The irony in the whole fertility journey is that when you finally get pregnant, you hate the fact you feel NORMAL. You have heard for years about morning sickness, you have watched friends vomit and tried to feel sorry for them when all you really wanted was to be pregnant and puking. And now, at last, you have achieved the pregnancy you so desired and you thought you would have a daily reminder that the 1,000 of shots really paid off.
As a physician, I see the patients who are really sick with morning sickness, also called hyperemesis gravidarum. And no one wants to be in their shoes (especially if breakfast is now sludging around in them). But I also see the patients who are worried sick that their lack of nausea means they may be miscarrying.
I, too, was there. I remember waking up one morning and being absolutely convinced I was miscarrying, since my chest was no longer tender and I didn’t have that bizarre feeling of both wanting syrup-soaked pancakes and wanting to puke. So at least I understand the desire to want to have morning sickness. But really?
However, when morning sickness does hit (and for many it will) it is nice to know some facts to keep it at bay. For one, 75% of women will have it. That also means 1 in 4 of you will be perfectly normal NOT having any nausea! Nausea and vomiting is associated with a decreased risk of miscarrying, but that is a loose association and likely includes the women who already have a non-viable pregnancy. Approximately 0.3-1.0% of women will have severe hyperemesis. This usually presents itself as an inability to work or care for other children, dehydration requiring hospitalization, and potential consequences to the mom and baby. It is true that the baby is a “parasite,” stealing from the mom the vitamins and calories it needs; therefore the effects on the baby may be hard to discern.
First thing to know is how to track the severity. There are several ways to measure its effect on you.:
- The scale in your bathroom
- The color of your urine
- Measuring your Ins and outs (quantify your liquids in and measure your urine in a urine hat- available at a pharmacy)
- Checking your blood pressure and pulse in the lying and sitting and standing position
- Blood tests
If you are losing weight and feel you are eating and drinking less, you need to start monitoring your hydration status. If the urine is darker yellow in color and your heart races when you stand up quickly, you are also likely getting dehydrated. A call to the office and often a visit can help to nail down he severity.
Doctors will often start with simple dietary recommendations. Eat small frequent meals—don’t get too full or too empty and NEVER be without food in your car or purse. Sucking on hard candy, chewing gum (not mint flavored), ginger chews, ginger ale, sour candy- all these may help but you may have to rotate your flavor of the day as you might become nauseated by it.
Other homeopathic remedies may help. Herbalists often have teas or acupuncturists can apply needles to help quell the nausea. Pressure on the median nerve with wrist bands designed for deep sea divers may also blunt some of the nausea. A walk in the fresh air may also help, even though it may be the last thing on earth you feel like doing when the pregnancy fatigue hits.
If this is not adequate, the next line of treatment is usually reserved for those who vomit or those who are severely incapacitated by their nausea. Bendectin was used for years in the US as a first line treatment but was pulled from the market in 1983 and never reintroduced despite many studies disproving any teratogenicity to fetuses. The best way to get this same type of medicine is a pill that goes by the trade name Unisom Sleep tabs. This is recommended as first line treatment by the American Society of OB/GYNs. However, it does make you sleepy.
Other options include: Reglan, Phenergan, and Zofran. Zofran has an oral tab that dissolves, which is especially helpful if you are puking. Most physicians will call in one of these prescriptions if over the counter remedies don’t help.
Occasionally patients will need an IV and fluids to get them to stop the cycle of vomiting. More extreme measures include prolonged hospitalization or loner lasting type IV’s that can infuse fats and nutrients that a simple IV can not.
Just because you had nausea in one pregnancy does not predict that you will have it in the next pregnancy, although there is a higher likelihood you will. If your mom or sister had severe morning sickness, you also may be more likely to get it. I have never seen a well designed study show that morning sickness is more strongly associated with one gender over another. Twins are usually associated with more nausea. And, many patients will not actually have MORNING sickness, but actually EVENING sickness or even AFTERNOON sickness.
And lastly, it usually starts at 6 weeks, peaks at 8 weeks, plateaus until 12 weeks and then starts to decline and be gone by 15 weeks. However, there are cases that will last the entire pregnancy. Severe vomiting can also cause problems with your esophagus and morning sickness can possibly cause ulcers, so consulting a doctor can be essential. Thyroid disease can often be masquerading as morning sickness.
So if you do actually have the pukes, don’t worry, there is a baby at the end of this all. And if you are in the lucky 25% who don’t have it, count your blessings, but see your doc if the anxiety about not having it gets too tough!
Dr. Mary Hinckley is a leading Reproductive Endocrinology and Infertility specialist at the Reproductive Science Center of the San Francisco Bay Area. She has extensively published articles in peer-reviewed journals on blastocyst transfer, avoiding triplet pregnancies, monozygotic twinning, operative hysteroscopy, correction of uterine anomalies, and biochemical pathways involved in ovulation and fertilization. She serves as a member of the Society for Reproductive Endocrinologists, the Christian Medical and Dental Society and the American Society for Reproductive Medicine. Her areas of interest include laparoscopic surgery, premature ovarian failure, oocyte freezing, and recurrent pregnancy loss.
It feels so good to feel so bad: The Truth behind Morning Sickness
The irony in the whole fertility journey is that when you finally get pregnant, you hate the fact you feel NORMAL. You have heard for years about morning sickness, you have watched friends vomit and tried to feel sorry for them when all you really wanted was to be pregnant and puking. And now, at last, you have achieved the pregnancy you so desired and you thought you would have a daily reminder that the 1,000 of shots really paid off.
As a physician, I see the patients who are really sick with morning sickness, also called hyperemesis gravidarum. And no one wants to be in their shoes (especially if breakfast is now sludging around in them). But I also see the patients who are worried sick that their lack of nausea means they may be miscarrying.
I, too, was there. I remember waking up one morning and being absolutely convinced I was miscarrying, since my chest was no longer tender and I didn’t have that bizarre feeling of both wanting syrup-soaked pancakes and wanting to puke. So at least I understand the desire to want to have morning sickness. But really?
However, when morning sickness does hit (and for many it will) it is nice to know some facts to keep it at bay. For one, 75% of women will have it. That also means 1 in 4 of you will be perfectly normal NOT having any nausea! Nausea and vomiting is associated with a decreased risk of miscarrying, but that is a loose association and likely includes the women who already have a non-viable pregnancy. Approximately 0.3-1.0% of women will have severe hyperemesis. This usually presents itself as an inability to work or care for other children, dehydration requiring hospitalization, and potential consequences to the mom and baby. It is true that the baby is a “parasite,” stealing from the mom the vitamins and calories it needs; therefore the effects on the baby may be hard to discern.
First thing to know is how to track the severity. There are several ways to measure its effect on you.:
-
The scale in your bathroom
-
The color of your urine
-
Measuring your Ins and outs (quantify your liquids in and measure your urine in a urine hat- available at a pharmacy)
-
Checking your blood pressure and pulse in the lying and sitting and standing position
-
Blood tests
If you are losing weight and feel you are eating and drinking less, you need to start monitoring your hydration status. If the urine is darker yellow in color and your heart races when you stand up quickly, you are also likely getting dehydrated. A call to the office and often a visit can help to nail down he severity.
Doctors will often start with simple dietary recommendations. Eat small frequent meals—don’t get too full or too empty and NEVER be without food in your car or purse. Sucking on hard candy, chewing gum (not mint flavored), ginger chews, ginger ale, sour candy- all these may help but you may have to rotate your flavor of the day as you might become nauseated by it.
Other homeopathic remedies may help. Herbalists often have teas or acupuncturists can apply needles to help quell the nausea. Pressure on the median nerve with wrist bands designed for deep sea divers may also blunt some of the nausea. A walk in the fresh air may also help, even though it may be the last thing on earth you feel like doing when the pregnancy fatigue hits.
If this is not adequate, the next line of treatment is usually reserved for those who vomit or those who are severely incapacitated by their nausea. Bendectin was used for years in the US as a first line treatment but was pulled from the market in 1983 and never reintroduced despite many studies disproving any teratogenicity to fetuses. The best way to get this same type of medicine is a pill that goes by the trade name Unisom Sleep tabs. This is recommended as first line treatment by the American Society of OB/GYNs. However, it does make you sleepy.
Other options include: Reglan, Phenergan, and Zofran. Zofran has an oral tab that dissolves, which is especially helpful if you are puking. Most physicians will call in one of these prescriptions if over the counter remedies don’t help.
Occasionally patients will need an IV and fluids to get them to stop the cycle of vomiting. More extreme measures include prolonged hospitalization or loner lasting type IV’s that can infuse fats and nutrients that a simple IV can not.
Just because you had nausea in one pregnancy does not predict that you will have it in the next pregnancy, although there is a higher likelihood you will. If your mom or sister had severe morning sickness, you also may be more likely to get it. I have never seen a well designed study show that morning sickness is more strongly associated with one gender over another. Twins are usually associated with more nausea. And, many patients will not actually have MORNING sickness, but actually EVENING sickness or even AFTERNOON sickness.
And lastly, it usually starts at 6 weeks, peaks at 8 weeks, plateaus until 12 weeks and then starts to decline and be gone by 15 weeks. However, there are cases that will last the entire pregnancy. Severe vomiting can also cause problems with your esophagus and morning sickness can possibly cause ulcers, so consulting a doctor can be essential. Thyroid disease can often be masquerading as morning sickness.
So if you do actually have the pukes, don’t worry, there is a baby at the end of this all. And if you are in the lucky 25% who don’t have it, count your blessings, but see your doc if the anxiety about not having it gets too tough!
