When Chantal Umulisa became pregnant with her first child, she expected some nausea and vomiting. Like many women, she had heard that feeling sick was a normal part of pregnancy and assumed the symptoms would eventually pass.

But the vomiting became so severe that she could barely keep down food or water.

"At first, I didn’t know what was happening to me. I couldn’t keep down any food or even water. It was terrible,” recalls Umulisa, a resident of Bumbogo.

Foods she previously enjoyed, including chips and meat, suddenly became difficult to tolerate. Even their smell could trigger nausea, while eating or drinking was often followed by vomiting.

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As the weeks passed, she lost weight, became extremely weak, experienced dizziness and sometimes fainted.

It was only after the symptoms persisted that she and her husband sought medical attention.

"We decided to visit our gynaecologist and explain what I was going through,” she says.

She was diagnosed with hyperemesis gravidarum (HG), a severe form of nausea and vomiting during pregnancy.

For Umulisa and her husband, the diagnosis was unfamiliar. They had assumed the vomiting was simply part of pregnancy and did not realise how serious it could become.

"The doctor explained it to us and advised me to go to the hospital for treatment, where I was given fluids, vitamins and medication to control the vomiting,” she says.

When morning sickness becomes a medical problem

Nausea and vomiting are common during pregnancy and are often referred to as morning sickness. For many women, the symptoms are manageable and do not prevent them from eating, drinking or carrying out their normal activities.

But for some, vomiting becomes persistent and severe.

Dr Concorde Ishimwe, a Chief Medical Officer at CHUK and King Faisal Hospital Rwanda, says the key difference is not simply how often a woman vomits, but whether the symptoms begin to affect her health and ability to function normally.

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"Normal morning sickness usually causes nausea and occasional vomiting, but the woman can still eat, drink and function normally. Hyperemesis gravidarum is much more severe, with persistent vomiting, inability to keep fluids or food down, weight loss and dehydration,” he says.

Warning signs include passing very little or dark-coloured urine, dizziness, fainting, severe weakness and repeated vomiting.

For pregnant women and their families, recognising these signs is important because severe vomiting can quickly affect hydration and nutrition.

A condition that can be easily dismissed

Vomiting during pregnancy is often considered normal. In Rwanda, as in many other settings, pregnancy-related vomiting can be treated as something a woman simply has to endure.

That perception can make it difficult for women and their families to recognise when symptoms have gone beyond ordinary morning sickness, potentially delaying treatment.

Umulisa's experience shows how easily this can happen. She and her husband initially expected the symptoms to pass, seeking medical attention only after her condition deteriorated.

Dr Ishimwe says women should not wait until they are severely dehydrated or weakened before seeking help.

"When a woman cannot maintain food or fluid intake and is losing weight, she needs to be assessed by a healthcare professional,” he says.

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When the whole day revolves around vomiting

For Hope Ingabire, a mother of three from Kanombe, severe vomiting affected much more than her physical health.

There were days when she was unable to go to work because of the vomiting and exhaustion. Even when she managed to report to work, concentrating and completing her normal duties became difficult because she constantly felt unwell.

Her responsibilities at home were also affected. Tasks she would normally handle became difficult as nausea, repeated vomiting and lack of energy left her exhausted. She also made frequent trips to hospital for treatment.

Looking back, Ingabire says the experience showed her how severely pregnancy-related vomiting can disrupt a woman's life.

The effects of HG are not limited to dehydration. Prolonged vomiting can cause electrolyte disturbances, weight loss and nutritional deficiencies. In severe cases, prolonged inadequate nutrition can lead to thiamine deficiency and associated neurological complications.

There can also be psychological and social effects, particularly when a woman is unable to work, care for her family or participate in normal activities.

Most women experiencing nausea and vomiting during pregnancy go on to have healthy pregnancies. However, severe and prolonged HG, particularly when accompanied by significant weight loss and nutritional problems, can increase the risk of poor fetal growth.

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Getting the right treatment

Diagnosis is primarily based on a woman's symptoms and their effect on her health.

Health workers assess the severity and duration of vomiting, whether the woman can keep food and fluids down, changes in weight, urine output and signs of dehydration. Blood and urine tests may also be used to assess complications and rule out other conditions.

Treatment depends on the severity of the symptoms.

Women with milder symptoms may benefit from eating small, frequent meals, drinking enough fluids and avoiding foods or smells that trigger nausea. When vomiting begins to interfere significantly with eating, drinking or daily activities, medication to control nausea and vomiting may be needed.

For women who are dehydrated, intravenous fluids and correction of electrolyte abnormalities may be necessary. Those who have experienced prolonged vomiting and poor nutritional intake may also require thiamine supplementation and nutritional support.

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"Treatment includes antiemetics, oral or intravenous fluids, electrolyte replacement, thiamine and nutritional support. Severe cases may require hospital admission,” Ishimwe says.

In Rwanda, women can seek care at health centres, district hospitals or referral hospitals depending on the severity of their condition.

Don't wait until you are too weak

The message for pregnant women is not that every episode of vomiting requires a hospital visit.

Rather, persistent vomiting should be taken seriously when it prevents a woman from eating or drinking normally or affects her ability to function.

A woman should seek medical attention if she cannot keep fluids down, passes very little or dark-coloured urine, experiences dizziness or fainting, loses weight, becomes progressively weak or continues vomiting despite initial measures.

Severe vomiting accompanied by abdominal pain or fever also requires medical assessment because other conditions may need to be considered.

For families, recognising these signs is equally important. A pregnant woman who is repeatedly vomiting should not simply be told to endure it because "that is what pregnancy is like.”

Umulisa's experience is a reminder of what can happen when severe symptoms are mistaken for ordinary pregnancy discomfort.

What began as vomiting eventually left her dehydrated, weak and losing weight before she received the treatment she needed.

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Knowing when to seek help

Hyperemesis gravidarum does not necessarily mean a pregnancy will have a bad outcome. But the condition can become serious when vomiting prevents a woman from maintaining adequate fluids and nutrition.

Early assessment allows health workers to identify dehydration and other complications and begin treatment before the woman's condition worsens.

For pregnant women, the simplest guide is to pay attention to what the vomiting is doing to the body.

If a woman can no longer keep down food or fluids, is losing weight, producing very little urine, becoming dizzy or faint, or is too weak to carry out normal activities, it is time to seek medical care.

Pregnancy may come with nausea and vomiting. But when a woman can no longer eat, drink or function normally, it should not simply be written off as morning sickness.