Morning sickness: what helps, what does not, and when it is something more

What is happening

Rising pregnancy hormones, a heightened sense of smell and a slower-emptying stomach combine to produce nausea that is rarely confined to mornings. It typically begins around week six, peaks around week nine, and settles for most women by weeks twelve to fourteen.

Some evidence suggests moderate nausea is associated with a lower risk of miscarriage — which is no comfort at 3 a.m., but does mean it is a sign of a pregnancy proceeding normally rather than a problem.

Absence of nausea is equally normal and says nothing bad about the pregnancy. So does nausea that stops suddenly around the end of the first trimester — that is usually the hormones settling.

What actually helps

Eat before the nausea does. An empty stomach makes it worse, so eat something dry before getting out of bed — a khakhra, toast, a biscuit — and keep small snacks every two hours rather than three meals.

Ginger has reasonable evidence: ginger tea, a small piece with honey, or ginger sweets. Vitamin B6 also has evidence and is often prescribed; ask your doctor for the dose rather than self-medicating.

Cold food often works when hot food does not — smell is a major trigger, and cold food smells less. Curd rice, fruit, cold roti, chaas, coconut water, lemon water and khichdi are commonly tolerated.

Avoid the triggers you can: cooking smells (ask someone else to cook or use the exhaust fan), strong perfumes, fried and very spicy food, and an empty or over-full stomach. Take the iron tablet after food or at a different time if it worsens nausea — and tell your doctor rather than stopping it.

Rest and hydration: fatigue worsens nausea, and small frequent sips of fluid work better than a glass at once. Sucking ice chips or frozen fruit helps some women.

Medicines and what to avoid

Safe, effective anti-nausea medication exists and is widely prescribed in pregnancy — doxylamine with vitamin B6 is a standard combination, and there are others. If nausea is affecting your ability to eat, work or function, ask for it rather than enduring; there is no prize for suffering through.

Do not take anti-nausea medicines left over from someone else, and do not use ayurvedic or herbal preparations for nausea without your doctor's approval — 'natural' does not mean safe in pregnancy.

Continue folic acid throughout, even if other supplements are hard to keep down. If the iron tablet is the trigger, your doctor can change the timing, the dose or the preparation.

When it is hyperemesis

Hyperemesis gravidarum is severe, persistent vomiting that prevents keeping fluids down and causes weight loss and dehydration. It affects a small percentage of pregnancies and it is a medical condition, not a failure of coping.

The signs: vomiting everything including water, weight loss of more than about 5% of body weight, dizziness on standing, passing very little dark urine, a racing heart, extreme weakness, or vomiting blood.

It needs treatment — intravenous fluids, anti-nausea medication, sometimes admission — and it improves with treatment. Delaying because 'all pregnant women vomit' leads to avoidable dehydration and hospital stays.

When to see a doctor

Go the same day for: inability to keep any fluids down for 24 hours; passing little or no urine; dizziness or fainting; weight loss; a racing heart; vomiting blood or dark material; severe abdominal pain; fever with vomiting; or nausea and vomiting that begins for the first time after week nine, which needs a different assessment.

Also tell your doctor if nausea is stopping you eating, working or sleeping — that is a treatable problem, not something to be endured until fourteen weeks.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions