“Why do they call it morning sickness when it lasts all day?” As an OB/GYN physician and mother, I’ve heard this question more than a few times - and with good reason. Approximately 50% of women experience nausea and vomiting during pregnancy, and another 25% of women experience nausea without vomiting. A percentage of these women get so sick, they require hospitalization, sometimes for extended periods of time. Left untreated, severe nausea and vomiting in pregnancy (called “hyperemesis gravidarum”) can lead to nerve damage from vitamin B6 or B12 deficiency or Wernicke’s encephalopathy (due to thiamine [B1] deficiency) in the mother. It can also lead to low birth weight babies or preterm labor, resulting in premature birth.

What Causes The Nausea?

Nobody quite knows for sure.  Scientists believe the stimulus for nausea and vomiting appears to originate from the placenta. Many believe it’s related to the levels of the pregnancy hormone hCG. Production by hCG by the ovaries peaks around 9 weeks, and the placenta takes over.

Some also believe it’s caused by deficiencies of B vitamins, since vitamin B supplementation reduces the incidence of nausea and vomiting in pregnancy.

Whatever it is, it’s a real problem for many pregnant women and effective treatment is key to a happy, healthy pregnancy.

How To Relieve Nausea And Vomiting In Pregnancy

The treatment for this condition is multi-fold. Listed below are the treatment interventions I recommend to patients.

Step 1. Believe your nausea will resolve.

For reasons we don’t really understand, there’s a mind-body connection when it comes to pregnancy-related nausea. Studies show a dramatic placebo effect for pregnant women being treated for nausea and vomiting. In other words, if you believe you’ll get better, you will! And if you believe you’ll be saddled with it the whole 9 months, you probably will. Think positive, and you’re much more likely to be skipping and dancing through your pregnancy, rather than checking into the emergency room.

Step 2. Get a diagnosis.

Before you assume your nausea is related to the pregnancy, make sure you’re not sick with something else. The last thing you want to do when you’re pregnant is miss a case of appendicitis. While the old adage “If you hear hooves, don’t assume it’s a zebra” definitely applies to nausea and vomiting in pregnancy, you can’t leap straight to the assumption that your nausea is normal, since it can sometimes signal other health conditions, such as the flu, a kidney infection, hepatitis, gallbladder disease, pancreatitis, or a condition that requires surgery. I’m not suggesting you need to go the ER the first time you vomit. Certainly, nausea and vomiting in the first trimester is common. But it’s unusual for nausea to appear, out of the blue, after that time. So if you sailed through your first trimester and you’re suddenly puking your guts out at 20 weeks, get thee to the doctor and get thee a diagnosis.

And make sure you pick the right doctor. Clinical trials show that if your doctor believes you’ll get well, you’re significantly more likely to do so.

Step 3. Change how and what you eat.

The goal is to get nutrients and fluids in - and help them stay in.

• Eat a small snack before bed at night.
• Keep crackers by your bedside and eat them before you even get out of bed in the morning. Getting vertical on an empty stomach can be enough to trigger the nausea.
• Try eating bland, dry, cold, high-protein foods.
• Chew and swallow your food slowly and mindfully.
• Eat small, frequent meals and avoid eating too much at one time.
• Try to separate drinking from eating (in other words, drink between frequent meals/snacks.)
• Drink. Drink. Drink. Try sparkling water or 7Up (as much as I’m not a fan of sodas, sometimes this can help you turn this corner). If you can manage to drink fresh fruit and veggie juices, all the better.
• Avoid fatty foods, spicy foods, and supplements or vitamins, especially iron. If this means skipping your prenatal vitamin until the nausea gets better, it’s okay.

Step 4. Optimize Western medicine.

Dehydrated women, especially those with ketones in their urine, will often need emergency intervention. If you can’t keep anything down - not even water - it’s probably time to call your doctor.  Approximately 10% of women with nausea and vomiting in pregnancy will need some sort of pharmacologic treatment.

• ACOG recommends as first-line therapy the combination of vitamin B6 (10-25 mg every 8 hours) and the antihistamine doxylamine (available over-the-counter as Unisom). This combination is associated with a 70% reduction in nausea and vomiting in pregnancy in clinical trials.
• IV fluid therapy
• Other drugs include:

o   Diphenhydramine (Benadryl) 

o   Hydroxyzine (Vistaril)

o   Metocloperamide (Reglan)

o   Trimethobenzamide (Tigan)

o   Droperidol (Inapsine)

o   Promethazine (Phenergan)

o   Prochlorperazine (Compazine)

o   Ondansetron (Zofran)

o   Glucocorticoids (for severe cases, only after 10 weeks gestation)

o   Total parental nutrition (TPN) is required in very rare cases for those who are losing dangerous amounts of weight

Step 5 (which can definitely be tried before Step 4 for those seeking more natural treatment): Experiment with complementary/ alternative medicine.

• Acupuncture and acupressure (such as wrist acupressure by Sea-band or Bio-Band)
• Vitamin B6 alone
• Ginger extract has been proven to work in randomized, double-blind trials and is as effective as Vitamin B6 

Step 6. Ask yourself whether anything else in your life is making you sick.

In this case, chances are good that you’re sick because you’re pregnant, but it always helps to question your symptoms. Is there something else in your life that could be exacerbating your nausea? Trouble at work? Tension in your marriage? Anxiety about becoming a parent? It may sound goofy, but try letting your morning sickness write you a letter. (As in “Dear You, Love, Your Nausea.) Try writing back. See what comes up.

What Works For You?

Share what works for you. Tell us your stories.

Wishing you wellness,

Lissa

Lissa Rankin, MD: Founder of OwningPink.com, Pink Medicine Revolutionary, motivational speaker, and author of What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend and Encaustic Art: The Complete Guide To Creating Fine Art With Wax.