Guide to morning sickness

By Heather Spies, MD Mar 29, 2016

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You are five weeks pregnant. You are ecstatic. You want to go out to lunch sharing your excitement with a friend. Or secretly looking on Pinterest for all the baby things you can’t wait to make. But instead of throwing yourself into the joy of it all, you are trying not to move, so you don’t throw up again. Ugghhh! Such frustration!

Oh, and another thing, you thought it was supposed to be MORNING sickness. Unfortunately, it is NOT truly morning sickness for most women — it can happen morning, noon or night, sometimes all three!

Morning sickness is a very common part of pregnancy. Up to 50 percent of pregnant women will have nausea and vomiting during pregnancy, and up to 80 percent will have at least some nausea. It is usually not harmful to your growing baby, but it can have a serious impact on your quality of life for a while. You may have trouble doing regular daily tasks or it may affect your work. So what can you do? You want to not only ENDURE this part of the pregnancy, but ENJOY it as well.

ADJUST! Try to embrace your new norm. Remember, this is only temporary. In the beginning of pregnancy, you do not need to eat a lot. Very small sips and bites will be plenty to keep your tiny fetus healthy. Your baby does not need much for nutrition yet. You should try to take your prenatal vitamin. If you can’t tolerate them during the day, try taking them at night to see if you better tolerate them then. If you can’t take a prenatal vitamin with iron due to upset stomach, a chewable or gummy prenatal is a good alternative for the short-term, but resume the prenatal vitamins with iron as soon as you feel better.
Keep a small stash of food on your nightstand, so you can start your day right. Sometimes if you get out of bed with your empty stomach screaming for carbs, it can take awhile to feel good enough to get going again. Some bland crackers — no fancy or fun chipotle flavors — or dry toast are a great option. Again, take only a few small bites.

Separate your sips (liquids) and your bites (solids) — the pregnant belly does not like mixing the two, so you are more likely to keep them down when you separate them by 30 minutes or more. Also, avoid extreme temperatures and drinking out of straws. You are more likely to tolerate things if they are not ice cold or very hot. Bland foods — nothing spicy, acidic or strong smelling — are recommended to keep nausea and morning sickness at bay. You can count on those cravings for spicy and unusual flavors to come later in the pregnancy.

Consume what sounds good to you. You deserve a “free pass” for a few weeks, if all that will stay down is small bites of strawberry Pop-Tarts. Be sure to go back to a well-rounded diet as soon as you start feeling better.

Consider ginger to help morning sickness and nausea — anything with real or fresh grated ginger may help. Small sips of ginger ale (not ice cold and no straw) or warm (not hot) ginger tea can calm an upset stomach. Sometimes sucking on a hard ginger candy or other low sugar candy can help, even if it just decreases the funny, sometimes metallic, taste in your mouth.

REST! You have a rapidly developing fetus growing inside of you — it makes sense you will feel like it is stealing all your nutrients and energy. You need extra rest during this time of gestation. Fatigue can definitely contribute to or worsen morning sickness. This is one stage of life where naps are definitely socially acceptable. Take advantage of it, if you can! Even sitting or resting when you can for a few minutes may help. Plan for eight to nine hours of sleep at night as well.

REPRIORITIZE! Stress can also worsen morning sickness. You might have to put some things on the back burner. If you are Type A and cannot sit and rest if the dishes are not done, the laundry is not washed and put away, and the house looks nice and tidy, give yourself a break for a few weeks. Let it go! If you just are not feeling well, you may have to let these “non-essential” tasks pile up at times. It’s OK. Anyone who stops by unexpectedly will know why and understand.

Spend time with the people in your life who help lessen your worries and stress. Avoid stressful situations or social events for a while. Take time to go get a massage, a manicure or visit your favorite music or bookstore. Designating an hour or more during the week to just sit and listen to your favorite music or to read a good book. Promote wellness and calmness in your mind. Don’t read something that will make you anxious, like a psychological thriller, or something that is sad or depressing. Also, don’t read a pregnancy book during this hour! Read something that will help you relax and take your mind off of pregnancy for just a little while.

THINK AHEAD! When do you struggle the most? Certain times of the day or night? Certain places or with certain activities? Certain smells? If you know what your triggers are, avoid them as much as possible. Ask your family and friends (politely ☺) to try to not eat their tuna sandwich next to you, for example.

PLAN AHEAD! Pack small bags of snacks to take with you. Take foods or drinks that
DO sit well with you. This way you can avoid having to try to grab from limited options at work or getting hungry in between meals and not having anything that settles well in your sensitive stomach.

Ask friends and family members to help out awhile. Even help with the littlest thing may give you some extra time to take those slow separate sips and bites, take a little rest or just survive the day sometimes.

While thinking of the week ahead of you, plan if you could lump errands together better so they don’t take as long. Think of things you could ask for someone to complete for you, so you can rest a little after work. Do you have a friend or neighbor that is going that way anyway and could maybe help you with one or two things on your “to do” list? Most people love the chance to help. Also, really LOOK at your “to do” list….many things really can wait until you feel better.

SPEAK UP! There are other options when what you have tried is not working. It is frustrating, and sometimes figuring out how to feel better or just get through your day can seem like a long trial-and-error, drawn out process. Especially if your sister-in-law and coworker who are also pregnant keep telling you how great they feel. But don’t give up. Call your physician or midwife and ask for next steps.

There are many different medical treatment options for nausea and vomiting in pregnancy.
Most women with nausea and vomiting in pregnancy have mild to moderate symptoms. Only about 3 percent of women affected are diagnosed with severe nausea and vomiting. The majority of the time, even though you FEEL terrible, you are not likely dehydrated, and you likely do not need IV fluids or hospitalization. If you cannot keep any food or drinks down for more than a couple days and you begin to lose weight, you should contact your provider. Nausea and vomiting in pregnancy usually will not harm your health or the baby’s, but if it is severe and is left untreated for weeks or months, it can sometimes affect the baby’s birth weight. It could also lead to problems with your fluid balance, thyroid or liver.

You may be at increased risk of having this form of severe nausea and vomiting, if you have a multiple pregnancy, such as twins, triplets, etc., you have had severe nausea and vomiting in a previous pregnancy, your first degree relatives had severe nausea and vomiting or you have a history of motion sickness or migraines. If your provider determines you do have a condition of severe nausea and vomiting, called Hyperemesis gravidarum, you may need treatment in the clinic or hospital to restore body fluids and stop your vomiting.

If you have made the changes mentioned in your diet and lifestyle, but you are still feeling miserable most of the time, your medical provider may recommend starting a medication for treatment. The American College of Obstetrics and Gynecology recommends starting with vitamin B6 and doxylamine first. These can be bought at any pharmacy, or your provider can prescribe a prescription combining the two into one pill. These have been used for decades and have been found to be safe for baby.

If you try vitamin B6 and doxylamine and they do not work, then your doctor may prescribe another medication. Many medications are available and appear to be safe in pregnancy.

TAKE HOME MESSAGE: Keep your provider informed of how you are feeling. If you try one thing for a few days or a week and are not having improvement, let your provider know so you can discuss the next option on the list. It is common for one medication to work for some women, but a different one may work better for others. If at first you don’t feel better, try, try, try again!

HANG IN THERE! For most women, nausea is mild to moderate and will resolve or becomes very mild by the second trimester. Usually between 14 to 16 weeks of pregnancy, you will reach a point where you start to feel a lot better. You get your energy back, you can keep your favorite food down and, yes, even go out to lunch or go shopping again.

Don’t let nausea in pregnancy steal your thunder, try these tips and call your provider, if they are not working — so you CAN start to jump for JOY!

For additional reading, Your Pregnancy and Childbirth, Month to Month, Revised 6th edition can be ordered at: http://www.acog.org/Patients/ACOG-Pregnancy-Book.

To find an OB provider in your area, visit www.sanfordhealth.org.

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