Morning Sickness: Coping With The Worst

When Jennifer first discovered she was pregnant, she was elated. Her excitement, however, was soon replaced by nausea and vomiting. Within a few months, her morning sickness became so bad she had lost 20 pounds and had been hospitalized twice for dehydration. Jennifer had hyperemesis gravidarum, the medical term for more serious morning sickness. The more severe condition strikes only 1.5 percent of pregnant women, but it can lead to dehydration, weight loss, nutritional deficiencies and electrolyte imbalances. Jennifer went on to have a healthy baby girl, but will never forget the experience. "I just wallowed in it and suffered," she says. "It was the worst feeling in the world." Most women experience morning sickness in its more common form, which is more of a nuisance than a medical emergency, and usually disappears by the 10th or 13th week of pregnancy. It occurs in two out of every three women and, despite its name, can strike at any time of day or night. Symptoms can include nausea, sensitivities to food, smells and odors, and occasional vomiting, as well as unusual food cravings.

What Causes Morning Sickness? Researchers have posed several theories over the last few decades, but no evidence conclusively pinpoints a cause of morning sickness. According to Dr. Eric Ganz, associate attending physician for the OB/GYN department at St. Luke's-Roosevelt Hospital Center, "There isn't an exact mechanism that causes morning sickness, but it's related to the high amount of pregnancy level beta HCG, human chorionic gonadotropin.” Steven Ravins, M.D., an OB/GYN with offices in Forest Hills and Jackson Heights, Queens, and assistant director of OB/GYN at North Shore University Hospital (NSUH) at Forest Hills, says many pregnant women feel worse in the morning due to low hydration levels. Since during the night “you dissipate a lot of your fluids through perspiration and breathing, you’re most concentrated in the morning,” Dr. Ravins explains. “And in the morning, all those compounds from the pregnancy that cause the sickness are also most concentrated.” Estrogen levels may also play a role. According to research summarized by the Hyperemesis Education and Research Organization, a non-profit agency devoted to helping women with morning sickness and offering information for physicians, women who get sick while taking birth control pills are more likely to experience morning sickness. However, no consistent difference in estrogen levels between women who get morning sickness and those who don't has been confirmed. Dr. Ganz says that, although no single mechanism causes it, he checks his patients for other health problems that may be causing the sickness, such as hypothyroidism and problems with the upper gastrointestinal tract. If everything else seems to be healthy, he treats the vomiting and nausea as morning sickness.

Got Morning Sickness? Even if you don't know the cause of your morning sickness, there are several things you can try to help you cope. Sheri Pepper of Sebastopol, Calif., experienced frequent nausea throughout the second trimester of her pregnancy. She found that lying down often and eating crackers helped. She also tried wearing Sea Bands — acupressure wristbands worn for seasickness. She says the wristbands "helped a little bit, but nothing took away the nausea completely." Jennifer admits that she didn't do much to help her morning sickness. She was advised to eat small, frequent meals, and she didn't. Now pregnant with her second child, she says that this time around she was more careful in the beginning. "I ate a lot as soon as I found out I was pregnant to avoid losing weight," she says. "Sure enough, I got sick again around the fifth or sixth week, but this time, because I have a toddler, I couldn't just lie down whenever I felt like it." Eating more frequently did indeed help, she says. When I was pregnant with my son and immobilized by morning sickness, my group of nurse-midwives advised me to eat small snacks high in protein. The protein raises your blood sugar level and helps to keep the nausea at bay. I found that a slice of cheese, a hardboiled egg, or a piece of toast with some peanut butter helped keep the queasiness at bay.

Eating by Instinct Oddly enough, many women crave unhealthy foods and have voracious appetites in between bouts of nausea. Sheri Pepper craved A & W hamburgers and bologna sandwiches on white bread slathered with mayonnaise and mustard. However, according to Miriam Erick, in No More Morning Sickness, this can actually be a good thing. Erick, a registered nurse, claims that what women want to eat is probably what they should eat, as it will help them get food down and keep it down. Monica Daniel, a certified midwife, agrees with the premise of Erick's book and advises her patients to eat whatever foods they feel they can tolerate, even if it means cola and white bread. She told me that "if women try to force themselves to eat what they think they should eat, and it makes them sick, they need to just let it go and eat what they can tolerate. Women are often advised to eat bland foods, and yet they tend to like strong flavors like limes or pickles."

Medical Relief If your morning sickness gets so bad that you cannot tolerate even small, frequent meals, you can try working with your healthcare provider to find safe homeopathic remedies or other over-the-counter drugs. Canadian women have access to Diclectin, a morning sickness drug chemically similar to Bendectin, which was banned in the United States in 1983 because of mounting lawsuits linking it with birth defects. However, according to American Medical News, extensive research has since proven Bendectin to be safe and effective. In fact, women in the U.S. may soon be able to purchase Diclectin, as the Canadian manufacturers have sought approval to sell the drug in the U.S. Women suffering from hyperemesis may end up hospitalized for treatment with IV fluids along with drugs like Phenergan to help minimize nausea and vomiting. “Within a day or two we get them to start to feel better and can usually discharge them 24 to 36 hours later,” says Dr. Claudia Ravins, director of OB/GYN at NSUH at Forest Hills. But if a patient is really ill, home care arrangements — just for fluids — can also be arranged, Dr. Ravins adds. “We’ve had some terrible cases of hyperemesis that we’ve controlled with home care, and it’s been fabulous, because the patient can be at home with her family.” Check with your healthcare provider to see what is available for you.

Natural Remedies If you're interested in finding natural, drug-free alternatives to help you cope with nausea, many women find chiropractic care, massage, acupressure and/or acupuncture to be helpful. The downside? Health insurance doesn't always cover these approaches. The most important thing you can do, Dr. Steven Ravins says, is be aggressive about hydrating yourself — particularly upon awakening. “Even if you drink a gallon, it takes a good hour or so for the body to start absorbing some of this liquid. It may be in your stomach, but it’s not in your circulation, diluting out those hormones.” If a woman can keep herself hydrated, she’ll start to mobilize, Dr. Ravins says, “and over the course of the day, she’s going to feel much better.” Dr. Ganz concurs. "Women don't have to eat, but they do have to drink." He recommends drinking small sips of Gatorade or another drink with electrolytes to help maintain your electrolyte balance. Whatever you can tolerate and keep down will help you — and your baby — stay healthy. Finally, perhaps the best coping technique is to remember the purpose of the nausea and sickness: you are having a baby. Sheri Pepper says that when she felt her worst, she would lie down and think about the tiny person growing inside of her. "I think knowing that it wasn't a permanent condition and that this beautiful baby was growing inside me did the most to get me through it," she says. It may seem like an impossible outcome, but in just a few short months, all of this will be forgotten when you look into your baby's eyes for the very first time.

New Iron Supplement Prevents Sickly Side-Effects

Even if you're not having a hard time with morning sickness, you may be feeling queasy because of the common side-effects of manufactured iron supplements. Rather than discontinuing use of prescribed iron pills, a study published in the Clinical and Laboratory Haematology Journal has shown that a new product, Spatone Iron+, can help prevent iron deficiency in pregnant women without any gastro-intestinal side-effects. The product is a naturally-occurring spring water that provides 100 percent of the average daily iron requirement for pregnant women, most of whom only acquire 50 percent of the average daily requirement through their diets. "This is great news for pregnant women, especially for those weary of taking iron pills because of the unpleasant side-effects," says Dr. Dan McKenna, specialist registrar in obstetrics and gynecology, Antrim Area Hospital, Northern Ireland. "Our research shows Spatone Iron+ helps prevent iron deficiency in pregnant women, and it does not cause constipation and stomach irritation that traditional iron supplements do." Iron deficiency is a common problem in pregnant women. In the U.S. it is estimated that 35 percent of pregnant women in the first trimester suffer from iron deficiency; that number jumps to 85 percent in the third trimester. A growing baby places enormous demands on iron reserves, and significant amounts of iron can be lost during childbirth as well — so it is crucial that these iron stores be replaced as soon as possible. If iron is not kept at the required levels, anemia may set in; and this not only causes lack of energy, but in severe cases it can lead to breathing difficulties, palpitations, and chest pains. For pregnant women having trouble swallowing pills, Spatone Iron+ comes in single packets that can be poured into fruit juice. Because the iron is already in the water, it is absorbed faster and more easily by the body. So only a small amount needs to be taken to obtain the average daily iron requirement. Additionally, any excess iron the body does not require is expelled easily, so it does not produce unpleasant side-effects normally associated with iron pills, says Spatone's distributor, Sea-Band International, which also manufactures a well-known anti-nausea wristband. Spatone Iron+ is available at all Osco-Savon drug stores, Walgreens.com, in New Jersey at Harmon drug stores, and in upstate New York at Kinney drug stores. The cost for a 14-day supply is $9.99 and $19.99 for a 28-day supply. For more information, access www.sea-band.com.

— Lauren C. Freedman