Vomiting in the second trimester: what is normal and what is not

What is still normal

Morning sickness usually eases by weeks twelve to fourteen, and for a minority it continues into the second trimester or, occasionally, throughout the pregnancy. That is uncomfortable rather than dangerous, provided you are keeping fluids down and not losing weight.

Reflux and heartburn also rise in the second trimester as the uterus grows and hormones relax the valve at the top of the stomach — that can produce vomiting after meals rather than in the morning.

The distinguishing question is not when it happens but whether you can keep fluids down and whether your weight is rising as expected.

When vomiting is telling you something else

New vomiting that starts in the second trimester deserves assessment, because the common first-trimester explanation no longer applies. Causes to exclude: urinary infection (extremely common in pregnancy and a cause of preterm labour if untreated), food poisoning or gastroenteritis, gallbladder problems, and thyroid disease.

Vomiting with severe headache, visual changes, upper abdominal pain on the right, or sudden swelling can indicate pre-eclampsia — that is a same-day emergency even though it feels like a stomach problem.

Vomiting with fever, burning urination or back pain means a urinary infection until proved otherwise. Do not wait it out.

And hyperemesis gravidarum — severe persistent vomiting with weight loss and dehydration — can continue well past the first trimester and needs treatment rather than endurance.

Managing it

Small frequent meals rather than three large ones, and never letting the stomach get completely empty. Dry, bland things first thing.

Fluids in small constant sips through the day rather than a glass at once. Coconut water, chaas, lemon water and ORS all work.

For reflux-driven vomiting: eat dinner two to three hours before lying down, keep meals small and less fried, and raise the head end of the bed rather than piling pillows.

Ask about medication. Safe anti-nausea options exist in pregnancy and there is no prize for suffering — doxylamine with vitamin B6 is a standard combination, and there are others.

Keep taking folic acid and iron; if the iron tablet is the trigger, ask about changing the timing or the preparation rather than stopping it.

When to see a doctor

Go to hospital immediately at any stage for: heavy bleeding, severe or constant abdominal pain, a gush or steady trickle of fluid, severe headache with visual changes, sudden swelling of the face and hands, high fever, fainting, or reduced fetal movements after 28 weeks. Call 108 if you cannot travel quickly.

Same-day: vomiting that keeps nothing down for 24 hours, passing little or dark urine, dizziness or fainting, weight loss, vomiting blood or dark material, fever, burning urination or back pain, severe abdominal pain, or vomiting with severe headache and visual changes.

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

Q: My nausea stopped at twelve weeks and came back at eighteen. — Worth a call. It may be reflux or an infection rather than a return of morning sickness, and those need different treatment.

Q: Can I take an anti-vomiting tablet from the chemist? — Not without a prescription. Some are safe in pregnancy and some are not, and the chemist cannot make that judgement.

Q: Will vomiting harm the baby? — Occasional vomiting does not. Prolonged vomiting with dehydration and weight loss can, which is why hyperemesis is treated rather than tolerated.

Q: Is it true that sickness means a healthy pregnancy? — Nausea is associated with lower miscarriage risk in some studies, and its absence means nothing bad. Both are normal.