Pregnancy-- Morning Sickness
krpe...@gmail.com
unfair! We all know that the first few months of fetal development are
critical for the baby's health. Why then are so many women so sick
early in pregnancy, and what can be done to help them? Finally, is it
possible that morning sickness is actually a good thing to have?
It Should Be Called "All-Day" Sickness
For many pregnant women, morning sickness should be called all-day
sickness. The preferred term is pregnancy sickness. It is awful! It can
range in severity from none (20 percent of all pregnant women don't get
it) to persistent vomiting so severe that hospitalization and treatment
with intravenous fluids are needed to save the patient's life. Usually,
it is a constant feeling of nausea, like you are about to throw up,
along with an incredible sensitivity to all odors, such that even a
whiff of something you thought that you loved can set off another bout
of nausea and/or vomiting.
Why Does Morning Sickness Exist at All? -- Traditional Explanation
Doctors used to be taught that morning sickness was psychological, a
sign that the patient is ambivalent about being pregnant. This theory
is a bunch of baloney, and I refuse to discuss it further.
Many articles link morning sickness to the pregnancy hormone hCg.
Morning sickness tends to be worse with multiple gestation (a high
hormone state) and it tends to be minimal in pregnancies that end in
miscarriage (a low hormone state). I tell patients that it may not make
any sense, but the sicker they are, the "better" the pregnancy. This
theory doesn't explain everything however, and this does not mean that
a woman with no morning sickness will not have a good pregnancy. The
key question to me is "Why do normal, healthy pregnant women get so
sick?"
An Evolutionary Explanation
The best theory I have seen to explain morning sickness comes from
Margie Profet, an evolutionary biologist (and a recipient of a 1993
MacArthur "genius" prize). In her book, Protecting Your Baby-to-Be
(Addison-Wesley, 1995) she states that morning sickness is the result
of thousands of generations of evolution, and that it's purpose is to
improve the survival of the human species!
Morning sickness is Mother Nature's instinctive toxin avoidance
mechanism. It is our biological radar, warning us when something
potentially hazardous is coming our way. For thousands of years, humans
were hunter-gatherers, eating whatever and whenever they could. Many
plants produce toxins designed to enhance their survival by damaging
the reproductive potential of the animals that ingest them. (For
example, the plant lupine produces a reproductive toxin so severe that
if a pregnant animal even drinks the milk from another animal that has
grazed on lupine, the litter will be born with severe bone
abnormalities, scoliosis, cleft palate, and malformed limbs.) Today, we
extract many of these "toxins" and use them to our advantage, only we
now call them herbs, spices, drugs, and medications!
The evidence supporting this theory is extensive. For example, fetal
organ development is usually completed by week 14 of pregnancy. During
those first 14 weeks, the fetus is exquisitely sensitive to the
damaging effects of toxins. The first trimester is also when nearly all
miscarriages occur. Nearly all cases of morning sickness resolve by the
end of week 14!
Severe Morning Sickness
About one to three percent of pregnant women experience severe morning
sickness. It can lead to profound dehydration, mineral and electrolyte
abnormalities, and acid-base changes in blood chemistry. Treatment
requires intravenous fluids and possibly hospitalization. Contact your
doctor right away if you have any of the following symptoms:
* Throwing up everything, food and liquids, for more than a couple of
days.
* Losing more than 5 percent of your body weight (for example a
120-pound woman loses 6 pounds) compared to your pre-pregnant weight.
* Feeling constantly dizzy, lightheaded, very weak, and you have a dry,
pasty mouth.
Management of Mild Morning Sickness
>From the evolutionary theory comes some helpful advice for dealing with
morning sickness. First, trust your instinctive food aversions. If it
doesn't smell good, look good, or "sound" good to you to eat it, then
don't.
Below are two lists: The "avoid" list is far more important than the
"try this" list. Avoidance serves two purposes. One is to help avoid
something that can aggravate the morning sickness. The other, and even
more important, reason is to avoid substances potentially toxic to the
first-trimester fetus!
Things to Avoid
1. Avoid odors as much as possible. Have your husband take breath
mints. Use odorless hygiene and laundry products. Avoid odor-filled
places (crowded public places, public restrooms, smelly gyms, etc.).
Have your home cleaned to try and eliminate any musty or moldy
household odors. Get rid of smelly stuff in the fridge and place opened
boxes of baking soda inside.
2. Avoid unripe fruits and most vegetables (especially mushrooms), and
canned fruits and vegetables.
3. Avoid greasy and high-fat foods (dairy products are usually okay).
4. Avoid burnt foods. Avoid barbecued food.
5. Avoid raw fish (sushi) and avoid nuts.
6. Avoid spices, spicy foods and herbs: garlic, onion, dill, oregano,
etc.
7. Avoid food flavorings and condiments: ketchup, mustard, steak sauce,
etc. Small amounts of salt are okay.
8. If vomiting more than once a day, stop all vitamins (yes, even
prenatal vitamins) except folic acid (0.4 mg. daily) and B-6 (25-50 mg.
daily).
9. Avoid Emmetrol, a children's anti-nausea agent (often advised to
help morning sickness). It is safe but in my experience never works,
and often makes patients throw up even more.
10. Avoid coffee, tea, chocolate, and any substance which is bitter in
it's native form (before sugar and fat have been added to it).
Things to Try
1. Keep saltine crackers on your nightstand. Eat one as soon as you
awake, while still lying down if possible. Then wait a few minutes
before getting up. The crackers will absorb stomach acid that may have
accumulated during the night.
2. Eat things a baby would like (boring, bland stuff), like plain white
breads, cereal, noodles, rice, plain yogurt.
3. Eat ripe soft fruits. Drink fresh-squeezed fruit juices, ice cold
and watered down a bit.
4. Try a blender-shake made with ice, plain yogurt or milk, and ripe
fruit or fresh fruit juice. Whey or soy protein powder can be added if
your diet is low in protein.
5. Eat white cheese. It digests slowly and lessens stomach acid
production.
6. Dry, white meats like turkey breast are well tolerated.
7. Drink flat Seven-up or Sprite (pour into a cup, then stir).
8. If vomiting, drink Gatorade-type drinks rather than water to replace
minerals.
9. Drink liquids with crushed ice, using a straw.
10. Eat small meals all day long, up to ten times a day.
11.. If you have to cook, try to microwave, steam or boil foods. This
lowers the "burned food" odors.
12. To help nausea, try the following:
* Vitamin B-6, 50 milligrams once or twice a day
* Ginger, either tea or candied
* Atomic Fireball candy (one patient swears they help)
* Lemon drops
* Wrist bands, also known as acupressure or "sea" bands (personally, I
am skeptical, but when you feel so lousy, anything harmless is probably
worth a try)
What If You Don't Have Any Morning Sickness?
Assuming that the pregnancy is healthy, I would strongly advise still
following the suggestions in the "avoid" list. If morning sickness is
really designed to prevent toxins from reaching the unborn baby, not
having morning sickness may theoretically cause more harm than good.
Using Medication
There are times where the morning sickness is so bad that without
medication the patient may have to be hospitalized, or alternatively,
medication may be necessary for someone to be able to leave the
hospital, or for someone to function well enough not to miss work. In
those cases, the benefits of using the medication are felt to outweigh
the risks to the fetus. However, only a qualified Ob/Gyn practitioner
should make these types of decisions.
Conclusion
To learn more, I highly recommend Margie Profet's book. It has helped
me to finally understand what has always bothered me (and really
bothered so many of my patients). Normal (not severe) morning sickness
isn't unfair after all. It is an evolutionary miracle, designed to
benefit the survival of the species by reducing the risk of miscarriage
and birth defects. I hope that the information in this article, and
understanding what it means, will make dealing with your morning
sickness just a little bit easier.
Copyright © 1999 Bryan S. Jick, M.D., F.A.C.O.G.
- Bryan S. Jick, M.D.,