Midwifery Care · Antenatal Support
Hyperemesis Gravidarum
Severe nausea and vomiting in pregnancy, taken seriously, from the very first conversation. This isn't something to push through, and it's not something you should ever have to prove.
I'm Jennifer, a Registered and Endorsed Midwife in Paddington. I've been where you are, and I built this part of my practice for exactly this moment.
If you're vomiting blood, can't keep any fluids down, feel faint or confused, or have a fever, severe abdominal pain, or a headache that won't go away — please go straight to your nearest Emergency Department rather than waiting for an appointment.
Jennifer Hazi · Registered and Endorsed Midwife · 11 years in practice
Why I Take This Seriously
I had hyperemesis in every one of my own pregnancies. For the first ones, I was mostly told to try ginger and wait it out. It wasn't until my last two that I finally had care which matched how unwell I actually was, and even then, I felt I had to keep proving it to those around me.
Since then, the guidelines have changed, and there's now real research pointing to a possible genetic contributor to hyperemesis gravidarum. There's a clearer, evidence-based path for treatment today, and I built this part of my practice around the care I wish I'd had.
As an Endorsed Midwife, you don't need a referral to see me directly. I can offer a proper assessment, real treatment options, and, where needed, prescribe medication or arrange IV fluids myself.
Here's exactly what happens when you reach out.
What Happens When You Book With Me
No confusion about what to do first. Just three simple steps.
Reach Out
Book directly, by telehealth or in person. Most women start with telehealth, since leaving the house can be the hardest part. No referral needed.
We Build a Plan Together
Medication if it helps, fluid replacement if you need it, or simply a clear next step and someone checking in on you.
Ongoing, Caring Follow-Up
In clinic, at home, or by telehealth, reviewed roughly every one to two weeks until things settle.
With the right care, many women find they can eat properly again, get their days back, and actually be present for the rest of their pregnancy, not just surviving it, but living it.
How to Be Seen
No referral needed for any of these appointments.
Telehealth Review
45 minutes. Assessment, medication prescription or review, and a management plan. Available from home, which matters when leaving the house feels impossible.
$185 · Medicare rebate $75.65
Book Your Appointment →Clinic Appointment
45 minutes. In-person assessment and management at The Gathering Space, Paddington.
$185 · Medicare rebate $75.65
Book Your Appointment →Home Visit
45 minutes. For women too unwell to leave home.
$270 (including travel fee) · Medicare rebate $75.65
Contact to Arrange →Not Sure This Is You?
Every pregnancy is different, and it isn't always obvious where normal morning sickness ends and something more serious begins. Here's how to tell.
| Morning Sickness | Hyperemesis Gravidarum | |
|---|---|---|
| Vomiting | Occasional, you can keep some food and water down over the day | Frequent, hard to keep anything down, can cycle for weeks or months |
| Weight | Rarely lose weight | Weight loss from being unable to eat or drink enough |
| Tiredness | Doesn't usually stop daily life | Exhausted, unable to work, care for yourself, or care for others |
| Hydration | You can usually stay hydrated | May need treatment for dehydration |
| Emotional impact | Some ups and downs, but you feel mostly like yourself | Isolation, anxiety, and depression are common |
Adapted from NSW Health's hyperemesis gravidarum vs. nausea and vomiting in pregnancy comparison table.
And please hear this: none of this is your fault. Current research points to GDF15, a protein linked to nausea and appetite regulation, as a likely biological driver of HG. Not stress. Not a weak stomach. Not "just" anxiety about the pregnancy.
Check your score →How unwell are you? The PUQE‑24
Three questions about the last 24 hours. It's the same score the Australian guidelines use, so you and your care team are talking about the same thing.
Choose one answer for each question. Your score adds up as you go.
What your score means, and what to do next
4 to 6 · Mild
Mild by this measure. It can still wear you down.
- Rest when you can. Tiredness makes nausea worse.
- Eat small, frequent snacks so your stomach is never empty. Protein snacks can help.
- Sip fluids between meals rather than with them. Cold or frozen drinks are often easier.
- Avoid fatty, spicy and fried food, and strong smells. Let someone else cook if you can.
- Ginger and vitamin B6 (pyridoxine) are available over the counter. Acupressure wrist bands help some women.
If you're not improving in a few days, or your score goes up, book in.
7 to 12 · Moderate
Medication helps, and starting it now works better than waiting.
- MotherSafe describes doxylamine, taken with vitamin B6, as the first-line medication for nausea and vomiting in pregnancy in Australia. It's an antihistamine, available over the counter, and considered safe in pregnancy. Other over-the-counter antihistamines are also used.
- If that isn't enough, there's a range of prescription medications. Book an appointment with me or your GP to talk them through.
- Do the score again in a day or two.
13 or more · Severe
You need medical care now, not more ginger.
- Book an appointment today, at home, in the clinic or by telehealth.
- You'll need an assessment for dehydration and to check for other causes. You're likely to need prescription medication, and you may need IV fluids.
Whatever your score, if this is stopping you eating, working or caring for your family, or you're struggling emotionally, that's reason enough to book. Constipation and reflux are common too, and some anti-nausea medications make constipation worse. Both can be treated, so mention them.
Go to emergency now if you
- are vomiting blood
- can't keep any fluids down
- are passing very little urine, or it's very dark
- feel faint, dizzy or confused
- have a fever, severe tummy pain, or a headache that won't go away
Not sure? MotherSafe is a free NSW advice line: 02 9382 6539 (Sydney) or 1800 647 848 (rest of NSW), Monday to Friday. This is general information, not a diagnosis or a treatment plan. Talk to your midwife, GP or pharmacist before starting any medication. Treatment information from MotherSafe, Nausea and Vomiting of Pregnancy (NVP) and Hyperemesis Gravidarum (HG), June 2024. PUQE-24: Ebrahimi N et al, J Obstet Gynaecol Can 2009.
What medication can I take?
Most women are told to try ginger and wait. If that isn't enough, there are medicines that are used in pregnancy, and they work better started early than once things are severe.
The steps below follow MotherSafe, the free NSW pregnancy medicines service at the Royal Hospital for Women. They're general information. Talk to your midwife, GP or pharmacist about what's right for you before you start.
Ginger and vitamin B6
Ginger may help with nausea. Vitamin B6 (pyridoxine) can be trialled as well. Both are available from a pharmacy or supermarket.
Doxylamine, with vitamin B6
"Doxylamine is the 1st line medication to treat NVP recommended in both Australia and worldwide." (MotherSafe)
- It's an antihistamine, and MotherSafe describes it as considered safe in pregnancy.
- In Australia it's sold as a sleeping aid, so ask your pharmacist for it by name.
- It can make you drowsy. If that's a problem, MotherSafe suggests taking it only at night.
Other antihistamines
Diphenhydramine, cyclizine or promethazine are other options. Use only one antihistamine at a time.
When that isn't enough
There's a range of prescription medications that are safe to use in pregnancy and have been shown to help. This is where an appointment comes in. I can assess you, prescribe, and review how it's working every week or two. If you're dehydrated, IV fluids can be given at home or in the clinic.
Doses, as published by MotherSafe
These are MotherSafe's general doses for pregnancy. Check them with your pharmacist, who can see what else you take.
Doxylamine and vitamin B6, taken together
MotherSafe suggests this schedule if drowsiness isn't a problem.
| Medicine | Morning | Afternoon | Night |
|---|---|---|---|
| Doxylamine 25 mg tablet | ½ tablet | ½ tablet | 1 tablet |
| Vitamin B6 (pyridoxine) 25 mg tablet | 1 tablet | 1 tablet | 1 tablet |
| or Vitamin B6 (pyridoxine) 100 mg tablet | 1 tablet, once a day | ||
If doxylamine makes you too drowsy, MotherSafe suggests taking it only at night, or taking a smaller dose. The maximum dose of vitamin B6 is 200 mg a day.
Other medicines
| Medicine | For | MotherSafe's guidance |
|---|---|---|
| Ginger | Nausea | 200–600 mg every 8 hours. No more than 1800 mg in 24 hours. |
| Vitamin B6 (pyridoxine) on its own | Nausea and vomiting | Usually 75–100 mg a day. No more than 200 mg a day. |
| Diphenhydramine, cyclizine or promethazine | Nausea and vomiting | Over the counter. Ask your pharmacist for the dose. Use only one antihistamine at a time. |
Constipation and reflux are common with pregnancy sickness, and some anti-nausea medicines make constipation worse. Both can be treated. For now, see the MotherSafe factsheet for what's used, and mention them at your appointment.
Is it safe for my baby?
It's the question every woman asks, and it often stops women taking medicine they need. MotherSafe's factsheet says moderate nausea and vomiting won't harm a developing baby, and that the medicines above are used in pregnancy. Being severely unwell and dehydrated, without treatment, carries its own risks.
If you want to check a specific medicine, MotherSafe will talk it through with you for free.
MotherSafe: 02 9382 6539 (Sydney) or 1800 647 848 (rest of NSW). They offer assessment, management advice, referral and follow-up for nausea and vomiting in pregnancy. Source: MotherSafe, Royal Hospital for Women, Nausea and Vomiting of Pregnancy (NVP) and Hyperemesis Gravidarum (HG), June 2024. Doses are MotherSafe's general guidance, not a prescription. Check with your midwife, GP or pharmacist before starting any medicine, especially if you take other medicines or have other health conditions.
If You're Also Struggling With Your Mood
HG doesn't stop at your body. The exhaustion, the isolation, and the feeling of not being taken seriously can tip into something bigger. Perinatal anxiety and depression are common alongside severe nausea and vomiting in pregnancy, whether or not you've experienced anxiety or depression before, and it's a normal part of what we'd talk through together, not a separate issue.
PANDA National Helpline · 1300 726 306
Monday to Friday, 9am–7.30pm · Saturday, 9am–4pm (AEST/AEDT) · open all public holidays except Christmas Day.
PANDA is not a crisis service. If you're having suicidal thoughts or feeling disoriented, call Lifeline on 13 11 14 (24/7). Call 000 for police and ambulance if you or someone else is in immediate danger.
What the Guidelines Say
Australian and New Zealand clinicians follow the SOMANZ position statement on managing NVP and HG. The short version: you don't need a specialist referral, waiting it out isn't the recommended approach, treatment escalates only as needed, and fluid replacement often doesn't require hospital admission.
More Support, Beyond This Practice
MotherSafe
Free NSW telephone counselling on managing nausea and vomiting in pregnancy and medication safety. Call 1800 647 848.
Download their NVP/HG factsheet →Fees and Medicare
| Appointment | Length | Fee | Rebate | Out of pocket |
|---|---|---|---|---|
| Telehealth Review | 45 min | $185 | $75.65 | $109.35 |
| Clinic Appointment | 45 min | $185 | $75.65 | $109.35 |
| Home Visit | 45 min (incl. travel) | $270 | $75.65 | $194.35 |
| Fluid Therapy | — | Standard fee + $20 | Varies | Contact to confirm |
Rebates shown are estimates. For full description see Medicare. Yours may be higher once your family's Medicare Safety Net threshold is reached.