Morning Sickness

Also known as: Hyperemisis Gravidarum

Morning Sickness

Problem

Is this your symptom?

  • Main problem is nausea, vomiting, or "morning sickness"

  • Nausea and vomiting begin during the 4th-8th week of pregnancy

  • Patient is less than 20 weeks pregnant

If NOT, try one of these:

What to Do

Select the First Symptom that Applies

Call 911 Now

  • You think you have a life-threatening emergency

Go to ER Now

  • Vomiting blood or black (looks like coffee-grounds)

  • Vomiting more than once and you:

    • Have diabetes

    • Have other risks (brain tumor, cancer chemo, inguinal hernia, or recent surgery)

  • Severe eye pain

  • Severe stomach pain

  • Constant stomach pain lasts more than 2 hours

  • Recent injury to the stomach

  • Recent injury to the head

  • Diabetes and have blood glucose over 400 mg/dl (22 mmol/l)

Call Doctor Now or Go to ER

  • Severe vomiting (6 or more times / day)

  • Can't keep any liquids down (without vomiting) for more than 1 day

  • Weight loss greater than 5 pounds (2.5 kg)

  • You feel dehydrated (dizzy, dry mouth, very thirsty)

  • You feel weak or very sick

  • You think you need to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Moderate vomiting (3-5 times) for more than 2 days

  • Pain or burning with passing urine

  • Alcohol or drug use

  • Diabetes

  • Weak immune system (HIV, cancer chemo, long-term steroid use, splenectomy)

  • You think you need to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Mild vomiting (e.g., 1-2 times / day) for more than 1 week and not better after using Care Advice

  • You have other questions or concerns

Self Care at Home

  • Mild nausea or vomiting from Morning Sickness

  • Ginger or acupressure bands, questions about

  • Prescription medicines, questions about

Home Care Advice

Treating Morning Sickness (Nausea and Vomiting of Pregnancy)

  1. What You Should Know:

    • Nausea and vomiting are common during the first 20 weeks of pregnancy. About 4 out of 5 of pregnant women have nausea. About half of pregnant women have vomiting.

    • These symptoms are called morning sickness. For some women the symptoms are worse in the mornings. But for many women these symptoms can occur any time during the day. Thus, a better term for these symptoms is Nausea and Vomiting of Pregnancy (NVP).

    • Pregnant women with vomiting need to stay hydrated. Women who become dehydrated should call or see their doctor.

    • Most women with morning sickness can treat it at home.

    • Here is some care advice that should help. Follow this step-by-step approach.

  2. Step 1 - Clear Liquids:

    • Sip small amounts of water, bouillon, or sports-rehydration liquid (Gatorade or Powerade).

    • Other choices: ½ strength flat lemon-lime soda or ginger ale; Pedialyte popsicles

    • Goal: The goal is to drink 6-10 cups (1,000-1,500 mL) per day. You can do this by drinking ½ cup (4 oz, 120 mL) per hour for 12 hours.

  3. Step 2 - Diet - Crackers:

    • Starchy foods are most easily handled by the stomach

    • Eat small frequent meals ("grazing throughout the day")

    • Try eating dry crackers or bread before getting out of bed in the morning

    • Try crackers, ginger snap cookies, white bread, white rice, noodles, mashed potatoes, cereal, or apple sauce.

    • Other choices: clear soup with rice or noodles.

  4. Step 3 - DIET - Starches, Chicken, Fish:

    • Advance diet as tolerated.

    • Eat small frequent meals. Divide your food into 6 smaller meals per day.

    • Try soups, pasta dishes, mashed or baked potatoes, or rice.

    • Try baked chicken or baked fish.

    • Eat foods that taste good to you

    • Avoid fatty and spicy foods, and foods with strong aromas.

  5. Prenatal Multivitamin:

    • Take a prenatal vitamin (with Folate) every day.

    • Take it with food. This may help decrease stomach upset.

    • Some women find taking it at bedtime causes less nausea.

  6. Vitamin B6 (Pyridoxine):

    • Has been shown to help reduce symptoms of morning sickness for some women.

    • It is available over-the-counter.

    • Dose: 10-25 mg by mouth two or three times a day. Do not take more than 50 mg a day. Take it with food.

  7. Additional Diet Suggestions:

    • Try eating dry crackers or bread before getting out of bed in the morning.

    • Eat small frequent meals ("grazing throughout the day").

    • Eat foods that taste good to you.

    • Avoid fatty and spicy foods, and foods with strong aromas.

  8. What to Expect:

    • The symptoms typically start around the 4th-8th week of pregnancy. They get worse until the 11th week.

    • The symptoms then start to get better and usually go away by the 20th week of pregnancy.

    • Morning sickness does not harm the baby and does not cause birth defects. However, it is important to stay hydrated.

  9. Call Your Doctor If:

    • Severe vomiting (6 or more times)

    • No urine for more than 12 hours

    • Fever, stomach pain, diarrhea, or vaginal bleeding occur

    • You think you need to be seen

    • You become worse

What to do When Morning Sickness Gets Worse

  1. What You Should Know:

    • It sounds like you are not dehydrated at this point.

    • There is no risk to the baby from morning sickness. However, it is important to not get dehydrated.

    • Here is some care advice that should help.

  2. Clear Fluids - Drink clear fluids in small amounts for 8 hours:

    • Water or ice chips are often the best source of fluids.

    • Sports-rehydration liquids (Gatorade or Powerade) are also good. Other options include ½ strength flat lemon-lime soda or ginger ale.

    • Sip small amounts frequently (1 tablespoon every 5 minutes)

    • After 4 hours without vomiting, increase the amount.

  3. Solid Foods (After 8 hours without vomiting):

    • Begin eating bland foods after 8 hours without vomiting. Start with foods like saltine crackers, ginger snap cookies, white bread, rice, mashed potatoes, cereal, and apple sauce.

    • As you improve, slowly return to your normal diet in the next 24-48 hours.

  4. Avoid Meds:

    • Stop using any over-the-counter medicine for 8 hours. Reason: Some of these can make vomiting worse.

    • Do not take ibuprofen (Motrin, Advil) or aspirin. These medicines (NSAIDs) should not be used when pregnant and can irritate the stomach.

    • Call your doctor if you vomit a needed prescription medicine.

  5. Stop Iron Pills:

    • Iron pills are prescribed to prevent and treat anemia.

    • Iron can irritate your stomach. Stop taking iron if you have morning sickness are are vomiting.

    • Your doctor can tell you if and when you should re-start the iron.

  6. Sleep: Try to go to sleep (Reason: sleep often empties the stomach and relieves the need to vomit).

  7. Call Back If:

    • Unable to keep ANY liquids down (without vomiting) for more than 24 hours

    • No urine for more than12 hours

    • Fever, stomach pain, diarrhea, or vaginal bleeding occur

    • You become worse

Ginger and Acupressure Wrist Bands

  1. Ginger:

    • The spice ginger may help lessen nausea and vomiting during pregnancy.

    • Available over the counter as a capsule. The dose is 250 mg by mouth four times a day.

    • Another option is to drink a glass of ginger ale (or ginger tea) as needed.

    • Studies suggest that ginger is probably safe in pregnancy. Remember to discuss this with your doctor at your next office visit.

  2. Acupressure Wrist Bands (e.g., SeaBands or AcuBands):

    • Some people think that acupressure bands decrease nausea and vomiting during pregnancy. However, so far studies have not shown for sure if they help.

    • A button in this elastic wrist band puts pressure over the "Neiguan point". This point is located about 3 fingers above the wrist joint, on the palm side of the wrist.

    • Wrist bands may be worth trying. They cost about $10 and have no known bad side effects.

  3. Call Your Doctor If:

    • Severe vomiting (6 or more times)

    • No urine for more than 12 hours

    • Fever, stomach pain, diarrhea, or vaginal bleeding occur

    • You think you need to be seen

    • You become worse

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Causes and Background Information

Key Points

  • Nausea and vomiting are common during the first 20 weeks of pregnancy. About 80% of pregnant women have nausea. About 50% of pregnant women have vomiting.

  • These symptoms are called morning sickness. For some women the symptoms are worse in the mornings. But for many women these symptoms can occur time during the day. Thus, a better term for these symptoms is Nausea and Vomiting of Pregnancy (NVP).

  • Most women with morning sickness can take care of themselves at home.

  • Morning sickness does not harm the baby and does not cause birth defects. However, it is important to stay hydrated.

Symptoms

The main symptoms of Morning Sickness are:

  • Nausea

  • Vomiting

The symptoms typically start around the 4th-8th week of pregnancy. They get worse until the 11th week. The symptoms then start to get better and usually go away by the 20th week of pregnancy.

Usually, there are no other symptoms besides nausea or vomiting. There should be no fever, stomach pain, or vaginal bleeding. If other symptoms are present, then there may be something else causing the nausea and vomiting.

Cause

The cause of morning sickness is not known. It may be from the effects of pregnancy hormones and emotional factors.

Complications

  • Dehydration

Vomiting Severity is defined as:

  • Mild: 1 - 2 times/day

  • Moderate: 3 - 5 times/day

  • Severe: 6 or more times/day, vomits everything or nearly everything

What are Signs of Dehydration?

Signs of dehydration include:

  • Feeling dizzy

  • Dry mouth

  • Feeling like fainting

  • Very thirsty

  • Pale skin

  • No urine in more than 12 hours

  • Dark yellow urine

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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.