Morning sickness helps you and your baby
and vomiting in pregnancy and dietary characteristics across
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
Children Exposed to Maternal Nausea and Vomiting of Pregnancy
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)
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.
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
Birth With Sol
has a great selection
of remedies for Morning Sickness.
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
Motion Sickness Tablets ($6.59) and Baby's
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.)
sickness cures and remedies - pregnancy nausea relief,
causes and cures for nausea
vomiting in pregnancy (NVP) - from motherisk.org - Get support
from the Motherisk Nausea and Vomiting of Pregnancy (NVP) Helpline
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
This is an oldie but a goodie! Flat coke has been used for many years to help calm the tummies of sick kids. Some moms say it works well for them, too. And please don't get anything with nasty artificial sweeteners in it. If you're sick enough to be trying this, your body is already under stress and doesn't need additional chemicals that could worsen the nausea. And you probably need the calories anyway! (To make flat coke, you pour some (half a can?) into a glass and wait until the fizz is completely gone.) Some people prefer flat ginger ale, which has the added anti-nausea benefits of ginger.
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
NEW! - Preggie Pops
are naturally flavored lollipops that relieve pregnancy
nausea. [Ed. - See also: Can
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.
Sound Relief from the symptoms of morning sickness. - A midwife study
in the UK found this to be effective for 90% of women!
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.
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
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
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.
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.
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
Some things to try for hyperemesis:
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
literature review of the effectiveness of ginger in alleviating
mild-to-moderate nausea and vomiting of pregnancy.
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]
and Vomiting of Pregnancy [Medscape registration is free]
Ginger Root In Pregnancy
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.
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..
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!
Marijuana and Medicine: Assessing the Science Base from , with a
brief reference to marijuana
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!
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
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.
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
Recovery From Hyperemesis Gravidarum [Medscape registration
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
"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.
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
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.
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
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).
Burning fat releases toxins stores in the fat, and that might be
causing the nausea.
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?
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?
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
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.
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.
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.
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
* 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.
Program - Memorial Women's Hospital at Long Beach Memorial
I am working with a mom who was hospitalized several times during
her first pregnancy for hyperemesis. Any suggestions for major
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
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.
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.
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.
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 !
Round here, phenergan suppositories are the trick! TERRIFIC (and
they usually work). Perhaps she should ask her OB if she should
increase the dosage?
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
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
B6 50mg tabs-1 tab po tid or qid in combination with Bendectin
25mg-1 tab po tid or qid.
NOTE - Avoid confusing Unisom Tablets with Unisom SleepGels,
which contain a different medication.
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
One of my clients found that royal jelly helped her nausea; this
makes sense because of its high vitamin content.
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.
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.
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