Morning Sickness

The very term ‘morning sickness’ could be considered a misnomer as women can have it at any time of the day or night. Very few women actually experience it in only in the morning. While morning sickness is generally thought of as being due to hormonal changes that occur during pregnancy, the exact cause is actually not known. Anthropologists believe that in the past morning sickness provided a protective function for the unborn child by causing women to avoid foods that were more likely to be contaminated with parasites, bacteria or other harmful substances (1). Some women’s aversion to meat, fish, poultry, eggs, alcohol and caffeine during pregnancy appears to support this hypothesis.

Morning sickness usually occurs in the first trimester of pregnancy, beginning around week 4 and continuing until week 12 to 14. Some women, however, continue to have morning sickness into their second trimester and a few have it through their entire pregnancy. Approximately 1 in 200 women experience a severe form of morning sickness, referred to as hyperemesis gravidarum (see section below) (2).

There are a number of indications as to whether a woman might experience morning sickness during her pregnancy:

• Experienced motion sickness in the past
• History of migraine headaches
• Female foetus
• Young age
• First pregnancy
• Mother or sister experienced morning sickness
• Experienced nausea when taking the Pill (3).

While the main symptoms of morning sickness are nausea, vomiting and loss of appetite, women can also experience depression or anxiety. For some women this may be the first time they have had any significant period of illness and knowing how to deal with it can be difficult. Being unwell for any length of time can lead to feelings of frustration, hopelessness and depression, particularly if there does not appear to be any end to the symptoms. Women also tend to feel anxious about the effects their morning sickness could be having on their unborn child.

Morning sickness can result in absences from work. Not having an adequate amount of sick leave, workload issues and employers lack of understanding about the situation can all be stressful for women. Experiencing morning sickness also means that women may have to inform their employer and/or other staff members of their pregnancy earlier than they would normally have chosen (many women like to wait until after their first trimester before making any announcements). Women with existing small children may find it difficult to care for them and the children may not understand why their mother is not her usual self.

Unfortunately, health care providers and even other mothers can be quite dismissive of morning sickness, perceiving it as something that just has to be endured. This can leave some women feeling like no one is listening to them or that they are complaining unnecessarily. Advice that it will pass by the second trimester is of little comfort to a woman in only her fifth week of pregnancy. Instead, women need to be given emotional support at this time as well as strategies that may assist in reducing symptoms. Women should never be made to feel that their concerns or experiences are superficial. Mild to moderate nausea and vomiting during pregnancy does not appear to have any negative effects on the unborn baby and so reassuring women of this is also very helpful (4).

Treatment

Women experiencing morning sickness should visit their doctor at an early stage. Early treatment appears to reduce the severity and duration of morning sickness. The treatment options available will depend upon the severity of the morning sickness, but will usually initially include dietary and lifestyle changes.

There appears to be a never ending list of ‘cures’ for morning sickness. While many are helpful, their effectiveness can vary between women. In addition, the numerous suggestions of what to eat or do can leave those suffering from morning sickness on an endless quest to find what will make them feel better. This can add to women’s feelings of frustration and helplessness.

Below is a list of some of the more tried and tested strategies to combat morning sickness. Women are encouraged to try them but to keep in mind that different strategies work for different women. In addition, the more severe a woman’s morning sickness is the less likely the strategies are to provide complete relief from symptoms.

Changing eating habits
An empty stomach or a too full stomach can make nausea worse. Therefore, women should try and eat small amounts regularly throughout the day. Small, high protein meals appear to reduce nausea and vomiting. Eating something before getting out of the bed in the morning also seems to help settle the stomach. Women should avoid any foods that aggravate their nausea. These are most commonly fatty, spicy or acidic foods. Women should not force themselves to eat any foods as this tends to only make the nausea worse.

Limit time spent preparing food
A woman’s sense of smell during pregnancy is often heightened and this can set off their nausea and vomiting. Not spending as much time preparing or cooking food can, therefore, reduce some of the triggers for nausea. Getting someone else to prepare items that are the cause of nausea (eg., cooking the meat portion of a meal) can be helpful. If this is not possible women should try and prepare simple meals that do not involve lengthy preparation or cooking. Cold foods tend not to give off as strong odours so they may be preferable.

Keep hydrated
As with food, it is best to take in fluid in small amounts throughout the day. If keeping water down is even difficult, sucking on ice cubes can help. Women should avoid drinks containing caffeine as it is a diuretic and can worsen dehydration.

Vitamin B supplements
Vitamin B6, or pyridoxine as it is sometimes referred, has been found to be effective at alleviating nausea and vomiting in pregnancy (5). Women should check with their pharmacist or doctor about the appropriate dosage.

Ginger
A number of randomised controlled trials have found ginger reduces nausea and vomiting during pregnancy (6). An effective dosage is 1 000 mg (250 mg of ginger, 4 times daily). Women can take ginger in the form of ginger tea (4 cups made by steeping ½ teaspoon fresh grated ginger in each cup of hot water for 5-10 minutes) or ginger capsules. Women also report finding ginger ale (4 cups made with real ginger) or crystallized ginger (2 pieces, each piece 1 inch square, ¼ inch thick) helpful, but the sugar in these products may make morning sickness worse for some.

Acupressure wrist bands/acupuncture
Acupressure wrist bands were originally designed for motion sickness but they have also been found to be effective for morning sickness (7). They work by applying continuous pressure to the P6 acupressure point located on the inside of the wrist and can be obtained from the chemist. Acupuncture has also been found to be helpful (8). Women should consult a qualified practitioner such as a member of the Australian Acupuncture and Chinese Medicine Association (AACMA).

When dietary and lifestyle strategies do not work

If a woman has tried strategies with no success she should revisit her doctor. There is no need to have exhausted every known ‘cure’ before seeking further help. A doctor may prescribe an antiemetic, a medication that helps prevent and control nausea and vomiting. A commonly prescribed antiemetic for morning sickness is Maxolon. Maxolon is classified as a Category A drug in pregnancy. Category A drugs are those that “have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed” (9). If Maxolon is ineffective there are a number of other medications available (see hyperemesis gravidarum section below). Women who are unable to keep enough fluids down may need to be hospitalised for re-hydration.

Other considerations

Women should refrain from brushing their teeth after vomiting as stomach acid may have coated the teeth, leaving them vulnerable. Instead women should wipe a small amount of toothpaste containing fluoride onto the teeth with their finger and rinse with water.

Women should always check with their doctor before taking any over the counter medications or complementary therapies for the treatment of morning sickness. Some may be unsafe to use during pregnancy or the dosage for pregnancy may be different.

Subsequent pregnancies

Women who experience severe morning sickness are often understandably concerned about it occurring again in subsequent pregnancies. For some women the possibility is enough for them not to have further children. Women with reservations about subsequent pregnancies should discuss the situation with their doctor. One study has shown that taking antiemetic drugs before symptoms begin in a subsequent pregnancy reduces the severity of the morning sickness (10).

References

1 Flaxman SM & Sherman PW.Morning sickness: a mechanism for protecting mother and embryo Q Rev Biol 2000; 75:2:113-48

2 Eliakim R, Abulafia O & Sherer DM. Hyperemesis gravidarum: a current review Am J Perinatol 2000; 17:207-218

3 Davis M. Nausea and vomiting of pregnancy: An evidence based review J Perinat Neonat Nurs 2004; 18:4:312-328

4 American College of Obstetricians and Gynecologists. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists: nausea and vomiting of pregnancy Obst Gynecol 2004;103:803-11

5 Sahakian V et al. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study Obstet Gynecol 1991; 78:33-6

6 Bryer E. A literature review of the effectiveness of ginger in alleviating mild to moderate nausea and vomiting of pregnancy J Midwifery Womens Health 2005; 50:1:e1-3

7 Tiran D. Nausea and vomiting in pregnancy: safety and efficacy of self-administered complementary therapies Complement Ther Nurs Midwifery 2002; 8:191-196

8 Davis M. Ibid

9 MIMS

10 Koren G & Maltepe C. J Obstet Gynaecol 2004; 24:5:530-3

11 Davis M. Ibid

This article was written by Kirsten Braun and reviewed by the Editorial Committee for Health Journey, Vol 2 2007.

Please note that this article is an archive. While every effort was made to ensure the information was accurate at the time of publication, the article has not been updated since this time. 

Last Modified: June 1, 2007