When the news broke on Monday that Prince William and Catherine were expecting a baby, the first story I saw was focused on the pregnancy announcement. There was only a passing comment included about her having a short stay in the hospital for hyperemesis gravidarum, which was defined as acute morning sickness requiring supplemental hydration and nutrients. The vast majority of the comments on the article were congratulations and nothing more.
My first thought on reading the article was, "oh that poor woman". As the days pass and I see more articles, however, I'm getting angry. It's almost always a bad idea to read the comments on news articles. It's a sure fire way to question your faith in humanity. Since this is a topic I know all too well, I keep getting sucked in despite my better judgment. The derisive statements claiming Catherine is at fault because she's too thin and that she wouldn't have a problem if she'd just eaten a sandwich every once in a while before pregnancy or that she's a weak rich girl being spoiled by a hospital stay for morning sickness are starting to make my blood boil.
First things first, it seems Catherine has been thin her entire life. While it seems everyone agrees she has lost weight in the last year, I think it's unfair to speculate about whether this loss was intentional or not. I'm guessing being in the spotlight so much is stressful. Her husband is probably the only person that knows for sure whether stress has led to the weight loss or if she's purposely lost weight. Here's the thing, I'm 5'6". I weigh anywhere from 120-125. I hear everything from "how can you be so skinny after 3 kids?" to a genuinely concerned, "how much have you eaten today?" from well meaning friends. The "just eat a hamburger!" jokes are abundant. No one is going to tell you, "hey, not cool and not funny" if you make jokes that a woman is anorexic, would fall over in a strong wind, has no breasts or must never eat dessert. I can only speak from my own experience, but it's not a choice for me. I have about a 5 pound range I fluctuate in, no matter what. Just as it's hurtful to an overweight person to endure fat jokes when they're working hard to lose weight and it's just not happening, an underweight person who can't gain weight really doesn't want to hear that you think their body is revolting, or your suggestions of "why don't you just eat a sandwich?" Gee, never thought of that. Also, while Catherine in particular does appear to be underweight, there seems to be a skewed view of what a healthy weight looks like. While I have been officially "underweight" at different points in my life, I'm not right now. Plenty of people would argue that I am. While I'm constantly told to gain weight by those around me, multiple doctors have told me I'm fine and not to worry about it. My surgeon went so far as to say, "I've seen your insides, you're perfectly healthy, you don't need to gain weight".
But all of this is a moot point. Hyperemesis gravidarum is more common in women who are overweight (source, back-up source, yet another source), not overly skinny women. Genetics actually seems to be one of the stronger risk factors. Daughters of women who experienced hyperemesis have almost triple the risk of developing it compared to the general population (source). Carrying a girl or multiples also increases the risk.
More importantly, Catherine was not hospitalized because she had morning sickness and couldn't hack it. Most women who have been pregnant have experienced morning sickness. It's a little like being carsick off and on throughout the day or possibly all day. You throw up periodically, then you feel better and eat more. Hyperemesis is NOT morning sickness. Only 0.3-2% of pregnancies are affected by hyperemesis (source). A 2006 Canadian study that looked at nearly 158,000 deliveries found 0.8% required hospitalization for hyperemesis. I had hyperemesis. I was hospitalized for hyperemesis. My doctor admitted me to the hospital because I was literally starving to death and severely dehydrated. When you spend 3 days in the hospital with hyperemesis, it's not because you threw up a few times. It's because you need at least IV fluids and sugar, possibly even total parenteral nutrition, to survive. From my own experience, my blood pressure was so low I would black out when I stood up; I could only stay awake for 20 or 30 minutes at a time; I couldn't get anything, even water, down; oral zofran and phenergan did nothing to improve my situation; I was on IV fluids for most of the day before I was hydrated enough to give a urine sample. Let me tell you, it was a fabulous time. When women present with hyperemesis, their lab work can often shows signs of starvation and dehydration, electrolyte imbalances, nutrient deficiencies and abnormal liver and thyroid levels (source). Thankfully, we can now recognize and treat these symptoms, but they are life threatening if not treated. In fact, Charlotte Bronte died of hyperemesis gravidarum.
You know that moment just before you vomit? You're miserable and there's no comfortable position to be in and your mouth is salivating and you just know any second, it's all over. Imagine feeling just like that for hours.
Imagine gagging and heaving as you try to swallow even though you're so thirsty and so hungry.
I did the regular morning sickness thing with my earlier pregnancies. I threw up at work and in the car and at home, then I went about my day. It was almost a badge of honor, a right of passage. Hyperemesis is NOT morning sickness. The Duchess has not run off to the hospital because she upchucked a few times. Chances are, she was utterly miserable on Monday and for quite a while before that. Chances are she's feeling quite a bit better at the moment now that she's fully hydrated and likely been on IV zofran for several days. Chances are she's hanging out in "regular morning sickness" land for the time being. I send her congratulations, but also sincerest empathy and wishes that she is one of the lucky ones who sees slow, but steady improvement from this point on.