A combined report by two charities in the UK – British Pregnancy Advisory Service (bpas) and Pregnancy Sickness Support (PSS) – has issued a warning that difficulty in obtaining swift treatment and support for severe and debilitating pregnancy sickness could make some women feel they are left with no option but to end otherwise wanted pregnancies.
The charities have also revealed that as many as 1,000 abortions take place each year because of the severe pregnancy sickness known as Hyperemesis Gravidarum.
The report says that despite the increased awareness about the condition through coverage of the Duchess of Cambridge’s experience of Hyperemesis Gravidarum, many women still feel the decision to terminate is one stigmatised and judged by those who feel it is “just” morning sickness, a perception which only adds to the distress of ending a wanted pregnancy.
In their report, the two charities note that with nearly 1 million pregnancies in the UK in 2013, we can estimate that around 10,000 women per year may suffer with HG and many thousands more with sickness that affects their ability to go about their daily lives. Given the levels of morbidity caused by severe nausea and vomiting in
pregnancy (NVP) and HG, it is hardly surprising that recent research found around 10 per cent of sufferers terminate otherwise wanted pregnancies for the condition. Some studies suggest the figure is much higher, with
around 15-20 per cent of women with HG ending their pregnancies.
The two pregnancy charities have together surveyed more than 70 women in the UK who had experienced Hyperemesis Gravidarum and undergone abortion. While many of the pregnancies were not planned, the overwhelming majority were wanted.
Women are often expected to either tolerate their symptoms or terminate their pregnancy. Nearly half of the women surveyed described difficulty obtaining appropriate medication, with specific treatments refused. In particular, women reported being denied some of the more effective treatments because of concerns about cost but also the impact on the foetus, even though there is a broad body of evidence indicating these treatments are safe.
This suggests that nearly 60 years on from the Thalidomide disaster, some doctors remain hesitant about offering pregnant women medication, and women in turn anxious about whether such drugs are safe in pregnancy.
However there are a number of treatments now available for severe pregnancy sickness, and clear guidance from NICE’s Clinical Knowledge Summaries on what can safely be offered to women which provides the reassurance healthcare professionals and women need. As well as alleviating the suffering such sickness causes women, early treatment in the community may prevent sickness leading to serious illness and dehydration, which requires hospital admission. While some community-based treatments are more expensive than others, all are cheaper than a hospital stay for dehydration.
There is no medication that can completely alleviate symptoms for all women, and many women will know abortion is the right option for them when faced with an HG pregnancy. But no woman should be left for her symptoms to deteriorate to the point that she feels abortion is her only option in an otherwise wanted pregnancy, and any woman who wishes to try other treatments before terminating must be given the chance to do so.
Some of the important findings of the survey are:
- Just over a third of the pregnancies were planned (38 per cent), a similar proportion unplanned (37 per cent) and a quarter (25 per cent) categorised as neither planned nor unplanned. [Note: It is important to recognise that while “unplanned” is often used interchangeably with “unwanted”, this does not necessarily reflect women’s feelings about their pregnancy].
- Overwhelming majority of women (84 per cent) said they would have wanted to continue with the pregnancy if they had not been suffering HG, and for most HG was the only or the main reason for ending the pregnancy.
- The overwhelming majority (95 per cent) of the women, unsurprisingly described their symptoms as “intolerable”.
- More than half already had one or more children, and for the majority of these women it was the impact that HG had on their ability to care for their existing children which was a key factor in their decision.
- Nearly half of women (47 per cent) said they had either asked for medication and it had been refused, or that they did not ask for medication and that they were not offered any. Of this group of women, 40 per cent said they had asked for medication and it had been refused, and the remainder had not requested medication and were not offered any.
- Around 15 per cent of respondents were worried about the impact of medication on their pregnancy.
- A third of women said they requested a particular medication, and of these most were refused (66 per cent).
Caitlin Dean, chair of Pregnancy Sickness Support, said: “Most pregnant women expect “morning sickness” and are willing to tolerate severe symptoms before seeking help, so by the time she is presenting at the GP or hospital, staff can be confident that her symptoms need to be taken seriously and likely need treatment. The severity of the condition should not be underestimated and the risks and complications of not treating it need to be appreciated. We may not have a cure for HG yet, but we can do much more to support women earlier with the range of safe and effective treatments available. Women should not be expected to choose between tolerating dangerous levels of sickness or terminating a wanted pregnancy before all treatment options have been explored.”
Clare Murphy, director of external affairs at the British Pregnancy Advisory Service, said: “Any woman who needs an abortion should have straightforward access to one. No woman should ever feel stigmatised or judged for doing what is right for her and her family. But misplaced concerns about the impact of medication on the foetus should not prevent a woman accessing the care she needs to continue a wanted pregnancy. Women who need medication must be able access this, safe in the knowledge that abortion is there as a back-up should they not sufficiently ease her sickness and enable her to get on with her life.”