Morning sickness or nausea in pregnancy occurs to some extent in eighty to ninety percent of all pregnant women. Only ten percent of pregnant women do not suffer from morning sickness at all and in another ten percent, the morning sickness persists all the way through the pregnancy. One of the concerns with respect to morning sickness is the associated fatigue. It is a bit of a vicious circle in that the more nauseated you feel, the more exhausted you feel and the more exhausted you feel the more nauseated you feel. Whether or not you require medical treatment will depend on how severe your morning sickness is. In particular whether or not it is interfering with your ability to function in everyday life and whether or not persistent vomiting means that you are at risk of dehydration as you are unable to keep down any food or fluids.
There are some simple dietary changes that may help your morning sickness. Women with morning sickness feel better if their stomach is not empty so therefore try and have frequent small snacks rather than large meals. Eat the food that you tolerate the best. For most women this is carbohydrates, such as dry biscuits, toast, rice, pasta etc. Similarly with fluids – try and drink those fluids that you tolerate the best. For many women, cold drinks that are carbonated and citrus flavoured such as lemon or orange flavoured soda drinks are tolerated the best. Finally try and avoid trigger factors that tend to set off your morning sickness such as food smells and hot, stuffy, noisy areas. Similarly pre-natal vitamins may cause morning sickness to be worse so it is best to try and take them at the end of the day after a small snack.
Where your morning sickness has resulted in either dehydration from lack of fluid intake due to vomiting or is severely impacting on your quality of life, your obstetrician may recommend some medication to try and alleviate symptoms. There are a number of natural remedies available through pharmacists that contain a number of different agents which some women find effective for mild nausea. They are definitely not helpful if you have significant vomiting. These agents such as Blackmores Morning Sickness Blend contain pyridoxine or vitamin B6, ginger and a few other vitamins.
Pyridoxine and vitamin B6 can help mild nausea. Again, they are not helpful if you have severe vomiting. The recommended dose is 25mg up to four times a day and there are a number of studies suggesting they help mild symptoms. Other over the counter medications that may help mild morning sickness includes the antihistamines such as Phenergan which has an anti-nauseant effect. If these simple measures don’t help then your obstetrician may give you a drug requiring a prescription. These agents may include metoclopramide (Maxalon), which can be taken as a tablet up to four times a day but perhaps the most effective drug is a medication called ondansetron (Zofran) which is usually taken two to three times a day. Zofran is probably the most effective agent.
If dietary advice and medication taken orally are not sufficient and you find that you are unable to keep down fluids or food, you may require a short stay in hospital for intravenous therapy. If this occurs I always get a dietician to see my patients to try and give some sensible dietary advice and to ensure that the pregnant woman is receiving a reasonable diet and this may require supplementation. Whilst in hospital you will be placed on an intravenous drip which will be used to give you fluids as well as anti-nauseant medication.
The majority of pregnant women with morning sickness improve between twelve and fourteen weeks with about eighty to ninety percent of women finding the nausea completely resolves and they can start enjoying their pregnancy again.
Every pregnancy is almost like starting a fresh and just because you’ve had severe morning sickness in one pregnancy does not follow that you will necessarily have severe morning sickness next time round.
Dr Len Kliman is one of Melbourne’s most experienced and trusted obstetricians and gynaecologists.
With over three decades of experience he had delivered over 20,000 babies and still counting.
In 2017, Dr Kliman was awarded an Order of Australia for his services to obstetrics and gynaecology.