One-third to one-half of all pregnant women experience nausea and vomiting. It is not clearly understood what causes nausea and vomiting in pregnancy (morning sickness).

Nausea and vomiting usually begins between the first and second missed menstrual period and lasts until about the time of the fourth missed menstrual period, or the end of the 3rd month of pregnancy.

Morning sickness (nausea and vomiting) can occur at any time of the day or night, and symptoms may persist past the 3rd or 4th month of pregnancy.

You may lose weight, or have inadequate weight gain if nausea and vomiting becomes severe. Fortunately, nausea and vomiting severe enough to produce weight loss, dehydration, and an upset in the body`s chemical balance are rare. However, if vomiting is severe enough to result in dehydration or nutritional shortages, it is called hyperemesis gravidarum, or hyperemesis.

Treatment

If nausea and vomiting persist, your doctor/midwife may prescribe one or more treatment options. The goals of any treatment for nausea and vomiting are to reverse the effects of fluid loss and provide emotional support to deal with the stress related to morning sickness.

Treatments that may be considered include:

• Dietary changes
• Medications (oral, rectal, injections, subcutaneous, and infusions)
• Intravenous fluids
• Intravenous nutrition

It is often necessary to prescribe a combination of these treatments. Your doctor/midwife/nutritionist will work with you to determine what is best for your situation.

You may be asked to keep a record of what you eat and drink, how much you urinate, and the amount of vomiting you are having. These records will help determine how well you are responding to treatment.

You will know best when you are ready to begin your normal activities. Do not rush things just because you are feeling a little better. It is best to wait until you can go for several days in a row without any vomiting, and you are hungry again, before getting back to your normal activity. Patience is a very big part of your therapy. It is common to have many "good days" followed by a few days when you don`t feel quite so well.

Dietary Considerations

Your doctor/midwife may ask you to allow your stomach to rest by not eating or drinking anything for the first 24 hours of treatment. A refreshing mouthwash will help with the dry mouth you may notice during this time.

After this "time out" from eating and drinking, you may be asked to begin taking small amounts of very cold liquids such as ginger ale or lemon-lime soda. It is best to not drink through a straw. The extra air that you swallow through a straw may upset your stomach.

After a day or two if you are feeling better, you may be asked to begin to eat small amounts of solid foods like crackers, dry toast, cereal, or baked potatoes every couple hours. Some women find it works well to switch between taking liquids and eating solid food. Just remember that any liquid or solid food should be eaten in small, frequent amounts. You may continue to add different beverages and foods when you feel like it.

Try to avoid anything that upsets your stomach. Most people have certain foods they like better that others. Eat a balanced diet, keeping in mind the foods you prefer. Most women do better eating four to six small meals a day. You may need to do this for the rest of your pregnancy.

Medications Used to Manage Nausea and Vomiting

Your provider may prescribe medication (antiemetics) as part of your treatment. Several different medications can be used. These medications are given by different means (oral, rectal, injection, subcutaneous, and infusion).

These medications work by quieting the vomiting trigger zone in the brain. Any medication you receive should be kept out of the reach of children and pets, and should be stored away from heat and direct light.

To avoid further nausea and vomiting

Once you begin to eat solid foods, eat a nutritionally complete diet. This diet should be high in complex carbohydrates (such as bread, rice, potatoes) and protein, and low in fat.

• Drink plenty of fluids.
• Eat often - before you start feeling hungry. Low blood sugar can cause nausea and shakiness. Some women find that sucking on hard candy when they wake up is very helpful to settle their stomach.
• Try eating a small snack the minute you wake up.
• Get up slowly after you have had your snack to avoid nausea.
• Eat many small meals each day, including a late evening snack; however, avoid lying down immediately after eating.
• Avoid eating any food that makes you feel queasy just from the sight or smell.
• Get plenty of rest. Being overly tired can set off nausea.
• It may be helpful to temporarily stop taking your prenatal vitamins and other dietary supplements until you are back on your regular meal schedule (check with your provider).

Remember that not all of these ideas will work for everyone. Nausea and vomiting, for most women, only lasts a short time, and you should start to feel better around the end of the third month of pregnancy. It is important to take it "one day at a time."

Reprinted with permission from Her Healthcare.

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