When morning sickness is not just in the morning…

By Anchen Verster – nursing sister and midwife

“Morning sickness” is a rather unfair term given to describe nausea and/ or vomiting during pregnancy. Why unfair? Because it is not necessarily confined to the morning. I have a hunch that it might not have been a female who coined the term but let’s allow sleeping dogs to lie! Nausea and Vomiting in Pregnancy (NVP) affects 70-80% of pregnant mothers and may extend throughout the day. It doesn’t always go away once you have crossed the 12-week mark. Most mothers have some or complete relief roughly round 14-18 weeks but for some (10% of pregnant mothers) it will only go away once your little one is in your arms. It is useful defining the two types of Nausea and Vomiting in Pregnancy. General NVP can be mild to severe and ranges from nausea with or without vomiting for a period each day. If you fit into this group you won’t really care if it’s mild or severe – even if mild it can feel pretty debilitating and have an impact on your daily activities.

Hyperemesis Gravidarum (HG) is the term given to pregnancy nausea and vomiting where a mother loses 5% or more of her pre-pregnancy weight and has other symptoms related to the vomiting such as dehydration. This of course can be harmful to mother and/or baby. HG sometimes requires hospitalization and intravenous fluids. When it is extremely severe mothers require feeding via a naso-gastric tube or special intravenous feeds (par-enteral feeding).

Risk factors for NVP during pregnancy are varied and some of the research is inconclusive but here are a few of the stronger predictors:

  • A history of frequent nausea or motion sickness
  • It is your first pregnancy
  • You had NVP during a previous pregnancy
  • You have a mother or sister who had NVP or HG during pregnancy
  • A multiple pregnancy (twins, triplets etc.)
  • Carrying a female baby rather than a male
  • Previously having difficulty with nausea when taking Oestrogen containing medication like oral contraceptives

Some research aimed to look at the emotional component of morning sickness but these studies were inconclusive.

Don’t automatically assume that the nausea is pregnancy related. There are some other health conditions that may be causing the nausea so it is important to mention the nausea to your midwife or doctor so that they can do a thorough examination and rule out other issues.

Each mom with NVP doesn’t find the same things relieving so you usually have to try a few options first until you settle on two or three things that bring relief.

  • Ginger tea, biscuits or lozenges. Some mothers find ginger very helpful while others find it brings no relief. Ginger is not recommended for use when you are on anti-coagulants.
  • Eat regular small meals. Mothers who have big gaps between meals tend to have more nausea.
  • Eat something dry before getting out of bed – it seems that as soon as you get out of bed your metabolism changes and this we know from rising body temperature even if you have been awake for a while but still in bed so the secret here is to eat one or two dry crackers as soon as you wake up
  • Get plenty of sleep. Being over tired can aggravate nausea. Some also find it helpful if they follow predictable sleeping patterns, in other words get into bed at roughly the same time every evening and try not to have late nights. If possible and it suits your predisposition you can try and have a rest in the afternoon, even fifteen minutes can help. Some mothers store a roll up mattress in their office at work and lie down for the last twenty minutes of their lunch break.
  • Taking extra vitamin B6 (pyridoxine) may be helpful. Discuss dosages with your caregiver especially if you are already taking a multi-vitamin.
  • Eat protein more than carbohydrates. Carbohydrates have an oscillating effect on blood sugar and this may aggravate NVP. Of course, refined sugars should be avoided, as their effect on blood sugar is even more intense.
  • Some studies show that small regular amounts of sports liquids that replace electrolytes are relieving.
  • Stay hydrated. Large amounts of fluid at one time may be nausea inducing but small regular sips should help you stay hydrated without being uncomfortable. Keep a bottle of water with you at work or out-and-about so that you have an idea of how much you are taking in per day. See if you prefer hot or cold liquids and go with whichever works best. Some find sucking ice helps too.
  • Avoid smells and circumstances that aggravate the nausea for example a stuffy room, food cooking, gym smells, strong perfume, public toilets etc.
  • If these things do not help your NVP, ask your caregiver to prescribe medication that is safe for you and your baby
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