The dreaded nausea - you're not alone!

Some women (about 25%) manage to escape the dreaded nausea in pregnancy but for the majority, this is a challenge, particularly in the first trimester. It can be severe enough to interfere with work and family relationships and in 0.3 to 1% of pregnant women, may even require IV hydration and medication. But, for the majority, the American College of Obstetrics and Gynecology reports...

"About 50% of women have nausea and vomiting in early pregnancy, and an additional 25% have nausea alone," writes Jennifer R. Niebyl, MD, from the University of Iowa Hospitals and Clinics in Iowa City.

Dietary counseling to eat small amounts of food several times a day may be helpful, as well as to avoid exposure to odors, foods, or supplements that appear to trigger nausea, particularly fatty or spicy foods and iron tablets. Other helpful strategies may include eating and drinking fluids between meals or eating bland, dry, and high-protein foods.

n some women, alternative therapy remedies such as ginger and acupuncture may be effective, and these may be given at any point during the pregnancy.

For nausea and vomiting accompanying weight loss in the first trimester of pregnancy, pharmacologic therapy is indicated. Approximately 10% of women with nausea and vomiting in pregnancy require medication.

Evidence from randomized trials supports the use of vitamin B6 (pyridoxine), 10 to 25 mg every 8 hours, and doxylamine, 25 mg at bedtime and 12.5 mg each in the morning and afternoon. Unisom SleepTabs (Sanofi Aventis; oral vitamin B6 and doxylamine), which are available over the counter in the United States, have been studied in more than 6000 patients and control participants, with no evidence of teratogenicity. In randomized trials, this combination has been associated with a 70% reduction in nausea and vomiting, and the American College of Obstetricians and Gynecologists therefore recommends it as first-line therapy for nausea and vomiting in pregnancy." (Medscape)

Continuing nausea and/or vomiting that does not respond to the above regimen may require prescription medication. There are several options so this should be discussed with your health care provider. If dehydration occurs along with electrolyte imbalance, more aggressive treatment may be needed but IV therapy has its risks (infection is the most common) so this should only be used when there is a weight loss greater than 5% and in those who have not responded to these less invasive treatments. This is considered to be hyperemesis gravidarum. In some cases a single IV rehydration is all that is needed to reduce the risk of dehydration.

Labor of Love

After the birth of one of my babies, a neighbor showed up with bucket, cleaners and gloves in hand saying, "I'm here to clean your bathroom."  How did she know my bathroom needed cleaning?  Oh, yeah - she was a mother too.  Who has time to clean the bathroom with a newborn or even in the later months of pregnancy?  OK, anytime in the pregnancy.

What a nice gift that was!  I got a sparkling clean bathroom, like the housekeeping services in the hospital. That and a few hot meals brought by other neighbors made my transition to real life and my waiting family much nicer.

As I thought about nausea and vomiting of early pregnancy I remembered this and realized that would be a wonderful gift for any newly pregnant mom too.  Nothing like being so nauseous you can't function and having to bend over the bowl - what a lift of the spirit if someone came before and made sure it was sparkling clean, ready for the sometimes expected unexpected.  So, if dad-to-be wants to help this would be perfect!  While he's down there, a little floor mopping in those hard-to-get-to areas around the commode would be an added bonus.  It's just not right for the nauseated woman to have to do the cleaning here.

The best part about my friend's labor of love was she didn't wait to be asked and I didn't have to think of something I needed from her - you know "let me know if there's anything I can do to help."  Sometimes the biggest help is not having to think about it or ask for it.

More ideas of how dad can help here.

Nausea & Vomiting

One of the most common symptoms of pregnancy, nausea and vomiting plagues 80% of all pregnant women. At least you know you're not alone! The good news is that 90% of these women are feeling much better by the midway point in pregnancy; often much sooner with the first trimester being the most affected.

The AAFP (American Academy of Family Practice Physicians) website has a very thorough explanation of this condition.

Some tips to help you get through this:

• You tend to become most nauseous when your stomach is empty. This is one reason it has been dubbed "morning sickness." You may have heard that it will help to keep some crackers at the bedside to eat before even rising out of bed. This is a tried and true technique. It can be hard to eat regularly when nothing sounds good to you. Try to find a few foods you tolerate and make sure you keep plenty on hand with "on the go" emergency snacks with you too.

• Especially if you are vomiting, you may become dehydrated so keep some ice chips and/or water handy for sipping. If you are not keeping anything down, you may need extra help with hydration so talk to your doctor in this case. A condition called hyperemesis means "too much vomiting." There are available treatments and we don't want you to get into distress here. Your doctor may prescribe medications and sometimes IV therapy is needed, either on a one-time or ongoing basis.

• Sea bands or nausea wrist bands are available with boating supplies because they are sometimes helpful when people get sea sickness. Some pharmacies also carry this with their antinausea treatments for motion sickness. This uses accupressure to help decrease nausea and some women find this helpful. It is totally safe, non-pharmacological and uninvasive. What do you have to lose?

• It is always wise to discuss medication and supplements with your doctor but for years people have used ginger, either in capsule form or herbal teas to reduce nausea.
  

• Many doctors are recommending a combination of Pyridoxine (Vitamin B₆) and Doxylamine (Unisom). The AAFP says that 25 mg B6 taken orally every eight hours (75 mg per day) is often effective for controlling nausea and vomiting. In these doses, vitamin B₆ has not been found to increase the risk of birth defects. A single 25-mg doxylamine tablet taken at night can be used alone or in combination with the B6.

• If your nausea interferes with your life and is making you miserable your provider may recommend a prescription strength medication. There are several options available such as phenergan or Zofran (now available as a generic and very effective without making you drowsy). These also have not shown increased risk of birth defects. There are several other options also available so talk to your doctor or midwife.
  

• If you seem to be spending extra time in looking into the toilet, keeping your bathroom super-clean will help you get through it. If this is tough for you and you don't have someone willing to do it for you, it might be worth it to pay someone to come in for an hour or so each week to make your environment more pleasant as opposed to something that might aggravate the condition!

I have to agree with suggestions from the March of Dimes Blog for how hubby or significant other can be a hero to the mom-to-be: Click here.

About.com's Robin Elise Weiss suggests:

Over the counter medications can be helpful for some women. None of these are approved for use with morning sickness, but with guidance from your doctor or midwife, they may be helpful:

• Vitamin B6
• Reflux medications (Pepcid, Zantac)
• Emetrol
• Unisom Nighttime Sleep Aid (not the SleepGels) combined with vitamin B6
• Some herbal substances with the help of your practitioner

There are also prescription drugs that can be useful in helping control nausea and vomiting. These can include:

• Zofran (expensive, not always covered by insurance)
• Phenergan (pill and suppository form)
• Compazine

Medications are not used for the entire pregnancy unless symptoms persist that long. You and your practitioner can talk about what the best plan is for your pregnancy.