27 Sep ‘N’ is for…Nausea!

By Nicolette Ferreira

Morning sickness… bleggh! Why do we feel nauseous during pregnancy and, (much) more importantly, what can we do to alleviate nausea and vomiting in pregnancy?

Why do pregnant women develop morning sickness?

According to Doctor Jennie Nowers (a South African GP now living in Australia), pregnancy nausea is the result of rising levels of bHCG (human chorionic gonadotropin). Whoa, I know, that’s a mouth-full! Simply put, it is the hormone detected in your urine during a pregnancy test. “The levels rise rapidly in the first trimester,” says Dr. Nowers, “and then start to fall in the second trimester. It is also why it is worse with multiple pregnancies as hormone levels are higher.”

Doctor Marilize de Wet (a GP from Somerset West and mother of three) explains that bHCG levels never return to 0 again during pregnancy, and because each woman’s body reacts differently to bHCG levels, some women may experience nausea throughout their pregnancy.

Hyperemesis Gravidarum (HG)

In extreme cases of nausea and vomiting, moms-to-be have to be hospitalised for what is known as hyperemesis gravidarum (HG). Quite recently we have learned of the Duchess of Cambridge, Kate Middleton, who was hospitalised for this condition.

HG is specifically dangerous as it might put excessive physical and emotional stress on both the pregnant body and unborn baby by leading to mother and baby becoming dehydrated and malnourished (some women lose a worrying percentage of body weight). The mother also, understandably, has no way of continuing a normal daily routine. This could be extremely worrying if a mother already has another child who needs to be taken care of.  Renee Izambard, wife of Il Divo singer, Seébastien Izambard, recalls her experience with HG as follows: “It [the vomiting] was constant, up to 40 to 50 times a day until I would vomit blood. I was suffering from malnutrition and dehydration. So I was hospitalized…”  http://www.dailymail.co.uk/health/article-2037894/Il-Divo-singer-S-bastien-Izambard-wife-Renee-tell-childrens-traumatic-births.html

Why do moms develop Hyperemesis Gravidarum?

It remains a debated topic why certain women tend to develop HG. Most sources seem to agree it might involve genetics (see http://www.reuters.com/article/2010/11/04/us-morning-sickness-idUSTRE6A34VJ20101104) or a person’s individual body chemistry (as explained by Dr. De Wet above – why certain women have morning sickness throughout their pregnancy).

In the case of multiple pregnancies (twins, triplets, etc.), it could be the body’s reaction to significantly higher levels of bHCG in the system. Dr. De Wet also says that a history of migraine and nausea might lead to HG, as well as overall bad health (being overweight or too stressed).

An EMG reader’s experience with HG:

Renée Murphy, a mother from Somerset West, was hospitalised with HG when she was expecting their twins, Rose and Heather.

“I had my first scan at six weeks and it was confirmed that I was indeed expecting twins. I remember taking a big bucket with me to the scan, as I constantly felt sick and could not eat anything! I was sent to hospital to be put on a drip – by then I already had a few days of excessive vomiting behind me and I was getting weaker.

After being put on a drip (which together with anti-nausea tablets did bring some relief), I had to go on a diabetic diet. Shortly after I could go on to a normal diet again, but with very little dairy products. I remember having horrible hunger pains (which worsened the nausea), but eventually (after the drip, diabetic diet and later normal diet with limited dairy), I was able to snack on some Tennis biscuits and Lays chips (salt and vinegar).

The anti-sickness medication that I received once I was discharged, unfortunately did not work for me and after three to four days of suffering at home I had to go back to hospital. I was given anti-sickness medication through a drip, leaving me wondering whether I was doing any harm to our unborn twins.

I also ended up getting a cold and eventually Bronchitis, as I had grown so weak. This was further agony, as I had to have physiotherapy and had to inhale through a nebuliser.

All in all I was admitted from week 6 to the end of week 13.  My whole family was praying that I would get better.  I did not know what to do anymore and in fact dreaded going home as much as I did not want to be in the hospital.  Being on the drip gave me horrible nightmares: I would be doing superhuman things in my dreams!

Once the first 13 weeks were over, I was still very weak – I had lost 12 kilograms. Someone suggested that I should take a certain health drink.  I started taking it and slowly got some strength back. Smoothies and jelly were also on the menu. I could also eat tomato and cheese sandwiches, but not much else.

While I was in the hospital, one of the nurses told me that another woman suffering from HG could only eat Marie biscuits and drink Coke for the whole duration of her pregnancy!

There are differing opinions regarding what causes HG. In my case it could be the multiple pregnancy, the IVF hormones I received (as I felt nausea building up during the treatment) or my Thyroid problem. Thank the good Lord that both our daughters are healthy!”

Relief for general nausea in pregnancy

We asked a few moms what helped them best with pregnancy nausea – what works for one might not work for another, but hopefully you will find something here that can help. If you suffer from HG, eating some of the foods suggested below might not help you at all – but in that case your healthcare provider will take care of your nutritional needs, possibly through intravenous nutritional support or by supplying you with an appropriate diet.

What alleviated your morning sickness?

Tracy Brown* (Stellenbosch): Dry, bland foods. This usually included crackers or toast, only lightly buttered. You don’t feel like eating, but really, hunger pains worsen the nausea. Sprite or anything with ‘bubbles’ also helped.

Este Van Wyk* (Bredasdorp): Medication took the edge off the nausea for me.  Ask your doctor or pharmacist about ‘pregnancy-safe’ medicines for morning sickness.

Marni Viviers (Somerset West): Sweet, milky rooibos tea brought me relief! Oh, and fizzy drinks – something that I do not usually drink.

Danica O’Niell (Somerset West): Eating brought a lot of relief to my nausea, even though I didn’t feel like it, of course. Foods such as potatoes, fish, fresh fruit and vegetables made it a little better.

Renée Murphy (Somerset West): Ice cubes helped a little… It is a good idea to make a smoothie and freeze it – the theory is that you do not throw up ice.

Karien Bredenkamp (Durbanville): Snacking on dry, tasteless crackers helped me to manage morning sickness. Drinking iced tea kept me hydrated (I actually could not drink water – it made me feel nauseated!).

Lea Matthews* (Bloemfontein): I had to stop taking my multivitamins, as it significantly increased my nausea!

Christa Linde* (Robertson): I purposefully avoided certain smells in the house. I took the courage to ask certain people to not use certain substances close to me – whether cologne or food ingredients!

Liesel Venter (Cape Town): Bread or pasta salad! I also had to use medication.

Angelique Geldenhuys (Stellenbosch): Any starchy foods brought me great relief!

Erica Neser (Stellenbosch): Cream Crackers – either dry, eaten before getting up in the morning, or otherwise with a little bit of Bovril. And ginger snaps!

What helped for the Lady Kate?

Internet sources reveal that this is what worked for the Duchess Kate’s excessive vomiting and nausea:

• Nibbling on lavender shortbread biscuits (Not sure where we’ll find these! Perhaps someone could work out a homemade recipe for us?!)
• Scented candles, made with the oil from the rare South African plant, buchu (aah… proudly South African!) and with the oil from lavender, sweet basil and jasmine
• Hypnotherapy (a therapist can help with the negative thoughts connected to foods or smells leading to morning sickness)

And did you know?

Author Charlotte Brontë is often thought to have suffered from hyperemesis gravidarum. She died in 1855 while four months pregnant, having been afflicted by intractable nausea and vomiting throughout her pregnancy, and was unable to tolerate food or even water. http://en.wikipedia.org/wiki/Hyperemesis_gravidarum

Everyone seems to be getting it! A lucky few escape it… Pregnancy nausea forms part of the experience of being pregnant. If you know of something that can bring some relief to your fellow ladies in suffering, please do leave a comment. If you are at a point where nothing seems to be helping for your nausea, know that “this too shall pass”. Trust those around you to take over whatever tasks they can help with, and rest in the knowledge that your body is partaking in the greatest miracle of our universe…

* Pseudonyms have been used