Perhaps that early positive pregnancy test around the time of your missed period should come with a recommendation that you take a week or two to indulge in all of your favorite foods because chances are that shortly thereafter, you’re going to feel a bit sick. It’s been called “morning sickness” for eons but the truth is that it can occur at any time of the day. As the pregnancy progresses and hormones rise, most women experience some level of nausea, vomiting, food aversions and constipation or diarrhea. It typically begins around week six and then tapers off from weeks 11-13. Some lucky women will have very mild symptoms for just a short time and others can have quite severe symptoms lasting well into the second or third trimester. Health care providers generally refer to these symptoms as NVP – “nausea and vomiting of pregnancy.”

Despite all we know about pregnancy, no one has quite figured out what causes NVP though theories abound. It is often proposed that the nausea and aversions to food are somehow protective so that women don’t eat foods that are more susceptible to bacteria (meats, vegetables). Others have even postulated that it is to prevent women from seeking alternative mates while gestating. Most pregnant women will emphatically agree, however, that they’d much rather have relief than a lesson on the biological cause of their nausea.

Is there any way to relieve symptoms without medication?

Many women assume that medications are the only choice and are concerned about risks so choose to suffer through but this is unnecessary. There are many safe and effective options for dealing with NVP and while none are likely to completely eliminate the symptoms, often a small improvement is enough to make this part of pregnancy bearable. Starting with food/beverage choices, it is important to keep hydration a priority. The baby is generally perfectly fine even if you’re not eating enough food but becoming dehydrated could be a problem and it also worsens the nausea so you need to get fluids. If you can’t drink water, try watered-down juices (full strength tends to be too sweet), lightly carbonated beverages (a splash of seltzer in juice), herbal teas (ginger, mint and chamomile are good choices), milk or non-dairy milks such as rice/soy/almond. Also, try sucking on ice pops, using fruit juice ice-cubes, or freezing fruit (like grapes or berries) to nibble on which will provide small bits of fluid.

Regarding foods, most people migrate toward bland carbohydrates such as rice and crackers or fruit. In fact, protein tends to work better at keeping symptoms at bay so try to add things like nut butters (if you don’t like peanut butter, try almond, cashew, macadamia butters), bland cheeses, yogurt, avocado, beans, small pieces of cold chicken, tofu. Cooler foods tend to give off less odors so it may help to keep the oven/stove off during particularly bad times. Smoothies (blended yogurt/fruit drinks) are also a good option particularly if you are vomiting frequently. To mitigate early morning nausea and vomiting, it may help to keep a small protein snack by your bedside to try to eat in the middle of the night (if you get up for the bathroom or are otherwise awake).

Additional, non-medication options include changing your prenatal vitamin to a chewable option or even a children’s vitamin until symptoms abate, acupuncture and acupressure, ginger (in it’s raw form or capsules), motion sickness bands, or hypnosis; these all have conflicting reports of success but they certainly won’t hurt to try.

What about medication options?

All women and their providers aspire toward a medication-free pregnancy but it simply isn’t always the case. Fortunately, for moderate-severe NVP, there are several different medications available and all of them are considered quite safe. In addition to the obvious goal of feeling better and getting through the day, there are benefits to treating nausea and vomiting that might be overlooked. Significant NVP is associated with increased depression/anxiety, lost work hours and income, risk for dehydration (which can negatively affect amniotic fluid levels), and difficulty in relationships including difficulty in parenting other children. Furthermore, it is often the case that if treated early – before symptoms become debilitating – patients are able to get enough food/fluids in and the sickness actually clears more rapidly.

The first line of treatment is typically a combination of vitamin B6 and doxylamine (brand name Unisom – an antihistamine that is often used for motion-sickness and insomnia). From there, providers typically use a step-up approach with progressively stronger medications that act in a variety of ways. Usually, combinations work better than single medications both by addressing differing symptoms and by reducing the side effects of using higher doses of a single medication. Ondansetron (Zofran) is the most commonly used medication for symptoms not easily relieved and it generally works well. However, it does cause constipation in many patients particularly at higher doses. On this subject, providers tend to vary slightly in which medications and what dosages they recommend to their patients so it really is best to discuss your personal medication management with your own provider.

What else should I know?

A small number of women get such severe nausea/vomiting that they lose weight and become dehydrated. This condition is called hyperemesis gravidarum and needs to be addressed aggressively with IV hydration, medications and occasionally hospitalization. If you cannot hold any food or fluids for more than 24 hours or you are losing weight, you need to contact your provider for advice.

Morning sickness or NVP is common, normal and, in fact, a somewhat reassuring sign of a healthy pregnancy. But that doesn’t mean it doesn’t cause considerable suffering to some women. If you’re not getting adequate relief with lifestyle and dietary modifications, please discuss treatment options with your provider. Remember that it typically starts to resolve toward the end of the first trimester so do your best to be gentle on yourself, get plenty of rest and hold tight for the relief to come. You can likely, also, look forward to some increased energy around the time the nausea starts to disappear so that you can enjoy being pregnant and look forward to motherhood.