When to get advice about vomiting and nausea in pregnancy

feeling sick during pregnancy and Hyperemesis Gravidarum

Feeling sick is a well known symptom in the early weeks of pregnancy. In fact, for some women feeling sick prompts them to take a pregnancy test. Most women experience episodes of feeling nauseous and sometimes vomiting during pregnancy. How do you know if it’s something you need to speak with your midwife about? Here’s everything you need to know…

What causes nausea and vomiting during pregnancy?

It is thought to be caused by a number of changes that happen now you’re pregnant, especially certain hormonal changes. 

Once pregnant, your levels of hormones called HCG (human chorionic gonadotropin) and oestrogen increase. Additionally, changes in your digestive system occur due to increased levels of the hormone progesterone. It is suspected that these hormones increase nausea and vomiting.

Do all women get nausea and morning sickness?

According to the Pregnancy Sickness Support Group, mild nausea and vomiting in pregnancy occurs in approximately 94% of pregnancies. Normally starting between weeks 4-6 of pregnancy and then easing anytime between 12-14 weeks.

Morning sickness shouldn’t last all day and night, and definitely not to the extreme where you can’t keep any food or drink down. If it is having an impact on your day to day life, speak with your GP or midwife straight away. This goes for nausea as well – just because you’re not being physically sick doesn’t mean it isn’t as severe.

 

Mild to moderate sickness

If you are experiencing occasional episodes of nausea and vomiting, it’s advised you aim to eat little and often. Try not to allow for your stomach to be completely empty as this can make your nausea worse. For example, eating some biscuits when you wake up. Something small and ‘carby’ can help line your stomach first thing in the morning.

Moderate to severe

When nausea and vomiting becomes moderate to severe, it is affecting your daily activities and is impacting upon your quality of life. Seek advice from your GP, midwife or health care provider. What you are experiencing should be validated and heard. 

Resting and eating little and often is advised. Also, at this stage appropriate medication should be considered and used. You should feel supported throughout the decision making to commence medication.

What is Hyperemesis Gravidarum?

Hyperemesis Gravidarum (HG) is severe nausea and vomiting that starts before 16 weeks of pregnancy and can persist throughout. It greatly impacts one’s ability to eat and drink (leading to dehydration and malnutrition), quality of life and ability to perform daily living activities like washing, dressing, work etc.

How many pregnant women experience Hyperemesis Gravidarum?

Approximately 10 – 20k women are affected by HG during their pregnancy each year in the UK. It sounds like a large number but this equates to only 1-2% of all pregnancies

Hyperemesis Gravidarum sickness and other symptoms

The symptoms of extreme nausea and vomiting usually peak at 9-13 weeks of pregnancy then may ease between 16-24 weeks. However severe symptoms can continue throughout. 

It is considered like so many other pregnancy related conditions, that if diagnosed early  we can try to prevent any worsening symptoms or side effects, some which can be long term.

Other symptoms of Hyperemesis Gravidarum

  • Metallic taste in mouth (can sometimes be severe that it is a burning sensation)
  • Excessive salivation (a watery mouth sensation that you get just before vomiting)
  • Heightened sense of smell (can be distressing if it’s family members, your partner or even your other children)
  • Acid reflux
  • Lethargy/fatigue
  • Headaches
  • Sensitivity to light/noise/movement can all be triggers 
  • Weight loss (usually up to 5% of pre-pregnancy body weight)
  • Constipation

HG and your mental health

Whether you have some or all symptoms (mild or more severe), including the extreme nausea and vomiting, HG can have a severe impact on your mental health and wellbeing. It’s a depressing condition to suffer with and can leave long lasting effects.

If you are experiencing occasional episodes of nausea and vomiting during your pregnancy and you are finding this distressing, talk to your Midwife/Health Care Provider. As a midwife, I have cared for ladies who suffer from emetophobia (an extreme fear of vomiting, seeing vomit, seeing someone else vomit or even the feeling of being sick). There may be underlying reasons why the nausea and vomiting is a trigger for you in relation to PTSD from trauma. Hence, you have a low threshold for these symptoms.

No matter your situation, you should feel supported and that your feelings and symptoms are validated, listened to and cared for. This is not a case of someone else saying to you “oh I was sick all the time when I was pregnant! I still had to go to work and get on with it”. This is a pregnancy induced medical condition that requires treatment and monitoring.

Treatment for Hyperemesis Gravidarum

The aim of introducing treatment is to rehydrate and provide nutrition that your body needs. Sometimes women have a drip of fluids commenced to rehydrate and rebalance. 

Medications known as anti sickness/nausea medications (antiemetics) are usually also advised. These can sometimes be given via an injection initially, then once vomiting is under control, taken as a tablet or a tablet that is left between your gums to dissolve. 

There are a variety of anti sickness medications that your health care provider will discuss with you. Sometimes you may need to try a combination of medicines to find the one that works best for you. It is important that your healthcare provider explains the risks and benefits of taking the medications during pregnancy, as there can be some side effects too. It’s a conversation to have with your midwife and doctor caring for you at the time.

Recovering from Hyperemesis Gravidarum

Sometimes women can experience ongoing reflux, muscle weakness, and even dental problems due to the acidity exposure. Talk this through with your midwife. If you are finding some certain smells or other things are triggering what you’ve experienced, talk about it. It’s not uncommon for this to happen, if you talk about it, it helps so that you can be appropriately supported.

The Pregnancy Sickness Support Charity offers support and advice. 

There is also a charity Hyperemesis (HER) which is an international charity offering support and latest research. They also have a facebook group, Her Foundation.Inc.

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