Nausea and vomiting in pregnancy problem that is common, physiological, irritating and when excessive can be debilitating too for a pregnant woman.

For time immemorial, and definitely immortalized by our movies, Sheela or the lady by any other name had to either faint or have nausea for the entire family to declare Mubarak ho, bahu maa banne wali hai. 

Nausea of pregnancy is that sick feeling almost 70 to 80% of the women have during the first 3 months of pregnancy. Ironically although it’s also called morning sickness, the nausea may persist through out the day. Besides the sick feeling there could also be an abnormal sensation of smell and an aversion to common food stuff and even some of the most favourite ones.

We don’t exactly know why it happens but its probably related to the pregnancy hormone that is human chorionic gonadotropin or beta hCG. As the levels rise the nausea may also tend to rise and then plateaus or disappears after the 12^th to 16^th week. The rise of beta hCG may not be able to explain everything because there are some super women who go through these first 3 months like a breeze without any symptoms. Probably there are additional factors like increased oestrogen levels, build-up of acid, underlying gastritis, type of food intake, stress levels of initial pregnancy days that also modify the severity of nausea. Sometimes an underlying urine infection in pregnancy may manifest as nausea.  But all said and done, the iconic image of a woman feeling nauseous and everyone in the family declaring she is pregnant is an image that is stuck in our minds and movies alike. 

There are certain women who have more nausea than others:

• Those having multiple pregnancies
• Some women who have a complication called molar pregnancy
• Some women who already have altitude or motion sickness
• If its your first pregnancy or if you have had nausea in previous pregnancies
• If your Body mass index is more than 30 and if for whatever reason you are under stress

While all the above is true and yes, most women do get nausea, it is important to stress at this point that not having nausea does not mean that your pregnancy is not going well…. so, enjoy the freedom from carrying a sick bag all the time and don’t stress about your pregnancy 😊.

Next let’s discuss what are the 10 things you can do to battle this nausea and vomiting in pregnancy :

1. Keep your mind busy. If you are a working woman go to work, if you are a home maker, keep yourself busy, take up a new hobby maybe. If nothing else, go for a walk or a swim. Do not however overexert yourself as fatigue can increase nausea too.
2. Keep a toasted bread or 2 crunchy biscuits by your bed side. Have one of them even before you get out of bed in the morning. This neutralizes the acid that you have built up over the night.
3. Have small frequent, non-spicy and non-oily meals through the day
4. Avoid foods or smells that make you sick
5. Some women are lactose intolerant. The best way to find out is to go off all milk and milk products for a week or so and see how you feel.
6. Have less water with your meals and more in between 2 meals. Although food and water and both important, keeping yourself hydrated is more important
7. Sniff a lemon and keep a piece of ginger in your mouth. Studies have shown that these two really help a lot.
8. Try acupuncture or acupressure. There is a point called Neiguan point. You can stimulate this point on your own simply by placing your thumb 2–3 finger widths down from your inner wrist, between the two prominent tendons.
9. Try slow controlled breathing
10. Lastly if nothing helps, speak to your doctor because there are fantastic approved medicines for this which can help you. We normally start with B6 supplements and then gradually move up the list to other anti-vertigo and anti allergics and finally anti vomiting medicines. Please remember 3 things:
    1. You will not attain nirvana by torturing yourself, take medicines if needed
    2. Listen to and trust your doctor. He knows more than you and cares for you and your baby probably even more than your family member does.
    3. Severe nausea and vomiting of pregnancy called hyperemesis gravidarm can be threatening both to the mother and the baby. Do not let it reach that situation. 

When is it that you need to press the panic button and speak tour doctor urgently. 

If you have vomiting to the extent that you  

• have very dark-coloured urine or have not had a pee in more than 8 hours
• are unable to keep food or fluids down for 24 hours
• feel severely weak, dizzy or faint when standing up
• have tummy (abdominal) pain
• have pain or blood when you pee
• have lost weight

we would need to admit you and rehydrate you using intravenous fluids and give you nutrition via the drip as well. Usually these situations resolve quickly and in just a few days you can be home again and enjoying your pregnancy. Sometimes when we break this whole cycle of vomiting in the hospital, the problem doesn’t come back even when you back to the same routine at home. 

Also read: First Trimester Investigations – why are they essential ?

This brings me to the end of yet another discussion. This discussion is also available as a podcast – check out here.

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