Tuesday, September 4, 2012

The Nausea & Vomiting of Pregnancy Go-To List

Over the past few years, I have noticed that I have become the "morning sickness go-to person." Through Facebook, or my blog, or just through knowing me, people know that I have had experiences with severe NVP, and every couple of months I get an email from someone saying, "Help! I have horrible morning sickness, can you help?" And because I participate in many online birth groups, there are often requests for NVP help there as well. 

Lately, I have realized that I am reinventing the wheel each time someone asks me this question - writing emails with everything I can think of regarding NVP, over and over again. This week, therefore, I decided that I needed to write down everything that I could think of into a document so that I could keep it handy to have when this question is asked.

And so... here is my rough draft! I would love-love-love it if my wonderful readers could read this through and add their comments. Did I write anything incorrect or incomplete? Did I miss anything? This list is a bit patchy, just because it covers everything from mild NVP to hyperemesis, so I'm guessing that it will need a lot of revision.

Please feel free to share the link to this document, but do not copy it into another website. If any birth professionals would like to print this for clients, I would be honored - just give credit on the print-out.

And now... what do you think? Please let me know! 

Notes on Morning Sickness

- Because “morning sickness” is a vastly incomplete and inaccurate term, I will use the more technical abbreviation “NVP,” which stands for “nausea and vomiting of pregnancy”

General Notes

-       - The general idea with NVP is that it occurs solely in the morning and that it lasts only through the first trimester. For some women this is true. However, for many women it is VASTLY INACCURATE.

o   Many women experience NVP in the evenings, or in the mornings and the evenings, or in varying degrees around the clock. I have always had mine around the clock with the worst nausea being from 3 p.m. to bedtime.

o   For some women, NVP decreases after the first trimester. For others, it lasts till around 20 weeks. For some women it lasts till the birth. For some women it decreases in the second trimester and returns in the third trimester.

o   Morning sickness usually tapers off gradually rather than suddenly resolving at a set week of pregnancy.

-       - If you are carrying multiples, you can (usually) expect morning sickness to be worse than in a singleton pregnancy. More babies = more NVP!

-       - The timing of NVP appearance varies. Very rarely (as in my case), NVP will make an appearance before a positive pregnancy test can be obtained. Usually it hits between weeks 5 and 7.

-       - Though an absence of NVP does not mean that something is wrong, the appearance of NVP does usually mean that your baby is thriving.

-     NVP experiences cover an astoundingly large range – everything from “Morning sickness? What morning sickness? I feel great!” to “I don’t feel so great” to “I feel downright awful” to a mother who is fighting for her life in the hospital with life-threatening hyperemesis gravidarum. Different remedies will work for different women and for different levels of NVP – what may be helpful for mild NVP will be worse than useless for severe NVP (example: crackers). Look through these suggestions and try different things – remember that different things will work in different situations. If something doesn’t work, ditch it and try something else.

What To Do?

Nausea and Vomiting of Pregnancy – Mild to Moderate

-       Ginger: Ginger is the most well-documented herb for NVP. It is found in many forms:
o   Powdered, in capsule form – health food store
o   Ginger ale – Must buy from a health food store, and look at the ingredient labels. Most grocery store “ginger ales” are not true ginger ales and may not even contain ginger.
o   Ginger snaps.
o   Candied Ginger
o   Ginger Syrup (look at Whole Foods)
o   A supplement called “Morning Sickness Comfort” (formerly “Morning Sickness Magic”) which also contains vitamin B.
o   I should say that I find no particular benefit from ginger. However, it is helpful to a majority of women.

-       Lemon: Hard candies, lemon water, sucking on a lemon, lemon essential oils

-       Peppermint: Hard candies, essential oils (can put on your pillow)

-       Switch to a food-based prenatal vitamin

-       Over the Counter things to try: Benadryl & Dramamine

-       Pregnancy Teas: Try the pregnancy tea by Earth Mama Angel Baby – good stuff. Check out the pregnancy area in your health food store (Sprouts, etc.) – they usually have morning sickness teas.

-       Red Raspberry Leaf Tea: Buy the bulk herb at a local herb shop or online at a good herb store like Mountain Meadow Herbs. Brew and then drink hot or cold, or even freeze and make a slushie out of it.

-       High-protein: This is a BIG ONE. Eat protein – lots of it. Meat, eggs, nuts, cheese. Every snack or meal should either be protein, or have protein in it.

o   I have had my best luck doing a very-low-carb, high-protein diet that I started pre-conception. This is mostly for hyperemesis mothers who deal with severe morning sickness. Email me if you want information. However, one way or the other, simple carbs will usually make you feel great momentarily and then even worse as your blood sugar crashes. Staying away from carbs (or at least simple carbs) and bulking up on protein (as much as possible) is what really works for me.
o   However, I should note that (especially once nausea is established), some women have good luck with sources of simple carbohydrates (sugars) such as flat coke and hard candies and preggie pops.

-       Constant snacking: This is another BIG ONE!!! Don’t go more than an hour without snacking. Carry snacks with you wherever you go. If you need to get up in the middle of the night to snack, fine. Do it. I kept cheese slices in a cooler next to my bed. If your stomach gets the least bit empty, you will pay in increased nausea. Try also to eat at least a few minutes before getting up in the morning.

-       Keep hydrated. Dehydration = worse and worse nausea. Try different things if you have trouble handling water. Pregnancy teas, etc.

-       Vitamin Shots: With my last pregnancy I got Vitamin B/Folate/Magnesium shots at our local naturopathic college. I think they helped, and I plan to do it again. To find out where to get these, locate a local naturopath.

-       A naturopath can also help you with acupuncture and/or homeopathy if you are interested in those modalities. Acupuncture in particular has a very good track record with NVP.

-       Supplements: Vitamin B complex, magnesium, zinc. Herbs: Milk thistle. Other: Digestive enzymes, good probiotic.

-       If all else fails, try a liquid nutrition drink, such as Ensure or Boost. I recommend chocolate!  Slimfast and jello are other options.

Is something wrong?

-       This level is characterized by the following:
o   I can’t keep anything down.
o   I am no longer using the bathroom (or not very often).
o   I am losing weight.
o   I am feeling panicky or desperate.
o   I am vomiting multiple times per day.
o   I am having trouble handling ordinary everyday tasks.

-       To check if you are dealing with hyperemesis, visit www.helpher.org. Click on the “For Mothers” tab, and click on the “Do I Have Morning Sickness or HG?” option – you will find a table comparing normal NVP with hyperemesis gravidarum (HG), or extreme nausea and vomiting of pregnancy.

-       HG often requires treatment. See your doctor or midwife immediately to get help. This may involve:

o   IV hydration
o   Hospitalization for severe cases
o   Home health care for severe cases 
o   Zofran – either oral tablets, orally disintegrating tablets (ODT), or a Zofran pump (depending on how sick you are and how well you can tolerate meds by mouth)
§  There are other anti-nausea drugs given during pregnancy (usually Phenergan and Reglan), but they have more side-effects than Zofran and are usually less effective

-       If your care provider is not supportive, look immediately for another care provider. Care providers can vary immensely on their willingness to take HG seriously, and some will laugh it off or tell you to eat crackers. This is NOT OKAY, and you need to move on.

-       Go to the helpher.org website and read, read, read. You will find tons of information and support.


- There are MANY lines of thought on morning sickness prevention, all of which require pre-conception efforts, and none of which is guaranteed to work. (In other words, DON'T GET YOUR HOPES UP.) I will list as many as I can think of and leave it up to you to research them (though feel free to ask any questions):

o   Magnesium (building up tissue levels pre-conception)
o   Body alkalinity
o   Liver cleansing
o   Milk thistle (for liver cleansing)
o   Very-low-carb diet for insulin regulation
o   Pre-conception diet (clean, good supplements, sunshine, etc.)
o   Gut health


Thoughts, dear readers? (p.s. Forgive the formatting - it got rather screwy.)

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