FAQ: How do I decide if I should try to get pregnant again?
Below is a list questions for mothers, who are trying to get pregnant again, to ask themselves:
- How do I know if I will have HG next time?
- Are you willing and able to endure what you did in your previous pregnancy?
- Did you try all of the medication options available including Zofran and steroids?
- Is your doctor or midwife willing to set up a plan for your treatment and offer all options?
- Are you unwilling to take medication or do you have serious concerns over safety?
- Would you be willing to have a special IV (PICC) inserted for nutrition if needed?
- Did you require numerous medications and invasive treatments like a PICC line in your previous pregnancy?
- Did you terminate your previous pregnancy due to the severity of HG?
- Do you have good social support and adequate help at home?
- Do you have children at home that will require your care?
- Do twins or multiples run in your family, or do you require fertility treatments that increase the risk of multiples?
- Are you back to normal health?
- Do you have money saved up to pay for assistance at home, co-pays and out of pocket expenses, including childcare and non-covered treatments?
- Do you have insurance coverage for medications like Zofran and treatments like home IV and nutritional (TPN) therapy?
- Do you have to work or can you take a leave of absence from employment?
- Did you have complications other than HG like gestational diabetes, thyroid disease, clotting disorders, or high blood pressure (i.e. preeclampsia, hypertension)?
- Has your health care professional suggested that another pregnancy could be dangerous or pose significant risk to your health now or in the future?
- Is your partner or spouse willing to support you through another pregnancy?
- Do you have flashbacks, severe anxiety or nightmares about HG?
1. How do I know if I will have HG next time?
If you have had severe HG more than once, you have a very high probability of having HG again. Recent research by the HER Foundation finds over half of women (about 2/3rds) will have HG in every pregnancy. Your chances are greater if you have a relative with a history of HG, especially a sister. Health professionals often underestimate the recurrence rate of HG.
2. Are you willing and able to endure what you did in your previous pregnancy?
Don't assume your next pregnancy will be different. Subsequent pregnancies are often similar though sometimes they vary - either better or worse. For some women, each pregnancy gets more severe. Hope for the best, but be prepared for the worst.
3. Did you try all of the medication options available including Zofran and steroids?
If yes, and they did not work, know that there are few other options available currently and you may be limited to those treatment options. For some women, starting treatment earlier in pregnancy - at the onset of HG rather than after symptoms are severe, makes surviving HG possible. Also, for some, trying medications via an IV or special pump that offers continuous dosing, may be very beneficial. For a small but significant number of women, treatments are not tolerated or have no beneficial effect in any combination. These women will likely find future pregnancies to be just as resistant to treatment. Other options besides pregnancy are likely better choices.
4. Is your doctor or midwife willing to set up a plan for your treatment and offer all options?
If your next pregnancy is similar or worse, you may face a great deal of suffering. Having at least one if not two health professionals, and a perinatologist, prepared to care for you is important to ensure you get the care you need. One may be unavailable during the time you most need medical care or may be uncomfortable treating severe HG.
5. Are you unwilling to take medication or do you have serious concerns over safety?
Considering most pregnancies are similar if not worse, medication is often necessary to avoid therapeutic termination or miscarriage. Review the medication page on the HER Foundation site to be informed of the risks to you and your baby. All medications carry risk, but the risks are often outweighed by the benefits they offer in managing the symptoms of HG.
6. Would you be willing to have a special IV (PICC) inserted for nutrition if needed?
Sometimes women require IV nutrition (TPN) which means you will need help at home daily, home health care nurses, and careful monitoring by health care staff to avoid infection and other complications. It is also expensive but can be life-saving. If you are unwilling due to cost, discomfort, or concerns over safety, please read up on it to be informed. There is always the possibility you will be faced with severe HG and even the choice between losing your baby or IV nutrition.
7. Did you require numerous medications and invasive treatments like a PICC line in your previous pregnancy?
Each medication carries some potential for risk to your baby, and introduces the possibility of side-effects or medication interactions. PICC lines (or other central lines) are risky and not to be taken lightly. For those very ill, they can be life-saving and necessary, however, avoiding them is ideal. If you feel that no matter what, you will require extensive medical care, remember these present risks that you cannot always control or prevent.
8. Did you terminate your previous pregnancy due to the severity of HG?
Know that the severity often repeats in future pregnancies. Proactive, aggressive care that is planned in advance is critical to surviving more severe cases of HG. Sometimes each pregnancy will be worse than the previous even with good care. This could be due to the brain becoming more sensitive to the vomiting stimulus, thus making the brain less able to control the vomiting. If you would not terminate again and enter unto pregnancy without a plan, you are taking a significant risk.
9. Do you have good social support and adequate help at home?
This is something that is very important to all pregnancies, but more so for surviving HG, especially if you have children to care for already or get very sick. Women with very high stress levels have higher rates of postpartum depression, and increase the risk of emotional and behavioral disorders in their child.
10. Do you have children at home that will require your care?
It will be difficult if not impossible to maintain a normal routine for your children. You may need to depend on family, friends or day care in order to care for your child(ren) during the worst of HG. This can vary from a few weeks to the entire pregnancy. Contrary to popular belief, HG does not end at 13 weeks. It often eases by mid-pregnancy, but some symptoms may last until delivery. The longer HG lasts, the greater your fatigue and debility, and the longer your recovery.
11. Do twins or multiples run in your family, or do you require fertility treatments that increase the risk of multiples?
Multiple pregnancies have a higher risk of HG due to the higher level of hormones in their body.
12. Are you back to normal health?
Try to be in the best physical and mental health possible before pregnancy. Some women lose a lot of weight and plan to be about 10 pounds over their normal (healthy for their height) weight at conception, so they have some weight to lose and additional stores of vitamins.
13. Do you have money saved up to pay for assistance at home, co-pays and out of pocket expenses, including childcare and non-covered treatments?
Surviving HG can be expensive if your insurance coverage is limited, you have severe symptoms, become debilitated, experience complications during or after pregnancy, or you lose your income. You can decrease the stress of HG by having extra money available for unexpected expenses. This will also prevent you from having to make choices in your care based on your finances and not your needs.
14. Do you have insurance coverage for medications like Zofran and treatments like home IV and nutritional (TPN) therapy?
One month of medications like Zofran can cost approximately $3000 (USD), and TPN at home costs upwards of $500 per day (USD). Without insurance, needed treatments may be too costly, leaving you to suffer unnecessarily. Ensure you have a plan that will cover all possible treatment options and make sure you have waited the required time period for eligibility. Also check to see if HG would be excluded for some reason. It is also very helpful to know the process for seeing a specialist (e.g. if your insurance requires you to get a referral). Be sure that your preferred doctors and hospital are covered by your insurance, or that you have the extra money required to see doctors outside of your network.
15. Do you have to work or can you take a leave of absence from employment?
Review your finances closely and determine if you could live without all or part of your income, and for how long. There is no guarantee that you will be able to take a leave from work or be able to return quickly. Alternatively, explore medical disability options and ask your health professional what criteria is used to determine when you would be placed on disability. Also, be familiar with your employer's policies on taking a leave of absence or your vacation time. If your HG symptoms are not severe, consider part-time or flex hours.
Finally, know that physical work is not recommended during pregnancy and practically impossible with HG. If this is part of your job, other options will need consideration. Recovering from HG and a complicated pregnancy can take months, not just weeks and planning ahead for this is crucial, especially if you have HG beyond mid-pregnancy.
16. Did you have complications other than HG like gestational diabetes, thyroid disease, clotting disorders, or high blood pressure (i.e. preeclampsia, hypertension)?
These complications may return in future pregnancies and present significant risks to the baby if not controlled. The risk of harm to you and baby is high if you do not respond to the treatments offered or cannot tolerate the treatments. The more complicated the pregnancy, the more difficult it is to manage, and the higher the probability you will have an early delivery or other adverse event.
17. Has your health care professional suggested that another pregnancy could be dangerous or pose significant risk to your health now or in the future?
Some women have long-term health issues due to HG including heart or brain damage, gall bladder disease, extensive damage to teeth, hernias, stomach ulcers, bone loss, depression, and joint damage (esp. jaw - TMJ). Pregnancy and delivery alone present many risks that can be life-threatening. These risks may be too great for you, especially if you have children at home that depend on you. This is something you will need to discuss in depth with your family and medical professionals before deciding. There are other options such as adoption and surrogacy, which are chosen by women with HG who desire to continue their family despite HG. It is very important to understand the risks to you and your child so you can make an informed decision.
18. Is your partner or spouse willing to support you through another pregnancy?
You will need as much support as possible to endure HG. Without a supportive person around you, it will be difficult to ensure you get the care you need. When you are ill, it's difficult to advocate for yourself. Since many women with HG go on to experience postpartum depression and anxiety due to trauma, it is critical that you have support beyond pregnancy. Physical recovery can take several months, and emotional recovery much longer. If your partner or spouse is not supportive of another pregnancy or had great difficulty coping with previous pregnancies, ensure you have alternate support systems in place and think carefully about your decision. If you become too ill to care for yourself, you will need someone close by to advocate and care for you.
19. Do you have flashbacks, severe anxiety or nightmares about HG?
HG is often very traumatic. The thought of enduring it again often creates a great deal of anxiety for women. If you are still suffering from the trauma of HG, professional help is needed to help you prepare for another pregnancy. Some areas have groups that specialize in women's health during and after pregnancy. Your OB may be able to offer referrals. It is not uncommon for women to feel anxious when trying to conceive, knowing that HG lies ahead. Being prepared and informed about managing HG will ease the anxiety.
Updated on: Apr. 18, 2013