she says I was looking over your chart and I think you had HD and I said I tried to talk to my OB that I had that I had that and she just kept dismissing and she said you just need to be on the lookout that it can resurface again with each pregnancy and it usually is tends to get stronger with each one. So like I said it was my milder or pregnancy with with nausea and vomiting. So when I had my second pregnancy, much more intense, we went to the ER. And this time I was I was cusping, on losing eight to 10 pounds. And same thing that I just need to eat small meals. So I suffered, I didn't realize that I actually was developing PTSD from that pregnancy and how bad the nausea and vomiting was, I didn't start gaining weight until I was 30 weeks pregnant. And they still were very dismissive, that it was HD, they would not they did, they really did not want to give me that diagnosis.

I'm still struck by the fact that they told you that I'm always critical of the fact that they just force everything into a science and this black and white perspective of a woman having to lose 5%, which for most women is only six or seven pounds anyway, if we're looking at 5%. But weren't they a little suspicious of the fact that you were 14 weeks and lost any weight rather than gained weight? Did they have any explanation as to why that was happening? Or because it didn't fit in that box, they totally dismissed it and said, you know, eat crackers a few times a day, if you're not feeling so great? Did they just say nothing about it?

She told me, like I said, Eat small meals, try crackers, modify your diet. And she said, Well, it's not really HD until it's 5%. And it can't be normal for some women to lose weight. And it's flabbergasting to me, because I can't find anywhere where it says that it's ever healthy, to lose weight by complete starvation and dehydration. Now I understand when we are not pregnant losing weight, we go into a calorie deficit, but they still educate you to reach for the right proteins, the right carbohydrates and fiber. I wasn't getting any protein down, I was lucky. I think one of my safe foods with my first pregnancy was dry cereal. And it had to be extremely, extremely ice cold milk. And I could only get a couple bites in if I went for bite number four, that was my limit. And I would vomit. It's kind of like when I've had, I've taken care of patients who've had gastric bypass, and they're kind of the same way. If they eat one too many bites, it's all going to come up they have to learn that and that's a whole nother Avenue. But I really started to feel like Wow, that must be what this feels like. And then I got into my own head thinking. Maybe I'm just being too too much of a baby here. Maybe I really am. This is normal. And how is it that with all these women I know no one's mentioned how really severe morning sickness is. I thought I was I was trying to dismiss myself. And it wasn't until Marsha said something. She goes, I actually think you had HG because I'm looking at your trends. You didn't start gaining weight with your first pregnancy until you were 28 weeks. And then I had her at 38. So from 28 to 38, I gained 25 pounds because I woke up 28 weeks pregnant and everything was gone. And I got to have a beautiful end of my pregnancy. But mind you, that's your third trimester. Why was nobody asking? What's going on?

I think one thing that might be helpful for us to do here is to distinguish the difference between morning sickness and hCG. If most women are treated as though they just have severe morning sickness, that's a that's one mechanism for women feeling nauseous and pregnancy related to the hormones of pregnancy. Right. Now he has a different underlying pathophysiology. So Kimber, can you explain that?

Yeah, and actually, the the underlying pathophysiology, we believe actually underlies morning sickness as well. It's just that it's stronger in mothers who have hCG. And so he is interesting, because some of us will have morning sickness to start. And then because it's not treated, or because we become malnourished, or because we have other issues, severe reflux, excessive spitting, those kinds of things, then it progresses into Hg much more quickly. And so when that hormone in our body that is new to a lot of us is called GDF. 15 is related to a gene called gdF 15. So our research discovered a few years ago, that this hormone is elevated, and those who have hyperemesis now for some of us, it's elevated prior to pregnancy. And those of us who are elevated elevated prior to pregnancy, when they get pregnant, then it's already elevated and we don't have as strong of a reaction so we tend not to get as sick. Those of us who have low gdF 15 levels prior to pregnancy tend to hit it feel that onslaught of gdF 15 and they have an immediate reaction of being sick. And then as that elevates in our pregnancy, we get sicker and sicker and the That's really important because one of the things that I've talked about for many, many years, I've done this now for 24 years. And I have long said in my presentations, that there's this kind of hyper mimetic cycle of when you start getting malnourished and dehydrated, that it takes you into this worst vomiting and nausea cycle that you can't get out of. And so the reason why that is now we understand is likely because gdF 15 causes nausea and vomiting or weight loss, and it changes your taste perception. So things that normally taste good and normal, tastes horrible when you're pregnant. So I mean, I can't tell you like I was a very healthy eater before I was pregnant. But during pregnancy, it was nothing but junk food, a lot of the time I had moments and days here and there where I could eat decent, but junk food appealed to me much more not because I didn't want to eat healthy, but because everything else just tasted like dirt in my mouth, or weeds and weird textures to food. So that we now know that's in part caused by gdF 15. So those of us with high gdF 15 levels, which, ironically, is elevated in part to not eating and low potassium levels, infections, like UTIs, and metabolic stress. So all of those things are part of a study. So you get into the cycle of all the things that he is causing making you worse. And so because doctors don't want to treat it early on these issues, just continue to build and make your DD 15 go higher. So it's a really important concept to understand this is a paradigm change for this, for this condition. Because now that we know this, we know we have to treat it early, in order to prevent severity and progression, and prolonged suffering and prolonged recovery. And this idea of just waiting for it to get better. It doesn't usually do that, except in some people will suddenly get better. But if your GED at 50 levels just stay really high throughout your pregnancy. Some people seem to have symptoms, even postpartum, possibly related to gdF 15. So it's a really important understanding. It's not hCG. And it's not all these other things we've thought about for so long.

So are you saying that even the common recommendation for a woman who has morning sickness in the first trimester is just write it out? For the first trimester? Yes, everybody's was always told that it was related to the HCG hormone hormone of pregnancy that's building up in your stomach. And if you have an empty stomach, this is why the recommendation is to eat small, frequent meals, that hormone is going to impact you more. And you're saying it is not that No, no, it's interesting, because GFP, this is still very much in. There's not a ton of studies out there looking at the cycle of gdF 18, like the rise and fall during pregnancy, but it does tend to have a similar rise to HCG, which is why we've thought for a long time, that's probably what it was. But then there's some variation. And I think it's because it depends on our condition. Are we getting sick? Are we malnourished, all those things make it go higher. So it's very hard until we have, you know, really large numbers to know. But this GD F 15 is something that affects lots of different populations. It's not just like an American thing. So.

So what about the the women who it does spontaneously resolve at 12 to 14 weeks, sometimes it takes up to 16 weeks? I feel like that's the vast majority of women who have morning sickness, should they be worried early on that this could become hg? Or how do you recommend providers and women manage this at the first signs of nausea and pregnancy?

Well, I think there's a few things that they can do one, it really is a degree. And we have tools on our resume on our website called like the hope score that I created, that is a, an assessment tool that looks at the severity of the symptoms in total. And that's really helpful for determining are you in this kind of really mild range, or do you have combination of symptoms that makes you more severe, that's a really key thing. But if you have mild symptoms, you're eating okay, you can function a little bit, you know, maybe pushing through is okay, or just getting a low dose of medication after the first eight to 10 weeks, which is when they're most concerned about safety. And maybe that's okay, but if you're losing weight, and you're in bed, and you can't function, that is not a good idea to just wait, our research from years ago, found that the mothers who took medication during pregnancy for HGW actually have better outcomes, fewer losses, fewer terminations, and fewer children with neurodevelopmental issues than the moms who didn't take anything and just toughed it out.

I haven't. I have a little aside and a question that's in the form of a question. One of my close friends had three babies and for the third only as an Ashtons case, she she kept suffering from it and it makes sense if it based on what you're saying, but my friend was only affected by this in her third pregnancy. We didn't know what this was. She was never officially diagnosed. So I've always said she had severe morning sickness basically that lasted till Mi four hours a day until she was about 28 weeks. But she was bedridden. They actually had to fly her mother in law from Texas to be with her in Minnesota, just to just to support her because she couldn't get out of bed. This is a very cheerful, resilient, energetic friend, it was really surprising to see her in a state like this. And I remember she was telling me one day that her mother had heard acupuncture really helped, and that her mother had made her an appointment for the next day, when she went and she immediately became better. What have you heard about acupuncture? Yeah, I actually tried acupuncture during my pregnancies and tried, actually quite a few natural remedies. The vast majority of us have a very small if any response. I'm surprised, honestly. I don't know. You don't mean we she was when she tried it.

I guess. I mean, she was really far along. I thought she was around 28 weeks or so. Okay.

Yeah. Sometimes when moms try it later in pregnancy, they have to hit it around the time that their symptoms just like with Ashton went away. Right. And so sometimes, you know, that becomes kind of a confounding issue that we don't know exactly what the what the treatment was. But for the most part, most studies find that acupuncture has small benefits, if any, for the majority of the moms that are really sick.

And I just want to I just want to put out there though, in fairness to acupuncture, that it would also depend on the acupuncturist you go to they really absolutely trained and specialized. Absolutely no, Ashton, we do want to get back to your story. Is this a good place for us to resume with Ashton story here? Should we do that? Yeah, yeah. Okay, let's do that.

So, my second pregnancy, I did end up losing anywhere from eight to 10 pounds. And her my nausea and vomiting never stopped with her. And I think it was such a stressful pregnancy that I actually couldn't really feel comfortable to deliver. And I was really, I didn't start feeling better this time until 30 weeks, but unlike my first it didn't stop. It was just kind of just in the morning. And I suffered through the day, but I was able to gain a little bit more weight with with my second pregnancy, I delivered at 41 weeks and six days, I had a I had a home birth, I loved it, and I would do my home birth again. I had luckily Caden's had no complications, except for when we found out that she does have a speech impairment. And the research from HG is showing that I was only able to take a prenatal vitamin, maybe five times while I was pregnant, and it was a real chore to get that nutrient down. So it's, it's a miracle that cadence is healthy. But it's, I don't say that because I want anyone to think like, oh, well, I'll be okay. Because that lady was okay. I was not cared for appropriately. And more intervention should have been made. She has a speech impairment, but luckily, it's we're getting a handle on it. And she's, she's improving. But I do believe that it was very much related to my lack of nutrition and nourishment during my pregnancy. In April of 2021, my IUD was set to expire. And so it was either Well, should we try for another one? Or? Or do we have my husband do the vasectomy? We always wanted to have five, six kids, we did. But after that second pregnancy, we saw that things were probably not going to go that way. Because that was that was pretty rough. But we thought, Well, I'm a nurse now. Let me I know more. And we're gonna we're gonna get on top of it better. And we're going to be proactive about it. And I had briefly seen the her foundation online. And I was perplexed to find out how many providers don't know anything about hyperemesis and I think one of the biggest drawbacks is the fact that for some reason someone keeps educating our health care providers from ER nurses to nurse practitioners, pas, medical physicians, OB GYN that this is a rare condition. And therefore, they think that they'll never see it in their practice and their 30 years of practice. So they're very quick to dismiss you if you have your center. So when I found out that I was pregnant, very very planned third pregnancy because we wanted to get it right knowing that this is going to be a little bit tougher, and I'm going to need some help because of how sick I'm going to get. Not realizing though just how you don't think he can get worse. Oh, it can get worse. And I found that I was pregnant. I'm very in tune with my cycle. I found out I was pregnant within 60 days post conception I was just already feeling symptoms and by four weeks and four days the nausea started I thought okay, no big deal I I'm going to note we know better. I'm going to handle this this time and It was sorry. It's at seven weeks I had to go into the emergency room because I hadn't drinking water in a week and getting a hold of a doctor through their office. It trying to explain to their clerk who takes appointments that I need to see a doctor now, I'm losing weight. I haven't had water and they are just well have you tried crackers? Have you tried ginger? Take your prenatal vitamin at night. I haven't taken a prenatal vitamin. I think I took two right before my sickness started. And I went to the ER and unfortunately, this was still when COVID was really big, so they weren't letting any support persons in the back and I didn't have great cell phone service. So getting in touch with my husband being another part of an advocate or my sister being another advocate in the hospital parking lot with lack of service. I couldn't leave a urine sample. And the nurse practitioner told me that again in 2021, so friends not safe, you can't take it. It's not safe to offer reglan and I had taken reglan once with my second pregnancy and I had one of the severe side effects of it's kind of like tardive dyskinesia, where you feel like you constantly have to pass something and shuffle your feet. And it's extreme anxiety and restlessness. So imagine being so nauseous, but at the same time, you have to continuously walk around, even though you're malnourished and dehydrated, you don't have the strength to walk around. But the regular one of the side effects is that it's not for everybody. But I found that myself and a few other in the support group that I'm in, they experienced it to very out of body constantly feel like you have to hit yourself. And they tried to even give it to me with Benadryl. It didn't even touch it at all, because they didn't want to give me Zofran.

So I'm assuming I don't know the first thing about any of these drugs, I'm assuming Zofran is now approved, and it's has few side effects, and it generally works for women. Is that what you're indicating? Well, it's actually Zofran has been approved since the 90s for use in general, but there are no drugs approved specifically for hyperemesis gravidarum. So there are no specific treatments that are approved by the FDA for hyperemesis gravidarum. So Zofran is used off label, it's used for post op and other kinds of GI issues. But it happens to be one of the most effective drugs for HG because it blocks serotonin triggers to the vomiting center in the brain. So it helps reduce the vomiting greatly. It's a very effective drug for many women.

In my education, which was very little on hCG. In nurse midwifery school, Zofran was the drug of choice. So what is going on with providers saying you can't take it?

So round 2014, the CLI just came out. And around that time, there was a big push to stop using Zofran, since likely just was out, but likely just as made of doxylamine and vitamin B six and a delayed release combination. And it's not, it's for the vast majority of women is not effective as a sole treatment for HIV, it might help some, but it's not effective for that. So you either have to combine it with Zofran. Or maybe just take So Fran, but because of that there was a big push to say that Zope brand was not safe. And there were some not well done studies that came out that found very small risks of cleft palate and septal defects in the heart. But the data was some of the studies were done by litigants who wanted to sue the manufacturers of overran. And so this whole big tsunami of litigation came out and most of the people I was a pediatric ICU nurse, and we would see these multi syndrome kids. And those are not people who have drug harm issues. Those were patients who had, you know, multiple issues, genetic issues and other kinds of problems. So these parents who were very desperate came brought all these cases up saying well, I took Zofran, which about 20% of the population took Zofran. So if there was any kind of an issue, there were all these masks, cases against GlaxoSmithKline. to sue to say the Zofran was not safe. So it became a huge thing in the OB community to stop using Zofran but the risk overall went from point 8% In that one study that was really impactful to I think it was 1.6% it was like it was but it was double the risk, but the risk overall is two to 3%. Anyway, so it was still below the risk level. So it was really not significant.

So talking about that risk, the risk of cleft palate and heart defect Yeah, for Libby's, wouldn't it be likely that some of these mothers who were unable to eat effectively types of vitamins nourish their bodies are going to be at higher risk for these conditions? Anyway? Yes, exactly. And so what we did is we did a Zofran study with our team, and we looked at mothers who had hyperemesis that took Zofran and those who didn't. And the, the malformation rates were no different between the two groups, the other anywhere in that study over 1000. Yeah, but they the reason why it was really important is when you look at these large scale, they, you know, hundreds of 1000s of women in these studies. The problem with that is they look at people who are prescribed Zofran, that doesn't mean they took So Fran, and so will you start generalizing that it's really not appropriate. So that was one of the strengths of our study was smaller. But when you look at all these women, we know these women from, you know, these were in our community, they knew whether they took Zofran and we were able to have that information. So very, very important to see that.

Ashton, do you want to continue with your story? Yes.

So I went to the ER, and they wouldn't prescribe me Zofran I had tried to advocate, you know, I'm a nurse and I, I knew from the second pregnancy, I'm not taking reglan, it's not going to it just makes it worse. It doesn't even touch the nausea and vomiting and I feel like I actually need to be a monkey tapping my head rubbing my belly at the same time, but there's nausea and vomiting and they really were dismissive about it and they said we'll just take it with Benadryl. And then as Kimber stated like, just because you prescribed Zofran doesn't mean that we can get it down and doesn't mean that we can take it so same thing with the reglan. It was a tablet. Has anyone ever tried to swallow while nauseous and your gag reflex is hypersensitive, even if it was going to go down. It was a battle, I mean, a battle to keep it down. And that's if a few hours later I start to dry heat. And some of it came up, you know a little bit disintegrated. Not a whole tablet, but I could see white stuff that it hadn't yet gotten all the way through. So then I got to the point where Okay, I'm done. This wasn't even working. That maybe was missed. It's sometimes it's really hard for me to say the word miscarriage because I it's just hard. Because I just really feel that I would have a baby here if I had gotten the proper care. And I really went through a type of depression that I have never experienced in my life and a lot of guilt. Because for the first three days after her the placenta and baby I had at home delivered i I've never experienced a miscarriage before. And when I had that loss on top of dry heaving, and there was a lot going on, by yourself in a bathroom, it's quite the experience and I couldn't look at the baby and but I can tell you that I peed. It was very small, and it was very green. And I I think that I had been I think I had miscarried for a couple of weeks. And my body wasn't letting it go. And I think that had they may be done one more ultrasound in the ER a couple days later. Maybe they would have helped more. That wasn't the case. So I'm sorry.

Yeah, you know, it's interesting, because just off the side, but, you know, I met with some of the leadership at one of the organization, one of the OB organizations, and they just said, you know, we have so many things we're working on, it's just this is just really not a priority. And when you hear a story like Ashton's it's really hard not to, to at least want to give it some some attention because he is actually leading cause of hospitalization in early pregnancy and the second leading cause to preterm birth overall. And when you think about that, that makes it something that's very important to be talked about and the impact financially. The number of people who have all these children with issues those are all very important things a lot of us have children with issues up to one and to have the downstream effects then they don't even consider but when you I have no doubt we could Find lobbyist groups with deep pockets that are fighting for things that affect far fewer people than this is effective. Yeah, so. So, pregnancy, three was a loss. And pregnancy four was a blighted ovum. There was never a baby developed, there was just a sack and I can say that that was probably what I would assume normal morning sickness feels like so I, I think that I have experienced HG and normal morning sickness. And that maybe we we miscarried. Baby number five, though, is probably what put me over we were not trying. That was another surprise after two consecutive losses. And we had to have a sit down. So baby three was a loss, baby four was a blighted ovum. So to live births, two consecutive losses. Pregnancy number five was a surprise after the two consecutive losses, we were not expecting to have that baby. And I went to a prestige hospital in San Diego County thinking that I was going to be safe. And unfortunately, that physician refused to give me a central line for IV fluids at home. I had originally met with one of the physicians there who agreed to start steroids at nine weeks, if I can just get to nine weeks. She'll start me on steroids. And I said, Okay, I can do that. But you're gonna have to give me So Fran. And she was very compliant. And she would she would give it when I made it to nine weeks though with that specific pregnancy. It's like, they just pulled the rug out from underneath me. And they said, Oh, actually, no, steroids aren't safe. We can't give those to you. And it's too risky to give you a central line for IV fluids. Even though I was hospitalized getting a banana bag continuous at 125 for three days. Mind you, my eyes knows. The only reason why I had input and output is because of that banana bag. And they said, Don't you want to go home? And I said, Oh, of course I do. I have children at home, I want to go home. And I said, but I think I need to go home at least with a PICC line. So I could have fluids for the next four weeks at home. They told me that it was too risky. And then argued a little bit that I was eating and drinking just plenty. I said no, I'm not. I'm i i order food to come into this hospital room because you could do it on the app. But I don't eat any of it. And I order a lot because I have no idea what's going to be safe. And I'll take one bite of this. Okay, I kept that down. can I do to know now It smells weird. I can't do a second bite of that food. Kimber would understand exactly how that feels. Like some of your listeners will understand, oh, yeah, the safe food for two foot two bytes. And after that it's done. And she said, Well, it looks like you're you're you're going to the bathroom just fine. You're paying out 800 cc's, which is a great output. I said, Well, yeah, because I have fluids going at 125. I haven't had any water since I've been here. And I and she says what liquids are you tolerating and I said I can handle a couple sips of orange juice. For some reason my body was really craving vitamin C. And like I said, one of my safe foods with all of my pregnancies was ice cold milk with a very dry plain Cheerios. And I can handle about three bites no more than four. And you got to go very, very slow. If you gorge it, it's going to come right back up. And she had the audacity to tell me that there was enough water in milk and orange juice to suffice, then apparently, milk and orange juice is now a clear liquid. And that's more than enough to live off of as you're growing a pregnancy, malnourished.

They don't learn the first thing about nutrition, knowing that we need other people and we've every woman needs a team of support when she has an issue. We should never go to just the one person who says they know the most about the physiology and how it will affect speech later. And how about the drug effect or the drug side effects? And then the nutrition aspect. We need to have a team supporting every woman with something that's serious.

Her advice might have applied if you were starving on a desert island. Sure milk and orange juice might have kept you alive for a week. That is not maybe to be maybe, but that's the third that's the big bar. We're alive.

Not sufficient for a woman trying to grow a baby in pregnancy.

Right. So I was discharged from the hospital. We were all my whole family was pretty upset that they wouldn't give me like my central line that I so clearly needed, and really perplexed and mind you when you have he can't even think straight. So I'm a registered nurse. I know how to be a patient advocate. It's actually one of my most wonderful parts of being a of my job is finding out what my patient needs and advocating for that for them. So I can even advocate for myself and my unborn child. And a few days later For I had a really bad episode of relentless vomiting, it just was it was not stopping. And it's not even vomiting. There's nothing down there. It's just dry heaving and retching on and off for hours and hours. And I had So Fran, but it was only tablets, and then they switched it to the pump. But the pump, Kimber can probably jump onto this, the pump isn't always as effective, because some of where you put your sights, it stops it, I don't feel like it absorbed well enough on some parts of my abdomen. And they said, again, there's nothing more we can do. When I know I, you guys can give me Zofran IV push at home, you just give me what I need for three, four days, and I'll administer it myself through my central line. But they didn't want to do that. So when I when I called attempting, once again to advocate, I need a central line, this pump isn't working, they want to increase the pump dose without a pharmacist, okay, if I couldn't get them to give me a console on on a conversation with that, they wouldn't give me IV steroids to start at an acute care and then change out to PO at home tapered down, they wouldn't do that. I can't keep going on like this, we're going to have to terminate the pregnancy that says I need help. Either you're going to help me or I have to terminate. And they didn't bat an eye and said, well, we'll just go ahead and have me help you terminate it. And it's the one it's it is the biggest regret of my entire life. And to say that there are not side effects to termination is an absolute disservice to women. i It's a lot for me to speak that out to the public for everyone to know, because it's not who I normally it's not where I normally stand.

I will forever regret. And I just want other women to know. And if they're feeling that they need to do that, that their doctors not listening to them to please contact the foundation. Because they're the side effects of terminating unwanted pregnancy, is that something I want other women to experience? I speak today hoping that maybe we can get real attention and real service to this condition. So my daughter's never experienced what I experienced. Unfortunately, they may have this condition, it's I hope I'm there to support them. And that this isn't going to be such a fight when they choose to have children. But I pretty, pretty upset that you think you went to a safe hospital for yourself and your baby.

And how quickly we're in such a critical, sensitive state of mind, physically, spiritually, emotionally, to allow me to make that decision without giving me all of the treatment options. I can understand if all of the treatment options were given, and they told me no. Sometimes I think they told me no. Because I had told them that this was a surprise pregnancy thinking that it wasn't wanted. Most pregnancies are surprises. And those are carried to term. Why wasn't mine.

And what we see with Ashton here is that, you know, we see the trauma that comes from being sick. And she talks about the the overwhelming vomiting. And one of the things that's really hard for people to understand is to say, when you have food poisoning, you vomit, you feel better. But that's not how it is with hyperemesis you have hours upon hours of feeling like you're going to vomit. And many women sit in the bathroom, and they vomit to the point that they pass out. And you feel like you're suffocating because it doesn't stop and you can't breathe. And that is a huge trauma for a lot of us. You then associate any food that comes to you, in your mouth, anything that touches your mouth, like I couldn't even open my mouth completely, like wide. Because one I had general issues from vomiting so much, it's so hard, but also just from anything touching my mouth making these thick. And so it's really important to understand, Oh, it's just not you just puke a few times in the you know, it's way more than that. It's a very deep thing. And then a lot of times we're denied care, one of the doctors that's in our leadership terminated because a very prestigious hospital would not give her would not give her medication that she needed. And so she terminated and you She's like, I'm telling you what I need. And they were like, we're not giving that and there was no reason that they could give it. So this is not, sadly, just a completely abnormal case of what action is, is thing. I was told when I was pregnant 25 years ago that I was rejecting my pregnancy because it was unplanned. I wasn't, I was sick, I didn't even know I was pregnant when I got sick. So, but Ashton also is showing us that, you know, the trauma regardless, it's not a not a morality thing. At this point, it's she needed to terminate this pregnancy to survive. And it doesn't matter whether you believe abortion is right, or abortion is wrong. At this point, it's the effect on the mom, the mom wanted this baby. And she's denied the care she wants. And in desperation, she's making a decision that she doesn't want to make a decision about. And she doesn't want to do what she's having to do. And that all in of itself is very traumatic. And so so many of the mobs in our communities have tremendous trauma. From termination, when we first started, the termination rate was around 15% in our community. And through changes in medical practice, and the advocacy work and the research that we've done, it's now been around five to 6%, for quite a while. And so we're very happy about that, because there's so many women who terminate one, two, I've even seen one woman Terminate 13 times. Because of what Ashton just said, she went to the hospital, they gave her a bunch of different treatments, didn't want to do any more, and basically abandoned her and said, No, we're not going to do anything more. So this is, unfortunately, something that we do see. And it's it's extremely sad to see Ashton was it put in an impossible position. Absolutely. Because she didn't want to lose her baby. Right. And in the only option she was presented with was keep your baby and risk harming your baby. Based on how this is going risk losing your baby later, or risk having a baby born harmed. That was all she was given. So she would have had the guilt by terminating or the guilt to potentially lose the baby later, because of her inability to eat and care for herself or even drink water. It was an impossible decision. It was like a slow death or a quick one was was the choice she was going to. And she was given nothing else. Right?

The absurdity in it all is that they're withholding medication that can help you to avoid harm to your baby. Right? They're not giving medication because they're saying it's unsafe for the baby, yet, letting you continue the way you were feeling and not eating is harmful to the baby.

Yeah, I hear that argument that, well, it's not safe to give the medication. And I always post the question back. But is it safer to abort the baby? I mean, which one safer have a small potential cleft palate that you can repair? If that's the concern? Or? Yeah, I have to say earlier in this conversation, I was waiting to say, so what are the risks of this medication, and all of a sudden, my perspective has shifted. Like, it's like you almost you almost can't care. Because when you look at the position that Ashton was put in, it's far too common for women to not get the care that they need for hyperemesis. And this results in, you know, up to one or two women having symptoms of trauma and persistent depression, anxiety, and having up to one and two kids having neurodevelopmental issues, behavioral disorders, emotional issues. And these are things that we see can be prevented, and a lot of moms if they get good care, especially nutrition, so the her foundation is here to help guide care. And we don't prescribe care, but we offer you guidance on what to talk with your physician about we have lots of resources to help you determine how severe your symptoms are, help you figure out how to advocate for what you need, find support, find all kinds of just different resources. And we have a whole clinical team of people here who are very knowledgeable about HG, we also do a lot of research on hg. So reach out to us, we have lots of resources, we can help moms. And you know, with good care, the vast majority of women don't have to make the decision to ash and had to make and they can go on to have a pregnancy and have the family that they want. It may not be easy, but we can definitely help a lot of women get through their pregnancies a lot easier.

Thank you so much. I cannot thank you both enough for what you're doing. Ashton. I just want to say that we all know what it feels like to not even want to get words out of the mouth because of the guilt and the burden. And I'm so I don't even have the emotion. I'm so sorry about your experience. But it's so clear to me that you are putting yourself through this discomfort and suffering today only to spare other wounds from what you went through. And that's the only reason we're here because this is the last thing you ever want to talk about and just thank you so much for coming together and telling the story as we needed both of you in this episode just thank you so much.

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I really appreciate you guys for being very open minded with this and I hope that your listeners you guys have a lot of physicians that also listen, and I hope that they're going to now take this opportunity to go to the HER foundation.