Morning Sickness
"My morning sickness lasts all day. I'm afraid that I'm not keeping down enough food to nourish my baby."
Welcome to the queasy club — a club that up to 75 percent of pregnant women belong to. Happily, though you and all the other miserable members are definitely feeling the effects of morning sickness — a misnamed malady, as you've already noticed, since it can strike morning, noon, night, or all three — your baby almost definitely isn't. That's because your baby's nutritional needs are minuscule right now, just like your baby (who's not even the size of a pea yet). Even women who have such a hard time keeping food down that they actually lose weight during the first trimester aren't hurting their babies, as long as they make up for the lost weight in later months. Which is usually pretty easy to do because the nausea and vomiting of morning sickness don't generally linger much beyond the 12th to 14th week. (An occasional expectant mom continues to experience symptoms into the second trimester, and a very few, particularly those expecting multiples, may suffer some well into the third.)
What causes morning sickness? No one knows for sure, but there's no shortage of theories, among them the high level of the pregnancy hormone hCG in the blood in the first trimester, elevated estrogen levels, gastroesophageal reflux (GER), the relative relaxation of muscle tissue in the digestive tract (which makes digestion less efficient), and the enhanced sense of smell that pregnant women develop.
Not all pregnant women experience morning sickness the same way. Some have only occasional queasy moments, others feel queasy round the clock but never vomit, others vomit once in a while, and still others vomit frequently. There are probably several reasons for these variations:
Hormone levels. Higher-than-average levels (as when a woman is carrying multiple fetuses) can increase morning sickness; lower levels may minimize or eliminate it (though women with normal hormone levels may also experience little or no morning sickness).
Sensitivity. Some brains have a nausea command post that's more sensitive than others, which means they're more likely to respond to hormones and other triggers of pregnancy queasiness. If you have a sensitive command center (you always get carsick or seasick, for instance), you're more likely to have more severe nausea and vomiting in pregnancy. Never have a queasy day ordinarily? You're less likely to have lots of them when you're expecting.
Stress. It's well known that emotional stress can trigger gastrointestinal upset, so it's not surprising that symptoms of morning sickness tend to worsen when stress strikes.
Fatigue. Physical or mental fatigue can also exacerbate the symptoms of morning sickness (conversely, severe morning sickness can increase fatigue).
First-time pregnancy status. Morning sickness is more common and tends to be more severe in first pregnancies, which supports the idea that both physical and emotional factors may be involved. Physically, the novice pregnant body is less prepared for the onslaught of hormones and other changes it's experiencing than one that's been there, done that. Emotionally, first timers are more likely to be subject to the kinds of anxieties and fears that can turn a stomach — while women in subsequent pregnancies may be distracted from their nausea by the demands of caring for older children. (Generalities never hold true for every expectant mom, though, and some women are queasier in subsequent pregnancies than they were in their first.)
No matter the cause (and does it really matter when you're upchucking for the third time today?), the effect of morning sickness is the same: pure misery. Though there is no sure cure for the queasies but the passing of time, there are ways of minimizing the misery while you're waiting for a less nauseous day to dawn:
■ Eat early. Morning sickness doesn't wait for you to get up in the morning. In fact, nausea's most likely to strike when you're running on empty, as you are after a long night's sleep. That's because when you haven't eaten in a while, the acids churning around inside your empty tummy have nothing to digest but your stomach lining — which, not surprisingly, increases queasiness. To head off heaving, don't even consider getting out of bed in the morning without reaching for a nibble (crackers or rice cakes, dry cereal, a handful of trail mix) that you stashed on your nightstand the night before. Keeping nibbles next to the bed also means you don't have to get up for them if you wake up hungry in the middle of the night. It's a good idea to have a bite when you rise for those midnight bathroom runs, too, just so your stomach stays a little bit full all night long.
■ Eat late. Eating a light snack high in protein and complex carbs (a muffin and a glass of milk, string cheese and a few dried apricots) just before you go to sleep will help ensure a happier tummy when you wake up.
■ Eat light. A stuffed tummy is just as susceptible to queasiness as an empty one. Overloading — even when you feel hungry — can lead to upchucking.
■ Eat often. One of the best ways to keep nausea at bay is to keep your blood sugar at an even keel — and your stomach a little filled — all the time. To head off an attack of the queasies, join the graze craze. Eat small, frequent meals — six mini meals a day is ideal — instead of three large ones. Don't leave home without a stash of snacks that your tummy can handle (dried fruit and nuts, granola bars, dry cereal, crackers, soy chips, or pretzels).
■ Eat well. A diet high in protein and complex carbohydrates can help combat queasiness. General good nutrition may help, too, so eat as well as you can (given the circumstances, that might not always be so easy).
■ Eat what you can. So the eating well thing isn't working out so well for you? Right now, getting anything in your tummy — and keeping it there — should be your priority. There will be plenty of time later on in your pregnancy for eating a balanced diet. For the queasy moment, eat whatever gets you through the day (and night), even if it's nothing but ice pops and gingersnaps. If you can manage to make them real fruit ice pops and whole-grain gingersnaps, great. If you can't, that's fine, too.
■ Drink up. In the short term, getting enough fluids is more important than getting enough solids — particularly if you're losing lots of liquids through vomiting. If you're finding liquids are easier to get down when you're feeling green, use them to get your nutrients. Drink your vitamins and minerals in soothing smoothies, soups, and juices. If you find fluids make you queasier, eat solids with a high water content, such as fresh fruits and vegetables — particularly lettuce, melons, and citrus fruits. Some women find that drinking and eating at the same sitting puts too much strain on their digestive tract; if this is true for you, try taking your fluids between meals.
■ Get chilly. Experiment with temperature, too. Many women find icy cold fluids and foods are easier to get down. Others favor warm ones (melted cheese sandwiches instead of cold ones).
■ Switch off. Often, what starts out as a comfort food (it's the only thing you can keep down, so you eat it 24/7) becomes associated with nausea — and actually starts to trigger it. If you're so sick of crackers that they're actually beginning to make you sick, switch off to another comforting carb (maybe it'll be Cheerios or watermelon next).
■ If it makes you queasy, don't go there. Period. Don't force yourself to eat foods that don't appeal or, worse, make you sick. Instead, let your taste buds (and your cravings, and your aversions) be your guide. Choose only sweet foods if they're all you can tolerate (get your vitamin A and protein from peaches and yogurt at dinner instead of from broccoli and chicken). Or select only savories if they're your ticket to a less tumultuous tummy (have reheated pizza for breakfast instead of cereal).
■ Smell (and see) no evil. Thanks to a much more sensitive sense of smell, pregnant women often find once appetizing aromas suddenly offensive — and offensive ones downright sickening. So stay away from smells that trigger nausea — whether it's the sausage and eggs your spouse likes to make on the weekends or the aftershave of his that used to make you head over heels (but now makes you head for the toilet). Steer clear, too, of foods that you can't stand the sight of (raw chicken is a common culprit).
■ Supplement. Take a prenatal vitamin supplement to compensate for nutrients you may not be getting. Afraid you'll have trouble choking the pill down — or keeping it down? Actually, that one-a-day can decrease nausea symptoms (especially if you take a slow-releasing vitamin that's higher in quease-combating vitamin B6). But take it at a time of day when you are least likely to chuck it back up, possibly with a substantial bedtime snack. If your symptoms are particularly rough, ask your practitioner about taking extra vitamin B6, which can help relieve nausea in some women.
■ Tread gingerly. It's true what the old wives (and midwives) have been saying for centuries: Ginger can be good for what ails a queasy pregnant woman. Use ginger in cooking (ginger-
carrot soup, ginger muffins), steep it into tea, nibble on some ginger biscuits, nosh on some crystallized ginger, or suck on some ginger candy or lollipops. A drink made from real ginger (regular ginger ale isn't) may also be soothing. Even the smell of fresh ginger (cut open a knob and take a whiff) may quell the queasies. Or try another trick of the queasy trade: lemons. Many women find the smell — and taste — of lemons comforting (when life gives you morning sickness, make lemonade?). Sour sucking candies are the ticket to relief for others.
■ Rest up. Get some extra sleep and relaxation. Both emotional and physical fatigue can exacerbate nausea.
■ Go slow-mo. Don't jump out of bed and dash out the door — rushing tends to aggravate nausea. Instead, linger in bed for a few minutes, nibbling on that bedside snack, then rise slowly to a leisurely breakfast. This may seem impossible if you have other children, but try to wake up before they do so you can sneak in some quiet time, or let your spouse take the dawn shift.
■ Minimize stress. Easing the stress can ease the quease. See page 141 for tips on dealing with stress during pregnancy.
■ Treat your mouth well. Brush your teeth (with a toothpaste that doesn't increase queasiness) or rinse your mouth after each bout of vomiting, as well as after each meal. (Ask your dentist to recommend a good rinse.) Not only will this help keep your mouth fresh and reduce nausea, it will decrease the risk of damage to teeth or gums that can occur when bacteria feast on regurgitated residue in your mouth.
■ Try Sea-Bands. These 1-inch-wide elastic bands, worn on both wrists, put pressure on acupressure points on the inner wrists and often relieve nausea. They cause no side effects
and are widely available at drug and health food stores. Or your practitioner may recommend a more sophisticated form of acupressure: a battery-operated wristband that uses electronic stimulation.
■ Go CAM crazy. There are a wide variety of complementary medical approaches, such as acupuncture, acupressure, biofeedback, or hypnosis, that can help minimize the symptoms of morning sickness — and they're all worth a try (see page 85). Meditation and visualization can also help.
Though there are medications that may help ease morning sickness (often a combo of doxylamine — an antihistamine found in Unisom Sleep Tabs — and vitamin B6), they'll usually only be recommended or prescribed when morning sickness is severe. Keep in mind, too, that the antihistamine part of the combo will make you drowsy — a good thing if you're going to sleep, but not such a good thing if you're driving to work. Don't take any medication (traditional or herbal) for morning sickness unless it is prescribed by your practitioner.
In fewer than 5 percent of pregnancies, nausea and vomiting become so severe that medical intervention may be needed. If this seems to be the case with you, see page 545.
Excerpted from What To Expect When You're Expecting by Heidi Murkoff and Sharon Mazel. Copyright 2010 by Heidi Murkoff and Sharon Mazel. Reprinted by permission of Workman Publishing Company.
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