Hyperemesis Gravidarum Awareness

Maria Caulfield Excerpts

Wednesday 19th July 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I begin by thanking my hon. Friend the Member for Hyndburn (Sara Britcliffe) for a very moving speech. I express my condolences to Jess’s family and to Eddie, her partner, and let us also remember baby Elsie. My hon. Friend could not have expressed any better the impact on a whole family, a community and an individual, and I agree with every word she said. We met recently to discuss Jess’s case, and I am happy to continue to work with my hon. Friend on this issue.

Unfortunately, there are many women like Jess going through this. They are probably watching or listening to the debate, and will take comfort from the fact that they are not on their own, and that there are many others who feel like this. Every pregnant woman who is living or has lived with hyperemesis gravidarum or a difficult pregnancy—particularly those like Jess, who had such an active life before becoming pregnant—will recognise that isolation and loneliness. It is an all-encompassing feeling of not being physically well, which takes a toll on mental health as well.

To echo my hon. Friend’s words, hyperemesis gravidarum is a severe form of nausea and vomiting. She is right that we need to move away from the term “morning sickness” and to instead use the term “pregnancy sickness”, and we should also be aware that HG is very different from pregnancy sickness. Any woman who has experienced nausea or vomiting during the early stages of pregnancy knows how debilitating that is. However, when that continues week after week, and they see other pregnant mothers glowing and thriving in pregnancy, and sharing photos on Instagram and social media, it adds to the difficulty, and the feeling of isolation because they are not dealing with pregnancy in the same way as many others.

Hyperemesis gravidarum can affect between one and three in every 100 pregnancies, so it is not a small number. Thousands of women are affected. It can affect an individual’s mood and their ability to work. Many mums are keen to work for as long as they can, because they want to take as much maternity leave as possible after they have given birth. The effect of not being able to work, and the effect of HG on home life, particularly if mums have other children for whom they care, cannot be overestimated.

Although most women can be treated at home or as an out-patient, some need to be admitted to hospital. As my hon. Friend said, if they are not able to eat or keep fluids down, it is vital that medical care is there when they need it. Too many women are left feeling isolated and unsupported. There is stigma and a taboo; there is little understanding that this condition is very different from morning sickness, and that it affects women’s mental health, as well as their physical ability to cope with their pregnancy.

I absolutely agree that more needs to be done to address this issue. The National Institute for Health and Care Research is awarding funds for research on the causes of the condition, the way it can be managed and the nutritional impact on pregnancy. The women’s health ambassador, Professor Dame Lesley Regan, who is an obstetrician, is keen to look at hyperemesis gravidarum, because in her clinical practice she has seen its effect on women. She will host a webinar on hyperemesis gravidarum on 27 September in her role as chair of Wellbeing of Women, which is a leading women’s health charity. That public webinar, which is free for people to sign up to and attend, will explore the experience of patients with this condition and provide options for treatment, support and self-care. I encourage anyone who has been affected by it or has an interest in it to sign up. The details will be published on the Wellbeing of Women website. If the women’s health ambassador is championing improvements in this area, that is the start of the conversation. It will start Jess’s legacy, in terms of raising awareness for other women.

Mental health support is often not accessible. This is not the only case of women not being listened to when it comes to women’s health. Ahead of the women’s health strategy, we issued a call for evidence, to which we received more than 100,000 responses. Whether it was on endometriosis, the menopause or fertility issues, the overwhelming response was that women are often not listened to when they ask for help, either because healthcare professionals were not aware of the conditions that women were raising, or because the attitude of healthcare professionals, whether to pregnancy, the menopause or puberty, was, “This is part of a woman’s cycle, and you just have to get on with it.” We want to end that stigma.

There are so many interventions that can help women throughout their life course, regardless of their condition or the life change that they are going through. Through the women’s health strategy, we want to change that attitude, so that when women ask for help, they have a positive experience and feel supported.

We are looking at perinatal mental health. Tragically, the most common cause of death in new mums is suicide; that is absolutely extraordinary. It is tragic to hear that Jess died by suicide because she felt so isolated and helpless in dealing with her condition. We will hopefully publish the suicide prevention strategy very soon, and new mums—indeed, mums in general—will be a priority group in it. We recognise that there is not support for mums during and after pregnancy. We want to address the fact that suicide is the leading cause of death.

We are doing that already. Mental health services around England are expanding to include new mental health hubs for new, expectant or bereaved mums. We are opening up 33 of them, which will provide psychological therapy, maternity services and reproductive healthcare for women with mental health needs following trauma or loss, or directly related to their experience of pregnancy or birth. Those will be available in England from March 2024. I know that is no consolation to Jess’s family, but we are absolutely addressing that as quickly as we can.

We also recognise the importance of supporting women’s health in the workplace. My hon. Friend is quite right that there are laws in place to protect women when it comes to maternity leave and discrimination around pregnancy. I am happy to work with the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Mid Sussex (Mims Davies), on raising awareness of this condition, because employers are not aware that it is very different from early-stage morning sickness or pregnancy sickness, and that female employees will need help, support and understanding. They should not be afraid that the situation will eat into their maternity leave or, as my hon. Friend the Member for Hyndburn said, statutory sick pay. I am happy to have discussions with my hon. Friend the Under-Secretary of State for Work and Pensions. We have been working closely on the menopause in the workplace, so I am happy to take that up.

Hyperemesis gravidarum is not included in the women’s health strategy, which looks at the priority areas of women’s health, although pregnancy is. I would like to address that, because I have heard clearly from my hon. Friend, through what she said about Jess’s tragic experience and the outcome for her family, how difficult this issue is. I take on board that many healthcare professionals, particularly those whom a woman will see before she sees a midwife, will not have had training or support in understanding the extent of this condition. As my hon. Friend said, even midwives do not get specific training on HG.

I suggest that, following the webinar in September that the women’s health ambassador is leading, we organise a roundtable with her to discuss the findings, and see how we can take some of this forward. Through the National Institute for Health and Care Research, we have money for research, which could be on managing the condition; psychologically supporting women who are struggling with its devastating and debilitating effects; or the use of drugs such as Ondansetron. We need an evidence base, so that we can support primary care teams and midwives in giving medication safely to pregnant women. There could be research on hydration and nutrition support for those not able to keep down food and fluids; on the training and education of medical staff and midwives; on removing the stigma and taboo; or on raising awareness among healthcare professionals, the public and pregnant women. They may not realise that HG is a condition for which they should be able to get help and support, and that it is not just them being unable to cope with morning sickness. Some women do feel that, when they actually have a condition that makes their experience different from what many women go through.

The offer is on the table; I can meet my hon. Friend to see if we can draw some findings from Jess’s terrible experience, so that we can eliminate the chance of that happening to other women. In the minutes that I have left, I extend my thanks to my hon. Friend, and say to Jess’s family that I am so sorry to hear of their experience. I am happy to support Jess’s legacy, so that we change the experience for pregnant women who suffer with hyperemesis gravidarum, and never again hear such a tragic story.

Question put and agreed to.