Our expert shares her insights on morning sickness

Midwife, educator, and mum Grace Strange, shares expert insights on morning sickness, a very common pregnancy side effect.

Morning sickness, also known as all-day nausea, vomiting, dry retching, reflux and sensitivity to food taste, sight and smell. Oh what a wonderful start to pregnancy! I still have vivid memories of being pregnant with my much-wanted, IVF baby girl and feeling so sick and completely rotten for a solid 20 weeks. Every week hoping and praying that this was the week I would turn the corner and start to feel better.

I was not alone in my experience! Morning sickness occurs in up to 70% of pregnancies. Symptoms vary in severity from person to person but usually begin around four to seven weeks, peaking at nine weeks and in most cases are gone by 16-20 weeks.

Around 2% of women will get hyperemesis gravidarum which is where they have persistent vomiting that leads to dehydration, weight loss and hospital admissions.

So what actually causes morning sickness? For many years there was much speculation as no one really knew. Some thought it was due to the high levels of pregnancy hormones such as HCG and estrogen. Or there was also speculation it was because of low blood sugar levels or altered blood pressure levels, or changes in metabolism. In 2023 scientists at University of Cambridge in the UK had a breakthrough and discovered that it is due to a hormone produced by the fetus, a protein known as GDF15 that causes morning sickness. The severity of your morning sickness depends on a combination of how much of the hormone is produced by the fetus and how much exposure the mother had to this hormone before becoming pregnant. Although this is a huge development, especially for those women who suffer from hyperemesis, treatment and how to expose oneself to these high levels of GDF15 before getting pregnant to become sensitised, is still under investigation. There is one theory that metformin, an oral hypoglycemic drug that is used to treat diabetes is known to increase levels of baseline GDF15 in non-pregnant women. So, this may help to boost GDF15 levels and help desensitise women before they get pregnant? Worth a chat to your lead maternity carer about especially if you have any risk factors for hyperemesis.

Speaking of risk factors, there are many and considering seven out of 10 women get morning sickness, chances are high that you will experience it at some point in your early pregnancy. You might be more at risk if this is your first pregnancy, you are having twins or triplets, had severe nausea and vomiting in a previous pregnancy, if you tend to get motion/car sickness, have a history of migraine headaches, or even if morning sickness runs in your family.

Many women describe morning sickness as feeling like your hungover or seasick. It might feel like you have an upset stomach and you don’t feel like eating. Some women describe it as feeling like heartburn or reflux. Some women vomit multiple times a day others dry retch while others feel only nausea. You might find that certain foods or smells trigger it. You might also find that you have trouble cleaning your teeth because your gag reflex is so strong you can’t handle having your toothbrush at the back of your mouth.

Don’t be fooled by the name, it is certainly not just feeling sick in the morning, for some women they feel sick the whole day and during the night if they wake. Some women actually feel ok in the morning and much worse in the afternoon and evening, everyone experiences it so differently.

If nothing is working and you are unable to keep anything down, including small amounts of water, if you are losing weight, if you have excessive saliva production that exacerbates nausea, if you have extreme exhaustion that makes it difficult to go about your normal daily routine or if you have signs of dehydration, then you probably have hyperemesis gravidum and need to contact your lead maternity carer straight away. There unfortunately are not any cures for hyperemesis at this stage, but it can be managed and leaving it untreated can be extremely dangerous to you and your baby.

If you are experiencing morning sickness, I am so sorry. It’s tough because most morning sickness symptoms are experienced in those first 12 weeks when no one knows you’re pregnant. Please know that you are not alone. If you are struggling, please reach out and get some help both for the physical symptoms and for your mental health. Being nauseous and vomiting 24/7 for weeks on end is incredibly tough so have lots of grace for yourself and get all the support you need to survive this time. Thankfully it doesn’t last forever.

GRACE'S TOP TIPS

So, what can you do to help manage the symptoms of morning sickness?

🔲  Get lots of rest. Being stressed and tired can make symptoms worse so make sure you get to bed early and try stress reducing techniques such as deep breathing and meditation.

🔲  Eat and don’t get hungry. As much as you don’t feel like it, eating 5-6 small, frequent meals throughout the day will keep your blood sugars stable. Try eating a bland, protein rich diet and avoid eating foods that are super fatty. Some people find ginger biscuits or ginger tea can settle the tummy and nauseous feeling. If you feel particularly sick in the mornings try eating a piece of toast or some crackers before you get up.

🔲  Keep well hydrated. If you find it hard to drink plain water, try adding some lemon or mint to it. Suck on crushed ice or ice blocks. Some women find icy cold fluids much easier to tolerate. Small frequent sips of water between meals might be easier to keep down. You can also keep yourself hydrated by drinking soups, smoothies or shakes. Fluids with electrolytes might also help but talk to your lead maternity carer first.

🔲  Gentle exercise and fresh air might take your mind off it and help you to feel better. Take a short walk outside or do a gentle pregnancy yoga or pilates class.

🔲  Other remedies that have limited evidence but anecdotally can help are acupressure/seasickness bands around wrists, acupuncture, peppermint and ginger. Avoid wearing clothes with tight waist bands, try not to get too hot and stay away from strong smells.

🔲  Vitamin B6 supplement has been proven to significantly improve nausea in women with severe nausea – again talk to your lead maternity carer before taking this.

🔲  There are plenty of pharmacological options too for anti-nausea medications that can give you some relief of these symptoms. Talk to your lead maternity carer about these options.

Grace Strange is a midwife and creator of Antenatal Co. – independent antenatal classes that were born out of a desire to ensure parents have access to the very best antenatal education and head into labour, birth and beyond fully prepared. Find out more at antenatal.co.nz or on Instagram @antenatalco.

PHOTOGRAPHY: Catherine Smith