Important: This is intended as general information only. It may not apply to your specific situation. It is not a substitute for medical advice. If you have a question or concern, please raise it with me at your next appointment or contact me sooner if it's urgent.
Nausea and Vomiting in Pregnancy
Nausea and vomiting in pregnancy (known formally as hyperemesis gravidarum or, more commonly, as morning sickness) is very common, particularly in the first trimester. For most women, this is certainly annoying, but relatively mild and manageable. In most cases, symptoms begin to settle towards the end of the first trimester.
Some women, however, are not so lucky. For some women symptoms continue until much later in the pregnancy (for some, they continue throughout the entire pregnancy) and some women can become quite dehydrated and start to lose weight. Ideally, we want to avoid getting to the stage that you become dehydrated and start to lose weight. This is not a great situation for the body to be in generally and, as you might imagine, not the best environment for a developing fetus. If you are having trouble eating anything and are struggling to keep down fluids, you should contact me.
Here are some of the ways we can address nausea and vomiting in pregnancy, starting from the simplest measures and progressing up to the more intensive treatments. Most people find they can manage their symptoms with a few of the more simple measures and very few people require the more full-on treatments. Try to be proactive and contact me early if you think things are spiralling out of control. The earlier we are able to treat you, the more likely we are to be able to use the simple methods only.
Simple lifestyle changes:
You may find that some activities make you vomit. If you can, you should try to avoid these. For example, if cooking meat makes you gag, see if someone else can take over that task until you’re feeling better. If brushing your teeth makes you vomit, try rinsing with mouthwash instead – your teeth won't get quite as clean but this is OK in the short term (I’m not suggesting mouthwash as a longterm substitute for brushing and flossing!)
Try not to get too tired, as being tired will make your nausea worse. Often, this is much easier said than done – but try not to pack too much into your evenings and weekends and take the opportunity to rest when you can.
Simple dietary measures:
Eat small meals frequently – letting yourself get really hungry may make you nauseated, as may large meals. If you are on the go, it may help to carry some simple snacks with you, to nibble on from time to time.
Eat whatever you can manage – if all you can keep down is toast, then eat toast. Don’t eat broccoli just because it’s good for you, if it makes you nauseated.
Have food and fluids separately – some people find that having a drink with a meal can make nausea worse so try separating your meals and your drinks.
Water is not the only fluid – if it makes you fell sick (some pregnant women find that they don’t like the ‘taste’ of water in the first trimester) try drinking fruit juice, sports drinks or cordial instead. These drinks are all pretty sweet so you may want to dilute them. Remember the important thing is to keep your fluids up – the kind of fluid you drink is less important.
Ginger – some women find ginger to be helpful. This can be in the form of tablets, gingerale or ginger beer, cordials, tea, ginger flavoured sweets or ginger in the food you eat. The evidence for ginger as a treatment is not great but it may work for you and, unless you really don’t like ginger, it’s probably worth a try.
Vitamin B6 – again the evidence is not great that this actually works but it may be worth a try.
A variety of medication is available to help with morning sickness for women who need it. Rest assured that I will not prescribe anything that is dangerous for your baby, so anything that I recommend for you will be quite safe. If you get to the stage that you need medication, the best approach is to take it regularly until your symptoms are well under control and then to reduce the dose gradually. Waiting until you are desperate and then using the smallest amount possible does not really work all that well. Medications we may use include:
Metoclopramide (Maxolon, Pramin) – a simple anti-nausea medication taken anywhere from once to four times a day. This medication has been used for a long time in pregnancy and has a long record of safety. It can be given as a tablet or an intravenous or intramuscular injection.
Ondansetron (Zofran) – also safe in pregnancy, this medication is better at treating nausea than metoclopramide but has the disadvantage of being quite expensive. It comes in wafer form for women who are too sick to swallow tablets and can also be given intravenously.
Sedating antihistamines – particularly useful at night
Corticosteroids – women with severe nausea and vomiting that hasn’t settled down with other treatments may improve with a shot course of steroids (not the same sort of steroids that body builders take) which are safe in pregnancy.
If other methods have failed and you are significantly dehydrated, we may need to arrange for you to be admitted for IV rehydration. We can give IV anti nausea medication at the same time. Some women may need to spend a few days in hospital. For other women, it may be possible to come in two or three times a week as an outpatient for some IV fluids to help maintain adequate hydration (dehydration makes nausea worse).
So, you can see that there are lots of different options for treating nausea and vomiting in pregnancy, all of which are quite safe. While mild nausea is common and self limiting, please contact me if your symptoms are more severe and we can work out a treatment plan that is appropriate for your situation.