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Last Updated: Saturday, 27 October 2007, 02:06 GMT 03:06 UK
The clinic helping sick pregnant women
By Jane Elliott
Health reporter, BBC News

Esther Bissessar
Esther is pregnant for the third time
When Esther Bissessar became pregnant with her third child she knew just what to expect from the first few months - extreme and unremitting sickness.

During her first pregnancy Esther was admitted to hospital several times with hyperemesis - extreme pregnancy sickness.

The frequent vomiting would leave her so weak that she had to be admitted for rehydrating and anti-emetic drugs.

Then after a couple of days Esther, 34, from London, would be released and allowed home.

Shorter stays

She managed to avoid hospital in her second pregnancy, during which she also had hyperemesis, but a milder version.

This time, Esther, who is now eight months pregnant, has been back to hospital, but says a new dedicated clinic has made the whole experience much less traumatic.

It definitely helps you are with women with same condition and similar stage of pregnancy
Esther Bissessar

The clinic, based at the Royal London Hospital is the first in the country, and allows women like Esther to get day care on the ward and then go home to their families.

"It is really nice, you get one-to-one and you get specialist care," she said.

"It definitely helps you are with women with the same condition and at a similar stage of pregnancy.

"Unfortunately I also had gastric problems as well as my hyperemesis so I had to stay in longer.

"But it was still good to be treated at a clinic where everybody has the same problem and everyone knows what hyperemesis is."

Ester says she felt sick from week six onwards but is now starting to feel better.

"When I got it in my first pregnancy I did not know what it was and nor did anyone from my family," she added.

Quiet atmosphere

About 4% of women get hyperemesis, which causes repeated vomiting, dehydration and weight loss.

Some women are so badly affected that they cannot even swallow their own saliva without needing to be sick. But even though the condition is distressing and worrying for the mother, it rarely affects the baby.

Avoiding sickness
Try a biscuit before getting out of bed
Avoid strong smelling foods
Try food and drinks containing ginger
Try sipping on herbal teas like ginger, lemon and peppermint throughout the day

Sister Leesa Green runs the service at the Royal London, which has been open for a year.

She said the specialist clinic is cutting the amount of time the women spend in hospital.

The clinic, formerly an under-used teaching room on the gynaecological ward, has been adapted specifically for women with hyperemesis.

It has comfortable reclining chairs, music if wanted, cooling fans and its own dedicated nurse.

"When mothers arrive at the day clinic they are often very ill, weak and dehydrated," said Ms Green.

"Some can be very alarmed and worried about their baby. We sit them down in comfortable chairs and give them intravenous fluids and anti-sickness medication.

"Usually within six hours you can see them looking and feeling much better.

"Where necessary we perform an ultrasound scan just to check the health of the baby. While they are in the clinic I can also reassure them about hyperemesis and what they can do to help themselves."

She also checks their blood and urine to make sure there are no additional problems.

Specialised care

Ms Green explains that previously all cases came to the hospital via A&E admissions, but now once they have been initially assessed she can make appointments to see patients as and when they are needed.

"Previously they might be on the wards for up to five days, but now they can be in and out within 24-48 hours if they have no other problems."

While they are in the clinic Ms Green, who recently featured in the Nursing Standard, coaxes them to eat a little plain rice or potatoes.

"It is no use them trying to keep down spicy food," she said.

"While they are here we try to educate them about what to eat.

"We find that women like it better here than on the wards because it is quieter and they are with other people with the same condition."

She said that although hyperemesis can strike any ethnic group, women from the Bengali and South Sea Islands populations appear to be particularly badly affected.

But the reasons for this remain unknown and Ms Green points out that the Royal London has a high number of patients from the Bengali community.

Mr Emeka Okaro, consultant for emergency gynaecology, said: "In the population we are dealing with hyperemesis is quite a common condition.

"When we came up with the idea for the hyperemesis clinic we were trying to improve the level of care and reduce the length of time patients had to stay in hospital.

"So far we have seen some great results and the feedback from the patients has been very positive."

He said the system was working for the hospital, but more importantly the patients approved of it.

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