Hyperemesis Gravidarum Tells Us More About Our Maternity System Than We Think
By Charlotte Howden
Over the past 24 hours I've read Baroness Amos' Independent Investigation into Maternity and Neonatal Services in England alongside the accompanying Call for Evidence report. Together they represent more than 250 pages of evidence gathered from over 10,500 women, birthing people, support partners, NHS staff and organisations across England.
There is much to welcome. The investigation identifies a maternity system where women are too often not listened to, where services are fragmented, communication breaks down, and the quality of care can still depend on where you live. Those conclusions are difficult to dispute.
I approached the reports with one question in mind: What do they tell us about Hyperemesis Gravidarum?
The answer wasn't what I expected.
Women with HG are present throughout the evidence. They describe fighting to be believed, being told to "eat ginger" despite significant weight loss, struggling to access treatment and encountering healthcare professionals who didn't understand the seriousness of their condition.
Yet by the time the investigation reaches its recommendations, HG has largely disappeared.
That isn't because it falls outside the scope of maternity care. In fact, I think the opposite is true.
Reading these reports reinforced something I've been thinking about for a long time. Hyperemesis Gravidarum isn't simply another pregnancy complication. It's one of the clearest indicators of whether our maternity system is functioning as it should.
Most women with HG become seriously unwell before they've even had their first antenatal appointment. They move between GPs, NHS 111, emergency departments, early pregnancy units, maternity assessment units and pharmacy services, trying to find someone who can help. Responsibility is often unclear, care becomes fragmented and women are left navigating the system while becoming progressively more unwell.
That isn't unique to HG. It's exactly the kind of system failure Baroness Amos describes throughout the report.
The investigation identifies services that don't join up, inconsistent decision-making, poor communication, failures in triage and women feeling they must fight to be taken seriously. Those themes are instantly recognisable to anyone who has spent time listening to women with Hyperemesis Gravidarum.
One recommendation stood out. Baroness Amos describes maternity triage as increasingly becoming the "A&E service for maternity" and argues that improving triage would save lives and reduce harm.
For women with HG, that moment often determines everything that follows. Severe pregnancy sickness is either recognised as a serious medical condition requiring urgent treatment, or it is dismissed as something to endure. The consequences of getting that decision wrong can be profound.
The report acknowledges that evidence was submitted on many specific pregnancy conditions and explains that it wasn't possible to examine each one in detail. That's entirely understandable.
What I find harder to understand is why one of the clearest examples of the report's own findings isn't used to illustrate them.
This isn't about asking for a chapter dedicated to Hyperemesis Gravidarum.
It's about recognising what HG reveals.
If we want to know whether women are listened to, whether services communicate effectively, whether pathways are joined up and whether serious illness in early pregnancy is recognised before women deteriorate, we already have a condition that answers those questions.
Perhaps it's time we stopped thinking about Hyperemesis Gravidarum as a niche pregnancy condition and started recognising it for what it is:
A test of how well our maternity system works.
At The HG Collective, we're committed to ensuring Hyperemesis Gravidarum is recognised not as a niche pregnancy condition, but as a key indicator of the quality, safety and equity of maternity care. Through research, policy, clinical engagement and lived experience, we're working to ensure HG has a permanent place in the national conversation about maternity improvement.