Nausea and vomiting in pregnancy
Why nausea happens in early pregnancy, why its absence is nothing to worry about, when it needs medical attention and what helps.
Nausea and vomiting are perhaps the complaints most closely associated with pregnancy. The fact that the first question asked after a missed period tends to be about nausea makes it seem less like a discomfort than a defining sign of pregnancy.
A degree of nausea in the early months is entirely natural. It can occur at any time of day, but because it is often worst in the morning it became known in the literature as morning sickness.
In most women nausea and vomiting are mild, and they ease and disappear after the third month. This nausea does not harm you or your baby, and it does not mean anything is wrong. If anything, in some cases it can be a sign that the baby is doing well.
Having no nausea at all can also unsettle some mothers-to-be and raise worries about whether the baby is healthy. But it is not a sign of any problem with your health or your baby's — if anything it means you are fortunate.
Why it happens
No single cause of nausea and vomiting in pregnancy has been identified, though rising pregnancy hormones are held responsible. What is interesting is that the nausea usually eases and passes in the third month — the period that coincides with the development of the baby's organs. It is almost as though the baby, wanting to protect itself against anything harmful the mother might eat, lets her eat nothing at all.
Some research also points to the mother's psychological state as a trigger. Nausea and vomiting are more frequent and more severe in unwanted pregnancies, or where there is conflict at home. And letting a mother with nausea hear her baby's heartbeat during an examination eases the nausea, at least briefly. All of this seems to support the psychological side.
When to call your doctor
In some cases nausea and vomiting are severe and continue throughout the pregnancy. When the mother cannot eat at all, loses weight and her fluid and electrolyte balance is disturbed, the condition is called hyperemesis gravidarum, and it needs proper treatment and monitoring.
What can help
There is no cure for nausea and vomiting in pregnancy. Some research has shown that severe cases are less frequent in women who have taken a multivitamin regularly from the beginning of the pregnancy.
Certain measures can ease the nausea and help you feel better:
- Stay away from smells that bother you.
- Rather than three heavy meals a day, increase the number of meals.
- High-protein snacks such as yoghurt can be eaten through the day.
- Salted crackers before getting out of bed will settle your stomach.
- Avoid fatty and spicy foods.
- Rest will help.
One food supplement whose effect has been shown in research is ginger — as a capsule, or brewed. The most important point here is that no supplement, herbal or otherwise, should be taken without asking your doctor.
Although nausea and vomiting come with pregnancy, in severe cases your doctor may investigate whether something else is behind it — a multiple pregnancy, a molar pregnancy, thyroid disease or a urinary infection, for example.
Once these have been excluded, your doctor may suggest medication. Vitamin B6 may be recommended first. Multivitamin tablets are large and hard to swallow and can seem to make nausea worse, but the vitamin B6 they contain is effective in easing it; crushing the tablet and taking it with a liquid you can manage is one way. If that does not help, your doctor may move to other medicines. There are anti-sickness medicines that can be used safely in pregnancy, and they should never be taken without a doctor's advice.
If severe nausea has disturbed the body's fluid and electrolyte balance, intravenous fluids may be needed to correct it.