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Nausea/Morning Sickness

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Resources




Doxylamine-Pyridoxine Combo Prevents Nausea in Pregnancy
[2/20/13]


Dr. Katharina Dalton calls morning sickness "a sign that the ovarian progesterone is insufficient and the placenta is not yet secreting enough progesterone." She says that giving the woman extra progesterone will ease the symptoms.

Morning sickness helps you and your baby

Rates of nausea and vomiting in pregnancy and dietary characteristics across populations
Gillian V. Pepper AFF1 and S. Craig Roberts AFF1
Proceedings of the Royal Society B: Biological Sciences

Rates of nausea and vomiting in pregnancy were correlated with high intake of macronutrients (kilocalories, protein, fat, carbohydrate), as well as sugars, stimulants, meat, milk and eggs, and with low intake of cereals and pulses.


Study links morning sickness to higher IQ

Long-term Neurodevelopment of Children Exposed to Maternal Nausea and Vomiting of Pregnancy and Diclectin
Irena Nulman, MDCorresponding Author Informationemail address, Joanne Rovet, PhD, Maru Barrera, PhD, Dafna Knittel-Keren, MA, Brian M. Feldman, MD, Gideon Koren, MD
Volume 155, Issue 1, Pages 45-50.e2 (July 2009)


Herbal Allies for Pregnancy by Linda Woolven from Mothering Magazine - has a section on Morning Sickness.


If you're so sick that you don't have much energy to do anything, you can go to pregnancystore.com and order several things at once from their section on Pregnancy Morning Sickness Relief:

Morning Sickness Magic ($14.95)- contains ginger and vitamin B6, which research shows to be helpful.

MorningWell Morning Sickness Relief Audio Program ($34.95) - this helped 9 out of 10 women

Relief Band ($79.95) - One of my clients said this gave her the most relief.

They also have other aids, such as PreggiePops, B-Natal TheraPops and Lozenges, and nausea bags.



If the non-pharmaceutical remedies don't work for you, we know that the combination of Unisom and B6 really does work well for many women.

Here is a link to an ABC 7 article and this one talks about its being FDA approved.


vitaminshoppe.com has surprisingly good resources about nutritional supplements for pregnancy nausea.


Birth With Sol has a great selection of remedies for Morning Sickness.


Preggie Pops & Preggie Pop Drops for Morning Sickness from Butterflies & Hiccups


The Morning Sickness Store at drugstore.com also offers multiple relief products:

Relief Band Morning Sickness Relief Device - $94.99 with free shipping. This may be a more advanced version of the "Explorer Motion Sickness Device" - not sure, but they're charging more for it than the Pregnancy Morning Sickness Relief center at pregnancystore.com

Relief Band Explorer Motion Sickness Device - $79.99

The also offer Apothecary Cola Syrup ($4.19), Hyland's Natural Relief Motion Sickness Tablets ($6.59) and Baby's Bliss Morning Sickness Magic ($9.49). The rest of the items they offer are pharmaceuticals, which it's best to avoid during pregnancy, especially during the first trimester!!!


Severe Vomiting During Pregnancy Causes Serious Risk to Mothers, Infants [Medscape registration is free]

This is a somewhat odd study, as it is a retrospective study that can only conclude that "women hospitalized with hyperemesis gravidarum had an increased risk of preeclampsia compared with those not hospitalized for the condition".  This almost implies that it was the hospitalization that caused the subsequent problems, which is a real possibility.  It would be nice if they could compare in-home treatment with hospitalization for the same severity of symptoms, so that we can separate out the effects caused by hospitalization from the effects of the hyperemesis itself.  In particular, hospitalization carries a significant risk of exposure to unusually virulent and resistant pathogens, which could cause most of the complications seen.


If your drinking water is acidic, this could be contributing to your nausea.  Check the pH of your drinking water or just consider switching to alkaline water and see if you feel better.  (NOTE - Especially if you've been also been constipated, this is even more likely a part of the problem.)


Morning sickness cures and remedies - pregnancy nausea relief, causes and cures for nausea


Nausea and vomiting in pregnancy (NVP) - from motherisk.org - Get support from the Motherisk Nausea and Vomiting of Pregnancy (NVP) Helpline - 1-800-436-8477


Blooming Awful - Around 3 in every thousand pregnant women experience severe nausea and vomiting known as hyperemesis gravidarum (HG).
If you are (or were) one of them, or you know someone who's going through it, we're here to help you.  (A site from the UK.)


Hyperemesis Education and Research Organization, a non-profit organization dedicated to providing comprehensive education, support, and a multi-disciplinary forum for exchange of information related to Hyperemesis Gravidarum



General Remedies for Nausea



The ReliefBand® is worn like a wristwatch; it produces very mild electrical signals to calm nausea.  So far, my clients love it!


B-natal - "Sweet Relief for Morning Sickness - The easiest way to lick morning sickness!" - These are lollipops with vitamin B6 added; these can be very helpful for women who can't take vitamin B6 supplements in capsule or tablet form.  And I like that they use real sugar instead of that SPLENDA® No Calorie Sweetener stuff, but they've got some artificial dyes in them, which could actually add to the nausea!  They cost about $10/box of 12; shipping is free with 3 or more boxes.

Their site has some nice pages about the Causes of Nausea and  Morning Sickness Tips .


NEW! - Preggie Pops are naturally flavored lollipops that relieve pregnancy nausea.  [Ed. - See also: Can pregnant and breast-feeding women consume SPLENDA® No Calorie Sweetener?]


You can now purchase the MorningWell Morning Sickness Relief Audio Program in the United States from pregnancystore.com.

MorningWell - Sound Relief from the symptoms of morning sickness. - A midwife study in the UK found this to be effective for 90% of women!


Revived Focus on Treatment for Morning Sickness - September 11, 2000 [Medscape registration is free.]


A large well-done study in England showed fabulous results from a diet of...... potato chips and lemonade!  But sometimes, medication is needed.  Zofran is expensive (up to $30 bucks a pill) but works BEAUTIFULLY.  I also believe in Vit B-6 50 mg tid and continuing folic acid supplementation.



One of my clients said that Odwalla protein drinks worked well for her when nauseated.

A friend of mine would drink lemonade. It didn't work for me but it did for her. Another tip somewhat related is I was always thirsty but water would often make the nausea worse. Putting sliced citrus in my water worked amazingly well.


Susun Weed, author of "Wise Woman Herbal for the Childbearing Year," says walking at least one mile a day can help alleviate morning sickness.


Some people say that nausea beyond mild nausea between weeks 4-12 is caused by a contracted blood volume.  It's easy enough to try to remedy this by drinking lots of water (3 quarts - 12 glasses each day) and taking baths to keep the fluid out of the tissues.


I found that eating a peppermint pattie did the trick for me . . . the combination of peppermint, sugar and feel-good hormones was just what I needed.


Morning Sickness links collection from about.com


First we suggest chamomile, ginger, peppermint, small frequent high protein meals, eating whatever she wants even if it is junk, B6, acupressure, emetrol, coke (the soft drink!) and ginger ale? I always start with the above, but sometimes they just don't work.

Home iv therapy often works great. It enforces a certain amount of "doing nothingness" which is helpful. It prevents dehydration. I also use (not all at once) Reglan, Compazine (po or suppositories), Tigan suppositories (no one likes them because they burn), Phenergan is ok but for some reason I never use it. Don't know why. The old tried and true remedy for morning sickness was Bendectin...a combination of B6 and the antihistamine doxylamine. This is currently marketed as Unisom, an OTC sleep aid. I try this also.


Aromatherapy

Peppermint oil may cause liver problems if taken internally. However, as aromatherapy, peppermint oil in water, then diffused in the air can be effective for treatment of morning sickness. It will also nullify the effects of any homeopathics you are taking, so be aware.

Homeopathy

Most of you know most of the home remedies. Homeopathic Sepia supposedly works for 80 - 90% of women, according to HOMEOPATHY FOR PREG & CHILDBIRTH...well, of course, it didn't do anything for these women. Well, I learned to not be picky. This won't necessarily sit well with many of you out there (it took me some letting-go to get used to it), and it may not work for you, but these women ended up eating whatever they could to stay standing up. These, luckily, were all women who normally ate very healthily...veggies, fruits, whole grains, etc. ALL four of them ended up eating things like chocolate, crackers, almost no vegetables (they all, eerily enough, had aversions to vegetables and COOKING), bad cereal, white bread, KFC, Taco Bell, bologna...they didn't feel great about it at first, and neither did I, but each made that decision (separately from each other) to get calories in however they could. We had tried every other remedy we all knew of, but for this particular string of women, nothing worked. Luckily, it passed for each of them at 14 weeks, and with that, so did my clump of raunchy-diet moms :)

I always ask moms what they've eaten over the past few days (never much, they don't have any problem remembering) What do all pregnant women (except me) eat? And what seems to stay down? Ice cream. Even though the thought of eating ice-cream when nauseated makes me feel barfy, it seems like it's what is most likely to stay down. I recommend they start with a teaspoon, wait 10 or 15 minutes and try a tablespoon. Stick with a tablespoon or two every 15 minutes, then after an hour add some dry toast or crackers. Fluids only in small amounts the first couple of days, and only with food.

It seems like people who complain of even the most extreme nausea have some food they've kept down. That's what they should eat at first. I think a lot of women try too hard to eat what is supposed to be good for them and baby, when their body is telling them something else. I'm also amazed that some of these ladies will call with major nausea, weight loss, come in with ketones off the chart and pee that looks like black tea, but they don't want to take time off work to eat every 15 minutes. Even though they can barely walk into the exam room.

I think that besides getting nutrients back into their bodies, maybe they need a few days of real rest.

A key is to do these things before it gets to the unisom, phenergan injected B6 stage. Once it gets there it can easily go to the Pedialyte enema or IV stage.


My last pregnancy I had several weeks of throwing up if I moved from one room to the next. I lived on dried fruit and cheese, both in small amounts. Between "meals," I drank Perrier. Sometimes what actually felt best was that greasy bacon and egg and hashbrown breakfast my husband likes to make now and then. I think the fat helped. Forget crackers, they're useless. And yes, I do remember an occasional Coca Cola. You get to a point where you just eat anything that will stay down, or that will not be too unpleasant coming back up (grape juice).


I find that this is more individual. I had one mom who ate scrambled eggs for three weeks. Another who ate raw potatoes. I make suggestions but I assume that each will find the thing they can tolerate. I think the frequency is probably as important as the food.


Some things to try for hyperemesis:

I had one woman that ate Mini Frosted Wheat Biscuits almost constantly through the day, but it worked. The important thing is to supply calories. Protein, vitamin & mineral intake can be corrected when she's eating better.

I tell moms to eat whatever it is that they can keep down. They need calories and fluids. If it can come from nutritious sources, so much the better. If not, so be it. We can work on nutrition later. I know there are studies showing that protein deficit in the first trimester is bad. So what, I say. The authors of the study were never pregnant and sick! When I was pregnant, the only things that provided any calories were Italian subs with onions, hot peppers and vinegar from a little sub shop near Tufts where I was taking summer school classes in Italian Renaissance art and Gestalt psychotherapy. I had an Italian sub on the way to class, and one on the way home. With my next pregnancy, and driving 80 miles each way to work nights in L&D in OKC, I lived on root beer floats from A&W Drive In in Oklahoma.


With my first I had a bout of severe, prolonged vomiting during 2nd trimester after normal morning sickness had stopped. Dehydration, etc., was closing in fast. A lady who worked in the shop next to where I worked gave me this trick. I was desperate enough to try it and it worked. I've noticed that other women have to be really desperate before they will try it, too.

In the morning (or whenever your stomach is empty) go in the bathroom and throw up until you throw up bile - deep bile. Rinse your mouth slightly with water but don't drink it. Do not eat or drink anything for at least 30 minutes. This can give relief for up to 36 hrs (usually the minimum is 12 hours).


Morning sickness can be caused by a host of variables.  Finding out which one (or more) is causing the problem will help.

Low blood sugar:  eat, eat, eat. When you wake up to pee in the middle of the night have a quarter of a sandwich.

Electrolyte imbalance: usually occurs after one has gotten out of balance.  Drink gatorade or a mixture of like to get back into balance.  I especially recommend a sports drinks with protein, such as Accelerade.

B12: I have found that to work when a lady is very sick.  Injectable works best for me.

Pepcid AC: some women get reflux with pregnancy.  This stops it, allows them to eat so they avoid electrolyte imbalance & low blood sugar.  They might do even better with Cell Tech's Contain supplement, which I consider a better approach to heartburn.

Psychological:  hmmmmmmm.  Have seen this.  Sometimes just talking out problems/stresses helps.

A good B complex should be taken as soon as possible.  Other vitamins can be added later.


Last week I went to run an IV for an Amish midwife friend.  Her daughter was sick, again, with her second babe.  As we all sat and talked, while the IV dripped, my friend told of how sick she got with all of her babies and everything they did didn't help.  I asked if after she threw up if she was hungry?  She said no.  Same with her daughter.  I had a Pepcid AC in my purse and threw one at her daughter and told her to chew.  Ten minutes later her daughter told us she already was feeling better and quite hungry.  Reflux.

One other time, while dripping on a very thin lady, I gave her a tablespoon of yogurt every 15 minutes.  After and hour and a half she threw up only the last tablespoon.  Low blood sugar.  She is now pregnant with her third child and has needed no IV.  She knows she must eat all the time even during the night.

Others only need B12 injection about once a week (if it gets too bad they need it every other day but soon go to once a week and then go down from there).


I am the self proclaimed Hyperemesis Queen and can offer some advice. I found that drinking sips of water made things so much worse. I suggest having her try sips of rice milk- not cold. Not soy, either. It tones down the acidity in the stomach which is welcome when you're puking up bile all the time.

Also, sipping coffee had a wonderful effect on me. I do not usually drink it, but it really helped me in my pregnancy. It toned down the nausea.  Ginger, mints, phenergan, etc. are all a big joke! With the true hyperemesis NOTHING is going to help but time. With my second baby I had severe vomiting all the way through, losing 34 pounds by the end of the pregnancy. I am still suffering from it, and my baby has, too. I was always told that the baby will get what it needs, that she'll take it from me, etc. I know now that was NOT true....

I think that as a midwife, you can help her through the emotional and psychological stuff more than actually being able to help the problem get resolved. I had so many TERRIBLE feelings and tons of guilt, (failing body, incapable, killing the baby, worthless to my other child and family, wanting to just die...) which are way worse to experience than the hyperemesis. Well, may not!

Also, I have heard recently of a bacteria called Helicobacter Pylori (H. Pylori) that may have something to do with it.


My comment on this - water is hypotonic, and many women in pregnancy can only tolerate plain water in small amounts.  For those women, I suggest diluting sports drinks or clear juice to the point where there is a little flavor and drinking that instead.  Most juices and sodas are hypertonic, and that is why they tend to further dehydrate.  Mineral waters are also often better tolerated for much the same reasons.
For treatment, I have my compounding pharmacist make up an oral suspension of doxylamine (unisom) and pyridoxine (Vit B6) in a flavor of the mom's choice (default is peppermint).  Standard dose is 10 mg/25 mg per 5 ml, but I have been known to vary that.  I also have in office a transdermal phenergan that works really well acutely.  I have also had good results with the preggiepops.


For women who are constipated and experiencing severe nausea, it makes sense to work to relieve the constipation first.  It's possible that the pregnancy hormones are being reabsorbed from the intestines when passage is so slow.


Recently I read something that said there is a correlation between nausea/vomitting in early preg and dehydration.  Simply getting the woman to drink a lot more fluid can help.


Liquid chlorophyll aids and improves the digestive system and cleansing toxins in the digestive tract.  It is also high in calcium and iron so that can also aid general health. The brand I get suggests 15mls a day, but I take 25mls about lunch time and after a week it has made an amazing impact.  I still have the odd bout of nausea but have found that it occurs when I have taken the chlorophyll later than usual or actually missed a dose the day before.  It is not something that can harm so trying it can't hurt.  It is a disgusting colour and the majority of brands are flavoured with peppermint oil which is also in itself a tummy settler.



Ginger Root and Other Herbs for Nausea



A literature review of the effectiveness of ginger in alleviating mild-to-moderate nausea and vomiting of pregnancy.
Bryer E.
J Midwifery Womens Health. 2005 Jan-Feb;50(1):e1-3.

"Mild-to-moderate nausea and vomiting of pregnancy affects up to 80% of all pregnancies. Concern about antiemetic use and the time-limited nature of symptoms has restrained the development of effective treatment approaches, yet supportive, dietary, and lifestyle changes may be ineffective. This article reviews 4 recent well-controlled, double-blind, randomized clinical studies that provide convincing evidence for the effectiveness of ginger in treating nausea and vomiting of pregnancy. It also provides a dosage update for the various forms of ginger." [Full text]


Ginger Reduces Nausea and Vomiting of Pregnancy [Medscape registration is free]


Ginger Root In Pregnancy


Ginger for Nausea


Ginger root is a life saver for many. I have had at least 2 women who were on Phenergan and in bed, who were able to get off the drugs and be up and around with ginger. It's worth a try anyway. I give 2 capsules 3 times per day.


If Ginger is tried, it should be taken as 1 gram of powder daily, in 4 divided doses. Use for short periods of time, and do not exceed 1 g. daily. No reported side effects. (pg. 116 Herbal Prescriptions for Better Health by Donald J. Brown, ND) The author cites a Danish study: Fischer-Rasmussen W, Kjaer SK, et al.: Ginger Treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 38:19-24, 1990.


Milk Thistle- This should contain 80% silymarin, the active ingredient, 280-420 mg. daily in 3 divided doses. It is available from Metagenics/Ethical Nutrients at 800-647-6100. The book The Naturally Healthy Pregnancy, a Guide to the Childbearing Years by Shonda Parker would be a good resource for this. 1-888-HERB-101.

MT is essentially free of side effects and is considered safe to use during pregnancy and lactation. (pg. 152 Herbal Prescriptions.) Many references are listed in the back of the book supporting its use in aiding liver function. Too many to list.


[from ob-gyn-l]

I have been using ginger root for nausea for about four years. I start them out with 1000-1100mg q AM and then every 6-8 hrs as needed. Ginger root has been well studied and is more effective than Dramamine for treatment of motion sickness. I also add Vit. B6 100mg BID. Works over 95% of the time.


We use ginger in many forms for relief of nausea. It can be in the form of ginger root capsules (desiccated ginger....same stuff used for cooking), tea made from freshly grated ginger, ginger ale (with real, rather than artificial ginger), ginger cookies, a product called Ginger Works which is ginger in some sort of thick, sweet syrup. There are actually controlled clinical trials which showed that ginger was more effective than Dramamine for motion sickness (don't have the reference, but could find it.) The study involved spinning folk in those space simulators, and measuring the time until they vomited....demonstrated the superiority of ginger over Dramamine.


Two articles are in the literature.

1. Erick,M Vitamin B-6 and Ginger root in Morning Sickness J.Am. Dietetic Assn. 1995;95:416

2. Fischer-Rasmussen and Dahl Eur. J Obstet. Gynecol And Repro. Biol. 1991;38:19

There are several on Ginger to treat other forms of nausea including motion sickness and post anesthetic..



Medical Marijuana for Nausea



See also: Comfort Measures for Labor - Cannabis/Marijuana


The issue of hyperemesis gravidarum is so serious that we should leave no avenue of research unexplored in the efforts to help the suffering women and their babies.  You've probably all heard stories of women with such severe vomiting that their doctors recommended terminating the pregnancy rather than put their own health in serious jeopardy and with the knowledge of the damage that the severe malnutrition was doing to the baby.  So . . . I think we really need to pay attention to something as seemingly effective and harmless as medical marijuana.

In reading through the information available on the web about marijuana and pregnancy, I came across several references to the increased risk of pregnancy among teens who smoke marijuana.  Well . . . that risk certainly doesn't apply to this situation!  <grin>


Marijuana and Medicine: Assessing the Science Base from , with a brief reference to marijuana and pregnancy.


The May/June issue of Mothering Magazine features an article entitled "Medical Marijuan - A Surprising Solution to Severe Morning Sickness".  This is well worth reading and deserves serious medical attention.  I would much rather see my clients smoking occasional medical marijuana than taking some of those new anti-nausea pharmaceuticals, which are Category C and D!

Medical Marijuana: A Surprising Solution to Severe Morning Sickness
By Erin Hildebrandt
Issue 124 May/June 2004


References from H.E.R. - Hyperemesis Education and Research Foundation:

Eran Kozer, et. al.
Effects of prenatal exposure to marijuana.

International Association for Cannabis as Medicine
Does cannabis/THC do harm to the fetus if it is used during pregnancy?

Washington Hemp Education Network
Cannabis Indications



Chiropractic for Nausea



I've heard chiropractors say that they've often helped women with hyperemesis.  They've also noticed a correlation between hyperemesis and TMJ problems, or a history of wearing braces.



Acupressure/Acupuncture for Nausea



Acupuncture May Ease Morning Sickness

If morning sickness has you on pins and needles, acupuncture may bring relief, a new Australian study suggests. The ancient Chinese art helped ease nausea and vomiting symptoms among nearly 600 women tested, reports BBC News Online. The women, all less than 14 weeks pregnant, received weekly 20-minute acupuncture sessions for four weeks. Most symptoms were gone by the second week, the Adelaide University researchers report in the American journal Birth. As many as 80 percent of women experience morning sickness during early pregnancy, the BBC says. [3/1/02]

Between 1 and 2% of pregnant women experience hyperemesis gravidarum, or severe morning sickness. A randomized, placebo-controlled crossover study found that stimulating acupuncture point PC6 helps ease nausea and vomiting. Thirty-three women (average age 28.4 years) were divided into two groups. Group A received deep needle insertion at the PC6 point on both forearms three times per day for 30 minutes. Group B received a form of placebo acupuncture, with a needle inserted superficially approximately four inches above the wrist on each arm. On days one and two of the eight-day study, each group received their treatments; after two more days of no treatment, the procedures were switched for each group. Each day, the women rated degree of nausea and recorded instances of vomiting. Those women given active acupuncture experienced a "significantly faster reduction of nausea" compared with those who received a placebo. This reduction was seen in both groups; identical results were seen in each group when the treatment was switched. The incidence of vomiting was also reduced in both groups, with a much greater reduction seen in those receiving active acupuncture. Daily vomiting had been reported by all 22 women at the study onset; by day three less than half of the women in the active group were still vomiting compared with 75% of those in the placebo group.

-Journal of Pain and Symptom Management, October 2000;20(4):273-279.


Acupuncture May Facilitate Recovery From Hyperemesis Gravidarum [Medscape registration is free]


I recently had a client with severe hyperemesis, on home IV's with a PIC line, etc.  She went to our local acupuncturist and reported immediate relief with the first puncture.  It lasted about two days.  The acupuncturist also gave her a lot of interesting dietary info.  The return of the nausea was frustrating, and the client was unable to continue paying (>$100/session) for it, but the relief was dramatic.


Someone once told me about an acupressure point on your ear that when squeezed will completely take away your nausea.  I've never had a chance to find out first hand as I didn't get it until my 2nd trimester with my last birth and I completely skipped my first trimester this time without the morning sickness, but I have shared it with others and everyone who has tried it now swears by it.

Basically, the area is right on the outside edge of your ear - right across from the opening.  Stick your finger in your ear and then slide it across to the outside edge.  On my ear (and I haven't looked at others to see if they have it : ) I can run my finger down the inside of the outside ridge of my ear and feel a little bump.  The 'right' spot is just below it.  Many people notice a sore spot there when you squeeze it.  If you feel a tender area there, you've found the right place.  Whenever you feel the nausea, just find the place and squeeze that area with a good amount of pressure and hold it for 30 seconds. If the nausea is still there, you can hold it for up to 2 minutes.  And you can use either ear or even alternate if you wish.


"Sea Bands" are the most effective remedy for morning sickness that is freely available. You will find them at travel agents as well as some health food stores.


The ReliefBand® device is a watch-like device worn on the ventral side of the wrist. When activated, the device emits a low-level electrical current across two small electrodes on its underside. The ReliefBand® device is the first patented, commercially available Nausea-Vomiting device to reach the clinical marketplace.

The ReliefBand® NST(TM) device is indicated for use in the treatment of nausea and vomiting (NV) due to chemotherapy, motion sickness, and pregnancy.


P6 was 3 fingerbreadths up (toward the elbow) from the wrist joint on the inner part of the arm (the flexor surface). Apparently this works for any kind of nausea (including chemotherapy -induced nausea).


P6 or Nei Kuan is three fingers' breadths from the wrist crease, between the 2 central flexor tendons (flexor carpi radialis). The wristbands are used to provide pressure on this point. the hypothesis is that stimulation releases endorphins...therefore you would want stimulation for as long as nausea occurs. Most people like to take a break from the bands, since round the clock pressure can cause some numbness in the fingers, if the bands are too tight, and redness under the button.


References include:

Hyde, E. Acupressure therapy for morning sickness. A controlled clinical trial. Journal of Nurse-Midwifery 34(4):171-8, 1989

Belluomini, J., Litt, RC., Lee, KA., Katz, M. Acupressure for nausea and vomiting of pregnancy: A randomized, blinded study. Obstetrics and Gynecology 84(2):245-8, 1994

Dundee, JW., McMillan, CM. Clinical uses of P6 acupuncture antiemesis (Review). Acupuncture and Electro-Therapeutics Research 15(3-4):211-5, 1990.



Universal GI Remedies



I have a section in my teaching outline I call "Universal GI Remedies." It's sort of a shotgun approach to these things since they tend to be related.

  1. small, more frequent meals (you already covered)
  2. teas to be sipped hot: spearmint, peppermint, raspberry, chamomile, ginger (it's usually recommended to rotate teas since the mints contain a lot of tannic acid)
  3. chew food thoroughly
  4. avoid large amounts of fluid with meals (drink 15 min before and all the fluid will be absorbed if it's over 95% water)
  5. avoid greasy, gassy or fatty foods (snack on high-carbo foods)
  6. chewing gum (though I personally detest the habit) helps some
  7. moderate exercise improves GI tract function
  8. iron supplements can make some sick, if so consider nutritional iron
Also there is a book called No More Morning Sickness by Mirriam Erick available from the ICEA Bookcenter. I haven't read it so I can't make a personal recommendation.


Protein Shakes



For several years now we have recommended Spirutein protein shake, available at health food stores. It comes in several appetizing flavors. Some health food stores have little sample packets, so you can decide which one you like the best. We have found that priming the protein pump is the most effective way to prevent/manage pregnancy nausea. Works wonders. You HAVE to force yourself to do it, though. Most people who force it for a couple of days, will then find themselves dramatically better. People who say they are too sick to try, remain that way. It is not a cure, but it sure does help. You should do 2 shakes a day, if you can -- morning and evening. You can mix the protein powder with milk, soy milk, rice dream, whatever you drink, plus you can blend it with all sorts of fruits, to make it a more palatable "smoothie". We hand out the recommendation to all of our clients. It is also great for people with low energy, and is great for late pregnancy when your uterus is heavy, and you can't get much food in. You can use other brands of protein, also -- Shaklee is also good.


Expecting Mom - I'm somewhat leery of powdered nutrition, but this does seem to be an option for women who need a little something extra.  "Expecting Mom contains a fruit and vegetable mix that makes it more than a prenatal supplement. It makes a great substitute for those days when it is tough to keep things down." 1-888-665-8243



Nausea as Body Ridding Liver of Toxins



Wow!  It's so sad that someone would think that morning sickness is a measure of good health!  In my practice I find that it indicates a condition of kidney toxicity usually secondary to a diet too high in refined carbohydrates.  I recommend dietary changes in combination with  herbal and enzyme formulas that are extremely effective.  I don't think I've ever seen a case of morning sickness that was unresponsive.

On a related note, Cholestasis of Pregnancy is also very treatable with natural remedies.  I feel so frustrated that women are told "it's just part of pregnancy"!

I feel, as I'm sure all of you do, that a healthy pregnancy leads to optimal health for the child. Symptoms to look for:  cravings for salt or sugar (can indicate adrenal stress), mid back pain or gas/bloating (can indicate pancreas stress), moving bowels less than 1x/day (liver stress).


I am going to try a preventative program to try to bypass that ever worsening vomiting. One theory is that the body is trying to rid itself of toxins by vomiting. We store toxins in our liver. Supposedly, if Milk Thistle (standardized to 80 mg. silymarin) is taken consistently before pregnancy and during the first trimester, the liver will gently detox, and hyperemesis can be avoided. I will find references and post them another time. Has anyone tried or heard of this?


Protecting Your Baby to Be, by Marjie Profet?


Have you read "Protecting Your Baby to Be", by Marjie Profet? She is an evolutionary biologist who has researched and tries to explain WHY morning sickness (early pregnancy sickness) happens. It's new, but so far I can see how she might very well be right. She suggests that women instinctively have aversions to different natural toxins in various foods that we "civilized" people have lost touch with over the years. Or our foods that are too processed - or washed off too much even - make us not realize what we should avoid. She has suggestions for pregnancy nutrition that are totally different in the first trimester from the 2nd two. I had terrible morning sickness with the first and partially with my 2nd but reading this book - I think - helped me. I tried all its' suggestions and they worked! I think it also helped psychologically to have a reason behind it and to understand a simple plan to avoid "bad" foods; to feel more in control and to be reassured that not eating a lot isn't a horrible thing in early pregnancy.

She basically said that white breads and rice and other grains, fresh fruit and dairy products are almost toxin-free and ok to eat. Everything else has various levels, and the worst to eat are vegetables! Also, spicy foods and many herbs, including many that are commonly used in everyday recipes. Salt is ok and important. I really recommend reading it - even if just out of curiosity.


I am curious about this book since I saw her speak on the old America's Talking Network when she was touring the talk shows about the book. The theory makes sense: that we get nauseated to help us avoid plant material that contains tetratogenic compounds. I know that if a ewe eats skunk cabbage on the 21st day of gestation her lamb will have only one eye and that in the center of its forehead. (:-o But during her segment she went on and on about how women need to avoid many kinds of veggies, cruciferous ones in particular, but she didn't give any information about what veggies women CAN eat. This concerned me as this occurred about the time the big Folic Acid campaign was going on. Does she give more info in the book about "safe" veggies?



Gagging with Toothbrushing



My dentist suggested using Colgate toothpaste because it foams less than most of the others - and to use a teeny tiny amount. She might also do better with a smaller brush, like a kids brush for right now.


  1. Relax face and mouth as much as possible, with her head in a neutral to downward tilt rather than upward...any muscle tension would probably increase gagging. Don't hold breath. Breathe deeply and spit often. Clean a quadrant at a time (or less).
  2. Don't even try to brush the back of the tongue. The tounge cleaners you can buy might work better for this.

  3. Don't use toothpaste...it is not necessary.  This would be a hard one for me, I gotta admit, but nothing invites gagging more than a mouthfull of  bubbles that requires you to hold your breath to prevent drooling it all over yourself. (Nice picture, eh?) If this is unacceptable, use as little as possible and not one of the really sharp-tasting ones that make you wince.


Nausea in Late Pregnancy



The demands of baby's growth in late pregnancy can lead to low blood sugar for women who simply aren't used to eating larger amounts.  These women may do well with a sports drinks with protein, such as Accelerade.


Dizziness and nausea isn't too uncommon in late pregnancy -- but it's usually a late afternoon sort of thing related to skipping meals. When it happens at night -- and when it is vomiting (not just nausea) ya gotta think of diabetes or pre-eclampsia. She may be just fine -- probably is just fine -- but her bp needs close watch. And some blood work would be very nice to have! (if these symptoms don't disappear -- and she didn't object, and could afford it, I'd want at least an cbc -- and i'd love a liver panel)  does she have recent labs? What's her hgb/hct?


I see this occur in a small but consistent subset of otherwise healthy gravidas and usually chalk it up to hypoglycemia and remind them to increase protein with a little bit of fat and watch the (empty) calories.


Could be stomach flu. Could be low blood sugar (that makes me vomit). But mostly, I'd want to rule out HELPP syndrome. That was the only presenting symptom in a client a couple of years back.



Preconception Prevention of Hyperemesis Gravidarum



I have been very impressed by the Pekana remedies.  Although it would be best to work with a naturopath or other practitioner knowledgeable about these things, you could reasonably do your own pre-conception detox with the Big Three Detox & Drainage Kit.

Disclosure: If you purchase these products by following the link above, I receive a small commission on the sale; the proceeds go towards paying the expenses involved in maintaining these web pages.


I have done a very small study on the way to prevent HG. I had a client who threw up 7 times a day for 5 months. When she was planning the next pregnancy, I had to go on a cleansing diet for 3 months prior to conception. She at no meat, fat, sugar, caffeine, additives, preservatives, etc. etc. She ate a perfect diet for three months and had no morning sickness with the next pregnancy. NONE!!!. We tried this with 3 other girls and it worked. I would give it a try. Our small sampling has shown great results.


This is a sample size of one, but an older mom had co-incidentally done a liver cleanse (including 20 grams vitamin C daily) for a couple of weeks before her pregnancy, and she had absolutely no nausea.



Hyperemesis - Severe Morning Sickness



Adverse infant outcomes in hyperemesis elucidated - Poor maternal weight gain is the most likely factor underlying the link between hyperemesis gravidarum and adverse infant outcomes, say experts.

Outcomes of pregnancies complicated by hyperemesis gravidarum.
Dodds L, Fell DB, Joseph KS, Allen VM, Butler B.
Obstet Gynecol. 2006 Feb;107(2):285-92.

CONCLUSION: The results of this study suggest that the adverse infant outcomes associated with hyperemesis are a consequence of, and mostly limited to, women with poor maternal weight gain.


Metoclopramide Plus Diphenhydramine Helpful for Severe Nausea, Vomiting During Pregnancy CME [5/18/09] - Medscape registration is free

    *  For treatment of HG, a new protocol consisting of IV metoclopramide 1.2 to 1.8 mg/hour plus diphenhydramine 50 mg every 6 hours appears to be a good therapeutic option for HG, with greater improvement in vomiting symptoms than achieved with the old protocol consisting of IV droperidol 0.5 to 1 mg/hour plus diphenhydramine 25 to 50 mg every 6 hours.
    * The new HG protocol was associated with significantly fewer adverse events than the old protocol, with lower rates of dystonia, tachycardia, and anxiety/nervousness. Length of hospitalization and rate of rehospitalization for HG were similar for both protocols.


Hyperemesis Program - Memorial Women's Hospital at Long Beach Memorial Medical Center


hyperemesisgravidarum.com


I am working with a mom who was hospitalized several times during her first pregnancy for hyperemesis. Any suggestions for major morning sickness?


Hyperemesis gravidarum is a tough cookie to treat. After trial and error, and consultation with my perinatologist friends, here is what I do. Granted, although I practice in a rural setting I do have access to techno-medicine. Do understand that all of this is strictly anecdotal. I would love to see some good research on this topic. I also really like what I read in Miriam Erickson's book "No More Morning Sickness".

The first thing I try are the simple stuff, midwifery stuff like ginger capsules, acupressure bands, grandma's tummy mint tea. For acute dehydration (weight loss, ketosis) a shot of B-6 with phenergan, and IV fluids until the ketosis is corrected. Then try feeding the mom slowly and have her take B-6 50 mg q hs. Sometimes use OTC Unisom with the B-6.  Give the mom a jar of ketostix and have her check her urine regularly. Be prepared to tank her up with an IV as needed. My perinatologist recommends Reglan as an anti-emetic.

I haven't yet done H. Pylori studies on a mom with hyperemesis. I currently have a mom in her last trimester with recurrent nausea and vomiting that I am going to do them on. I will have to consult about treatment if she's positive. I did have a mom who had been on prilosec and something else (don't remember exactly, don't have the chart right now!) throughout her pregnancy for her severe GERD. The perinatologist said that it was important for her to stay on her meds throughout as the potential complications should she get out of control with her GERD were more hazardous than the drugs during pregnancy and breastfeeding.  It's a tough problem. And I really think that the nausea and vomiting create the ambivalence about the pregnancy, not the other way. I have been blessed in my pregnancies to avoid vomiting for the most part. The thought of vomiting multiple times daily just makes me shudder.


I have had success with major morning sickness with an herbal blend of linden and meadowsweet- if she still gets bad off, an IV to replace her fluids can be used at home to prevent hospitalization....if you can't do that try a large very slow enema filled with plain Pedialyte and warm water. This works fine if you have time to hang out and minister to her all day. She will also need to get some reliable help for the next few weeks. Tell her not to be shy about it, and get commitments, perhaps as gifts instead of a baby shower! I get the blend from Blessed Herbs and just use as needed.


One Mother's Story and Suggestions for Corticosteroids for Intractable Hyperemesis

 I have had three pregnancies.  During my first and third pregnancies, I developed hyperemesis gravidarum prior to the end of my sixth week of pregnancy.  During the fourth week of my second pregnancy, I was hospitalized for a small bowel obstruction (a result of Crohn's Disease) and given intravenous corticosteroids (solu-medrol).  After my release from the hospital, I continued to take oral corticosteroids (prednisone, 60mg/day) for the duration of my second pregnancy.  Interestingly, I never developed hyperemesis gravidarum during my second pregnancy.

While suffering from hyperemesis gravidarum during my third pregnancy, I repeatedly asked my obstetrician whether the corticosteroids had somehow prevented me from developing hyperemesis during my second pregnancy -- an idea which she readily discarded.  I have since learned that the successful use of steroids to treat intractable hyperemesis gravidarum has been reported in several medical journals.  See, for example, Goodwin T. (1998) "Hyperemesis Gravidarum," Clinical Obstetrics and Gynecology," 41(3):597-605, Taylor R. (1996) "Successful Management of Hyperemesis Gravidarum Using Steroid Therapy," Quarterly Journal of Medicine, 89:2, 103-107, and Nelson-Piercy C., de Swiet M. (1994) "Corticosteroids for the Treatment of Hyperemesis Gravidarum," British Journal of Obstetrics and Gynaecology, 101:1013-5.

Obviously, corticosteroid use should be reserved for those patients who fail to respond to more conventional treatment.  During my third pregnancy, I was given every anti-emetic known to man, including Zofran, and I was put on total parenteral nutrition via a centrally placed double-lumen groshong catheter (spelling?).  Yet, I continued to vomit blood-streaked bile.  Ultimately, my pregnancy was terminated.  I believe that steroid use could have relieved my suffering and allowed me to continue the pregnancy.  Thus, I strongly encourage you to research this issue and consider recommending steroids for the most severe cases, particularly when the mother is considering termination.

For more information, contact Linda.


Treatment

A hydrating enema is an oldtime treatment (an invention from the days before IVs). Any nourishing substance can be absorbed by/through the bowel. Some might need a cleansing enema first; then a slightly sweet- slightly salty liquid is given. Pedialyte will work.. so will one tablespoon of sugar to one teaspoon salt to one quart of water (rough home equivalent for rehydration solution), some would advise weak raspberryl eaf tea and a little honey (and perhaps a pinch of salt). Give it warm, SLOWLY; you will probably be surprised at how well this is absorbed and tolerated.

For shock and collapse due to hemorrhage or any other cause, the patient may be given an enema of saline solution. the enema is prepared by mixing a heaped teaspoonful of common salt in a pint of boiling water. About a teacupful of this, cooled to a temperature of 100 deg F., which is warmish but not hot, should be injected slowly into the rectum and repeated at intervals of three to four hours.



Hyperemesis and Hyperthyroid



Recently someone referred to a linkage of hyperemesis to hyperthyroidism.. Well, we did TFT's on two hyperemesis patients since her comment, and both have come up with labs c/w hyperthyroidism. Of course our current back-up doesn't believe in the connection, and disputes the validity/accuracy of our lab instead. (Since HE didn't read it in the literature). Anyway, if anyone has a resource, citation or whatever, please let me know.


This link is well established but little known. I first saw a publication on the subject in Br.J.Obstet.Gynaecol. in ~1984/85. It's worthwhile checking TFT's if hyperemesis is really persistent. The abnormal thyroid function may be the cause or the result of the hyperemesis, but treatment of thyroid dysfunction may help the nausea.

Before you do the tests it's a good idea to look for a goiter. It can be so embarrassing to do the TFT's, get them back abnormal, refer to your local ( very clever ) endocrinologist, only for him to comment on the obvious toxic goiter !



Phenergan Suppositories



Round here, phenergan suppositories are the trick! TERRIFIC (and they usually work). Perhaps she should ask her OB if she should increase the dosage?



Bendectin



Each capsule contains 25 mg Vit B6 (pyridox), 5 mg Unisom (the OTC sleeping medication that is not Benadryl) and 1/4 mg folic acid.

Unisom is the new name for Bendectin minus the B6 that was in Bendectin.


But didn't they stop giving Bendectin for morning sickness because of teratogenic effects? I can't find Bendectin in any of my pharm. books...maybe they're all too new?


No, there was never any proof that Bendectin caused any problems at all. It was voluntarily taken off the market by the drug company because it became too expensive to insure for liability due to a few law suits.


Ah well, now here is the thing. As a result of all the accusations about Bendectin, it is now the best studied agent for treatment of nausea, and lots of good research to show it quite safe. The problem is the bad publicity. Also the problem to me is that it is easy to jump on this thing, and say, don't worry, we have these lovely pills to help you. Where is the research to get at the heart of nausea in pregnancy and prevent things. We need more research on other methods too, so we don't get complacent. But Ontario midwives are allowed to prescribe it, but my partner just prescribed it for the first time in 3 years.


You are right, Bendectin was taken off the market in the early 70's, but not because IT was teratogenic. It was taken off the market because of Thalidomide, and the awful limb deformities caused by that antinausea medication. I have on file (somewhere) copies of all the articles written about the studies done on all the components of Bendectin and none of them, individually or together, were ever found to cause an identifiable defect.

The pharmaceutical company simply didn't want to be the target of any more lawsuits, and so stopped making it.


A local midwife from the area who is not on-line with us is curious about the discussion of Unisom/Bendectin. Does anyone out there use it for pregnancy nausea, and if so what dosage do you recommend?


B6 50mg tabs-1 tab po tid or qid in combination with Bendectin 25mg-1 tab po tid or qid.



Vitamin K, Vitamin B6, and Unisom



NOTE - Avoid confusing Unisom Tablets with Unisom SleepGels, which contain a different medication.



Many years ago, there was concern about a possible link between Unisom/B6 and birth defects.  It was even pulled from the US market for a while.  However, subsequent studies showed no safety issues, and it has been available again in the US since at least 2000.  Canada and Europe never pulled it from the market.


Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.
Sahakian V, Rouse D, Sipes S, Rose N, Niebyl J
Obstet Gynecol 1991 Jul;78(1):33-6


I usually try vitamin B6 (pyridoxine) on its own first, 25 mg 3-4 times daily, not to exceed 100 mg a day.

If she doesn't feel better after two days of this, I keep giving the above dose of B6 and add the antihistamine found in Unisom - 12.5 mg of doxylamine 3-4 times a day.  (Note that the active ingredient in Unisom is actually diphenhydramine, not doxylamine.  The doxylamine might make her sleepy, since it is an antihistamine, but not as sleepy as taking Unisom)  Some compounding pharmacies will make this combination for your patient.


One of my clients found that royal jelly helped her nausea; this makes sense because of its high vitamin content.


Vitamin K and B6 Shots

I have a friend who is 12 wks pregnant and was very sick and dehydrated before the administration of vit K and B6 shots. She gets them every Mon. She can feel them start to wear off around Sat. By Tues she can eat and keep food down. She still feels a slight barfy throughout the week but it beats heading to the Dr. office for IV's. 

Vitamin B6 Shots and Unisom

B-6 and Unisom - I do the B-6 (called pyridoxine) IM, order from any major medical prod distrib and it works very well. Unisom - 1/2 or 1 2x/day is all I have had to use. Plus all of the other great natural things like ginger root or yellow dock; and my favorite book, from ICEA or your bookstore - "No More Morning Sickness" 

Oral Vitamin B6 and Unisom

I contacted my pharmacist and he immediately knew about Oral B6 and Unisom (yes, the sleeping pill) combination. You take B6 (the vitamin) in the morning and Unisom at night. I tried it and it really takes away the nausea. You still get those hourly hunger needs, but the nausea is gone and you can actually cope with the day. And a better bonus...you get the best night sleep ever.

Unisom (doxylamine) and vitamin B6 for morning sickness from University Health Services of Eastern Carolina


I have my compounding pharmacist make up an oral suspension that is 10 mg doxylamine (Unisom) and 10 mg pyridoxine(Vit B6) in 5ml of a peppermint syrup (if some one really can't handle mint he will use a different flavor but I think the mint adds to the efficacy).  This can be taken up tto 4 times daily if needed but the sleepiness from the doxylamine may be a limiting factor.  I have had some women with  persistent nausea that have continued to use this throughout pregnancy.

However, persistent nausea that starts after about 24 weeks ( or that recurs around then after ending around 12-13 weeks) is often due to reflux, and is better treated with famotidine or ranitidine (Pepcid, Zantac).  Also, don't forget that some persistent nausea and vomiting may be due to H. Pylori.


Hyperemesis and Vitamin B6

I did my thesis on hyperemesis and Vit B6. (They said to choose a topic that would hold your interest for two years, and since I do the hyperemesis thing myself, I chose barf.)

It was a midwife who introduced me to Vitamin B6 for hyperemesis. I did a placebo controlled, double blind, crossover study under the direction of Dr. Kochenour at Univ of Utah for my thesis. I researched all the way back to the early days of this century when vitamins were first discovered, and still have not found out why it works, but my study showed it does. This is what I do:

When a patient first comes in complaining of vomiting, but still not too peaked looking, I start her on something we called "Pyridox Plus" (with the pharmacist who helped us by formulating it for us. Each capsule contains 25 mg Vit B6 (pyridox), 5 mg Unisom (the OTC sleeping medication that is not benedryl) and 1/4 mg folic acid. They take it: one midmorning, one midafternoon, and two at bedtime. (The folic acid addition makes it reimbursable by Medicaid) I insist that they eat small meals every 1 1/2 hours, whether or not they throw them up. And not too much. A handful of pretzels with a little bite of cheese, etc. I recommend they sip either a caffeinated drink or tea with caffeine, hot or cold, all day.

If these measures do not work, I teach the spouse to give Vit B6 shots, and Rx a multidose vial of B6, and give them handfuls of alcohol swabs, 3 cc syringes, and strict instructions on how to handle the dirty needles. They can even save them in a peanut butter jar and bring them back to me for final disposal. The first week they get 100 mg, every day. I personally like to get mine at bedtime with 25 mg Phenergan added. The second week, we go to 150 mg, three times during the week. The third week, we go to 100-150 mg, depending on how they are doing, twice a week. Stays at this level until they are all better. At my defense, Dr. Kochenour asked how I knew when that point had been reached. I told him it was when I felt so much better, all day, every day, that my husband could no longer catch me to give me the shot! Some people need this all the way through.

For those worried about toxicity, my research showed that more than 500 mg/day was the toxic level, whether it was PO or IM, or even IV. (In early studies women got 1500 mg IV). There are no reports of teratogenic effects, but anyone, fetuses or grownups, can start having neural s/s, tremors, etc. when on sustained doses over 500 mg/day. None of my 100 patients who stayed at 150 or below, even every day, had any problems.


IV Vitamin B6 and Unisom

Bendectin, the only preparation shown to be effective for morning sickness was a combination of B6 and doxylamine....the antihistamine which makes up Unisom! Interesting that you came 'round to this too!

We give 100mg iv B6 in the office, but only weekly. I have tried to convince my partners that weekly injections are meaningless....so am glad to see your research that qd is ok. Have you published this, or is your thesis available through interlibrary loan?


Unisom

I recommend Unisom for morning sickness. Recommend 1 tab plus 25 mg B6 bid-tid. (Make sure it is the doxylamine unisom....there are some other kinds.)

 




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