Pregnancy nausea affects a staggering 70% of expecting mothers, and navigating through this common yet often challenging symptom can leave many women in search of answers and guidance.
In this enlightening Q&A series, registered midwife and childbirth educator Monique Maitland shares valuable insights and practical advice to help you better understand pregnancy nausea and know when it's time to seek medical assistance.
Q1. What are the symptoms of morning sickness & how long do they last?
Morning sickness is a common term used for many years to describe nausea and vomiting in the first trimester of pregnancy. However, morning sickness, contrary to its name, can occur at any point throughout the day. Therefore, the term ‘morning sickness’ is being used less frequently. The condition is often referred to as nausea and vomiting in pregnancy, or NVP.
NVP typically occurs between weeks 4 and 16 of your pregnancy - you may feel sick or vomit. These symptoms are usually manageable with the help of dietary changes and medication and shouldn’t disrupt your everyday life.
Women who experience mild and moderate NVP should still be able to consume food and fluids. Approximately 7 in 10 pregnant women will experience some form of NVP, but symptoms commonly ease after the first trimester. However, 1 in 5 women may experience morning sickness into their second trimester, and an unfortunate few women experience nausea and vomiting for their entire pregnancy.
It is important to note that every woman’s experience is different.
Common symptoms of NVP include:
Q2. Why do women get morning sickness/NVP?
The exact cause of morning sickness is not fully understood, it is believed to be related to hormonal changes, specifically increased levels of human chorionic gonadotropin (hCG) and estrogen.
Q3. Is there anything I can do to minimise morning sickness symptoms / NVP?
There are a few things that can help to minimise morning sickness symptoms or NVP including:
- Diet: small amounts of fluid and food throughout the day rather than eating fewer but larger meals. Foods should be rich in carbohydrates and low in fat and acid. If required, please seek advice from a dietician.
- Prioritize sleep: Sleep requirement increases in early pregnancy. Fatigue will exacerbate nausea and vomiting during pregnancy.
- Acupressure – using wristbands. They can be purchased from a local pharmacy.
- Short term use of ginger (<1000mg daily) – can help reduce nausea.
- Discontinue prenatal multivitamins – until symptoms ease. In some cases pregnancy multivitamins can contribute to NVP symptoms.
Antinausea Medication – Antiemetics are individualized and need to be prescribed by a doctor.
Q4. When should I seek medical advice for my NVP?
It is important to listen to your body - if you feel as though you need help, please seek medical advice. We often describe ‘morning sickness’ as a normal pregnancy related symptom because it is quite common, but you should not suffer excessively with it. You should seek help from your local GP, your maternity provider, or an emergency department if you are concerned.
Here are some guidelines to help you decide if you should be concerned about vomiting during pregnancy:
- Nausea and occasional vomiting.
- Mild to moderate symptoms.
- Symptoms usually occur in the morning but can persist throughout the day.
- Generally, you can keep food and fluids down and maintain adequate hydration.
When to Be Concerned:
Consult your healthcare provider if you experience any of the following symptoms. They may be signs that you are experiencing a more severe form of morning sickness ( Hyperemesis gravidarum -HG) that requires medical treatment.
- Severe vomiting: If you're unable to keep any food or fluids down and are vomiting excessively, it may lead to dehydration and nutrient deficiencies.
- Weight loss: If you're losing a significant amount of weight, it's a cause for concern.
- Dehydration: Signs of dehydration include dark urine, infrequent urination, dizziness, rapid heartbeat, and dry mouth.
- Intense abdominal pain: Severe or persistent abdominal pain may indicate an underlying issue unrelated to morning sickness.
- Blood in vomit: If you notice blood in your vomit, it's essential to seek immediate medical attention.
- Decreased fetal movement: If you're experiencing reduced fetal movement along with severe vomiting, it's important to contact your healthcare provider.
Remember, every pregnancy is different, and if you have any concerns about your symptoms, it's always best to consult your healthcare provider. They can assess your individual situation and provide appropriate guidance and support.
Q5. What is HG and what is the cause?
Hyperemesis gravidarum (HG) is a severe form of morning sickness, with excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids.
Just like NVP, HG can begin early in pregnancy, before women are 16 weeks pregnant and can extend up to and beyond 20 weeks’ gestation. Although less common, some women can have HG their entire pregnancy.
The exact cause of HG is not yet fully understood and research continues. It is likely multifactorial including hormones and digestive function. Causes may also vary between patients depending on biological make-up (genetics), body chemistry, fetal gender, and overall health. It’s important to note that you are not at fault for developing this condition.
HG can significantly impact a woman's pregnancy both physically & mentally. HG is often characterized by:
- Nausea & vomiting that is repetitive & relentless.
- Weight loss due to the inability to tolerate foods.
- Tiredness from persistent nausea & vomiting preventing you from completing everyday tasks & rest.
- Dehydration due to the inability to tolerate fluids.
- Shift in mental health: feelings of anxiety & depression due to the constant feeling of sickness can significantly impact your day-to-day life. HG can cause women to feel very isolated due to not being able to participate is previous activities & social events.
Q6. Are there any factors that put me at a greater risk of getting HG?
While the exact cause of HG is unknown, several factors may increase your risk of developing it. These factors include:
- Personal or family history: If you or a close family member (such as your mother or sister) have experienced HG in previous pregnancies, you may be at a higher risk.
- Multiple pregnancies: Women carrying multiples (twins, triplets, etc.) have a higher likelihood of developing HG compared to those carrying a single fetus.
- History of motion sickness or migraines: If you have a history of motion sickness or migraines, you may be more prone to developing HG.
- First-time pregnancy: HG is more common in women during their first pregnancy.
- Obesity: Women with a higher body mass index (BMI) may have an increased risk of developing HG.
- Trophoblastic disorders: Conditions such as molar pregnancies or choriocarcinoma, which involve abnormal growth of placental tissue, can be associated with HG.
It's important that while these factors may increase the likelihood of developing HG, they don't guarantee that you will experience it. Conversely, you may develop HG even without any known risk factors. If you have concerns about your risk of developing HG, discuss them with your healthcare provider, who can provide personalized guidance and support based on your individual circumstances.
Q7. How can HG be treated?
The treatment of hyperemesis gravidarum (HG) aims to alleviate symptoms, prevent dehydration, and ensure adequate nutrition. The specific treatment plan may vary depending on the severity of your condition and your individual needs. Here are some common approaches to managing HG:
Lifestyle and dietary changes:
- Eating small, frequent meals: Consuming smaller meals throughout the day instead of larger ones may help reduce nausea.
- Avoiding triggers: Identify and avoid specific smells, foods, or situations that worsen your symptoms.
- Stay hydrated: Sip fluids regularly, such as water, herbal teas, or clear broths, to prevent dehydration.
- Anti-nausea medications: Your healthcare provider may prescribe medications to help alleviate nausea and vomiting. These may include vitamin B6 supplements, antihistamines (such as doxylamine), or in more severe cases, medications like ondansetron or metoclopramide.
Hospitalization and intravenous fluids:
- In severe cases of HG, hospitalization may be necessary to administer fluids and nutrients intravenously to ensure proper hydration and nutrition.
- Your healthcare provider may recommend dietary modifications or provide nutritional supplements to ensure you're getting essential nutrients.
- Dealing with HG can be physically and emotionally challenging. Seek support from loved ones, join support groups, or consider counseling to manage the emotional impact.
It's important to work closely with your healthcare provider to develop a personalized treatment plan for your HG. They can monitor your condition, adjust medications as needed, and provide guidance throughout your pregnancy. Early intervention and consistent communication with your healthcare team are key to managing HG effectively.
A great resource for additional treatment of HG is accessible via the Hyperemesis Australia website.
Q8. Will HG go away once I give birth?
In most cases, hyperemesis gravidarum (HG) resolves after giving birth. However, it's important to note that every woman's experience is unique, and in rare cases, some women may continue to experience symptoms of HG even after delivery.
Recovering from HG postpartum can take time and although some women may not experience symptoms in the lead up to their birth or once their baby is born it has been suggested that it can take around 1-2 months of recovery for every one month you lived with NVP or HG. It is important that during this time you continue to look after both your physical and mental health.
Remember, postpartum care is an essential part of the overall pregnancy journey, and your healthcare provider can guide you through this transition and provide appropriate support and treatment if necessary.
Supports available include:
- Hyperemesis Gravidarum Australia
- Beyond blue
- Your healthcare providers
- Maternal Child Health Nurse
Q9. Where can I learn more about some mothers that have suffered HG?
If you are interested in hearing stories from other HG survivors, I share the below stories on my podcast Middee.
Tahnee Motti: HG and its impact on my mental health https://podcasts.apple.com/au/podcast/middee/id1575363001?i=1000611924973
Ella Heyne: HG, my mental health & a premature baby
Click here to see more blogs and Q&As from health experts.
Monique hosts podcast series ‘Middee’ providing modern-day midwifery, pre and post-natal community education.
New South Wales Government (2023) Hyperemesis gravidarum. https://www.health.nsw.gov.au/kidsfamilies/MCFhealth/Pages/hyperemesis-gravidarum.aspx#:~:text=What%20is%20hyperemesis%20gravidarum%20(HG,called%20hyperemesis%20gravidarum%20(HG).
Hyperemesis Gravidarum Australia (2023). Treatment. https://www.hyperemesisaustralia.org.au/healthcare-providers/treatment
Hyperemesis Gravidarum Australia (2023). About NVP + HG. https://www.hyperemesisaustralia.org.au/healthcare-providers/aboutnvphg
Her Foundation (2023). About Hyperemesis Gravidarum (HG) https://www.hyperemesis.org/about-hyperemesis-gravidarum/
The Royal Women’s. (2020). Nausea and Vomiting - Pregnancy- guideline. https://thewomens.r.worldssl.net/images/uploads/downloadable-records/clinical-guidelines/nausea-and-vomiting-pregnancy_280720.pdf