Morning sickness in pregnancy
Most women experience at least some sickness during their first trimester (usually from around six weeks) and the symptoms can come and go or occasionally develop later in pregnancy. 'Morning sickness' is a cruel misnomer though: for many pregnant women, the only time they don't feel sick is when they're asleep.
When does morning sickness start?
Nausea and sickness are often one of the first pregnancy symptoms, with the queasiness usually starting when you're around six weeks pregnant, though it can also begin a few weeks earlier. Many women experience at least some sickness during their first trimester, but it doesn't necessarily strike as soon as you've taken a pregnancy test for a missed period.
According to the law of averages, you can expect to feel the worst nausea around nine weeks. Every woman is different, though, so don't worry if your body is working to an alternative schedule.
When does morning sickness stop?
Pregnancy sickness will normally stop when you get to 12 weeks to 14 weeks of pregnancy but one in 10 unlucky women still feel sick after 20 weeks. And don't get complacent if it eases early; the symptoms can come and go.
Information from Pregnancy Sickness Support, which has lots of information on coping strategies, states: "These troublesome symptoms often disappear by themselves, usually settling by 12 to 14 weeks after the first day of the last menstrual period (LMP). Approximately 10% of symptoms will become worse after week 10 from LMP. However, occasionally women will continue to have symptoms beyond 20 weeks of pregnancy. If this happens to you, try to remind yourself that all pregnancies are different, and the 12 to 14 weeks duration is only an average.
“'Morning sickness' is a very inadequate term to describe the condition because NVP usually occurs both before and after midday, and it does not do justice to the range of severity that can occur. Nausea and vomiting in pregnancy (NVP) is a more appropriate and accurate term. However, if you read articles or hear about “morning sickness,” you can be sure the information applies to the same condition as NVP."
If you're suffering, there are a number of popular treatments which can help ease nausea, although no one has yet discovered a miracle cure – sorry.
What is morning sickness?
Health professionals actually favour the term 'nausea and vomiting in pregnancy' (NVP) because, in truth, it can strike at any time of the day or night. Such fun.It's a weird feeling, like having two stomachs – one that wants to throw up and burp constantly, and the other that is constantly ravenous and thinking about food all the time.
Some women are sick, others feel nauseous without actually being sick. At a point when you may already feel tired and emotional and have a heightened sense of smell, it can be very trying – especially if no one else knows you're pregnant yet.
Unfortunately, there is no magic cure if you're suffering, but there are plenty of tried-and-tested remedies which are worth a go.
“Just try and eat as much as you can (don't gorge, I mean little and often) and if you fancy something then have it. Anything to make you feel a bit more human.”
What are the causes?
Scientists don't know exactly what causes NVP, but those pesky hormonal changes are probably partly responsible. While there isn't a definite answer, it’s likely to be caused by one or other of the below (or a combination):
- A sudden increase in your body’s oestrogen levels
- A sudden increase in Human Chorionic Gonadotrophin (HCG)
- An enhanced sense of smell and increased sensitivity to odours
- A lack of vitamin B6
When are you more likely to suffer?
While it is a very common ailment – affecting around eight out of 10 women – you're more likely to suffer with it if:
- It's your first pregnancy
- You've had it in a previous pregnancy
- You've had motion sickness before
- You've got a history of nausea while using contraceptives that contain oestrogen
- There's a family history of it
- You're obese (BMI of 30 or more)
- You're expecting twins or triplets
- You're stressed (and who wouldn't be, during pregnancy?)
Severe morning sickness
The majority of women will experience nausea during pregnancy (roughly seven out of every 10 women according to NHS choices). But 1-1.5% of pregnant women suffer excessive nausea and vomiting, otherwise known as hyperemesis gravidarum. The British Journal of Midwifery's review of the effects of hyperemesis found four main themes. These were social isolation, being unable to care for themselves or others, negative psychological effects, such as depression, anxiety, guilt and loss, and, most worryingly, suicidal ideation.
The review also found that: “Despite recognition of the severity of symptoms, the negative effects on women's lives can sometimes be underappreciated by health professionals, social workers and the general public. A systematic review and meta-analysis in 2016 found a significantly higher rate of depression and anxiety in women with HG compared to controls.”
The impact this severe form of sickness can have on a woman's mental health, as well as her physical wellbeing, is considerable, so please do seek help if you feel that it's getting on top of you. Pregnancy Sickness Support has plenty of resources to guide you in the right direction, plus a helpline, should you want to talk to someone.
Signs and symptoms include:
- Long periods of feeling extremely sick, as well as severe vomiting
- Dehydration – due to being unable to keep fluids down
- Weight loss
- Low blood pressure when standing
- Ketosis – the body does not have enough glucose for energy, so it burns fat instead. That causes a build-up of acids (called ketones) in the blood and urine
Experts don't actually know what causes this condition, but some think it's tied to the changing hormones in your body when you're pregnant.
If you have had HG previously, you are more likely to experience it in your next pregnancy compared to women who haven't – and there is some evidence that it runs in families.
Morning sickness remedies
Unfortunately, there's no fix-all cure for pregnancy sickness. Everyone's different – a remedy or medication that works for someone else might have no impact on you. Try not to worry if some of the suggested solutions don't do the trick, but anything that gives you some relief has got to be worth a go at least once.
Although no one thing can stop it outright, there are a number of popular treatments that can help alleviate some of the discomfort you may be experiencing.
- Lots of rest
- Plenty of fluids – sip drinks slowly and frequently
- Travel sickness wristbands
- Ginger – the biscuit variety, or ginger tea works well
- Sucking on ice or ice lollies
- Vitamin B supplements
- Fresh air – take a walk or sit outside
- Distract yourself (easier said than done, we know)
What to eat
- Opt for bland, non-greasy foods that are easy to prepare
- Plain carbs like pasta, rice, bread and potatoes
- Snack on crackers, oatcakes or digestive biscuits
- Foods high in zinc: seeds, wholemeal bread, small amounts of eggs and red meat
- Avoid smelly and spicy foods
- Eat cold meals rather than hot ones – hot foods have stronger smells and flavours which may make you feel sicker
- Avoid drinks that are very cold, sour or sweet
- Try flat fizzy drinks to settle your stomach
- Fruit or herbal teas like peppermint tea
- Sorbet or ice lollies will help to keep you hydrated
Is sickness medication safe?
If you've tried natural remedies, including diet and lifestyle changes, and your nausea and vomiting are severe, a doctor may recommend a course of medication that is safe for use in pregnancy – probably anti-sickness medication (antiemetics) or an antihistamine.
Antihistamines, which are often used to treat allergies, can also work as antiemetics and your GP may prescribe a short course of these to help with nausea. Commonly prescribed antiemetics can have side effects, such as muscle twitching, but these are rare.
Nobody enjoys feeling or being sick but unfortunately for many, it’s part and parcel of being pregnant. Particularly in the early days when you may be trying to keep your pregnancy to yourself, finding ways to cope without giving the game away isn’t always easy.
Mumsnetters who’ve been there and done that offer some tips for coping with nausea when you’ve just got to get through the day.
When pregnant I was sick morning, noon and night – night being the worst actually. It's an insulting term for something that can take over your life.
- “Try to eat before you start feeling nauseous – having a snack next to your bed for when you wake up can help”
- “Eat a small bowl of porridge before you go to bed at night”
- “Snack regularly, if you feel you can keep it down, on crisps/biscuits/toast/sweets”
- “Try to think about other things while eating, and make the experience as pleasurable as possible”
- “If certain smells trigger your nausea, avoid them if you can”
- “Wear loose clothes so nothing digs into your waistline”
- “Carry mints everywhere (helpful as a breath freshener, too, if you're sick when you're out somewhere)”
- “Online food shopping, if going round the supermarket makes you want to retch”
- A little self-pity – “My aunt recommended sitting on the bathroom floor wailing 'Oh please, just let me die'. I felt more comforted by her telling me that than by all those who offered more conventional advice”
Morning sickness and work
As with any illness, if you are experiencing sickness and nausea to a degree that would impact your ability to work, you may want to – and are entitled to – take time off work. Your employer should respect this and be supportive.
The 2010 Equality Act states that it is unlawful discrimination for an employer to treat a woman unfavourably due to pregnancy or illness relating to pregnancy. Discriminatory treatment includes withholding sick pay and unfair dismissal. If you think you have been subject to discrimination, you may wish to claim for compensation through an employment tribunal.
In other words – if you're too sick to work, you're too sick to work. It's as simple as that. Visit your doctor and explain the situation, and ask for a sick note if you need it.
If an illness is pregnancy-related, it should be recorded as such – it won’t count towards your sickness record and you cannot be dismissed for it.
If you are able to continue working, you might want to tell your employer so they can make adjustments, which they are legally required to do to protect your health. For example, it may be that you need easier access to a toilet, or a desk not so close to the kitchen and the smell of someone heating up last night's curry for lunch.
Mumsnetters' tips for coping at work
- “Take things one hour at a time. It might sound silly, but I found that worrying about how I was going to get through a whole working week only made things worse.”
- “Keep nibbling throughout the day – make sure there are plenty of snacks in your desk or your coat pocket.”
- “I’m a teacher and found that walking around the classroom all day really helped – but I also made sure I properly rested during my lunch break.”
- “I used to wear travel bands under my shirt. It might not work for everyone, but it certainly helped me.”
- “Speak to your manager and see if you can work from home – it won’t help with the nausea, but you’ll be more comfortable and relaxed.”
- “Know your limits – if it gets really bad, go to your doctor and get signed off.”
When should I go and see a doctor?
If your nausea and vomiting can't be controlled, you will need to be admitted to hospital so that doctors can assess exactly what treatment you need. There are medicines that can be used to help alleviate the symptoms of HG, such as anti-sickness drugs, vitamins B6 and B12, steroids, or a combination approach.
You may also have intravenous fluids inserted into a vein through a drip, and the anti-sickness drugs may also need to be inserted into a vein or muscle.
Contact your GP or midwife immediately if you notice any of the following:
- You have very dark-coloured urine or do not urinate for more than eight hours
- You are unable to keep food or fluids down for 24 hours
- You feel severely weak, dizzy or faint when standing up
- You have abdominal pain
- You have a high temperature of 38°C or above
- You vomit blood
In addition, urinary tract infections (UTIs) can also cause nausea and vomiting. If you have any pain when going to the toilet or notice any blood in your wee, you may have an infection and this will need treatment. Drink plenty of water to reduce the pain, but get yourself to a doctor too (your body will thank you for it).
Is morning sickness a good sign?
Gross and debilitating as it is, it won't usually harm you or your baby in any way. In fact, if you do feel sick, research suggests you're less likely to have a miscarriage (clouds, silver linings, and all that).
Is morning sickness worse if you’re having a girl?
Pregnancy myths suggest that if you’re pregnant with a girl, you’ll experience worse sickness than those expecting a boy. There’s a small amount of evidence to back this up – baby girls produce more hormones, which may increase your nausea – but we wouldn’t recommend throwing out your list of boys’ names just yet. Plenty of women who give birth to baby boys are also unlucky enough to be saddled with all the vomiting.
Should I worry if I don’t get it?
Try not to worry if you don't get it – and keep your fingers crossed that you don't develop it later on in pregnancy. So long as your doctor says your hormone levels are fine, consider yourself as having had a lucky escape!
“I had none at all with my first pregnancy and he came out perfectly healthy. I've always had a bit of a beef against people who say 'sickness indicates a healthy pregnancy'. Rubbish! Everyone reacts to pregnancy hormones in their own way.”
Losing weight during pregnancy
If you do find your clothes feeling a little looser during your first trimester, most of the time there's nothing to worry about, and there's no risk posed to you or your baby. The nausea can often, unsurprisingly, mean that you don't feel like eating as much as you would normally, which can lead to weight loss – while the vomiting may cause you to burn calories. Pregnancy can also cause food aversions, which makes eating difficult. If you do experience dramatic weight loss, however, speak to your midwife or doctor and they can assess your condition and choose the best course of action.
Where can I access support?
Make sure you communicate with your partner, family and friends about how you are feeling, so they know exactly what you need and how they can make you as comfortable as possible. Whether it's a quiet room to lie down in or extra help with day-to-day tasks, don't suffer in silence and don't feel guilty about speaking up. Just because lots of women go through this experience, it doesn't make your case any less difficult or important.
If your symptoms are becoming more extreme and difficult to manage, make sure you talk to your employer as it may start to affect your work and they need to be aware of the situation.
There are also a number of services out there offering help and support, including:
- NHS choices
- Pregnancy Sickness Support – they have an information line, a wealth of advice from professionals, and forums where you can talk to people who have been through it
- Tommy’s – a really informative website, and they also have a midwife helpline