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How to Know if You Have Hyperemesis Gravidarum (And What to Do About It)

Congratulations on your pregnancy! How are you feeling? Have you been hugging the porcelain throne a lot lately?

Everyone will tell you some nausea or vomiting is completely normal during pregnancy.

What if the amount of nausea and vomiting you’re experiencing isn’t considered normal, though?

With my first pregnancy, I thought that morning sickness would be a rare and laughable occurrence. I was sorely mistaken. It was only after my daughter was born that I learned I actually had what was considered extreme nausea and vomiting. Some cases are so extreme they earn a technical diagnosis of hyperemesis gravidarum.

Here’s how to determine if you might have hyperemesis gravidarum, and what to do about it.

The Difference between Normal
and Hyperemesis Gravidarum

Is it safe to say we all expect to have an obligatory barf-fest after indulging in a craving now and again? It’s almost like a rite of passage.

What if that “rite of passage” turns into unrelenting, never stopping sickness?

Have a seat, friend (or curl up in bed), and let’s have a little talk about what’s normal morning sickness and what’s extreme morning sickness.

Is it Normal Morning Sickness?

Morning sickness seems like paying your dues for a sweet baby. We see it in the movies all the time: the lead character finds out she’s expecting and then hurls in a trashcan, or finds out the indigestion that was presumably from her lunch at a Central Park food cart was actually due to a bun in the oven.  

In other words, morning sickness is normal. If you think you might have a bout of morning sickness, try answering these questions:

  • Are you nauseated and sometimes vomit, but are generally able to keep food down?
  • Does your nausea come and go, and start to subside or lessen as your pregnancy progresses (disappearing shortly after first trimester)?
  • Are you able to stay hydrated?
  • Are you able to maintain most of your commitments and responsibilities?

If you have answered yes to these questions, then you’re probably experiencing some normal morning sickness.

Treating Normal Morning Sickness

Hang in there, momma. This will pass! There are some things you can do that might help while you bide your time to the glorious second trimester!

  • Ginger anything. Ginger is a natural remedy that can help settle that tummy. Items such as these tummy drops are spectacular when you need just a little something to calm your unsettled stomach, ginger ale (if it’s made with real ginger!), or these magical ginger chews.
  • Sea bands. Some moms find the acupressure route works like a charm for them. They come in some cute colors, too!
  • Trusty old saltines and lemon-lime soda. Morning sickness can feel like you’re fighting a bit of a stomach bug. Sometimes the same foods you eat when you have the flu settle a first trimester digestive tract.
  • Organic Morning Wellness Tea: this has a gentle blend of pregnancy safe teas to help settle an ailing belly.
  • Never let yourself get hungry. Keep snacks EVERYWHERE.
  • Hang in there. Really, truly, normal morning sickness subsides and you’ll be well on your way to enjoying your pregnancy glow!

Is it Hyperemesis Gravidarum?

Is the description of  “morning sickness” so distant from what you’re feeling you don’t even know how to describe it to your doctor?

Does telling a nurse how many times you’ve vomited sound like a work of fiction because it’s so unbelievable, even to you?

Or, perhaps you’re finding yourself a little resentful of those two pink pregnancy-stick lines, despite all the joy and elation you thought you’d feel. This is NOT what you thought you signed up for.  

The Signs of Extreme Morning Sickness

Why don’t you try these questions on for size and see if they sound more familiar?

  • Is your nausea accompanied by severe vomiting? Severe can be defined as every time you eat or drink something, or once per hour or more for several hours.  
  • Have you lost 1-2% of your body weight in a week? If you’re not sure, try this weight loss calculator.
  • Does your nausea seem to be never ending and constant no matter how close you are to second trimester?
  • Do you suspect you’re severely dehydrated? Signs of dehydration include urine that is dark yellow, or going 8 or more hours without needing the ladies’ room.
  • Does your vomiting prohibit you from keeping any food or water down, even in small amounts?
  • Are you too sick to participate in your normal activities?

If you answered yes to most or all of these, I want you to take heart. I get it. I’ve been there.

Actually, so has a princess…twice. (I’ll bet you never wanted this in common with royalty!)

You may have a case of extreme nausea and vomiting of pregnancy, sometimes called hyperemesis gravidarum. It’s thought that hyperemesis gravidarum is related to the sharp rise in hormones during pregnancy, but there is still a lot unknown about the cause of the condition.

Without proper treatment, it can be difficult to get the nutrition you need for a healthy pregnancy, can lead to hospitalization, and sometimes cause severe or life threatening complications for a mommy or her baby.

I don’t want to scare you. I just want you to know it’s ok to take this seriously.

Learn to Advocate for Yourself

Hyperemesis gravidarum can be difficult to diagnose because some of the diagnostic criteria can be subjective. Knowing how to advocate for yourself is the first step in being treated early and well. Early treatment is key: The sooner you can get your symptoms under control, the better!

After suffering from anything-but-normal morning sickness through two pregnancies, I found the biggest things that helped me were knowing that what I was going through had a name, and that I wasn’t the first person to walk this path.

I’m here to tell you: you don’t have to struggle through this alone.

You will get through this, and I’m going to help you weather the worst of it. Let’s bring more awareness to this condition together!

First Things First:
Speaking Up about Throwing Up

Be honest with your doctor or midwife. Significant weight loss is frequently the criteria health care practitioners will use to diagnose hyperemesis, but don’t let maintaining your weight be the only factor you consider in whether you should talk to your doctor. Your condition can be serious even if you don’t meet all the qualifications of an official hyperemesis diagnosis.

If you’re not able to keep down small amounts of fluid, if you are throwing up blood or bile, or if you become dehydrated, speak up.

It can be hard to share anything but great news about your pregnancy with your healthcare team, but they can’t help you if they don’t know exactly what’s happening in between visits.

Here are some talking points you can use to help guide your conversation with your doctor:

  • Over the course of the past few days, I have vomited an average of ____ times per day.
  • I am unable to keep most or all of my food down.
  • I am concerned I am not able to stay well hydrated.
  • I am vomiting even small amounts of water, but am very thirsty.
  • I am unable to sleep through the night because I am so ill.
  • According to my scale at home, I have lost ___ pounds in ___ days.

Don’t Hesitate to Seek a Second Opinion

If you feel you haven’t been heard, find a second opinion.

We choose our care providers for a variety of very personal reasons. I really liked and trusted my OB with my first pregnancy and assumed that her decision not to treat my symptoms was because they weren’t really that severe. I thought maybe I wasn’t interpreting my own condition clearly, and what I was going through was normal. I didn’t want to be the “squeaky wheel,” so I stopped speaking up.

When she closed her practice and I had no option but to find a new care provider during my third trimester, I realized the value of getting a second opinion. My biggest mistake the first time I was pregnant was not knowing how to advocate well for myself. Instead, I went untreated until my symptoms finally subsided around 25 weeks.

This isn’t to say you need to switch doctors if yours doesn’t want to take a certain treatment approach. A good doctor welcomes another physician’s input, so a second opinion is a great and safe place to start.

If you do feel the need to switch doctors, here are some tips are some tips to help narrow your choices.  

How to Survive
Hyperemesis Gravidarum

Some of the remedies I suggested for morning sickness might help alleviate your symptoms on “good” days, but what if you’ve already googled your poor barfy brains out trying to find something that actually works?

You have some additional options when teas and candies fail you.

Combating Hyperemesis Gravidarum #1: Change Your Diet

Have you tried eating easy-to-digest carbohydrates and sipping small amounts of fluid instead of packing all your recommended nutrients into your day?

This may be the first course of action. A common recommendation is not to drink water during meals, or have solids and liquids (like cereal and milk) together. And of course, avoid foods that smell nauseating or trigger your vomiting. Don’t force yourself to eat something that doesn’t sound like it will stick with you for the sake of eating.

Combating Hyperemesis Gravidarum #2: Drink More Fluids

I don’t mean “toss in a glass of water once in awhile”. I mean try to be as proactive as possible  in your attempt to get past the extreme morning sickness and give your body the fluids it needs.

Dehydration can get dangerous fast.  Check up on these dehydration symptoms, keep a “drinking log,” and find a really good marked water bottle like this one (dishwasher safe!) to stay up on your fluids.

It may also be a good idea to sip the occasional electrolyte drink like this one to  take the edge off. Dehydration can keep the vomiting cycle going, so trying to hydrate when you can is a good idea.

Combating Hyperemesis Gravidarum #3: Take Medication

There are a handful of prescription medications that are used to treat extreme nausea and vomiting.

Hear me out: There may come a point where the possibility of your illness continuing unchecked is a greater danger to you and your baby than the risk of taking medication.

Your doctor will discuss what medications you can take, review the side effects and risks associated with each one, and find the one that works best for you. These medications include anything from antihistamines, vitamin supplements, and antacids to anti-vomiting and anti-nausea medication. Don’t be afraid to speak up if something isn’t helping!

NOTE: IGNORE internet ads, comment threads, or other less than reputable news sources about anything your doctor prescribes for you. If you have concerns about risks, always go to a doctor you know and trust about them. Anecdotal reports are never a good place to start when you’re pregnant!

Combating Hyperemesis Gravidarum #4: Embrace Bed Rest

For very severe cases, your doctor may want you to stay in bed until you are well. You’re using all your reserves to survive, and rest can help. The bright side of this is if you and your doctor are able to get your symptoms under control early enough, you likely won’t need a stint of bed rest.

You Officially Have Extreme Morning Sickness.
Time to Manage Your Health.

If your nausea and vomiting is extreme, knowing your options and receiving treatment can go a long way…but not long enough.  

While treatments can keep symptoms at bay, they won’t always cure your nausea and vomiting.

What else can you do?

Make your health your first priority. This is challenging, especially if you are working, have other children, or other commitments. Sometimes it feels selfish to make our health our first priority. It’s not!

While extreme morning sickness can last all 40 weeks of pregnancy (yikes!), most women feel much better just past the 20 week mark, and see better days once they are through 16 or 17 weeks.

I know that seems like a really long time, but as the calendar ticks by, you will find yourself oddly triumphant as you have more good days than bad days. The first time you have more than 48 hours without vomiting you’ll want to tell everyone you meet about it!

Ok, I’m just kidding about that part, but you will celebrate the longer stretches between the rough days.  

Here are some things you can focus on while you muddle through the worst.

Caring for Yourself #1: Protect Those Pearly Whites

All that vomiting is hard on your teeth. My dentist recommended this mouthwash as a way to protect my enamel on my teeth. You probably won’t be able to swish every time your toss your cookies, but any time you can use it will help.

Caring for Yourself #2: Thirst Comes First

Focus yourself on hydration rather than calories if you need to.

  • Does chicken broth stay with you a bit longer than straight water? Drink it.
  • Does sparkling water seem more palatable than anything else? Buy it by the liter.
  • What about diluted sports drinks or an electrolyte water?
  • Experiment with hot vs cold beverages.

At my worst, I prefer near-brain freeze temps for my water. Do everything you can to keep your fluid intake up! Take small sips and pace yourself, your stomach is not going to be happy if you chug a gallon of anything in one sitting.

Caring for Yourself #3: Make Rest a Priority

Rest, rest, rest…and then rest some more.

Fatigue will contribute to nausea, which makes vomiting worse, which makes you dehydrated, which makes you more tired…you get the picture. It’s a really ugly cycle. Lay down, take a nap, or sleep a little later. Get rest wherever you can get it.

Maybe it means a little extra PBS Kids during the day than you’d normally prefer for your family, or you’re wearing an unwashed ponytail to work because it buys you a few more minutes in the morning!

Want to know my secret weapon when I was too exhausted to wash my hair? This unscented dry shampoo. It didn’t trigger any queasies!

Caring for Yourself #4: Enjoy the Rewards of Delegation

You’re using every ounce of energy you have to stay well right now. It’s ok to pass off your chores to someone else in the house.

Why not try a resource like Mindful Meal, who will plan your meals and grocery list with the click of a button? You can choose according to what sounds like it might stay down, and stay away from the kitchen while it’s cooking (or better, ask your honey to cook with the windows open!) Click here to try Mindful Meals for a whole month for only $10.

Can’t handle a grocery store with a smelly meat counter? Try a delivery service like Peapod, who will bring your groceries right to your doorstep, smells not included. (Get $15 worth of free groceries with code PPCJ15.) 

If you’re down for the count and your hubby is swamped taking on the responsibilities of two adults like a champ, would a little outside help make all the difference to you right now? There are cleaning and childcare services available through Care that will fit the bill!  (Use coupon code 30SAVESM to save 20%.) 

Caring for Yourself #5: Don’t Rush Any Family Plans

Take your time discussing future additions to your family. Experiencing this level of sickness catches everyone off guard, and can seriously throw a wrench into the visions you had for your family’s future. Can you give yourself a little time when it comes to planning your family until you get through this pregnancy?

For two solid years I was absolutely petrified of getting pregnant again. Any twinge of indigestion sent me straight to a pregnancy test in a cold sweat. Every time someone asked me when we were going to have another baby sucked the wind out of me. Then, when I thought I was absolutely ready to have another baby, I shared our news of a second pregnancy through tears because of how scared I was of being so sick again.

Even though the odds of having hyperemesis gravidarum in subsequent pregnancies are very high, having a plan of action in place before another pregnancy arrives can go a long way in changing the experience. Knowing what to expect is half the battle.

A frank conversation with my healthcare provider about my first pregnancy helped me feel like I wasn’t crazy for being hesitant to have another baby. Our chat empowered me to have realistic conversations with my husband about expanding our family, and helped me deliver gracious and informed answers to well meaning people who asked when we might have another child.  

Caring for Yourself #6: Talk to Someone

The impact of hyperemesis gravidarum is far reaching. It can interfere with relationships and can lead to anxiety and depression. It can even put you at an increased risk for postpartum mood disorders.

Talking to someone who had a similar pregnancy may help, but please don’t hesitate to start talking to a counselor to help you sort through this experience. It is traumatic and stressful, and is a different experience than you expected when you first saw a positive pregnancy test. Working through that mountain of feelings isn’t something you have to do without help.    

My Loved One is Suffering
from Extreme Morning Sickness.
What Can I Do?

Perhaps you’ve read this far because someone close to you is experiencing hyperemesis gravidarum, and you want to try to understand what they’re going through.

On behalf of every woman who has experienced extreme morning sickness, thank you for trying.

This condition is traumatic, and it’s painful when others brush it off as run-of-the-mill normal morning sickness.

Here are some ways you can encourage and care for someone who is dealing with hyperemesis gravidarum.

What NOT to Say to Someone with Extreme Morning Sickness

Hold the advice, not the conversation. Some common things pregnant women hear are:

  1. Are you feeling a bit nauseated? Just eat some crackers, you’ll feel better!
  2. No two pregnancies are alike, the next one won’t be so bad.
  3. Are you sure you should eat that?
  4. Oh you’re almost 12 weeks, your nausea will settle down soon.

Don’t say any variation of those things to someone with hyperemesis gravidarum!

I promise you, not only has she reached the end of the internet trying to find ways to feel better and come up empty, but she also has a very high chance of a worse experience with any subsequent pregnancies, and could very well be sick all 40 weeks. Plus, if she’s able to eat anything at all and keep it down, it’s better than throwing up the most healthy meal on the planet.

Talk to her about the weather, a book you’ve read, a TV show you’re really enjoying, or even the price of beans. Talk to her about anything other than how sick she is.

Chances are, she’ll appreciate a conversation that involves any subject other than pregnancy.

Be Sensitive About Weight

We all love hearing how slim we look, don’t we? It’s a little different for a woman with hyperemesis gravidarum. It’s hard for her to gain enough weight in the first half of her pregnancy and sometimes throughout her entire pregnancy.

What may be intended as a compliment only provokes worry about whether or not her baby is developing appropriately. Comments about being “lucky” that she hasn’t gained much are especially painful.

Give Her Time to Feel Like Herself Again

It takes an average of two months to recover for every month a woman is sick with hyperemesis gravidarum. This means if a woman is sick for 20 weeks, it may be well into her postpartum days before she feels herself again.

In fact, postpartum recovery for women who have experienced normal morning sickness is described in terms of months, but for women with hyperemesis gravidarum, postpartum recovery can be described in terms of years.

A vomit-free stretch doesn’t mean she’ll bounce right back to “normal,” it just means she’s been able to eat and is a bit less miserable. A round of vomiting can come out of nowhere, even if she’s been feeling well recently. She’ll eventually get back to her normal self, it just takes time.

Pick Up Where She Left Off

Find ways you can help, whether it’s with ordering a few rounds of Mindful Meals, providing child care, packing lunches for the kids, errands, chores, etc.

She’s using all her resources and energy to keep away from her most recent pastime of toilet-hugging. Cleaning the house or bringing a meal speaks volumes.

Hint: it’s much easier to eat a meal that she didn’t have to cook – or smell cooking – than one that was prepared in her home.

There is Hope for the Hurler

The ONE good thing about hyperemesis gravidarum, my friend, is that it is temporary. The days where you are at your worst really do feel like they go on forever, but with the help and support of those around you, you can make it through without significant physical harm to you or your baby.

I’ve heard you’re supposed to forget things about pregnancy and childbirth, but I don’t think anyone forgets an experience with extreme morning sickness.

Give yourself some grace and time to heal. No one expects pregnancy to be a debilitating condition, so when you find you’re unable to function due to hyperemesis gravidarum, it can make the rest of your pregnancy extremely difficult to navigate.

Hyperemesis feels isolating, but there’s an entire organization and online community for women like us, dedicated to raising awareness and funding research about this condition.

Ask questions, find help, and talk to those who understand what you’re going through.

Have you experienced hyperemesis gravidarum? Talk to us about some of the ways you managed extreme morning sickness during your pregnancy!

Have You Read These Yet?

We  honesty!  This post contains affiliate links that provide extra money for our mutual coffee habits addictions. Click here to learn more.


The HER Foundation. HelpHer.org
Hyperemesis Gravidarum. AmericanPregnancy.org
Dehydration Symptoms in Adults. WebMD.com

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