Hyperemesis Gravidarum – The Aftermath

When you’ve survived Hyperemesis Gravidarum, you hold your baby and thank God that you made it, and that your baby made it, and that you’re both  alive. You survived. Then you kind of forget about it, or try to, at least, while you get on with feeding your baby, changing her and learning to be a mother. You kind of assume that Hyperemesis Gravidarum is gone, and you hope that that’s the end of it.

I did, both times.

And for Ameli it was. She’s suffered no ill fate from this ghastly condition. I assumed the same would be true for her sister, born two and a half years later. But things were different. During my pregnancy with her I was already running on depleted supplies, and the sickness was worse, and when I started throwing up blood at 10 weeks, I went on medication because by 12 I couldn’t get out of bed without fainting. That’s not an ideal way to look after an almost two year old.

The medication I was on – Ondansetron, also known as Zofran – wasn’t specifically tested in pregnancy and my doctor wasn’t happy about giving it to me, but I showed him information about it being used for Hyperemesis Gravidarum in the US, and he agreed. He prescribed three tablets a day, but I took one in the morning so that I could eat something at least, which would carry me through the day. Anecdotal evidence mentioned incidence of deformities and I didn’t want to take any chances.

Aviya was born at home in water at 42+5, a perfect baby girl.

At 10 months and 8 days she rolled off a bed, but seemed okay. She was a bit cranky for a few days and cried whenever we tried to pick her up, but on investigation she seemed totally fine. (My mother is a remote areas nurse practitioner, and my brother is a medical student, so they should know.)  At 10 months and 10 days she took her first step on Christmas day, but even so… something wan’t right.

I finally took her to Perth’s Children’s Hospital where they said that she had broken something – her clavicle or scapula, I can never remember. We treated it, and went about our business. After all, we were in Perth for my mother, who was dying of cancer.  I never thought much of it again, only fearing for Aviya’s health whenever my mother commented on a blue ring around her mouth, saying that I had to get her heart checked out when I got back to England.

Months passed, we found ourselves back in England, trying to find a normal life again. Ameli started back at  nursery, Aviya was running around, engaging in the world, doing the things that one year’s olds do. Her first tooth appeared, and then her second tooth appeared and as happens with these things, so did her third and fourth. Our girl was doing great.  Until one day I had a piercing pain in my nipple as she tried to nurse!

Her tooth had chipped! No, not chipped broken! It looked like a vampire fang! I felt awful! How could I not have noticed a fall that did that to her tooth! We went to the dentist and had it filed down, a traumatic experience for her, for sure.  Not a week later, guess what? Her second tooth did the same. Broken! I was glad her arm had broken in Australia and not England. At least there’s no medical record of it here. I mean, a broken bone and two broken teeth? I know what I’d be thinking.

Well, we took her to the dentist again, and again with the third tooth and again for the fourth. And again, and again. It was only when we discovered two abscesses in her mouth that the dental staff started to take it very seriously. They were going to put her on a waiting list for our area’s special care unit, but an hour later I got a call to say they were going to  transfer her to a hospital in London to be seen sooner.

Then the guilt sets in. The dentist said I should stop breastfeeding because that’s what’s causing the tooth decay (but not for the other teeth in her mouth?) Clearly, I’ll not be taking the advice to wean.

We brush her teeth, but probably not long enough.

Maybe I feed her the wrong things.

But no.

A bit of reading, and it turn out that – anecdotally of course – HG babies often have weaker enamel on their first four teeth due to malnutrition in the mother (or something like that).  She loses these teeth now, but her adult teeth should be fine. With removing them, however, there may be problems with her teeth descending as the ‘tunnel’ for them isn’t there. So she won’t lose her front teeth either. There’ll be nothing for the memory box.

But there’s maybe more.

While reading about all this, I found something else, slightly more alarming: again anecdotally, of course, but there are a number of babies who had  Ondansetron/Zofran who also developed heart problems – thinking about my mother’s comments about the blue ring.

Well. Nothing’s proven. But it’s a worry.

So my little girl has her first ever course of antibiotics for the abscesses. 

And we wait.

We wait for the GP appointment for the referral for the scan or whatever they do for her heart. Then we wait for the referral for her dental surgery. Then we wait and see what else life throws our way.

And whatever else Hyperemesis Gravidarum takes.

Did you have Hyperemesis Gravidarum? How has it affected your child or your life since having a child?

5 Great Recipe Ideas For Poorly Kids (Guest Post)

Despite our best efforts at natural immunity, sometimes our children get sick. Whether they go to school or not, just being around other children seems to make them vulnerable sometimes! Written in collaboration with Supersavvyme, this guest post has great ideas for foods that help fight colds and inflammation, and recipe suggestions for incorporating them into foods for poorly little people.

When children head off to school, they’re especially susceptible to catching coughs and colds from their friends and class mates. If a sick day under the duvet covers beckons, here are five tasty and nutritional recipes that will boost the immunity of your child when they’re feeling under the weather:

Easy Salmon Fishcakes – Serves 5

Salmon is rich in Omega-3, which reduces inflammation and prevents respiratory illnesses.

In a bowl, mix 1 (418g) tin of salmon, 2 beaten eggs, 4 tbsp dried breadcrumbs, 4 tbsp instant mashed potato flakes, 1 diced onion, 1 crushed clove of garlic, 1/4 tsp dried dill, 1/4 tsp celery salt, salt and pepper. Form the mixture into 5cm balls, and flatten into patties about 1cm thick.

Heat 2 tbsp olive oil in a frying pan over medium heat. In batches, cook patties about 5 minutes on each side, until lightly browned, and serve.

Garlicky Spaghetti – Serves 4

Garlic contains allicin, which helps fights infection and bacteria.

This is a great store cupboard meal that can be rustled up easily, and with just a few ingredients. Cook 400g spaghetti according to the packet instructions, drain and reserve 2 tbsp of the cooking liquid.

Over a low heat, crush and sauté 8 garlic cloves in 100ml olive oil until golden but not browned. If your child likes hot food, add 4 chopped and de-seeded red chillies, and the reserved liquid. Add spaghetti and season with 2 tsp chopped flat leaf parsley, salt and pepper. Toss until the spaghetti is coated in the mixture and everything is well combined. Serve with grated Parmesan cheese.

Easy Chicken Soup – Serves 6

When chicken cooks, cysteine is released- this amino acid has a chemical resemblance to a widely prescribed bronchitis drug, and has similar congestion relieving results. The soup’s salty stock also keeps mucus thin the same way cough medicines do.

Melt 55g butter in a saucepan over a medium heat and soften 2 sliced onions, 2 sticks of celery finely chopped, and 2 diced carrots. Stir in 25g plain flour and cook for 2 minutes. Add 2 pints of chicken stock and bring the mixture to the boil, whilst stirring. Season with salt and pepper, then simmer for 10 minutes, until the vegetables are tender.

Add 450g cooked chicken and heat through. Season again, and add 1 tbsp parsley to serve.

Yoghurt 

Yoghurt contains probiotics, which keep the gut free from intestinal bacteria that can cause unwanted diseases.

Avoid artificially sweetened or “fat-free”: go for natural yoghurts to best support your child’s health. If they don’t like yoghurt, try freezing home-flavoured yoghurt in lollipop moulds. Or serve yoghurt sweetened with honeyor even try this yoghurt cake.

Sweet Potato

Sweet potatoes contain beta-carotene, a form of vitamin A, which is vital for healthy skin, which of course is designed to protect you from bacteria and viruses.

These are a great alternative to the classic jacket potato, and can be served with any topping your child fancies. They are also good steamed or roasted, or as an alternative to pasta – or if you fancy cooking a new recipe, you could try this Sweet Potato and Spinach Bake.

Once you’ve cooked up a storm in the kitchen, make sure you take the pain out of washing up and other household chores with the great money off coupons you can take advantage of online.

Does A Newborn Need Additional Vitamin K?

(Q16 on the birthplan: Would I like my baby to be given a vitamin K injection?)

During my pregnancy with Ameli, I learned everything I could about everything pregnancy and birth related! I wrote a book full of notes, typed it all up and kept it with my birth plan so that if I had to have a justification for my decisions at any point, I’d have it on hand. I was blessed with an amazing midwife who didn’t even question my choices, so I never needed them, but here are my notes on Vitamin K… maybe you’ll find them useful. These notes formed the basis of my decision and are only intended to provide reference materials to start you off on your own research.

Vitamin K is routinely given because:

“The problem of bleeding into the brain occurs mainly from 3 to 7 weeks after birth in just over 5 out of 100,000 births (without vitamin K injections); 90% of those cases are breastfed infants because formulas are supplemented with unnaturally high levels of vitamin K. Forty percent of these infants suffer permanent brain damage or death.”Linda Folden Palmer, DC in International Chiropractic Pediatric Association Newsletter September/October 2002 Issue

Vitamin K may be needed when:

  • Premature clamping of the umbilical cord deprives babies of up to 40% of their natural blood volume, including platelets and other clotting factors
  • The use of vacuum extractor or forceps causes bruising or internal bleeding, which uses up the baby’s available clotting factors
  • Antibiotics are used in the birth, as they inhibit the baby’s generation of clotting factors.
  • C-Section

There are alternatives to a vitamin K shot:

For breastfed infants, an oral vitamin K preparation (Konakion MM) given in 3 doses of 2mg at birth, 7 days, and 30 days of life results in higher plasma vitamin K concentrations than a single injected dose at birth (although my current midwife doesn’t agree with this statement). The preparation must be Konakion MM, which contains lecithin and glycocoholic acid; vitamin K require emulsification and the presence of bile salts for its absorption.

For formula fed infants, formula contains enough vitamin K that no supplement should be necessary.

Arguments against the routine use of vitamin K – three main observations (Falcao):

Vitamin K1 Injection (Phytonadione Injectable Emulsion, USP) (10 mg/mL)

Nature seems to go to a lot of trouble in regulating the baby’s vitamin K levels: the level at birth gradually rises over the eight days following birth to a higher level. It is almost as if nature very specifically wants the baby to have a specific level of clotting factors at birth, followed by a higher level of clotting factors a week after the birth.

This may be related to the fact that in a physiological birth, where the baby gets all the blood from the placenta, the baby’s blood is a little thicker; this is especially true in the 72 hours following birth, since the babies naturally become a little dehydrated until the mother’s milk changes to a higher volume flow, so the blood is thicker.

There has been some association between vitamin K injection and childhood leukaemia. (Parker) Theoretical observations are that precise levels of vitamin K are required to regulate the rate of cell division in newborns and that excessive levels of vitamin K disrupt this regulatory process, thus increasing the possibility of leukaemia and other childhood cancers. (While a few studies have refuted this suggestion, several tightly controlled studies have shown this correlation to be most likely1,2.The most current analysis of six different studies suggests it is a 10% or 20% increased risk. This is still a significant number of avoidable cancers.3)

Follow up research indicated that the leukaemia might have been related to mercury used to preserve the vitamin K solution. Further research in 2003 found that there was no definitive link between childhood leukaemia and Vitamin K, but also that ‘small effects cannot be ruled out’.

Research shows that babies who contract meningitis are more likely to die if they have higher clotting factors. It’s not clear whether this is due to genetic factors or whether it applies to all babies who receive vitamin K. ( I can’t find any actual links to this research, despite it being mentioned all over the web!)

The warning label on Vitamin K injections is pretty scary too:

Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of Phytonadione. Typically these severe reactions have resembled hypersensitivity or anaphylaxis, including shock and cardiac and/or respiratory arrest. Some patients have exhibited these severe reactions on receiving Phytonadione for the first time. The majority of these reported events occurred following intravenous administration, even when precautions have been taken to dilute the Phytonadione and to avoid rapid infusion. Therefore, the INTRAVENOUS route should be restricted to those situations where another route is not feasible and the increased risk involved is considered justified.

Dangers of excess Vitamin K:

When a baby is born gently, without any intervention, antibiotic, or trauma, and no apparent bruising, and is breastfed, there is no need for Vitamin K. Administering vitamin K to these babies – especially if they are formula fed – can lead to excess Vitamin K, which in turn may lead to newborn jaundice.

Signs Suggesting Need for Vitamin K after birth:

  • bleeding from the umbilicus, nose, mouth, ears, urinary tract or rectum
  • any bruise not related to a known trauma
  • pinpoint bruises called petechiae
  • black tarry stools after meconium has already been expelled
  • black vomit
  • bleeding longer than 6 minutes from a blood sampling site even after there has been pressure on the wound
  • symptoms of intracranial bleeding including paleness, glassy eyed look, irritability or high pitched crying, loss of appetite, vomiting, fever, prolonged jaundice.

(This list is written by Jennifer Enoch. Midwifery Today. Issue 40.)

Natural alternatives:

Keep the umbilical cord attached until it stops pulsing. Do not cut it prematurely, as average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. (As Vitamin K doesn’t cross the placenta, this should make no difference to Vit K levels, but will help with iron levels etc.)

When breastfeeding (or just before starting), make sure to eat plenty of leafy greens or take a vitamin K supplement – vitamin K does not cross the planceta in pregnancy, but does enter breast milk in feeding. Anti-acids (used for heartburn) decrease the absorption of Vitamin K in the body – bare this in mind if you have lots of indigestion during pregnancy and be sure to increase with Vitamin K intake from around 38 weeks of pregnancy, as this will help prevent against haemorrhaging too.

Nettles are rich in Vitamin K – made into a tea you’ll get everything you need. Otherwise try a Nettle soup.

Conclusion:

My conclusion on this sensitive matter, based on the information available to the public and its potential impact on my own family, is thus:

Nature says a baby doesn’t need large amounts of Vitamin K, but that delayed cord clamping and the transfer of oxygenated blood gives the child enough resources to cope with the effects of a ‘normal’ birth. If the mother has been consuming Vitamin K in some form or another, it will immediately begin transferring through her colostrum, which is rich in Vitamin K and breastmilk and by eight days of age, baby will have the ‘right’ amount of Vitamin K (and since formula is fortified with vitamin K, formula fed babies shouldn’t require it at all) – since the disease it is meant to prevent doesn’t tend to occur until between 3 and 7 weeks I personally question the need for the injection.

At the same time, bleeding kills almost 2 in 10,000 babies, and this is the closest I could find to statistics as to deaths from the injections ** although we know that they have occurred. It says so on the label.  So really, the conclusion is inconclusive.

Every parent has to make their own decisions on this, but for me and mine, we’ve decided against vitamin K injections unless something in the birth necessitates it. We’ve also decided to follow natural alternatives, such as breastfeeding and a high maternal Vitamin K intake and to keep a close eye on the signs of bleeding as described above. 

** The FDA database contained a total of 2236 adverse drug reactions reported in 1019 patients receiving vitamin K by all routes of administration. Of the 192 patients with reactions reported for intravenous vitamin K, 132 patients (69%%) had a reaction defined as anaphylactoid, with 24 fatalities (18%%) attributed to the vitamin K reaction. There were 21 patients with anaphylactoid reactions and 4 fatalities reported with doses of intravenous vitamin K of less than 5[emsp4 ]mgs. For the 217 patients with reactions reported due to vitamin K via a non-intravenous route of administration, 38 patients had reactions meeting the definition of anaphylactoid (18%%), with 1 fatality (3%%) attributed to the drug.

 

References:

 

L. Parker et al., “Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study,” BMJ (England) 316, no. 7126 (Jan 1998): 189-93.

 

S.J. Passmore et al., “Case-control studies of relation between childhood cancer and neonatal vitamin K administration,” BMJ (England) 316, no. 7126 (Jan 1998): 178-84.

 

E. Roman et al., “Vitamin K and childhood cancer: analysis of individual patient data from six case-control studies,” Br J Cancer (England) 86, no. 1 (Jan 2002): 63-9

Further Reading: 

 

Meducation for Mums Talks Nurofen

I was recently invited to a seminar on child health sponsored by Nurofen, Bonjela and Karvol. The two speakers were Sarah Jarvis, a GP, and Dawn Kelly, a health visitor.

The speakers were very pro-(specifically) Nurofen in their leanings – understandable since it was a Nurofen sponsored event – which does make it difficult to know how much stock to put in their recommendations, so where possible, I have found independent evidence to support or refute their statements.

Following are the notes that I took from Dr Jarvis’ talk, and after them in italics are my thoughts on each subject. Remember as always that I am not a doctor and mine is not medical advice, just me sharing what has worked in our own home as we aim for pharmaceutical-free parenting and the knowledge I have picked up from my practice and learning of natural, original therapies.

– Babies should be expected to have 12 – 15 upper respiratory tract infections in their first year. This is due to a number of causes, such as teething, ear aches, coughs and colds, and post immunisation fevers. This is true. I have read it on the WHO website but can for the life of me not find the reference now. The best advice for dealing with upper respiratory tract infections is to breastfeed. It helps reduce the incidence of ear infections, can be used as a decongestant for the nose and sucking helps relieve pain from teething, amongst all the other health benefits. Can’t offer much advice on immunisations, but breastfeeding will help replenish and strengthen the immune system. If you’re formula feeding, make sure your baby has plenty of liquids to keep them hydrated post immunisation.

There are plenty of natural remedies to help too. Belladonna (among others) for fever and teething , chamomila and, pulsatilla for teething, and so on. Unfortunately Dr Jarvis expressly stated that homoeopathy doesn’t work – but forgot to tell my daughter who responds fantastically to it (possibly since she has no pharmaceuticals in her system?).

– Ibuprofen is effective from about 3 months, works in 15 minutes and lasts up to about 8 hours with a minimum of at least four hours between doses. (In contrast, paracetamol works for about 6 hours per dosage and can be administered every 4 – 6 hours)

mumschoolIbuprofen works better than paracetamol, although paracetamol can be used from about two months for post- immunisation fevers.

The NICE guidelines state that Ibuprofen has “the fewest side effects and has been in clinical use for a long time. If it doesn’t work, it is reasonable to use another from the propionic acid group.”

A study of paracetamol and ibuprofen on fevers in children found that either ibuprofen alone, or ibuprofen and paracetamol together, both lowered fever quicker in young children who were unwell with fever, than using paracetamol alone. If ibuprofen is known to be better and work faster, it concerns and confuses me that Calpol is still the best seller!

– She also said that paracetamol and ibuprofen do not necessarily shorten an illness, nor do they make it longer. Having a fever may not actually bother your child, so if they do not seem bothered by it, don’t be bothered about it either – just keep an eye on it. If your child is bothered, give paracetamol or Ibuprofen, which works faster and for longer.

Agreed – they are not healers, they just help with pain or inflammation. Also agree regarding the temperature. Most parents only take a child’s temperature when they are ill. It’s really important to find out your child’s core temperature when they are healthy as not everyone has a core temperature of 37.4 – that is just a normal average. So a child with a core temperature of 36 degrees might be a lot sicker at 38 degrees than one who has a normal core temperature of 38 degrees. Knowing their healthy temperature helps determine how ill they really are and at what point you should start worrying.

– I was very interested in her comment about febrile convulsions: she said that although 1/3rd of children will suffer febrile convulsions, neither paracetamol or ibuprofen actually works for these. I found this particularly interesting as the post I wrote about Calpol and why it should be avoided illicited a few responses from parents saying that when faced with FC they would rather use Calpol than nothing. The NICE guidance concurs, however. Neither paracetamol or ibuprofen helps febrile convulsions and should not be used as a preventative. Unfortunately they don’t give any info on what should.

– Dr Jarvis mentioned something else new to me, which was that the old practice of cooling a child with a flannel is no longer recommended as it cools the outside temperature, but not the inside temperature, causing a false sense of security about the status of the temperature. Again, the NICE guidance does say this, and says that either ibuprofen or paracetamol can be used to reduce the fever.

– My final nugget quoted from Dr Jarvis is that despite recent newspaper reports, paracetamol does not cause asthma. If she’s right, paracetamol might not – but the additives in Calpol, the liquid paracetamol used for children that are known to cause asthma, rashes and other reactions do.

I don’t know about you, but I find the conflicting information and advice quite alarming and wonder how any of us have survived this long when evidence and contra-evidence and new evidence and refuted evidence flood our lives all the time! I think the truth about evidence is that it is highly subjective and dependent on who paid for it.

The study in the medical journal the Lancet, for example, which stated that ‘high’ paracetamol use (i.e. once per month) in infancy increased the risk of asthma by the time they are 6 – 7 year olds by 3.23 times is completely contrary to the information on the NHS website saying that it does NOT cause asthma, so who do we believe?

Well, in my home we use chamomile, Ashton and Parsons, Rescue Remedy, Belladona, Lavender, Pulsatilla and high doses of vitamin C, if all else fails we use raw, crushed paracetamol in water. (I have bought and tried Nurofen for Children since this event, and suffice for now to say that I would use it over Calpol, but more on that another day.)

And so far so good. We’re all healthy, my daughter has developed super fast and despite claims that ‘evidence shows that natural doesn’t work’, the evidence in our house, as paid for by us, shows that it does.

Five Great Things About Breast Milk

Breastmilk has been touted as the wonder drink. We’ve all heard how good it is for babies, and we all know that babies who have been breastfed are said to be healthier, less obese as children, and less fussy eaters than formula fed babies. We also know that breastfeeding is good for mothers. It reduces the risk of breast cancer, helps with wait loss and can help prevent post partum depression.

Even so, I am often surprised by the things that people don’t know about breastmilk. Here are a few of my favourites:
Read more: Five Great Things About Breast Milk