Morning sickness is not always a fair description of nausea and vomiting in pregnancy, because it is hardly an exclusively morning experience. It is especially common during the first part of pregnancy. There is no clear consensus within the medical community on what causes morning sickness. This unpleasant symptom has been associated with many varied conditions but increasing levels of hormones during pregnancy does play a role.
"How do I know if I have morning sickness?" Nausea, gagging, vomiting, aversion to food - if you're feeling these things on a regular basis, you have morning sickness. Mild cases of nausea and vomiting do not harm your baby. It will eventually end and you will be able to eat and feel better soon.
Most women wake up sometime around their fourteenth week and realize that their nausea has disappeared and that food is appetizing once again.
"What can I do to feel better?" Until nausea and vomiting goes away, here are some tips that might make you feel better:
Take a supplement of vitamin B6 (Pyridoxine). Pyridoxine has a good safety profile with minimal side effects and is easy to obtain; therefore, it is a reasonable first-line treatment for nausea and vomiting during pregnancy.
When you awake in the morning, sit on the side of the bed for a few moments and then get up slowly.
Eat dry toast or crackers in the morning while sitting on your bedside.
Avoid stuffy rooms and odors. Get plenty of fresh air. Try a short walk outdoors or sleep with your window open.
Cold, clear and carbonated drinks are tolerated well in small amounts. Also sour drinks such as ginger ale or lemonade are also tolerated better. Try drinking little amounts of fluids all throughout the day.
Eat frequently, five small meals each day. You do not want to let your stomach get empty. Make sure to sit upright after meals. Eat foods that are low fat and easy to digest.
Avoid smells that bother you. Aromatic therapies with a hint of lemon, mint, or orange have been described as useful.
Taking prenatal vitamins before bed with a snack, instead of in the morning on an empty stomach, may also be helpful.
Try children's chewable vitamins with folate if you cannot take your prescribed prenatal vitamin.
Acupressure wristbands used during the day do not require a prescription and have become popular.
Ginger containing food, such as ginger lollipops, help for mild nausea and vomiting.
Hypnosis has been reported to be helpful.
If your nausea and vomiting become severe: and you are losing weight and not able to keep any foods or fluids down, call your doctor. You need to be evaluated for a condition called Hyperemesis Gravidarum that requires a stay in the hospital.
Severe Morning Sickness Nausea and vomiting that is normally seen in early pregnancy varies in its severity. When it becomes severe, it is called "Hyperemesis Gravidarum." Frequent vomiting can lead to dehydration requiring hospitalization.
"When should I call my physician?" When morning sickness is mild, you do not need to see your doctor until your scheduled appointment, but you should definitely be seen if any of the following symptoms occur along with your vomiting:
Decrease frequency of urination
Dark colored urine
Dizziness when you standup
Constant vomiting during the day
If blood is seen in your emesis (vomit)
Associated lower or upper abdominal pain
Cramping and/or pelvic pain
You are not able to hold any liquids down
Fever
Diarrhea or constipation
"What causes severe morning sickness?"
The cause of severe morning sickness (Hyperemesis Gravidarum) has not been established, but several theories have been described.
Conversion reaction - You may have hesitancy about your pregnancy and instead of voicing your feelings; you convert your feelings into severe vomiting.
Hormones - The elevated pregnancy hormones, estrogen and progesterone, are thought to cause nausea and vomiting. Morning sickness is seen frequently in pregnancy with multiples (twins or more), due to the higher level of pregnancy hormones in twin gestation than a single pregnancy.
Decreased Gastric Motility - The food sits in your stomach and does not empty causing a burning sensation (indigestion)and pressure.
"Are there any treatments to stop my vomiting?" The treatment of severe vomiting in pregnancy is aimed at keeping you from becoming dehydrated. There is no treatment available to completely eliminate your symptoms, but we can make you feel more at ease. Fortunately by your second trimester your nausea and vomiting will subside and you will be feeling better. With or without treatment, all of your symptoms will resolve.
If you are not able to keep any food or liquids down, you should let your physician know. Your physician most likely will put you in the hospital and run a few tests.
In the hospital an intravenous (IV) line will be placed in your arm to replace your lost fluid and electrolytes.
Initially, you will not be allowed to eat or drink anything. This will allow your stomach to rest.
You will slowly be started back on food and drinks in about 24 to 48 hours. Your diet most likely will consist of high carbohydrate meals such as dry cereal. Your drinks will be carbonated, clear lemon tasting drinks such as 7-up, ginger ale or Sun Drop.
With severe forms of vomiting that do not respond to IV hydration and if you continuously lose weight, you may be started on parental feedings (feedings through your veins).
"What medications can I safely take?" To help you through this difficult time, your physician may prescribe medications that are safe to take during your pregnancy and will reduce your nausea and vomiting.
Vitamin B6 - Vitamin B6 supplements (10 to 25 mg tabs, three times a day) will help you with the nausea, but does not stop the vomiting.
Phenergan - Phenergan (Promethazine) is a great antiemetic medication that requires a prescription. It can be given either by mouth, injected or as a rectal suppository. You will most likely be prescribed the rectal suppository if you have frequent vomiting.
Reglan - Another great medicine to help stop the vomiting is Reglan (Metoclopramid). It prevents nausea and vomiting by helping the stomach empty quicker than normal. This will decrease indigestion and the burning feelings associated with nausea.
Zofran - One of the most expensive anti-nausea medications, Zofran (Ondansetron) is actually the most effective option. Zofran was initially used to treat vomiting in cancer patients receiving chemotherapy, but obstetricians found it works in pregnancy as well.
"I am worried that I will not gain enough weight with all this vomiting?" Almost all pregnant women that had severe vomiting in pregnancy will recover completely and gain adequate weight. But, it has been shown that you will probably not gain as much weight as others.
This is not a problem for your baby unless you were 10% underweight before your pregnancy. If you were overweight before pregnancy, it is less of an issue if you don’t gain the average amount of weight. The normal weight gain for pregnancy depends on your pre-pregnancy weight but on the average a woman will gain 14 to 25 pounds.
If you had to be re-admitted to the hospital multiple times for severe vomiting and did not gain the normal amount of weight, there is a small chance your baby will be smaller than normal.
If you had severe vomiting during this pregnancy, there is a 15 to 20% chance that you will experience this during your next pregnancy.
