Abortion: Last Resort For Hellish Morning Sickness

June 30, 2010 -- Anuja Batra is 18 weeks pregnant and has already lost nine pounds, instead of gaining the usual eight pounds. She throws up so often that she has been hospitalized seven times for being close to starvation.

Twice before, she tried to have a baby, but the vomiting was so horrific that on the advice of her doctors she chose to abort -- one at eight weeks and another at four months.

"It's hard to break the cycle," said Batra, a 37-year-old from Natick, Massachusetts, who hasn't been able to work for months. "It's every 15 to 20 minutes and lasts 24 hours or longer, and sometimes two or three days until the cycle breaks."

Hers is no ordinary morning sickness that can be relieved with a saltine cracker or ginger ale. Batra has a rare condition known as hyperemesis gravidarum.

Women report that the pain is so excruciating they hope for a miscarriage, and one study at the University of Southern California -- a leader in the field -- shows that as many as 1 in 7 of these women elect to abort.

Some doctors disparagingly call them "pukers" -- women who are so nauseated during pregnancy that they can barely function, lose weight and often end up on an IV in the hospital to avoid dehydration and malnourishment.

Moreover, doctors often have little expertise to help women like Batra who so desperately want to carry their babies to term.

In her first pregnancy, Batra said she had electroshock treatment because doctors were convinced her unrelenting nausea was "psychological."

"They laughed and told me I was making myself sick," she said.

But medical experts say the condition is real and on July 1, academics from around the world will meet at Warwick University in the Britain, hoping to find causes and treatment for hyperemesis gravidarum.

About 70 percent of all pregnant women have some morning sickness, which usually disappears before the end of the first trimester. But in about .5 to 2 percent of those cases, the nausea never lets up, according to the National Organization of Rare Diseases.

The condition is as old as pregnancy itself.

Jane Eyre author Charlotte Bronte died at age 38 along with her unborn child after excessive vomiting and "sensations of perpetual nausea and ever-recurring faintness."

"It's not that uncommon," said Miriam Erick, a registered dietitian who is helping Batra at her morning sickness clinic at Brigham and Women's Hospital in Boston. "And women just want relief."

For the last 15 years, she has been treating women with hyperemesis, propelled by the disregard she saw in the medical world.

"I heard so many unkind things about these women," said Erick, author of the 2004 book, "Managing Morning Sickness." "They're not the most popular patients and the more I listened to the gossip from the doctors and nurses and thought, it's not their fault."

The average duration for most women with hyperemesis is 17.3 weeks, but 22 percent have it until the birth.

Morning Sickness Triggers: Smells, Noise, Movement

Sleep and hydration, as well as salty and sweet foods like potato chips and lemonade, can bring some relief, but just as importantly, Erick helps women identify their individual triggers and encourages them along the way with daily e-mails and telephone calls.

"It's a big black box in obstetrics and we don't know exactly what causes it and it's hard to find one size that fits all when treating it," she said.

Smells, motion and noise are often triggers. Sometimes it's just the barometric pressure and humidity.

For Erick's former patient, Jacinta Telesford-Ximba, who threw up 8 to 20 times a day before having twins at 36 weeks, it was motion and food.

"I couldn't drive in a car," said the 38-year-old nurse from West Roxbury, Mass., who sought help from Erick.

"No one could cook in the house at all," she said. "I couldn't have anyone eat in front of me. The way people would eat or the way it was presented on a plate. I couldn't see salad bars or big entrees or even go to the [hospital] cafeteria."

She could barely look after her 3-year-old son and was confined to bed for months.

"The day I delivered I was still throwing up," she said. "I was in the hospital so often with an IV tube my veins were gone. That's how sick I was. And there is nothing you can do."

"There were days I thought my god I am dying," she said. "It's like circling down a drain."

Many of these women end up in the hospital dehydrated, with "mild starvation" and electrolytes out of balance, according to Dr. Dwight Rouse, an obstetrician from Women and Children's Hospital in Providence, Rhode Island, who works with high risk cases.

Severe dehydration can result in heart irregularities and even heart failure.

Rouse has seen patients with life-threatening electrolyte balances who vomited "to the point where they threatened their own health" and aborted.

Just last week, the British press reported that Cheryl Harrison, threw up 40 times a day and couldn't take care of her 5-year-old. She made the agonizing decision to abort at nine weeks.

She admits the termination was the "most horrendous decision I have ever made."

"I think there are other women who have terminated pregnancies for the same reason but it's a taboo, no one discusses it," she told the Daily Mail newspaper.

Karen Williams of Elmira, Calif., was hospitalized with hyperemesis 30 years ago while pregnant with her daughter. She was so malnourished her hair, eyebrows and eye lashes fell out and her nails split.

"I almost thought of not having her because I had never heard of anyone as sick as I was," Elmira wrote to ABCNews.com. "I was so sick and it was the most horrible nine months of my life. Whoever said you glow when pregnant had never met me."

Genetic Component Suspected in Extreme Morning Sickness

In the United States, about 59,000 women are hospitalized with the condition each year, according to Marlena Schoenberg Fejzo, a UCLA researcher and geneticist, who is leading a study to find genetic causes for hyperemesis.

Until now, doctors have suspected that the pregnancy hormones - estrogen, progesterone and human chorionic gonadotrophin (hCG) -- were to blame for morning sickness.

Some studies have implicated the olfactory system, which is responsible for taste and smell and even the H-pilori bacteria that causes stomach ulcers. Some studies have even looked at thyroid gene mutations and stomach rhythms to try to understand what sets off the brain's vomiting center.

But newer research, showing that women with mothers and sisters with the disorder are at greater risk, suggests that there may be a genetic component.

"Hopefully it will lead to better treatments," said Fejzo of the UCLA study. "The limiting factors are getting enough participants -- 1,000 cases and 1,000 controls -- and getting funding for the genetic analysis."

Fejzo said the number of women who experience hyperemesis is likely much larger than previously thought, because many women are never hospitalized.

That may have been the case with Alison Kenyon, a secretary from Farmington Hills, Minn., who was violently ill through all three pregnancies.

"I was told with the first pregnancy that 'all women go through this' by the RN who answered the phone," she wrote ABCNews.com. "She had no idea what I was going through. In retrospect, I think I should have rehydrated in a hospital but I didn't know any better."

Many nights in her first pregnancy, "I remember wanting to die instead of going to sleep because I knew I would feel absolutely wretched in the morning," she said.

"I was late for work many days and when I wasn't, I had to pull over on the freeway to puke my brains out," she said. "I spent half the work day cradling the public toilet at the office."

After three boys, she said, "Never again. I love my boys but that is pure evil."

Doctors say that most babies of mothers with hyperemesis are born healthy, though in severe cases, women can be at risk for early delivery or smaller babies.

But a new study is underway looking at the health outcomes of those babies.

Mother Loses Unborn Baby to Hyperemesis

Dr. Aimee Brecht-Doscher, a Camarillo, Calif., obstetrician, miscarried at 18 weeks after she had hyperemesis, vomiting up to 20 times a day.

"I couldn't eat or drink," she said. "I couldn't take time off from work, so I started taking medications and administering IV fluids to myself every night. When I was on call for labor and delivery, I'd hook myself up to the IV between deliveries. I kept thinking it would resolve, but instead it grew worse."

"Dehydration and malnutrition led to despair. I cried every day," she said. "I believe that [my baby's] death was caused by a specific vitamin deficiency, a vitamin I was not getting in my IV."

Sick with her second pregnancy, she gave birth to a son prematurely at 35 weeks, but today, at 7, he is healthy.

Brecht-Doscher now helps others with Help Her (Hyperemesis Education and Research), an organization dedicated to helping women cope with hyperemesis and finding better treatments.

Help HER was founded in 2000 by Kimber MacGibbon, a former nurse from Portland, Oregon, who also suffered from the condition in two pregnancies.

MacGibbon's son is now 11 and has behavioral, emotional and learning problems that she says may have been caused by her hyperemesis.

Five weeks into her marriage, the overwhelming nausea began. MacGibbon's midwife insisted, her body was "trying to reject the pregnancy."

Horrified and eventually losing 16 pounds off her 135-foot frame, MacGibbon was eventually hospitalized. She was so ill, she dropped out of graduate school.

"They say I looked like something out of a concentration camp," said the 42-year-old, who was eventually treated successfully with Zofran (ondansetron), a drug used to offset nausea in cancer chemotherapy, that has been approved as safe by the Food and Drug Administration.

Today, Help Her supports the research at both University of California and UCLA and is a source of hope for patients like Anuja Batra.

Batra now has 24 weeks to go in her struggling pregnancy, but she is cautiously optimistic that this one won't end up in termination.

"I know that at nine months, it will truly be the end," she said. "I know there is a baby waiting for me and that is my motivation."

In addition to sleep and good hydration, she is she is wearing a "relief band" -- a device that emits small electrical current to an acupuncture point in her wrist.

Her counselor, Miriam Erick, is also confident that Batra will finally get the baby she has wanted for so long.

"Hyperemesis has been around longer than God," said Erick. "I go to see them post-partum and they are so totally different, smiling ear to ear."