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Coping strategies

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This section contains helpful information that may help you to manage your symptoms. However, Pregnancy Sickness Support Trust will not be held responsible for any actions that you do or do not take based on this information.

If you are suffering from nausea and vomiting in pregnancy please understand that there is nothing that you are doing or have done which has brought on these symptoms.

It is not known what causes nausea and vomiting in pregnancy (NVP). Rumours and speculation abound in both the medical and lay press. What can be said with certainty is that you are suffering from a common problem that affects women of all personalities, ethnic backgrounds and types of environment.

NVP can be very unpleasant indeed and awful for the mother-to-be, and therefore it should not be ignored. Its most serious form, Hyperemesis Gravidarum, is when the symptoms are so severe that the mother becomes dehydrated, loses weight, and may have to be admitted to the hospital. When NVP affects the quality of life of the mother to be, treatment should be considered.

If you are experiencing symptoms of either NVP or HG, it is important to contact a GP as soon as possible. In the event of any emergency, contacting your GP and/or going to a hospital emergency department is important.

General Information

Nausea and vomiting in pregnancy (NVP) is a common condition affecting approximately 70% of pregnant women to a greater or lesser extent. About 45% of pregnant women suffer from vomiting with nausea, while an additional 25% have nausea alone. A more severe from of NVP is a condition called Hyperemesis Gravidarum. It is difficult to estimate the prevalence as it can go undiagnosed; however, a rough guide is 1% to 1.5% of pregnancies involve this debilitating condition.

Nausea and Vomiting in Pregnancy (NVP)

These troublesome symptoms often disappear by themselves, usually settling by 12 to 14 weeks after the first day of the last menstrual period (LMP). Approximately 10% of symptoms will become worse after week 10 from LMP. However, occasionally women will continue to have symptoms beyond 20 weeks of pregnancy. If this happens to you, try to remind yourself that all pregnancies are different, and the 12 to 14 weeks duration is only an average.

“Morning sickness” is a very inadequate term to describe the condition because NVP usually occurs both before and after midday, and it does not do justice to the range of severity that can occur. Nausea and vomiting in pregnancy (NVP) is a more appropriate and accurate term. However, if you read articles or hear about "morning sickness," you can be sure the information applies to the same condition as NVP.

Hyperemesis Gravidarum (HG)

With HG, the nausea and vomiting becomes so severe that the woman loses a large amount to weight resulting in her body becoming dehydrated and depleted of nutrients. The causes of HG are not completely understood; however, many people believe a combination of hormonal factors affect these symptoms.

Nevertheless, it is clear that HG is a debilitating condition requiring medical, practical, and emotional support.

Loneliness and Emotions

Suffering from NVP or HG can be a lonely and emotional experience. People may say things that indicate they do not understand what you are going through. For example, women with NVP or HG have reported that the question, “have you tried ginger?” can make them feel quite angry and frustrated. This is because they feel if someone really understood what they were going though, then someone would know that ginger would not help with the severity of the condition.

Coping Strategies

When people make these comments, try to remind yourself “they mean well, but they do not understand. I did not understand before I had this experience” may be useful.

Joining the Pregnancy Sickness Support Forum can help you connect with other women who are going through or have been through a similar experience. There is also a section for partners of women who are suffering from NVP or HG, which the women can not access.

Finding a sympathetic listener to talk to may also be helpful. Our telephone number is 024 7638 2020. You may call for information or a phone back for support. Alternatively, you can access our support network for one-to-one peer support from a registered and trained volunteer.

Many women who are suffering from NVP or HG become afraid of leaving their homes, worrying that they will be unable to control their vomiting in public. As a result, they may feel socially isolated, no longer spending time with their families, friends, or co-workers they used to see on a daily basis. It is important to try to continue to interact socially. If you do not want to leave your home, it may be helpful to try to call a close friend or family member with whom you can talk. Using other forms of social media, such as Facebook or Skype, can also help you to remain connected with your outside world.

Accepting that you are going to need help during this phase of your life may help you to come to terms with your experience. It may be very difficult to ask for help with tasks you were previously able to complete with ease, however accepting that you need help at this time in your life may help you to cope better.

You may find it useful to try to envision the end point and remember that this is a part of your life and reminding yourself as often as necessary that:

  • This condition is not your fault.
  • You have not done anything to cause NVP or HG.
  • There is nothing you could have done to prevent the onset of NVP or HG.

Remembering these points may be helpful. Some people find that having such reminders close at hand (e.g. on a post-it note, on their telephone notes) can help improve their mood.
It can be easy to feel sad that you are not having the ideal pregnancy you may have hoped for. Women are sold lots of ideas in our modern society, and having a perfect happy pregnancy is one of them. However, everyone has a different story, and your story may involve NVP/HG.

Inability to Eat

Many women suffering from NVP/HG find it difficult to obtain adequate nutrition and some lose weight. A small loss of weight can occur in early pregnancy, but if you lose more than 5% of your pre-pregnancy weight, you should inform your GP.

Coping Strategies

Keeping a daily diary of your symptoms may enable you to be prepared to eat and, most importantly, drink at those nausea-free times. Some people have found that the diary helps them to become more aware of their nausea-free times. The worse the NVP, the shorter these nausea-free intervals are, so it is important to be as ready as possible for them. Sometimes you may even feel hungry, but the hunger is often quickly followed by the onset of nausea. So, either feeling hunger or a nausea-free interval gives you a chance to eat straightaway, so knowing when these times are can help you to make the most of these opportunities. If you cannot face a meal, keep nibbling your favourite food, especially when nausea threatens. Some women with NVP say that eating, especially small frequent meals and stopping eating as soon as your stomach feels full, is the most common way to improve their symptoms.

A daily diary of your symptoms and eating small amounts can be useful for NVP or HG. Keeping track of how you are feeling and how much you have been able to eat and drink can help you gain some understanding of your condition. However, many women report not being able to keep down the smallest amount of food. Keeping a diary or asking a partner to keep a diary can help you monitor your condition to find out if there is even a small window of opportunity to try to consume some foods and liquids.

You may find it useful to ask a family member or friend to reorganize your household to minimise the impact of smells that trigger the nausea and vomiting.

Avoid certain foods that may contain harmful bacteria such as pate, liver, soft cheeses, and undercooked eggs. Also avoid peanuts. It may surprise you that women with NVP may still have cravings for some foods. You may happily eat the food you crave while you have NVP. Eating salted crisps may help you to eat a better meal.

Fluids: Remember to keep your fluid intake up to prevent dehydration. Again, use you nausea-free intervals to their best advantage alternately with solids if you cannot take both at the same time. Drink any non-alcoholic fluid you like, but avoid soft drinks with high caffeine content and not more than a total of three cups of coffee or tea per day. Many women find lemonade or fruit drinks very acceptable. Water is excellent, if necessary as ice cubes or frozen fluids. It is so important to drink plenty of fluid, in small frequent quantities, if that is all your NVP will allow.

Odours: If odours bother you eat cold food and hopefully your family will agree to do the same. Naturally you will avoid all odours and tastes that make your NVP worse. Your sensitive nose is possibly your worst enemy at present. The smell of cooking, especially fatty foods, coffee, tea, cigarette smoke, or perfume are the most common items stated by NVP suffers to make their symptoms worse. Normal odours can become unpleasantly nauseous, making shopping and cooking a trial. So, you may need to get extra help from your family and friends.

Vitamins

Take a pre-pregnancy prepared multi-vitamin that contains 400 micrograms of folic acid daily, which is the correct does in pregnancy. Some research has shown that taking Vitamin “A” throughout the pregnancy can be harmful to foetuses. Some research suggests that iron tablets while you have NVP, can make NVP and HG worse. However some women need iron tablets for specific conditions e.g. anaemia.

Rest

Rest, preferably lying down. The experiences given by pregnant women make rest their second most important way to help the symptoms of NVP. Pregnancy sickness is like motion sickness in this respect. Even small movements of the head, as in brushing your teeth, cam make NVP worse. However, some women have reported that lying down makes their symptoms worse.

The important thing to remember is that if rest works for you then try to arrange you day so that you get as much rest as possible. This can make some women feel guilty. If you do feel guilty, try saying something like “rest is important for me and my baby. This is my pregnancy and every pregnancy is different” at the time that you do notice yourself feeling guilty.

Employment and Housework

Five separate medical studies have shown that 30% of pregnant women in paid employment need time off work due to NVP. This statement indicates the significance of the condition. You are not alone if you require sickness benefit because of NVP! Employers also need to recognise that about 8.6 million hours of paid employment are lost each year in England and Wales due to pregnancy sickness. Several medical studies have shown that in excess of 50% of women with severe NVP struggle with their usual daily routine as housewives and mothers. Accept whatever help is offered. Indeed, organise the help if you can! If you have HG remind yourself that this is a debilitating condition, and it is your right to take time off work.

There is more information about employment on our employee information page.

Communication Strategies

Many women who suffer from HG may find it difficult to communicate the severity of their condition to others. You may find it helpful to have a speech prepared for when people ask you about your condition. If someone asks what is wrong you could say something like,

“I have a medical condition called Hyperemesis Gravidarum. A lot of people think it is like morning sickness, but in reality it is much more severe. Although most pregnant women feel nauseous during their pregnancy, most pregnant women do not have this condition.”

Talking to family and close friends about NVP or HG can also be difficult. Your partner and other loved ones may feel like there is nothing that they can do to help you. Let loved ones know that their continued love and support is appreciated and will help you through this difficult time. If a caregiver asks how you are feeling, you could say something like,

"I am still struggling with my HG, but I am grateful for your concern and support. Although I am a capable and independent person, I may need some extra help to assist me during this difficult time."

Even talking to health care professionals about NVP or HG can be difficult. You could try to say something like,

"I do not think that I am suffering from merely nausea and vomiting during pregnancy. My symptoms are much more severe. I have been unable to keep down food and water, and I vomit continuously throughout the day. I am concerned for my well being. Here is some information on Hyperemesis Gravidarum, which is the name of the condition I think I am suffering from."

Below are some additional strategies for communicating with your health care provider(s).

Contacting Health care Professionals

As NVP and HG are serious conditions, it is important to contact your GP as soon as you being experiencing symptoms.

Unfortunately, NVP or HG are not widely understood, and some health care professionals have more experience with this condition than others. This can be very distressing. Nevertheless, NVP or HG are serious medical conditions, and you should not hesitate to contact your GP with your concerns. If you are having a difficult time communicating with your health care professional, you could try:

  • Taking some information about NVP or HG to your consultations.
  • Asking your health care professional to call the charity.
  • Going to the consultation with someone who has seen first hand what you are going through can help to communicate your experience.
  • Take as much information about your body weight, fluid intake, and urination frequency as possible.
  • Take a urine sample, which can be tested for ketones, a sign of severe NVP.

Trauma

Nausea and vomiting in pregnancy and Hyperemesis Gravidarum can be very traumatic. It can put a severe physical and mental stress on a woman and those around her. The suffocation sensation that comes with unrelenting retching or vomiting can be quite traumatic, almost tortuous. Relationships can be strained. Women experiencing NVP or HG can feel a loss of control, as their lives turn upside down and are unable to care for themselves for a long period of time.

The fear, helplessness, and horror of HG may trigger traumatic symptoms, such as flashbacks, intrusive images, nightmare, numbness, depression, and a tendency to feel withdrawn. These symptoms can continue for some time after the baby is born.

Research suggests that the following may help with trauma:

  • Give yourself permission to look after yourself and to try to find a few moments for yourself.
  • Try to process you experience by writing about it or painting an image of your experience. It is important to write in the first person and present tense to help you capture as much detail as possible.

If you traumatic symptoms persist, it is important to seek further professional help.

Additional Coping Strategies

Some women have found the below techniques helpful. Remember that everyone is different, and some strategies may work better for you than others. Please be patient with yourself and give these strategies a chance.

Communication Strategies

Talking to others about your condition can be very challenging. Many people do not understand the severity of HG. Try to have a speech prepared to answer questions about your condition, and remind yourself that they are not trying to be unfeeling - they may just not understand.

Diary

You may find it helpful to keep track of how you are feeling throughout this experience, both physically and emotionally. Keeping a diary or journal of your experience may be helpful for several reasons.

A food diary can help you keep track of when are the best times for you to eat, how much you have managed to eat, and how much fluids you have been able to retain.

A diary can help you to process you experience, enabling you to make sense of how you are feeling and of what this experience means to you as a part of your life. Many people who suffer from medical conditions find that reflecting on their experience, through writing about it, helps them to make some sense of such an experience.

Keeping a diary or log of your experience can also help you to track what makes you feel better or worse. For example, you may find that relaxation in the morning helps with your nausea throughout the day. Or you may find certain movements, such as suddenly standing from a resting position, triggers nausea. It is important to keep track of how you are feeling. This will help you to become more aware of things you can do to help you condition.

A diary can help you to remember communication strategies you have found helpful or not so helpful. You may find having a particular speech prepared for when people ask you about your condition makes it easier to handle the interaction. Write this speech down; memorize it. This may help you to recall such a speech with greater ease when necessary.

Out and About

If you are able to get out for your normal daily activities you may find it helpful to carry a 'sick kit'. a small pack of wipes or tissues, some sick bags (disposable nappy bags are good), a small bottle of water and some mints or lemon sweets.

Some women find it easier in the car if they are driving while other prefer to be a passenger (especially if you are likely to vomit).

It is a good idea to empty your bladder before going out and regularly whilst out... relaxin produced in pregnancy can cause havoc with bladder control during episodes of vomiting!

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