“Shifrah: Supporting women with hyperemesis” – with Shayna Safran

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist, practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.

Shayna, welcome to the podcast. Thank you for coming in. It’s so nice to see you. How are you doing today?

Shayna: It’s such an honor to be here.

Dr. Fox: Thank you. Thank you for driving in. You know, we could have done this over the phone, but you said, “I want to do it in person.” And it’s just great. You’ve been to our office before several times. We’ve met several times. Full disclosure, I am one of the medical advisors to Shifrah, for our listeners. Again, not a job. It’s volunteer position, but they should know we recorded here for your video for your terrific fundraising and awareness campaign, which, as you told me, did even better than expected.

Shayna: It was amazing.

Dr. Fox: It’s great. And we’re going to get into Shifrah, obviously, in a lot of detail. But before we do that, if you could tell our listeners a little bit about yourself, who are you?

Shayna: Sure. So, it’s really an honor to be here.

Dr. Fox: Thank you.

Shayna: For all the listeners out there, I just have to say, Dr. Fox is amazing. It’s really an honor to have you as part of our medical team. And I’m so happy to be part of whatever you do within Shifrah and outside of Shifrah.

Dr. Fox: Thank you.

Shayn: I live in Chestnut Ridge, which is outside of Monsey. I’m part of the Jewish community. And I’m originally from Canada. Spent a number of years living in Israel. Now, I’ve been living in Chestnut Ridge for a good number of years. Professionally, I’m a marital and family therapist. But practically speaking, because I’m a survivor of HG, it’s been quite difficult to advance in my career since HG really interrupts your life. And each time I tried to build my practice or advance in my career in any way, and then I wanted to have another child, my career really was affected.

So, my HG pregnancies were all different. Some were more mild, some were more moderate. My last one was severe to the point of life threatening. And we’ll talk a little bit more about that soon. Because I had the whole gamut of the HG experience, I feel like I’m in a very good position to relate to women on the whole gamut of HG because HG really presents in so many different ways. There’s a very wide range of presentations. And I’ve kind of been there in all different ways, and I really know what it’s like.

Dr. Fox: So, this is obviously a passion for you because you went through it so many times. Did this first enter sort of your world as a therapist, meaning you first started with, I’m going to see women or talk to families who’ve had this, or did it not come up at all in your own professional world?

Shayna: No. Professionally, I was working with couples. So, it would come in occasionally, but that really wasn’t my focus. I was really kind of trying to keep HG out of my life as much as possible, except for when it intruded and I couldn’t control it. So, I really wasn’t looking to make HG a career or a focus at all. I was kind of trying to get around it as much as I could until after this last pregnancy when it just hit me so hard that I really had no choice but to confront it.

Dr. Fox: Right. So, tell us about that. What happened? Because you have how many children?

Shayna: I have six.

Dr. Fox: You have six children, and you’ve had it to some degree varying in all your children. So, what was it about this last pregnancy that sort of shifted you into, like, all right, we’re going to tackle this?

Shayna: So, the last pregnancy was extremely, extremely debilitating. I thought I knew what I was getting into. Like, I had done this before. I really wanted another baby. I knew what it was going to mean. And then all of a sudden, I just, like, totally became so, so, so sick. I didn’t realize that it could be possible for someone to get that sick with HG. Besides for the…what we could say is regular nausea and vomiting, I got a lot of, like, scary neurological symptoms. I lost my ability to walk on my own. I couldn’t talk. I couldn’t see clearly. I had debilitating migraines, and I really became completely incapacitated. I could barely lift my head off the pillow. And it was really, really scary. So, my family was really concerned. We knew what HG should look like. And this didn’t look like what we were used to.

So, we went to the doctor, and they were really concerned. I mean, I was, like, brought in a wheelchair and carried in. And the doctor said to me, well, why can’t you walk? And I kind of looked at him through my haze. And I was like, you’re the doctor. Why are you asking me what’s wrong with me? You should tell me. And he was like, I don’t know. I guess you just have HG. And he didn’t do any further testing. And he didn’t prescribe anything except for, like, the basic medication that I had taken all along, and just fluids. And I basically just lay there and starved. And it was awful. There are no words to really describe how awful it was.

And I survived, really, just by the grace of God. And the baby was also okay, by some miracle. But after the pregnancy, my body was destroyed. I couldn’t walk. I couldn’t lift the baby. I couldn’t take care of myself. And I had already gone through nine months of hell. And here I was, like a shell of a person. And it just didn’t make any sense.

So, we started to, again, look for a solution, look for a doctor who could help, and went to this specialist and that specialist. And nobody had any answers. And nobody was able to say, oh, this is what happens. And this is what you need to do. And they were all like, I don’t know, give it time. And I was like, time is not changing anything. I need answers. What happens to me?

And since nobody was able to give us any answers, we started to do our own research, and started to dig and dig. And I had always been interested in research and more medical minded, and started to read and read and read, and look at all the different medical associations and what their information on HG was, and go on to PubMed and read articles. And I came to the realization that I had developed severe vitamin deficiencies that weren’t attended to because a person can’t live just on water for nine months.

Dr. Fox: Right.

Shayna: And that’s what made me so, so sick.

Dr. Fox: When you say, we, who is the we? Is it just you and you’re saying we to be kind, or is there, like, a…was there, like, a team with you that were looking into all these things?

Shayna: Well, first of all, my husband literally kept me alive. So, I have to say, if not for him, I wouldn’t be here. He literally changed my IV bags. He carried me to the bathroom. He spoon fed me little, little, tiny bites of whatever I could possibly tolerate. And he kept the whole family going. And my family, my parents, my siblings were all really, really supportive in the actual research. I have one sister who is extremely, extremely determined. And she doesn’t take no for an answer. And she will find answers to whatever it is. She doesn’t give up.

Dr. Fox: I feel like everyone has a sister like that.

Shayna: Yeah. She’s really incredible. Her name is Ricky [SP]. And she just said, like, there has to be an answer. Like, how could it be that you went to every doctor and they just said, we don’t know? There has to be more information. And she just sat nights and nights and nights, and searched the internet, and went digging deeper and deeper. And then one day, she called me and said, you had a thiamine deficiency. And I was like, what’s that? And then she sent me information to read. And I was like…it was like textbook. All my symptoms were right there.

Dr. Fox: Right. And none of the doctors you saw…

Shayna: No. Nobody said anything about B1. Nobody suggested I take B1. Nobody said, like, you’ve got classic B1 symptoms. It was literally textbook, the blurred vision, the lack of balance, the severe head pain, the inability to speak, the refractory nausea. It was like…it was unbelievable that nobody had even considered it. And even had I been given vitamin replenishment routinely through IV as hyperemesis patients should receive, it would have helped, but I just got fluid. It wasn’t even LR, it was just basic water.

Dr. Fox: Right.

Shayna: So, she said, okay, this is what your problem was. And now, you need to start taking B1. And I started, even at that point postpartum, getting infusions of B1. And that’s when I started to get better. I started to slowly be able to walk on my own, started to see better, started to regain some of my basic functioning, and over time, with the vitamin infusions, build up some strength.

Dr. Fox: Did you know at the time, while you’re going through this when you were pregnant, before, you know, all the research and all this, did you know that something was off, that you weren’t getting sort of the treatment you needed? Or did you just feel like, I guess I have a worse case than everybody else does?

Shayna: No. At the time, I knew I was really sick, but I totally just trusted the doctor. And that was actually a very painful process afterwards to realize how the medical system really let me down by just kind of looking at the computer screen instead of looking at the patient. Like, they looked at my labs, and my labs looked okay. And they didn’t look at the person sitting there, who was so, so, so ill and say, like, what are we missing here? And I feel like had I had that kind of care, where the doctor would have seen me and really tried to think a little bit outside the box, like, this can’t just be typical hyperemesis, what can we do to help her, things could have been different.

Dr. Fox: And so, afterwards, when you sort of came to this realization and, you know, starting the treatments, what was it, if there was one thing or a moment that you can remember, that said, I’ve got to turn this into, like, something for others? It’s what you did, ultimately.

Shayna: Yeah. So, I had one friend… You know, HG, we find each other. We all become sisters. It becomes like a community. So, I had a close friend who also had HG. And when I was about a year postpartum, she was at the beginning of a pregnancy. And she reached out to me and said, like, help.

Dr. Fox: Yeah.

Shayna: And I said, okay, let’s see what we can do about taking some of this information and bring it to your doctor. And I gave her some information to bring to her doctor. And she did better. And then I was like, this is crazy. Like, there’s this information, it’s here, I have it. And I see that it makes a difference. Why don’t the doctors know this? And if we can have pregnancies and have the babies that we want so badly without having to give up our health, then that needs to get out there. So, that was the beginning. I had no idea where this would go. I was really, at that point, just feeling like, let me share this with some of my friends, just, you know, organically. Let me share this with the women that I know who have HG in my community. And they should bring this to their doctors. And I started to just kind of spread it by word of mouth just with my friends, because I saw the difference that it could make.

And shockingly, to me, they were just doing so much better. They stopped vomiting, they started eating. They were saying, this is like a whole different world. And one woman turned to 10, turned to 20, turned into 50. And by, like, 100 women, my rabbi, who I’m very, very close with, said to me, you know, this is something that’s really important for the community. And I think you need to start a nonprofit organization, and get this out there in a bigger way. And I was like, no way. No way. That’s not happening.

At that point, I was still really, really weak. Like, I still couldn’t walk more than five minutes at a time without needing to stop to rest. I still couldn’t drive, couldn’t really go out of the house. And I was like, I could barely take care of myself. How am I going to start a nonprofit? But he said, I really, really think this is life-changing information. And you can’t just keep it to the few women who can find you. This is something everybody needs to know.

Dr. Fox: That’s very forward-thinking, you know. That’s great advice. So, what do you… So, you obviously agreed to do it in some capacity.

Shayna: It took a few conversations. You really had to kind of work on me because it’s a huge responsibility to put yourself out there in the community like that. And the Jewish community is so supportive. We have so many different organizations for all kinds of different problems. But there was nothing for HG. There was no organization. So, it felt very scary to become that person to step into that space and take that responsibility to go public.

Dr. Fox: Right. How do you plan that? What’s the outline? Do you sit down with someone who’s done this before? Do you just reinvent the wheel? Like, I’m just…I’m really curious, like… Because you’re taking something literally from ground zero. It doesn’t exist, right, in the Jewish community. And you’re like, I’m going to do this. You got to fill out paperwork, you got to get donors, you got to… How do you even know what to do in that setting?

Shayna: So, what’s interesting is that this specific organization didn’t exist, but we have so many organizations that there is support for people who want to start a nonprofit. So, a friend of mine introduced me to Cynthia Darrison, who’s the executive director at Nefesh International, which is the international network of Orthodox mental health professionals. But on the side, Cynthia has a program called the Chesed Leadership Program, where she takes women in the Orthodox Jewish community who would like to do something for the community, and trains them in how to build a successful nonprofit.

Dr. Fox: Oh, wow. That’s great.

Shayna: It was incredible. So, I took her course. It was a yearlong course. And we learned everything we had to know, literally from how to file for 501(c)(3), to how to develop a board, how to fundraise effectively, how to train staff, how to interact with the community, cultural sensitivity. And it really taught me everything I needed to know to set myself up properly to run a successful nonprofit.

Dr. Fox: Wow. That’s amazing. I didn’t even know that existed. What a great resource.

Shayna: Yeah. It’s an incredible program. And she’s an incredible person to just dedicate herself to the people who want to give back to the community. So, I learned so, so much from that. And that’s really… And I still till today go back to Cynthia whenever I have a question. Anytime I need help with anything or I’m stuck, she’s just a wellspring of knowledge and guidance.

Dr. Fox: Right. And while you’re doing this, or while you’re starting Shifrah…but how did you choose the name Shifrah?

Shayna: So, that goes back to some biblical… I don’t know how many of your listeners are familiar with Bible.

Dr. Fox: Fair number. And if not, we’ll teach them.

Shayna: So, let’s go back to the story of the Jews in Egypt, way, way, way back when, when they were enslaved. And the Pharaoh was intent on killing the Jewish babies. So, he made a decree that as soon as all the babies were born, they should be killed. There were two midwives at the time, who were in charge of the births of all the Jewish women. And their names were Shiphrah and Puah. And he called them in and said, when you go to a birth, as soon as the baby’s born, you must strangle the baby. And the babies may not live. And that was just decreed to them on penalty of death, that if they don’t listen to him to kill the babies, he’ll kill them.

Now, these were really heroic, strong Jewish women. And they said to each other, we’re not going to let this happen. So, they went to the births, they helped the women, they let the babies live. And he called them back in and he said, what’s going on? I told you to kill the babies. And they said, well, the Jewish women just birth so quickly. By the time we get to the birth, the babies are already all born, and the moms are holding them. It’s too late. We can’t do anything. So, they defied his decree to save the babies.

And the word Shifrah is a Hebrew word, which means to improve, which means really to improve outcomes. So, what Shiphrah was doing was improving the outcomes of these babies that should have died, and she was keeping them alive. So, to me, that was very, very symbolic. Because we as women who have HG, it really is what feels often like a life and death struggle for us to bring these babies into the world to survive the pregnancy, and to get to the happy ending of a live and healthy baby. So, having that strength of I’m going to overcome HG, I’m going to get to the other end, I’m going to do this, and I’m going to have a better outcome, that, for me, was the symbol of what I wanted this organization to be.

Dr. Fox: Wow. When you’re doing this, what kind of support did you have from… I guess, obviously, family, friends are going to support you. But from the community at large, were there people who signed on early to help you or support you financially? You know, did you have that at the beginning, or was it really just, like, a one-woman show?

Shayna: So, I had…I definitely had support in terms of, as I mentioned, my rabbi before. He’s one of my biggest supporters, really, and encouraging everything I do. And I have wonderful family that is just so, so proud and cheerleading everything I do, and good friends. And I got a couple of women who went through HG themselves, who offered to volunteer at the beginning, to help with getting things set up, you know, just the technical aspects of IT, whatever I needed, and then helping with answering the phones.

The fundraising was a challenge. I had to put myself out there, start telling my story, and sharing a vision of what I hoped to accomplish. And people responded in a very heartwarming way, with enough at the beginning just to kind of get things off the ground, like for seed money. And then I shared my story with different people in the community who had potential to help, and they responded enough for us to grow. And we did a couple of events that helped with fundraising. And then we did this amazing crowdfunding campaign. And the community was just so responsive and so appreciative of what we’re doing and really there to help us to grow and to be able to improve our services and expand our services.

Dr. Fox: It’s really amazing. Were there any naysayers? Did you get any negative, whether feedback or people, you know, said don’t do this, or it’s not going to work, or it’s not worthwhile? You know, I’m just curious if anything came up in the opposite direction.

Shayna: There are always naysayers.

Dr. Fox: Okay.

Shayna: Right? There are always those people who are like, do you know what you’re doing? And how do you know if you could do this? And who says you know better than anyone else? And then the biggest question is, why do you think you know better than the doctors? So, that’s really…we haven’t talked at all about really what we do at Shifrah, the research I’ve done, but that [crosstalk 00:18:47] to that.

And that’s something that a lot of people struggle with, like, how could it be that there’s such a gap in knowledge and our providers don’t have this information or not giving us the care we need? And do you really think, like, you’re not a medical professional, that you know more or you know how to find more? So, that’s definitely something I’ve come across a little bit. But I really would have to say, those voices were really the minority. Most people were just so, so grateful and thrilled that someone was taking the initiative to do that research, to look a little further, to try to bring better opportunity to women who are suffering from this condition.

Dr. Fox: I’m trying to think. I don’t remember if it was how we got connected or we got connected at the same time, but I heard about you through my cousin.

Shayna: Yes, that’s how.

Dr. Fox: Yeah. So, it is how we got connected. I was trying to remember if he told me at the same time you emailed me or if, like, he said, you guys should connect. But my cousin, I know him as Koby [SP], but he’s Yaakov Robinson in Chicago. But sorry, Koby [inaudible 00:19:49]. And he said, yeah, this is, like, great. I met this woman. She had an event, and it’s really terrific stuff. You guys should speak. But I mean, there, you’re like…you’re going on tour. Right? This is at another city where you’re doing a fundraiser. So, I mean, obviously, you had some tailwind behind you already as this was going, which is great. And he said it was very, you know, successful. And it was very impactful. I mean, he doesn’t email me or, you know, WhatsApp me typically about people who he meets at a parlor meeting. So, that was good.

Shayna: Yeah. Well, that was really amazing. I got connected with a wonderful, wonderful woman, Chaya Tova Hartman, [crosstalk 00:20:24] in Chicago, who herself went through HG. I got connected with her through a mutual friend. And she was just so touched by what I was doing. And she said, “I really want to help you grow and expand. And I would like the women of Chicago to be able to learn about what you do.” So, I came in. We did a women’s event. And we didn’t know what to expect because the Chicago Jewish community, by comparison to New York, is a tiny community. The room was overflowing. We had probably, like, 100 or 120 women come to hear about HG. And it was just incredible. They were so eager to learn and so grateful to hear about what we have to offer.

Dr. Fox: We’re a small community, but we’re energetic. We’re full of passion as Chicagoans. We’re in.

Shayna: Absolutely. Very, very much so.

Dr. Fox: Yeah. It’s great.

Shayna: So, then I met Rabbi Robinson. And he said, you know, “I have this cousin, Dr. Fox. He’s really fabulous. He’s the best in MFM. And I think you should talk to him.” And I said, “Oh, please, can you introduce me?” Because I had known about…I heard about you before, but I wasn’t just gonna, like, call you up and say, “Hey, do you want to know what I’m doing?”

Dr. Fox: Well, I very likely would have responded anyways. So, I guess, why don’t you tell our listeners, what are you doing? So, what does Shifrah do? Right? So, we know how you got there. We know why you started it. We know that you have support for this. It’s related, obviously, for women with hyperemesis. But what exactly does Shifrah do?

Shayna: Okay. So, Shifrah does a couple of things. My goal in starting Shifrah was, I want women to be able to have the safest, most manageable experience of hyperemesis that is possible. And from my own experience… And as I said, I had multiple different experiences. So, I had really run the gamut of what HG could look like. And from my HG community of friends, I saw over and over that women were just so sick. They were vomiting, and vomiting, and vomiting, and losing weight, and getting dehydrated, not able to work, not able to take care of their family. But we really want those babies.

And I think, specifically in our community, in the Jewish community, there’s a very, very strong value on large families, and a very intense spiritual and emotional pull to have a family, and to have multiple children. And we really deeply want those babies. And women were really sacrificing their health in order to be able to have more children, and to grow their families.

And when I saw that there was information about how this could be done differently, that we weren’t being offered, my feeling was, like, this is what we have to change. We have to take what I’ve learned, and package it in a way that we can access as patients, because we need to be our own advocates. And if our doctors are missing that education, if there’s a gap for some reason, and they don’t have that information, and they’re not giving us the treatments that make a difference, then we need to stand up for ourselves, and be able to come in and say, hey, I want a better outcome. I think this will help me. Can we try it? So, empowering the women to know that there is a different way, and there are medications that can help.

I mean, so many women come to me and they have no idea that there’s anything more than Bonjesta that’s out there. They just were never exposed to treatment options. And giving them the knowledge that there are many, many medications that can help, and then at the same time, building relationships in the medical community, and reaching out to medical professionals and to the health care providers, whether it’s an MFM, or an OB, or a midwife, or a nurse practitioner, who supports women in this space, and offering them continued education, offering them information about how they can better support their patients so that we can have a better outcome.

So, what I started to do when I started Shifrah was try to put this material together in a way that is organized so that I can offer the providers and the patients a very clear step-by-step guide to what to do when you have HG and what the treatment options are. And together with my chief medical advisor, Dr. Angela Silber, who’s the chief at Westchester Hospital, Chief MFM, who is a wonderful, compassionate provider, and dedicated so much of her time to help us with this project, I started to just categorize all the different options, and find a way to make it clear so that both patients and providers can see that there are options, and then understand what each option does and how they best could be combined. And in that way, my goal was to give patients and providers the tools to know how to treat this illness so that the symptoms could be better controlled.

Dr. Fox: Yeah. And I think it’s very important to emphasize, you know, from my side, from the medical side, we’re not talking about someone who’s just, like, going on Facebook and throwing up, like, oh, hey, why don’t you try this? I’ve tried this. Sort of, like, you know, kind of, you know, wacky things that people sometimes see online or this or that. This is, like, very well-researched. This is with a lot of medical support and looking through this. And, you know, I know the booklet that you came out with. I obviously support it. I think it’s terrific. It’s the same things that are recommended by medical societies, obstetrical societies, MFM societies. Everyone does it a little bit different, sort of different flavor on it. You know, whether you go ABC or ACB, whatever. But that’s basically the menu that you put on there are the same things that you would get from the Society for Maternal-Fetal Medicine, for example, from American College of OBGYN. We’re not talking about, like, crazy things. This is what is supposed to be done.

But you’re correct. Patients certainly don’t know about this. Maybe they do. Maybe they don’t. But usually, they don’t. And unfortunately, some doctors, or midwives, or NPs, or whoever’s taking care of pregnant women, also don’t know about this because, you know… So, I’m in a high-risk practice. So, people with hyperemesis or history of hyperemesis will sort of gravitate towards our practice. So, we have a lot of experience with it. And we’re very comfortable with a lot of these medications.

And so, the booklet, you know, most of it, I was like, oh, yeah, like, we do that, we do that, we do that. This all makes great sense. But there’s a lot of people who maybe see one severe hyperemetic a year, maybe, or less. Right? And so, for them, they’re used to just seeing the “typical” nausea, vomiting. We just say, oh, it’ll get better, wait a few weeks, try this, this. And they’re not used to all these other medications. And so, as doctors, as providers, they’re just a little more unfamiliar with it. When do you start it? How do you dose it? Or they’re uncomfortable with it because maybe they heard this or they don’t know.

And that’s a reality. Right? And that’s understandable. But this really helps bridge the gap. Say, hey, can we try this? Can we not try this? And then either they’ll say, yeah, I’m on board with it, or they’ll be like, I’m in over my head. Let me get someone else involved as another doctor, which is totally fine. Right? If you’re a doctor, and you feel like you’re in over your head medically, that’s why they have other doctors. Just call a consult, phone a friend. Like, it’s totally normal. But this really…in my opinion, why I signed on, it really does bridge that gap of what people know and what can be known. Right? We don’t know everything. Right? We see people with hyperemesis. We don’t cure them. We just try to make them better.

There’s a great movie called “Miracle,” which is about the 1980 U.S. Olympic hockey team, that I quote all the time, because the coach was a real hardass. He’s really tough on them. And he’s trying to…you know, he’s working them, working them, working them. And there’s a scene where they’re doing something and he says, better, not good, but better. Right? And so, he’s telling them, like, it’s a little bit better, but we’re not there yet. That’s what I tell people with hyperemesis. Like, I don’t know if I’m gonna make your pregnancy good. Right? But it’s gonna be better. Right?

And that’s the key. Every step that you get better is a significant impact on someone’s life. Right? They go from not getting out of bed to getting out of bed, or they go from getting out of bed to being able to walk, or they go from eating a little to eating more, or they go from drinking a little to drinking more, or they go from throwing up eight times a day to one time a day. Like, all those, you’re not perfect.

Shayna: But it’s life-changing.

Dr. Fox: Yeah. It’s huge. I mean, there’s a massive impact. It’s the same thing, like, with pain. Right? [inaudible 00:28:48] surgeon. They have a lot of pain. It’s not like if you’re giving pain medicine, they’re running around the house with no pain. But they feel better. Right? They’re more functional. And that’s really, really important. And so, I do think that this kind of information, when it’s presented in a way that’s digestible, usable, you know, user friendly, is really helpful for everybody. So, that’s [inaudible 00:29:09], you know, A plus. I think that’s terrific. So, you’re giving information. What else are you doing? Because you’re doing more. But wait, there’s more.

Shayna: There’s always more.

Dr. Fox: Yeah.

Shayna: So, there’s the healthcare providers. There’s the individual patients. There’s the family support. Because HG is a crisis not just for the individual woman, but for the whole family, especially when it’s a family with other children. The husband needs support, the children need support. So, we have a program of peer support Zoom sessions, facilitated by mental health professionals, where women who are currently going through HG, or women who are postpartum, or their spouses can come together a couple times a month on Zoom to talk to each other and to get support for what they’re going through. Because the general feeling is nobody understands me.

And what I hear over and over and over with so much pain from women is that they’re going through what’s really a medical crisis. They’re really, really, really sick. They’re not able to eat properly. They’re not able to drink properly. They’re dehydrated. Often they’re losing weight. Many times, they can’t function properly, get out of bed, walk around. And even the ones who are less severe and are able to even go to work are still coming home, and feeling dizzy, and collapsing into bed. They can’t cook for their family. They can’t take care of their family. They’re really sick.

And then they get comments from their friends, well-meaning friends, and they’re like, but I was also nauseous. I also threw up here and there, and I just washed my face and went on, and I did carpool. So, like, why are you making such a big deal about pregnancy? We’re all pregnant together, and we all do this together. And that type of lack of understanding and dismissiveness is very, very, very hurtful.

So, women feel very judged sometimes for not being able to do pregnancy the way people expect them to. Like, am I weak? Am I just, like, not set up to be pregnant? Am I a failure because everyone else is, like, walking around doing fine and I can’t pull it together? And sometimes, it’s even from well-meaning family that are like, so, just go out and take a walk, and you’ll feel better. And they don’t understand that this woman is really, really ill. She’s sick. So, that feeling creates a lot, a lot of isolation and loneliness, and sometimes even trauma when they’re so misunderstood.

So, having a place where we can come together with other people who really, really get it is so validating and so, so supportive. And it makes such a difference because if you’re in a crisis and you’re alone, that’s just awful. And to add the emotional desolation on top of the physical symptoms is just…it’s just too much.

And then we get to anxiety, and depression, and PPD, and PTSD. But if you can take these same experiences and put them in a holding environment and say, yes, it’s a physical challenge that is horrific, but you’re not alone, and you’re understood, and you’re supportive, and there’s a community of people that have got your back, then the emotional component really gets dialed down. And a woman could feel sick, but not traumatized.

Dr. Fox: Yeah. And I would think, also as you grow, and get more support, and help more people, it’s also going to just raise awareness in the general community about this. So, there is hopefully less of those things, and stigma, and judging, moving forward. I mean, almost very akin to the conversation we have about mental health all the time, that is, the more people understand and are aware, hopefully, it’ll lead to that. It’s a long road for all of these things. But for whatever reason, people still do respond to medical things more than mental health, unfortunately. But that’s a reality. And so, hopefully, the more you do this, the more people will understand that it’s different for this person than maybe what I had in my pregnancy. What do you see as the future for Shifrah?

Shayna: So…

Dr. Fox: World domination? I mean, what are we talking about here?

Shayna: The future? Well, our prayer is that we find a cure. There are clinical trials going on. There is research ongoing. And really, our hope and our dream and our prayers that it should come soon. And…

Dr. Fox: Right. You hope to be put out of business, as they say.

Shayna: Yes. So, that would really [crosstalk 00:33:41].

Dr. Fox: That’d be great. That could retire this.

Shayna: Yes. That would be ideal. But until that happens, we would like early awareness so that women should know about HG right away. And especially the young women who are going through a first pregnancy and don’t have a barometer for what’s normal, they should know that if they’re feeling sick, they should reach out for help. And they shouldn’t wait till they’re 16 weeks and they’re half dead. But they should… So many young women just have misconceptions about morning sickness, and assume that morning sickness means this awful, terrible, horrible thing. And that if I’m vomiting 10 times a day, that’s morning sickness. And that education about morning sickness is an uncomfortable part of pregnancy. It’s not dangerous. It’s not debilitating. It should not cause you to vomit more than once or twice a day. It should not cause you to lose weight. It should definitely not cause you to dehydrate.

And if you’re experiencing something where you feel like I cannot function and I feel really sick, reach out for help. Because the earlier you can get help, the better your outcome. So, that awareness to reach out for help early. I mean, I always feel so sad when I get a woman who’s 18, 20 weeks pregnant, she lost 10, 15, 18 pounds, and she’s so sick. And I know that had she found me in week six or week eight, her story would have looked so different. So, getting that awareness out there, not only for the young ones, but for everybody.

And then with the providers that service our community and the providers that service any pregnant woman who has signs of hyperemesis should know that we’re here to help, and that there are treatment guidelines available that can alleviate so many of the symptoms that hyperemesis causes. Vomiting really can be controlled if medication is given properly. And as you said, Dr. Fox, these medications are well-researched. They’re safe. It’s so much better for mother and baby to take medication so that mom can eat and drink and be hydrated than to vomit multiple times a day. And how that affects the fetus is something that, really, down the line, we see not only with how big the baby grows, but how the brain develops. There’s higher rates of ADHD and autism out of HG because if a baby’s brain is not fed, it can’t develop healthy. So, keeping the mom safe by giving her safe and well-researched medication brings a safer, healthier pregnancy, and a healthier baby.

Dr. Fox: Wonderful. How do people find you?

Shayna: So, really, most of it’s word of mouth. In our community, we’re all really interconnected. So, women just talk to each other. And there are WhatsApp groups for everything under the sun. So, there are HG WhatsApp groups in different locations. And people just post, have you heard of Shifrah? Have you heard of this resource? We do very, very minimal advertising because as it is, I’m so over my head with what’s coming our way. And we do have a very…you know, we have a website. So, we are online. If people Google, they’ll find us.

Dr. Fox: Tell us what’s the website.

Shayna: So, it’s shifrah.org. And I do occasionally get women who just stumble upon us through Google. We do have quite a number of women coming through their rabbis. Because one of the other areas that I haven’t mentioned yet is that I do a lot of outreach work to the rabbis in the different communities because of the way the community is set up.

Dr. Fox: Right. They’re like a point person.

Shayna: Yes.

Dr. Fox: Yeah. For a lot of people.

Shayna: [crosstalk 00:37:10].

Dr. Fox: Yeah.

Shayna: Any crisis that a family will go through, they’ll pretty much first turn to their rabbi for help, for support, and for resources. Like, we’ve got this crisis. Where do we turn? Where do we go? So, if the rabbis know about Shifrah, they’ll be able to refer the families to us. And we get many, many, many of our referrals through there.

Dr. Fox: That’s terrific. Shayna, thank you so much for coming in to talk about hyperemesis, talk about your experience, and talk about Shifrah. Thank you for what you do, for having this organization.

Shayna: Thank you for being a part of it.

Dr. Fox: I’m honored to be a part of it. It’s really a terrific organization. And, obviously, wish you nothing but tremendous success until we cure this and put you out of business.

Shayna: Yes.

Dr. Fox: In which case, we’ll find something else for you to do.

Shayna: Absolutely. Thank you so much, Dr. Fox. This was truly a pleasure.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.