Morning sickness, Midwives, and Molar pregnancies

Morning sickness during pregnancy is very common, especially in the first trimester. There is an extreme form of morning sickness called hyperemesis gravidarum (HG). Women with HG have a lot of nausea and vomiting and often have difficulty keeping anything down at all. HG can persist all the way through the pregnancy rather than only the first few months. Some of these women lose weight rather than gain weight; some are hospitalized because they can’t keep enough fluids down to stay hydrated.

My cousin gets HG so badly in all of her pregnancies that she can’t even take care of herself, much less her children; she has to live with her parents or her in-laws when she’s pregnant so she can have constant help.

My first 3 pregnancies were easy compared to my 4th pregnancy. But that last one was a doozy. I had HG and vomited all the way up to my due date. I was usually at my sickest in the evening, when I ought to have been singing to my kids and snuggling with them as they were being put to bed.  Instead, my then-9-year-old daughter basically ended up putting her siblings to bed on a fairly regular basis, no bedtime songs and cuddles with Mama because she was lying on the floor with her face over a bowl.

I didn’t have HG as badly as some other women I know of. I was able to gain a normal amount of weight in my pregnancy, and I only had IV fluids once. However, I used many, many remedies to keep myself reasonably functional, including all the natural remedies such as peppermint and ginger and frequent snacks. A prescription of Zofran (from a certain CNM named Karla Jo Bennett) wasn’t helpful. What did help me was taking Unisom — the one with 25 mg of the active ingredient doxylamine succinate — twice a day (three times a day helped with the nausea/vomiting even more but it made me way too sleepy), taking loads of vitamin B-6 (micro-doses all day and a slow-release dose at bedtime), completely stopping my consumption of all grains, and most helpful of all, getting a shot of b-vitamins every day or two.

The first midwife I went to for b-vitamin shots was Karla Jo, but eventually my regular midwife taught me how to give myself shots, which was far less expensive and far more convenient than driving to the midwife’s office and paying her to do it every time.

I got tested for H. pylori (a bacteria in the stomach that is one cause of HG) and the test came back negative. Karla Jo was the midwife who was lucky enough to keep my stool sample in her freezer until the the lab came by to pick it up.

Karla Jo is a Certified Nurse Midwife (CNM), which is the kind of midwife with the most education and privileges (such as writing prescriptions).  Since she has more privileges than my regular midwife, the two of them worked together to meet my needs for medical care. (I saw several other types of medical professionals to try to get some answers about my HG, but in the end, no one could solve the puzzle, and eventually I gave birth and the problem ended on its own.)

Karla Jo is not just my CNM but she’s also my mom’s first cousin. I was close friends with her kids (my second cousins) when I was younger.  We went on homeschool field trips together; I played Foosball in their basement; and her daughter and I wrote sticker-covered letters back and forth.  I remember having dinner at their house once when they ordered plain cheese pizzas and added their own toppings after the pizzas were delivered (that was so foreign to me).  I attended the baby shower of one of her daughters and drove across Los Angeles to visit her other daughter, who was on a layover.

I was surprised when I saw Karla Jo in the sneak peek of Seeking Sister Wife, and I excitedly texted her and said, “You’re my friend Vanessa’s midwife! I saw you on TV!” and we laughed about it and she told me about her experience with the TLC film crew.

Karla Jo was the midwife who performed Vanessa’s ultrasound in episode 5 of Seeking Sister Wife.  She had to give Jeff and Vanessa the sad news that Vanessa actually wasn’t carrying a baby, and the further bad news that she probably had a molar pregnancy.  It turns out she was correct, even though in 20 years of caring for women and babies, this was the first time Karla Jo had seen a molar pregnancy.

Molar pregnancies occur in roughly 1 out of 1000 pregnancies. This means it’s highly unlikely you will have one, but it’s likely that you know someone who’s had one. Karla Jo’s sister had one. So did my mother-in-law.  My regular midwife has seen 3 in her career.

In a normal pregnancy the hormone hCG (which is responsible for morning sickness) appears at implantation, increases to a peak between 8-11 weeks of gestation, and then decreases. The levels of hCG going down after the first few months is the reason why the symptoms of morning sickness typically lessen at that point.

The hCG hormone is measured in milli-international units per milliliter (mIU/mL). Normal levels approach 300,000 mIU/mL at the peak. In a molar pregnancy they go much higher, so even though the woman isn’t carrying a baby, she feels sicker than someone having a normal pregnancy.  She also has positive pregnancy tests despite there not being a baby, because hCG is what’s being tested with pee-on-a-stick pregnancy tests.

When you watch the early episodes of Seeking Sister Wife, and Vanessa is so sick, you can bet there’s a good reason she was experiencing the worst morning sickness out of all of her pregnancies. When Vanessa’s hCG level was tested it was 1,200,000 mIU/mL!

When Vanessa’s regular midwife Sherri Price couldn’t hear a baby with her doppler (as shown in episode 4), she asked her good friend and fellow midwife Karla Jo if they could come to her office (which is at her house in Pleasant Grove, Utah — not in Genola, Utah like SSW implies) and have Karla Jo take a look with her ultrasound machine.

After Karla Jo said yes, Sherri mentioned that, oh by the way, a camera crew is coming.

Karla Jo hadn’t planned in advance on being filmed that evening, and she didn’t get home until just before the film crew wanted to start filming.  She had had a full day and the film crew and everyone else beat her to the house.  Her husband fed them ice cream and entertained them for an hour.  (At one of my appointments with Karla Jo, her husband took my kids into their backyard and let them collect the eggs from their chickens.)

Most midwives don’t have their own ultrasound machine (they’re a pretty expensive piece of equipment to just use occasionally), but Karla Jo has one. So she is kind of the go-to when another midwife wants her client to have an ultrasound done.

Karla Jo says it was an interesting experience to have a film crew present while she did her work.  Normally she would have dimmed the lights in order to see the ultrasound screen better, but the film crew needed the lights bright.

She didn’t get told anything that happened after everyone left that day.  She didn’t know for sure if she would end up in the final cut; she didn’t get a copy of the episode; she didn’t get told when it was airing.

As far as the filming and editing of the show, Karla Jo say the editing was done in a deceiving manner.  For instance, the audio is edited enough so that at times she is shown saying the exact opposite of what she actually said (for instance, the word “don’t” got cut out of one of her statements).  She also thinks the scenes she’s in that were posed (like when she was standing outside with Sherri) felt very fake.

Technically Karla Jo can’t use an ultrasound to diagnose a molar pregnancy, but you’ll notice that she was able to give a better idea of what was happening than the first midwife was, and she gave good advice to go ahead and get checked out by a radiologist.

I have seen people on social media criticize Vanessa for going to another midwife instead of the emergency room. The show said Vanessa’s problem was “possibly life-threatening,” but that doesn’t necessarily make it an emergency. Cancer is life-threatening as well, but no one calls an ambulance. Vanessa wasn’t bleeding or even cramping; the situation wasn’t so urgent that they needed the emergency room, and going to the ER wouldn’t have changed the outcome. Please, let’s leave the ER for true emergencies, rather than clogging them up with important but less-urgent medical situations.

As I said, at the time of Vanessa’s first prenatal with Sherri, she wasn’t bleeding.  However, early in Vanessa’s pregnancy, after taking a positive at-home pregnancy test, she was spotting quite a bit and even bleeding a lot at one point, so she thought maybe she was having a miscarriage.  She got an ultrasound, which appeared to show a very early embryonic sac.  She also got blood work done twice showing that her hCG hormone levels were rising at an expected rate.  So according to all that she was definitely pregnant.  She figured that she was either going to miscarry or not, but that it was out of her hands.

The bleeding eventually slowed and she continued to be pregnant (as far as she could tell), so she just figured things were progressing normally. There seemed to be no other reason for concern, and she planned her first prenatal for 12 weeks gestation as usual.

Her first prenatal is shown in episode 4, and the follow-up appointments and surgery are depicted in episode 5.  What the TV show doesn’t tell you is what happened after Vanessa’s surgery.

The pathology report fortunately came back negative for cancer from the mass that was growing inside her, and for a short time she thought Oh good, surgery went well and now I’ll just recover.

But Vanessa ended up with a painful complication.  Her high levels of hCG hormone triggered something called theca-lutein cysts, which are a type of ovarian cyst most commonly associated with molar pregnancies.

After Vanessa’s surgery, her ovaries looked fine, but within days the cysts grew as a result of those heightened levels of hormone. Her abdomen was filled with these ovarian cysts, as shown in the below ultrasound images.  She had so many and they were so large that she looked 8 months pregnant!

She literally could not lie down or hardly even recline because she couldn’t breathe. She also couldn’t eat because her stomach was so crowded.  It was several weeks after her surgery before she was recovered enough from those horrendous theca-lutein cysts to start feeling normalish again, and it took almost 2 months before her hormone levels were back to healthy levels.

Now, months after Vanessa’s surgery (a high-risk D&C), her hormones levels are good and her belly is back to its proper size, but she is still constantly on the lookout to detect further problems.  Any cells remaining in her uterus could begin to grow, or worse, metastasize into other parts of the body.  The way to determine if that’s happening is with pregnancy tests, so she has to avoid getting pregnant but take tests every 2 weeks to be sure the hCG levels aren’t rising.  If she gets a positive pregnancy test then she will have to hurry in to the doctor to determine what’s going on.

Although her experience was difficult and traumatic, Vanessa feels like it was divinely timed and directed, and she is at peace about it.  She is glad the viewers of the show got to see thru real events how loving and supportive her amazing family is.

But she’s still nervous about the future.  Once she’s physically and emotionally ready to get pregnant again, her odds of having another molar pregnancy are significantly greater than before: about 1 in 20.

Vanessa appreciated having supportive midwives to help her through her experience.  She loves Sherri and also speaks very highly of Karla Jo.  She reports: “Karla Jo was really great!  I would consider her as a midwife if I was still in the area.  I didn’t spend tons of time with her but she came VERY highly recommended by Sherri and I really liked her presence and personality. I felt very safe with her.”

Karla Jo Bennett serves Utah County, Salt Lake County, and surrounding areas. Her midwifery website is www.gentlebirthandwomenshealth.com.  (Sherri Price is retired now, so if you were interested in hiring her, you’re out of luck.)

Note: Vanessa Alldredge’s story and medical details shared with permission.

What do you think?  Have you ever had hyperemesis gravidarum?  If so, what was your best remedy?  Do you use a midwife or a doctor, and why?  Have you ever heard of anyone having a rare molar pregnancy?  Leave your thoughts in the comments below.