"Unequal Care Provisions Available"

I am unable to post the Brand Name of the medication it is known as and indicated as in the policy - therefore I am referring to it generically as Doxylamine/Pyridoxine.

I am writing to express my concerns regarding the Hyperemesis Gravidarum Policy (2020) and its implementation, which appears to not be adhered to in my experience. According to the policy (pg9), Doxylamine/Pyridoxine is designated as a first-line anti-emetic; however, during my consultation with an obstetrician and then a consultant in gynaecology, I was informed that it is not recognised. Both medics appeared misinformed about current treatment options available in Scotland. They could not explain why Doxylamine/Pyridoxine is stated in this policy as first line treatment. Instead I was told Doxylamine/Pyridoxine was not a first line treatment in HG, I could ‘come in for a drip like other girls’, offered medications that have more side effects, and that it ‘may pass and was generally taken unseriously.

The policy indicates that Doxylamine/Pyridoxine although first line is not available in Scotland, which contradicts the fact that it is accessible in other Scottish Health Boards, creating a postcode lottery for patients. I checked the SMC who indicate it could be requested for prescription, which other health boards have clearly done. I would like to know why Fife health services are not keeping pace with available treatments.

Additionally, why do NHS Fife not have a dedicated team specialising in Hyperemesis Gravidarum? This would facilitate communication among healthcare professionals (especially GP to consultant/midwife) as there seems to be significant disagreement and lack of awareness regarding effective treatment protocols. It would also act as emotional support for patients experiencing HG during, prior and post birth. Such as myself, wanting support prior to pregnancy with a clear care and treatment plan in place for all professionals to follow; but following an appointment with my GP in May there is no such thing. So who do I turn to, to ensure I will be supported prior to pregnancy and be offered medications prior to symptoms as per NICE guidance, as it is evidenced this will likely reduce duration and severity of symptoms.

Why if you are known to have HG is there not an option to be referred to a consultant or specialist team to discuss these issues?

As per national maternity voices website, NHS Fife wasn’t even recognised to have an MNVP Service. And if we do, then it’s very inaccessible as I would have complained directly to them to resolve.

This situation has profoundly impacted my health and family planning. I am in my 30s and have faced multiple (unwanted) terminations due to poor treatment options from multiple services in NHS Fife. My first pregnancies I was led to believe that the symptoms would naturally resolve, receiving only medication for seasickness from my GP with no onward referrals. This time, having a lot more evidence based research behind me and support from PSS I sought Doxylamine/Pyridoxine due to its efficacy and minimal side effects for many women, I was disappointed to be informed that it would not be prescribed it and felt like this was not a recognised debilitating pregnancy complication. I currently have no dependants/children for reference so has significantly impacted my life trajectory.

This is not a complaint about specific medics or staff involved, but the unequal care provision offered in NHS Fife compared to the likes of Lothian or Grampian. I am very disappointed in the lack of treatment options, awareness and support provided by NHS Fife regarding HG and feel not just mine, but other women's choices regarding pregnancy might have been quite different if efficient care was offered. Is there anyone driving these issues forward for a resolve and who?