We found James Owen Drife’s essay BMJ 2012;344:e567 on “Saving Charlotte Bronte” fascinating. However, the statement “Today her hyperemesis would be treated with a routine drip, but sometimes cure can be elusive, particularly if the patient resents the pregnancy,” suggests 1) that there is a cure for Hyperemesis Gravidarum (HG), and 2) that when this “cure” does not work, it is often because the patient “resents” the pregnancy. In fact, both of these conclusions are false. While the introduction of intra venous fluid treatment in the mid-1900s resulted in substantially lowering maternal deaths from HG, it is not a cure. In fact, in a study on pregnancy termination due to HG, Poursharif et al. reported in 2007 that as many as 19% of women with HG in the United Kingdom and 14% in the United States have had at least one therapeutic termination. The primary reason for the large number of terminations of wanted pregnancies due to HG was reportedly “no hope for relief,” suggesting there is a critical need for better treatments to save the lives not just of the mothers, but of their wanted unborn children. In fact, women that terminated were 3 times more likely to report their healthcare providers were uncaring or did not understand how sick they were compared to women who did not terminate. The cause of HG is unknown and over a century of unsubstantiated claims that it can be incurable for reasons such as the patient herself “resent(ing)” the pregnancy is exactly the abusive commentary that contributes to a poor patient-physician relationship and can lead the patient to elect termination. Suggesting the patient is somehow at fault for the severity of her physical symptoms when the fact is, we have no idea what causes nausea and vomiting in pregnancy is both unscientific and harmful to the patient. While Charlotte Bronte’s life would likely be saved today, we cannot say the same for her unborn child. We still have a long way to go to understand the cause and ultimately find a cure for HG, and it is articles like this that impede our progress.
Sincerely,
Marlena Schoenberg Fejzo, Ph.D.
Professor of Research, UCLA and USC
And
Kimber MacGibbon, RN
Co-founder, Director of Education and Research
Hyperemesis Education and Research Foundation (HER) www.HelpHER.org
Rapid Response:
Re: Saving Charlotte Brontë
Dear Editor,
We found James Owen Drife’s essay BMJ 2012;344:e567 on “Saving Charlotte Bronte” fascinating. However, the statement “Today her hyperemesis would be treated with a routine drip, but sometimes cure can be elusive, particularly if the patient resents the pregnancy,” suggests 1) that there is a cure for Hyperemesis Gravidarum (HG), and 2) that when this “cure” does not work, it is often because the patient “resents” the pregnancy. In fact, both of these conclusions are false. While the introduction of intra venous fluid treatment in the mid-1900s resulted in substantially lowering maternal deaths from HG, it is not a cure. In fact, in a study on pregnancy termination due to HG, Poursharif et al. reported in 2007 that as many as 19% of women with HG in the United Kingdom and 14% in the United States have had at least one therapeutic termination. The primary reason for the large number of terminations of wanted pregnancies due to HG was reportedly “no hope for relief,” suggesting there is a critical need for better treatments to save the lives not just of the mothers, but of their wanted unborn children. In fact, women that terminated were 3 times more likely to report their healthcare providers were uncaring or did not understand how sick they were compared to women who did not terminate. The cause of HG is unknown and over a century of unsubstantiated claims that it can be incurable for reasons such as the patient herself “resent(ing)” the pregnancy is exactly the abusive commentary that contributes to a poor patient-physician relationship and can lead the patient to elect termination. Suggesting the patient is somehow at fault for the severity of her physical symptoms when the fact is, we have no idea what causes nausea and vomiting in pregnancy is both unscientific and harmful to the patient. While Charlotte Bronte’s life would likely be saved today, we cannot say the same for her unborn child. We still have a long way to go to understand the cause and ultimately find a cure for HG, and it is articles like this that impede our progress.
Sincerely,
Marlena Schoenberg Fejzo, Ph.D.
Professor of Research, UCLA and USC
And
Kimber MacGibbon, RN
Co-founder, Director of Education and Research
Hyperemesis Education and Research Foundation (HER)
www.HelpHER.org
Competing interests: No competing interests