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Information for the Carers of Women suffering from Pregnancy Sickness
This section contains helpful information and some positive things to help manage symptoms of nausea and vomiting of Pregnancy (NVP). However Pregnancy Sickness Support Trust, will not be held responsible, for any actions that are taken or not taken based on this information.
We assume you are reading this information leaflet because your wife or partner or perhaps your daughter, relative or friend is suffering from nausea and vomiting of pregnancy (NVP) or you are the mother-to-be. It is a condition that can be very distressing. Certainly if you are her carer the condition will be affecting your life as well. Please also read our leaflet entitled “Helpful information about nausea & vomiting in pregnancy” as it contains other complimentary useful information.
Whether NVP starts early or late, that is before week 4 or after week 7, from the first day of the last menstrual period (LMP), or whether NVP starts severely or mildly, for most people NVP ceases between weeks 12-14 from LMP. However, about 10% of NVP gets worse after week 10 from LMP. Less than 10% of pregnant women have NVP which continues after the end of week 20 from LMP. For 30% of women, NVP ends quite abruptly, there being at least 14 hours of nausea in the week before symptoms cease. The remaining 70% of women show gradual improvement with episodes of nausea lasting less time and eventually there being only one episode a day. A day clear of NVP, is a good sign that symptoms will not last too much longer.
NVP usually occurs in waves or episodes typically lasting 1-4 hours, though the worse the NVP the longer each episode of nausea lasts. Between these episodes women find they are able to eat and drink. Indeed half of women suffering NVP find that eating actually reduces the nausea! In between these waves of nausea about half of mothers-to-be with even severe NVP actually have cravings for particular foods. It is acceptable for her to eat the foods she fancies with certain exceptions which include: Paté, Liver, Soft Cheeses and uncooked eggs (which may contain harmful bacteria). Peanuts should be avoided as these may cause the baby to develop an allergy to peanuts. She need not worry about a ‘healthy diet’ or specific meal times while she has NVP. Quantity is more important than content and often eating small amounts frequently can help to reduce NVP. Plenty of fluid is particularly important to prevent dehydration so she should drink as much as she comfortably can between episodes of nausea, with the exception of alcoholic drinks or soft drinks with high caffeine content. Three cups of coffee or tea should be regarded as a maximum per day.
Most women with troublesome NVP state that nausea (occasionally associated with retching) throughout the day is the most troublesome symptom of NVP, but actual vomiting is more serious as it is more likely to lead to dehydration. Persistent vomiting 4 or 5 times per day, dry mouth and lips, passing only small amounts of dark urine are signs associated with dehydration. They are of particular concern if they are associated with the loss of 5%, or more, of her pre-pregnancy weight, or the presence of ketones in her urine. Such symptoms, should be reported to your G.P. Ketones in the urine can be simply detected by buying a bottle of Ketostix from the chemist and following the instructions with the test. Severe dehydration may need intravenous treatment to correct fluid and electrolyte inbalance by a “drip” in hospital. About 1% of pregnant women require such treatment. Even severe NVP is not associated with any increase in abnormality for the baby, though an abnormality may occur in up to 1 - 3% of babies, at birth, whether the mother-to-be has any degree of NVP or none.
One of the most common things to make NVP worse are various smells, many of which are normally quite acceptable to her but become offensive when suffering from NVP. She may even smell unpleasant odours in a room which nobody else can detect. Certainly shopping and cooking can become burdensome. Cold food for the family will reduce the problem for her.
Experience has shown that another important way to reduce NVP is rest, preferably lying down, especially after meals or when nauseated. 70% of mothers who have severe NVP say that they “are not as efficient mothers as they would like to be” requiring extra help from carers or relatives. Indeed if she has paid employment it may help her to know that approximately 30% of pregnant women need time off work due to NVP. In addition she may well join the 50% of women with severe NVP who feel depressed due to the constant nausea itself and by the effect it is having on her life and yours. She may also develop fluctuating and variable aversions to various previously enjoyed stimuli, whether they are visual, smell, taste, tactile or sensual. She will therefore need your understanding and sympathy during this period.
If NVP begins to affect her life, treatment can be given, usually starting within 2-3 weeks after NVP starts. There is no treatment which cures NVP but there are several which can significantly improve the condition and there is evidence that early treatment may prevent severe symptoms developing. Treatments include taking a pregnancy prepared multi-vitamin tablet daily throughout pregnancy. Each tablet contains 400 micrograms of folic acid which is the correct daily dose in pregnancy, no vitamin A and up to 10mg of Vitamin B6 (pyridoxine) the vitamin known to reduce NVP. These pregnancy prepared multi-vitamin tablets can be bought at the chemist but your G.P. should be informed. For further information please see our “Treatments Available” leaflet (Link).
As the pregnancy progresses, you will ask, “What is the probability of these symptoms arising again in a further pregnancy?” From the few investigations that have addressed this aspect of NVP we would say that there is a 50-66% chance that NVP will be similar from one pregnancy to the next. This applies if the mothers-to-be has had severe or slight NVP in the present pregnancy. Therefore there is a 33% chance that NVP will be considerably better in a further pregnancy. It also follows that 33% of pregnant women may be unpleasantly surprised that NVP is much worse in a subsequent pregnancy. About 13% of women are surprised when NVP is the first indication that they are pregnant. This surprise element to NVP suggests that it is a physical bodily hormonal occurrence in pregnancy, rather than a nervous reaction to a stressful situation.
It is quite likely that neither of you will receive much sympathy or support for the problems of NVP, because 25% of women have no NVP during pregnancy and another 35% have only up to 33 hours or less of NVP in a pregnancy, so naturally 60% of women and their husbands or partners feel there is no significant problem with NVP. Also the term “morning sickness” tends to trivialises the condition and as just 14% of women have NVP. only in the mornings the term is clearly mis-leading. However, there are about 30% of pregnant women who have a total of between 100 and 700 hours of nausea during a pregnancy, so there will be strong support from a fairly small sector of women and their menfolk. Try to find a sympathetic friend who will understand your present problems all too well. To talk to us for information or support, please telephone 024 7638 2020 and leave a message and we will get back to you as soon as we can or e-mail us at: info@pregancysicknesssupport.org.uk
One of the problems for you both is that NVP is so unpredictable during pregnancy in both severity and duration (For further information please see our leaflet entitled “What causes pregnancy sickness”). However NVP when associated with a normal scan of the uterus is a good sign for a successful outcome for the pregnancy.
There is then a need for family, friends and employers to provide practical help to ease the burden of NVP. Understanding that the mother-to-be has an important problem at the present time, caused solely by being pregnant, combined with practical re-organisation of house duties, particularly in the kitchen, will no doubt be appreciated as a problem shared, even if it cannot be a problem halved.