Morning Sickness
Much of this information was gathered by midwives in my linage and shared with me.
What is it? Also known as “Morning Sickness”; this describes the common occurrence of feeling nauseous and or vomiting that develops for about 50-90% of pregnant women and people. Symptoms are quite variable and usually mild to moderate; some people may only feel a mild nausea in the early part of the day, for a few weeks; while others will feel sick all day long, with daily vomiting for much longer. For some, excess saliva also occurs. In general, this poses no risk to your baby or pregnancy.
When does it start? When does it end? Typically, it begins around 5-6 weeks of pregnancy, peaks around 10-11 weeks and abates sometimes in the late first or early second trimester (usually by 14-18 weeks). A smaller percentage of people will continue to have symptoms throughout the second trimester, and a few will experience this nausea and vomiting until birth.
How does it differ from “Hyperemesis Gravidarum”? Hyperemesis Gravidarum is the term applied to severe & sustained nausea with frequent vomiting leading to malnourishment, dehydration, and a weight loss of up to 5% of pre-pregnancy body weight. This condition, affecting up to 2% of pregnancies, often begins earlier and lasts longer than typical morning sickness. Because HG can impact the growth and well-being of the baby, and can cause premature birth; IV fluids, medications, and other medical treatment will be necessary. If you experience severe, unremitting nausea & vomiting/ symptoms of HG, we will consult/refer for medical care, treatment, and risk assessment. (Check out Her Foundation for more information.)
What causes it? The direct cause is not known, and it is probably multi-factorial. Pregnancy-related nausea and vomiting has been theorized to be linked to placental hormones, healthy thyroid function, slowed digestion, blood sugar changes, a function of the pregnant body protecting itself from potentially dangerous toxins, and psychological factors (but let’s be clear, this does not mean that it’s “all in your head”!) One of the reasons this is called “morning sickness” is because it is common for symptoms to occur when blood sugar is lower, after a fasted state (which happens for most of us, in the morning!)
Are there any risk factors for developing pregnancy related nausea and vomiting? While one who is pregnant may experience this; you may be more likely to develop morning sickness or HG if you have had hormone-related nausea (from contraceptives, or related to your menstrual cycle), have a history of motion sickness, or have a history of menstrual migraines or migraines with nausea and vomiting. Additionally, if you have a previous history of nausea and vomiting in pregnancy or if you are pregnant with twins or multiples, your risk is also higher.
What helps? Prevention and treatment are all about helping you to feel better and stay nourished and hydrated. Oftentimes it is necessary to try a variety of solutions and avoid a variety of triggers. What may have worked for your friend, may not be the thing that works for you! Nutritional and other natural therapies are often effective at reducing and sometimes eliminating your symptoms. Enlisting support, taking more time to rest, reducing external stress, and keeping your blood sugar stable are often key.
Concerning Signs? Please call your midwife if you experience any of these:
You cannot keep any food or fluid down and it’s been more than 12 hours
Signs of dehydration: peeing infrequently, dark-colored urine, dizziness, racing pulse, fever
Vomiting repeatedly throughout the day. Stomach pain. You see blood in your vomit.
You are having abdominal/pelvic cramping or contractions
You lose more than 5 pounds
Nutrition and Eating: Low blood sugar and an empty stomach can increase or worsen nausea. Eating small, more frequent protein-rich plus carb “meals” is usually the most helpful at preventing worsened symptoms. Some people do better with protein vs. carbs and visa versa. Take advantage of the time periods you feel good to eat with more balance. As you begin to feel better, and symptoms ease, you will be able to refocus your efforts on increasing the variety and nourishment value of your meals.
Eat something small and bland before getting out of bed. Dry crackers, a few almonds, or toast with nut butter are good choices. Follow that with a more substantial breakfast, a while later.
Keep a small protein snack at your bedside to eat if you wake during the night.
Eat before you get overly hungry or as soon as you feel hungry
Eat something with protein and complex carbs, every 2-3 hours. Eating helps break the cycle.
Try cold food (especially if food odors are bothersome).
Chew your food well and slowly. Wait at least 30 minutes between eating and drinking.
Eat probiotic foods such as live-culture yogurt or fermented pickles and sauerkraut
Try salty, sour, or dry foods
Try smoothies or shakes. Add collagen powder or a food-based protein powder to bump up your protein. Collagen powder is odorless and can also be stirred into any cold or warm liquid.
Avoid spicy, overly rich, fatty, sugar-laden, or fried foods.
DO try to eat small amounts of healthy, digestible fats such as avocado, nuts, olive oil, and coconut.
Drink cold or iced drinks such as fresh lemonade, diluted juices, carbonated water or real ginger ale, electrolyte drinks like Recharge or homemade laborade. Freezing these to make “popsicles” can also help. It is best to stay away from overly sugary drinks, especially those made with refined sugars. Avoid becoming dehydrated as this can make nausea worse.
Suck on lemon or lime slices.
Drink broths such as homemade bone broths, vegetarian “Magic Mineral” broth or choose organic store-bought broths, with minimal ingredients, free from MSG and other food additives (Pacific Food and Imagine make some boxed broths that are good choices).
Other foods to try are lean meats and poultry, mashed potatoes, ice creams and custards, scrambled eggs or egg salad, soups, oatmeal, fresh or stewed fruits, protein-based salads.
Common Triggers to Avoid:
Strong odors
Getting overheated
Excessive exercise
Being over-tired or very stressed
Visual or physical motion
Being in a stuffy room
Having a too empty or too full stomach. Eating a lot of sugary treats or snacks
Laying down too soon, after eating
Brushing your teeth may be a trigger OR may be very helpful
Supplements and Natural Therapies- Try one or all of these in whichever combination helps!
Ginger:
Chew on candied ginger.
Make a fresh ginger tea (steep 1 Tbsp chopped or a chunk of ginger in hot water, covered for 15 minutes. Add lemon or honey, if desired. Sip 8 ounces, warm or iced, throughout the day. This can also be made into popsicles.
Take ginger capsules, 250 mg, up to four times daily (= max of 1000 mg/day)
Vitamin B6:
This vitamin can greatly improve the nausea of pregnancy.
Take 10-25 mg of B6, three times daily. Do not exceed 100 mg/day.
Herbal Digestive & Liver Support:
Taking digestive enzymes at the start of a meal may help.
Nettle tea is a lovely source of micronutrients and minerals, as well as digestive support.
Herb Lore Pregnant Mother’s Liver Tonic (Tincture) is also a gentle support for your liver and digestion, improving symptoms. https://herblore.com/products/pregnant-mothers-liver-tonic
If heartburn is a problem, try chewing slippery elm lozenges or papaya enzyme tablets.
Homeopathy:
Ipecac 30C and Nux Vomica 30C are commonly effective homeopathic remedies
Ask your midwife &/or consult with a homeopath about other useful remedies based upon your unique symptom picture.
Aromatherapy:
Sniff lemon, ginger, peppermint, or orange essential oils or apply topically. I do not recommend ingesting essential oils in pregnancy unless under the care of a licensed aromatherapist.
Chew real peppermint or spearmint gum
Acupuncture/Acupressure:
Acupuncture can be a GREAT relief. Check with your midwife for practitioner recommendations.
“Sea Bands” stimulate the P6 acupressure point, helpful for reducing nausea and vomiting.
Environment:
Get extra rest, and extra help with your other children, meal prep, and household chores.
Get fresh air and sunshine. Open windows or have a fan blowing for circulation.
Gentle, regular exercise, such as daily walk or prenatal yoga helps digestion and elimination.
Try this breathing exercise: Breathe in for a count of 3; Hold your breath for a count of 3; Breathe out for a count of 3. By itself or in combination with aromatherapy, this has been proven to reduce nausea.
“I’m doing everything you suggested but I’m still miserable! I’m able to eat and drink and keep *most* of it down, but I’m throwing up a couple of times a day… Is there anything else I can do?
Yes. It is very important that you keep in contact with me about your symptoms and any supplements or over-the-counter medications you wish to try, or are currently taking, as well as whether they are helping or not.
If you have not yet tried Vitamin B6, please try taking 25 mg every 8 hours or three times daily.
If you have tried Vitamin B6, alone, at the suggested dose, and it is not working; you can try adding an over-the-counter medication called, “Doxylamine” (found as the active ingredient in Unisom SleepTabs and some generics). This combination has been well-studied and found to be generally safe to treat persistent nausea and vomiting of pregnancy.
Unisom SleepTabs (Doxylamine):
This is an over-the-counter medication. I recommend this only if you are experiencing moderate to more severe nausea WITH vomiting, have already tried adding Vitamin B6 alone, and other solutions are not improving your symptoms, or if your symptoms seem to be worsening. Please check-in with me first, before starting this, as this medicine, while well-tolerated by most people, can occasionally have side effects.
Because it is important to differentiate between symptoms we can continue to treat with midwifery care and Hyperemesis Gravidarum symptoms that warrant medical care, I will want to have a conversation with you about your symptoms, assess you and your baby’s vital signs, make other suggestions, OR we may decide that medical consult or referral is preferred or necessary. Additionally, there may be cases where your medical history or current medications make taking Doxylamine inadvisable.
Take 12.5 mg Doxylamine (1/2 tab) once daily, only before bed. If you do not get relief after 3-5 days, you can increase this to 25 mg (1 tab) once daily, only before bed. This medication will make you drowsy. Some people are able to split a 25-mg dose up and take half of it during the day without problem, but it is best to first try this when you have a partner around and do not have to drive or care for other children. It is an antihistamine and can also cause dry mouth, headache, constipation or diarrhea, and anxiety, in some people. Additional side effects may include irritability or restlessness, visual disturbances, and skin rash.
This should be taken in combination with Vitamin B6, as outline above, or per direction.
Do not buy the Unisom sleep “gels” or as they contain a different medicine. Other preparations may also contain different ingredients. Please check the label carefully.
If this combination is working well, but drowsiness or other side effects are a problem, I can also refer you to a medical care provider for prescription Diclegis, which is a sustained-release combination of doxylamine and pyroxidine (a form of B6) that may be more tolerable.
Resources for further learning and ideas
5 Real Food Tips for Managing Nausea by Lily Nichols: https://lilynicholsrdn.com/nausea-pregnancy/
The Midwife’s Cauldron Podcast: Pregnancy sickness and hyperemesis break through with Professor Sir Stephen O’Rahilly FRS
