Pregnancy Sickness Natural Medicine

The Morning Sickness Handbook

Learn how to increase & maintain the effectiveness of all remedies for true morning sickness help. What you need to know! The 4 DO Not's and the 8 DO's that Nasa learned about nausea during their astronaut training program that can help you. Don't buy these: The remedies that are definitely a total waste of your money. What other books will fail to tell you, but are the most essential keys to help with morning sickness. The 1 gigantic mistake moms make when trying out any remedy. The 5 facts every nauseous mom must know to discover relief from nausea. Why a remedy that worked for someone else doesn't work well for you. Natural remedies that are completely safe (even healthy for baby) and ones that are harmful. How nausea affects baby's health and what you can do about it. Help for those who haven't been able to take their prenatal vitamins. How to keep the important nutrients in your body. Learn how to brush your teeth without gagging. What is being crackered? Discover the things you are doing to make nausea worse. Important food choices. Supplement suggestions. Read more...

The Morning Sickness Handbook Overview

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My The Morning Sickness Handbook Review

Highly Recommended

The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this ebook are precise.

As a whole, this manual contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

How to cope with morning sickness

There is no clear explanation for what causes morning sickness other than the obvious physiology of early pregnancy. However, nothing has been specifically indicated, such as an excess of a particular hormone, that would explain why some women sail through early pregnancy feeling no different and others are practically confined to bed for three months Nor is their any interesting psychological research looking at whether the emotional aspects of pregnancy and the physical symptoms can be managed any differently. This leads us on to consider possible ways of managing morning sickness.

Information about morning sickness

What seems quite amazing is the fact that women do cope so well with morning sickness. Clearly if one were to feel like this without an explanation, then we would all be queuing at the doctor's surgery for treatment and probably absent from work. This doesn't seem to be the case. Generally, even with quite debilitating symptoms, women seem to carry on with their lives and don't demand specific help. An important factor therefore seems to be that we have a reason for our symptoms, which suggests that the more we are informed about what is happening to our bodies, the better able we are to cope. It is probably worthwhile at this time finding out what is happening to your body as it may help to put things into some sort of context. Your GP will probably give you some written information at your booking visit that will give diagrams and details of the development of the baby. All women should be given a copy of The Pregnancy Book by the Health Education Authority.

241 Nausea and vomiting in pregnancy

Of all pregnant women, 50-80 suffer from nausea and vomiting of pregnancy (NVP), also known as morning sickness - although symptoms may persist throughout the whole day. Usually limited to the first trimester, NVP may continue for the entire pregnancy. NVP may range from mild discomfort to severe vomiting and nausea, weight loss, dehydration and metabolic compromise. In severe cases, NVP can be fatal. The death of the famous Charlotte Bronte, author of fane Eyre (1855), reflects the potential severity of NVP and the fact that at that time (the turn of the twentieth century) no therapy was considered necessary, as NVP was attributed solely to psychological factors and as such was not treated medically. NVP may pose a serious socioeconomic burden, as 25 of women suffering from NVP miss work as a result of their symptoms (Vellacott 1988), Women with past pregnancies complicated by severe forms of NVP or hyperemesis gravidarum may benefit by pre-emptive therapy, initiated as soon as the...

Morning sickness Common causes

The causes of morning sickness are unknown. It is thought it may be due to high levels of HCG, which is secreted by the placenta, and to progesterone released by the ovaries. In some women, the problem is so severe that it causes a condition called hyperemesis or excess vomiting (Weigel & Weigel 1989, Whitehead et al 1992). Seventy to ninety percent of all pregnant women experience some form of nausea (Sweet 1997). Although there is a great deal of research on the subject, no firm conclusions can be drawn as to what causes it.

Symptoms associated with morning sickness

Morning sickness is linked to the digestive system and can affect the other senses of smell, taste and touch. Some women feel nausea just from the stimulus of things they see and handle. Others find that altering position, for example between sitting and standing, can make them feel sick. There is a strong link between sickness and the dreadful fatigue that a woman gets in early pregnancy. Symptoms associated with morning sickness (Whitehead et al 1992) include cravings, food aversions, pica, metallic taste, intense hunger, heartburn, belching, excess salivation or ptyalism, smell and tiredness.

BNausea and Vomiting Morning Sickness

This is referred to as nausea and vomiting that is severe and lasts beyond the fourth month of pregnancy. It causes weight loss and upsets fluid and electrolyte balance of the patient. (4) Nausea and vomiting are unreliable signs of pregnancy since they may result from other conditions such as

Transient hyperthyroidism of hyperemesis gravidarum

One of the most clinically recognized forms of gestational thyrotoxicosis is transient hyperthyroidism of hyperemesis gravidarum (THHG). It is characterized by severe nausea and vomiting, with onset between 4 and 8 weeks' gestation, requiring in many cases frequent visits to the emergency room and sometimes repeated hospitalizations for intravenous hydration. Weight loss of at least 5 kg, ketonuria, abnormal liver function tests, and hypokalemia are common findings, depending on the severity of vomiting and dehydration. Free thyroxine levels are elevated, sometimes up to four to six times the normal values, whereas FT3 is elevated in up to 40 of affected women, values not as high as serum FT4. The T3 T4 ratio is less than 20, as compared with Graves' hyperthyroidism, where the ratio is over 20. Serum TSH concentrations are very low or suppressed.17 TPO antibodies are negative. In spite of the significant biochemical hyperthy-roidism, signs and symptoms of hypermetabolism are mild or...

Do men get morning sickness too

Although the physical symptoms highlighted above should be common only to women, it may be that partners too experience unpleasant thoughts and feelings in early pregnancy. The early pregnancy does impact far less on the father partner and probably he is going to be less troubled now by worries about becoming a parent. However, some may find themselves anxious and confused.Where perhaps this is not understood as 'anxiety', this may result in physical symptoms in the partner. As we have said in relation to women we cannot be sure that all of the physical symptoms of morning sickness are generated hormonally, therefore, worries in the partner may lead to feelings of nausea, headaches and pains, and so on. More often than not, anxiety can lead to behavioural changes or what Psychologists might call 'acting out'. The news of a pregnancy may lead the partner to increase alcohol or drug use. He might stay out more, stay at work later or be more argumentative. Relationships are often...

Morning sickness

The initial anxieties of pregnancy can, however, be completely overshadowed by the overwhelming and unpleasant symptoms known as morning sickness. The term 'morning' can be misleading as the symptoms often continue throughout the day. Morning sickness can, of course, start before you know you are pregnant, almost as soon as conception has occurred. It may be what alerts you to the fact that you have conceived. These early pregnancy symptoms can be quite distressing especially if you are still reeling from the discovery that you are pregnant. Where there are mixed feelings about the pregnancy and thoughts of possible termination, this can be intensely distressing as the sickness brings a constant reminder of the reality of the pregnancy. The onset of morning sickness can be very sudden. It is not unusual to go to bed wondering why you don't feel any different yet and to wake up feeling like you've been hit by a bus. All manner of symptoms, physical and emotional, can occur in early...

Foreword to the first edition

12 chapters on diseases of pregnancy, four on difficult labour and 25 on postpartum diseases. Problems in pregnancy discussed include morning sickness, bleeding, threatened miscarriage, miscarriage, urinary problems and oedema. The discussion on labour problems includes formulae for promoting labour, and on dealing with a dead fetus, prolonged labour or retention of placenta. The discussion on post-partum diseases includes tetanus, puerperal infections, abdominal pain, persistent bleeding, retention of urine, lactation insufficiency and mastitis.

Forbidden points of pregnancy

There is much debate about the points that should be used in pregnancy. Some schools of thought say that you should not treat at all during the first 3 months of pregnancy, as acupuncture may cause miscarriage. I disagree with this view and have had some wonderful results in the treatment of severe morning sickness, which can be utterly debilitating for some women.

The Eastern philosophy of childbirth

The Chinese believe that if a pregnant woman pays attention to her diet, her environment and her emotional state, then the fetus will benefit. Sadness and grief are thought to deplete the Heart and Lungs, resulting in amenorrhoea. Worry knots the Qi, fear depletes the Kidneys. Anger, frustration and resentment are often to be seen in women suffering from morning sickness and excess bile. (This is discussed at more length in Ch. 5, p. 75.)

First trimester 1 to 12 weeks

Morning sickness morning sickness Western medical treatment of morning sickness Chinese viewpoint of morning sickness Morning sickness Recent research The common patterns of disharmony Hyperemesis gravidarum During the first trimester of her pregnancy, a woman very often feels, well, downright lousy Symptoms are many and various, including an overwhelming tiredness, a constant hunger, a craving for odd things to eat, an aversion to foods previously enjoyed, a mouth full of saliva or an unpleasant metallic taste, and nausea and sickness, often just in the morning but in some cases lasting all day.

Treatment and treatment planning

When I first started treating morning sickness, the only points I used were taken from prescriptions in various texts, and from observations of other practitioners. Little tends to be said about needling technique, except to tonify for a deficiency and reduce for an excess condition. However, I feel that pregnancy requires a gentler technique putting in the needle, finding the Deqi and leaving it in for about 10 minutes. This will help me to gauge the constitution of my patient, and her reaction to needles. In subsequent treatments I would then be happier to leave needles in longer. Treating morning sickness can be difficult because of the very varying manifestations of symptoms between individuals, and the variations in each patient's past health. For this reason you should use the prescriptive treatments that you may read in the texts with careful thought for the specific circumstances of your patient. I have had most success by making my treatments as simple as possible and by not...

Recent research

In 2002, Smith et al presented two papers on the outcome of a randomised controlled trial on 593 pregnant women who were less than 14 weeks pregnant and complaining of morning sickness. One article (Smith et al 2002a) reviewed the efficacy of acupuncture and the other the safety of acupuncture as a treatment for morning sickness (Smith et al 2002b). The women were split into four groups.

Results

The outcome was that all the treatment groups showed less nausea than those women who had no treatment. The traditional acupuncture groups showed less nausea in the first week of treatment, and the PC-6 only group from the second week of treatment. By the third week the sham acupuncture group showed less nausea. Perinatal outcome showed no difference in all four study groups so it was deemed that acupuncture in early pregnancy was thought to be a safe and effective treatment for nausea. A more recent pilot study on acupuncture and acupressure at PC-6 in the treatment of hyperemesis gravidarum (HG) showed positive results (Habek et al 2004). However, this was a small study and HG is a serious complication and care must be taken in the treatment of these women. PC-6 this is the point that has been most researched for its use in relieving nausea, not only for pregnancy but also for postoperative sickness. It helps to relax the chest and diaphragm and to ease the sickness by removing...

Vitamin B6

Vitamin B deficiency is associated with anxiety, malaise and depression. There has been controversy about B6 (Tuormaa 1998). Even so, for women who have suffered from hyperemesis in the past, it is a good idea to boost intake of vitamin B6 before attempting another pregnancy. If taken in doses of 25 mg orally, every 8 hours for 72 hours, this has been shown to have a significant effect, reducing nausea and vomiting in women with severe pregnancy sickness symptoms. A double-blind randomised controlled trial of 59 women showed that it helped those whose nausea and vomiting symptoms rated more than 7 on a scale of 0-10, but it was no more effective than a placebo for those who were not badly affected (Sahakian et al 1991).

Bowel problems

The Chinese viewpoint is that constipation is due to a Blood deficiency, especially if this is a pre-existing blood deficiency. It may also be due to Qi stagnation, which is common in the first 3 months because of the growing fetus. Another contributory factor may be if the mother is suffering from morning sickness and is not drinking the amount she should.

Complications

Multiple pregnancy should not be regarded as abnormal. However, with more than one baby the minor disturbances in pregnancy such as morning sickness, heartburn, back ache, sleeplessness and exhaustion are all more likely to be exaggerated. The mother should be encouraged to rest as much as possible to minimise the risk of such problems. Good nutrition from a well-balanced diet is especially important.

Case Study 161

The birth was relatively straightforward, but almost immediately after the birth she felt very depressed and at times suicidal. She felt hopeless and couldn't imagine how she would cope. Her main feeling was that she was trapped in an impossible situation that no one could help her with, and felt angry but was unable to express anything externally. Six months after the first two births she started to feel much better and eventually felt her normal self again. She came for treatment mainly to help with the morning sickness at the early stages of her third pregnancy.

Emotions

Emotions strongly affect morning sickness because of their links to particular organs. Anger. Anger causes Liver Qi stagnation. When the cause of anger is repressed frustration and resentment, it leads to Liver Qi stagnation which affects the Spleen, causing diarrhoea. The Stomach is also affected, as Stomach Qi is prevented from descending, causing obstruction, epigastric pain, belching and nausea. The influence of the Liver on the Stomach is frequently seen in patterns of disharmony of the Stomach.

The beginning of our journey

However, this book will not go into detail about the physical process of pregnancy but will concentrate on the emotional transition that takes place. Psychologists often talk about 'life events' as the significant building blocks that form our lives. These can be both positive and negative getting married, moving house, changing career, bereavement, illness, and so forth. The more of these events you experience at one time, the more likely it is that you will feel pressurised, stressed or depressed. Becoming a parent is probably the biggest transition that many of us will make. So many things change there are new roles to learn, new responsibilities to take on and parts of the old self to be given up. This is true for both mothers-to-be and fathers-to-be. Women also have to cope with the physical realities of pregnancy a changing body shape, morning sickness and sometimes serious health complications such as raised blood pressure. Labour and birth also pose new...

Kensington Publishing Corp

She has sold her toy shop, lost her boyfriend, and found out that she is pregnant. In search of a job with health insurance, she experiences a wave of morning sickness in the elevator on the way to an interview. Naturally, Damien Sharpton, known as the Demon, the man with whom she has an appointment, is in the elevator with her. In spite of this inauspicious beginning, she gets the job and easily conceals her condition since they don't come into contact too often, developing instead, an electronic relationship that leads her to believe that Damien's reputation as an ogre is greatly exaggerated. Since Mandy is the first person to penetrate his tough exterior, he invites her along on a trip to the Caribbean and becomes more enthralled. Things aren't easy once they're back at the office, but love finds a way in this truly wonderful tale.

Information And Protocols

Becomes independent of staff turnover. Individual protocols for all early pregnancy complications should be compiled into a file and placed in every assessment room for reference. These protocols will include fine details such as dosage regimens and timings between visits. Protocols relating to referral criteria, initial assessment, management of miscarriage, ectopic pregnancies, pregnancies of unknown location, gestational trophoblastic disease and hyperemesis gravidarum should be developed and made available to all members of the early pregnancy team. The evidence for each protocol is stated at the end of each section and the date of compilation also stipulated. Protocols should be revised on an annual basis according to current NHS recommendations. A suggested series of protocols will be offered in the following chapters.

256 Additional ulcer therapeutics

In a publication of several cases, it is discussed that when the symptoms of hyperemesis gravidarum are persistent into the second trimester, active peptic ulcer disease from H. pylori could be the cause (Jacoby 1999). The results of several studies do not support an involvement of H. pylori infection in the generation of gastrointestinal symptoms during pregnancy, although a possible relationship with severe forms of emesis is suggested by Larraz (Weyermann 2003, McKenna 2003, Larraz 2002).

What to expect The First Trimester

Another thing you can expect to some degree is morning sickness. The name is kind of general, and with good reason. This sickness can be anything from a little upset tummy to a full-blown, hold nothing back, tossing of one's cookies. Most women fall somewhere in between. The sickness can also appear at any time or throughout the day. So remember, if you see your wife heading towards the bathroom, don't stop her to ask her what's for breakfast and don't get in her way.

The midpregnancy making plans

The middle months of pregnancy may be a very different time psycho -logically from the experiences we have talked about in early pregnancy. Generally women feel healthier, their morning sickness having subsided and usually the pregnancy has been 'accepted', in that the woman feels more able to get on with everyday life, not as before, but in the new identity of pregnant woman. Obviously every pregnancy is unique and if you don't start to feel better, this isn't a sign of something being 'wrong' with the pregnancy. There may be many reasons for this if you already have a toddler to look after it may be difficult to recover from the extra demands that the pregnancy is placing on your resources both physical and psychological. It may be that your relationship is still adapting to the prospect of the baby or for a variety of reasons you may simply not be enjoying pregnancy.

248 Dopamine antagonists

Metocloprarnide is an effective antiemetic that acts both centrally (causing dopamine blockade in the chemoreceptor trigger zone and decreasing sensitivity of the visceral nerves that transmit G1 impulses to the central emetic center) and peripherally by stimulating motility of the upper gastrointestinal tract and increasing the lower esophageal sphincter basal tone. Metocloprarnide counteracts some of the physiological changes during pregnancy that may lead to nausea or vomiting, such as decreased lower esophageal sphincter tone (van Thiel 1977), and decreased propulsive motility time and increased transit time of the small intestine. Metocloprarnide is effective as antiemetic therapy for all stages of NVP, including hyperemesis gravidarum, and has been used to manage NVP successfully at home using a continuous subcutaneous pump (Buttino 2000). One trial combined droperidol with diphenhydramine for treatment of 80 women with hyperemesis gravidarum. This is the only published trial of...

Anytimeofday sickness

For some women, the nausea that can strike during the first trimester is worse in the mornings, maybe because the stomach is empty at that time of day. But ask anyone who's had morning sickness, and she'll tell you It can hit any time it wants. It often starts during the fifth or sixth week (that is, three to four weeks after you miss your period we describe how doctors calculate the timing of pregnancy in Chapter 2) and goes away, or at least becomes much less severe, by the end of the 11th or 12th week. It can last longer, though, particularly in women who are expecting twins or more. If you're experiencing nausea, we sympathize. Even when nausea doesn't actually cause you to vomit, it can be extremely uncomfortable and truly debilitating. Certain odors from foods, perfumes, or musty places can make it worse. Look in the nearby sidebar, Ways to keep nausea at bay, for recommendations on how to minimize morning sickness. If your queasiness gets out of control if you experience weight...

For Dads Watching Mom Grow

Often, it's the most fun part of pregnancy for both parents. Morning sickness fades away, fatigue subsides, and your partner begins to feel the baby move around inside her. Often, you, too, can feel the baby move by placing your hand on the mom's abdomen.

963Findings Related to Anorexia and Bulimia Nervosa

In those studies in which women with AN or BN were investigated together, risk and incidence of inappropriate weight gain 53-55 , hyperemesis gravidarum 56 , cesarean section 57 , preterm delivery 58 , LBW 56, 58, 59 , SGA 56, 58 , small head circumference or microcephaly 56 , short body length 59 , NTD 29 , and other birth defects 57 were high. In general, women who entered pregnancy in remission from their AN or BN had optimal maternal and fetal outcomes 50, 60 , while women with active eating disorders prior to conception and during pregnancy fared less well 24, 58 .

10Is acupuncture safe for pregnancy

Advocates of acupuncture treatment suggest that acupuncture during pregnancy is beneficial for both mother and baby. During the first trimester, acupuncture may reduce morning sickness and fatigue. During the second trimester, acupuncture can help maintain balance. In the third trimester, acupuncture can provide relief from backache and joint pain. Acupuncture is also used during labor for pain relief.

910monitoring and evaluation

More aggressive and intensive inpatient care may be warranted if monitoring and evaluation shows a worsening of the eating disorder, IUGR, or other fetal growth and development problems. In AN or BN, a reduction in body weight to less than 75 of expected hypokalemia, hyponatremia, or hypochloremic alkalosis dehydration hyperemesis gravidarum cardiovascular changes prolonged fasting uncontrolled binge eating-purging cycles severe depression suicidal ideation and any obstetrical complication are justification for hospitalization.

2116 Phenothiazines and thioxanthenes

Data on use during pregnancy are available for alimemazine, chlorpromazine, dixyrazine, fluphenazine, levomepromazine, pericyazine, perphenazine, prochlorperazine, promazine, thioridazine, trifluoperazine, and triflupromazine. The data on pregnancy outcome are conflicting. Case reports of malformations have been reported (e.g. microcephaly, syndactyly, cardiac malformations), but most larger studies have failed to demonstrate a significant risk for congenital malformations (Altshuler 1996, McElhatton 1992). Most information is available from studies in which pregnant women had been treated for hyperemesis gravidarum. For this indication, smaller doses are used than those needed to treat psychosis.

Fetal Risk Summary

During pregnancy, the benefits of treating allergic rhinitis with any product, including budesonide, must be carefully weighed against the potential risks of therapy. Consideration should be given to limiting corticosteroid exposure, especially during the 1st trimester. In contrast, poorly controlled asthma may result in adverse maternal, fetal, and neonatal outcomes (6). Maternal complications include an increased risk of preeclampsia, pregnancy-induced hypertension, hyperemesis gravidarum, vaginal hemorrhage, and induced and difficult labors. Fetal and neonatal adverse effects may be an increased risk of perinatal mortality, IUGR, prematurity, lower birth weight, and neonatal hypoxia. Because controlling maternal asthma can ameliorate or prevent all of these complications (6), the benefits of therapy appear to outweigh the potential risks of drug-induced teratogenicity or toxicity. Therefore, pregnant women who require an inhaled corticosteroid, such as budesonide, for control of...

5Is it normal to salivate more during my pregnancy

Morning sickness causing nausea can also lead to increased production of saliva. Heartburn, resulting from the acidic contents of your stomach, may irritate your salivary glands and worsen this problem. In these situations, over the counter medications (e.g. antacids) can be used to help reduce the salivation.

Disorders of bone and mineral metabolism during pregnancy and lactation

In a report of 45 pregnant women with hyperparathyroidism, 38 complained of nausea, vomiting, or abdominal pain 24 reported renal colic 22 had muscular weakness 22 manifested mental symptoms and 11 complained of skeletal pain or fatigue only 20 were asymptomatic 51 . Other clinical manifestations included hyperemesis gravidarum, weight loss, seizure, or other symptoms mimicking preeclampsia 46,48 . Many of the aforementioned symptoms are nonspecific and could have been due to the pregnancy itself. Objective findings included the following 24 had nephrolithiasis or nephrocalcinosis, 16 had urinary tract infections, 13 had bone disease on radiograph, and 11 had pancreatitis 51 . In another large series of 63 cases, 38 had evidence of bone disease, 54 had evidence of renal disease, and 30 had evidence of both 52 . The high prevalence of stone disease may be explained by pregnancy-induced hyperab-sorptive hypercalciuria that augments the hypercalciuria that otherwise would occur secondary...

4 Impact Of Eating Disorders On Pregnancy Course And Outcome

Hyperemesis gravidarum (HG) has been found to be more common in women with eating disorders than in control women. Abraham (17) reported that although the community prevalence of HG is 1 in 1000 pregnant women, nearly 10 of 25 actively bulimic women had experienced this symptom during their pregnancy. This finding was consistent with Stewart (18), who reported that HG occurred more frequently in eating-disordered women (relative to controls) who had ovulation induced in response to infertility. It is possible that the greater frequency of HG in women with BN may be related to fear of weight gain and may provide permission for bulimic symptoms. Because women with BN regularly use self-induced vomiting as a means of weight control and caloric compensation, the pregnant bulimic woman may see HG as an acceptable way to manage weight during pregnancy. In a sense, HG might allow her to continue her symptomatic behavior by hiding it under the pretense of a medical consequence of pregnancy.

Breast Feeding Summary

Benaron HBW, Dorr EM, Roddick WJ, et al. Use of chlorpromazine in the obstetric patient a preliminary report I. In the treatment of nausea and vomiting of pregnancy. Am J Obstet Gynecol 1955 69 776-9. 10. Sullivan CL. Treatment of nausea and vomiting of pregnancy with chlorpromazine. A report of 100 cases. Postgrad Med 1957 22 429-32.

Total parenteral feeding TPN

Figure 16.1 Suggested management pathway of pregnant women with hyperemesis gravidarum Figure 16.1 Suggested management pathway of pregnant women with hyperemesis gravidarum Nasogastric feeding is an option to consider but is usually poorly tolerated due to continuing nausea and vomiting, tube displacement and risk of aspiration. TPN is found to have a supportive effect and can be therapeutic in some cases of severe HG. Given that the route of administration requires a long line into a large vein over a long period of time, susceptibility to line infections, thrombophlebitis and bacterial endocarditis are recognized complications.20

2198 Herbs contraindicated during pregnancy

Ginger Nausea and vomiting, 250 mg four times a day or morning sickness maximum ginger is also frequently used as a tea or infusion Three published placebo-controlled trials have addressed the safety and efficacy of ginger for morning sickness. In 1990, Fischer-Rasmussen reported 30 pregnant women, randomly assigned, who were admitted to the hospital before 20 weeks' gestation, and received either 250 mg of powdered ginger capsules or placebo four times a day over a 4-day period. No adverse effects on the pregnancy and outcome were noted. Vutyavanicah (2001) conducted a randomized double-blind placebo-controlled study of 70 women with nausea of pregnancy with or without vomiting before the seventeenth week. Again, either 250 mg powdered ginger capsules or placebo four times a day was used. Good efficacy was reported, and no adverse effects were noted on pregnancy outcomes. A study in 2003 by Willetts, in a double-blind placebo-controlled trial, randomly assigned 120 women before the...

Lifestyle changes

It is certainly true that for most problems in life, whether physical or psychological, the more that we feel that we have some influence over them, the less we become victim to them, and the same thinking can be applied to morning sickness. Many women view morning sickness as a sign from their body that they need to change their lifestyle, perhaps change their diet, limit the range or type of activity they engage in, increase the amount of sleep rest they are getting, limit their drinking, and so on. This approach can of course prove unpopular if you have told yourself that 'having a baby won't change my life' or 'I'm not going to give up my interests just because I'm having a baby'. Perhaps it's important to remember that morning sickness doesn't last for ever and there is no harm in doing it differently for a while. Getting more sleep, avoiding where possible stressful situations, leaving aside troublesome tasks until you feel better and changing your diet may all help. There are...

Relaxation

Often during pregnancy women learn the skill of relaxation to cope in labour but it may also help to cope with morning sickness. The reading list on p. 188 includes some relaxation tapes, which can be purchased. Simply follow the instructions on the tape. You may be able to borrow tapes from your local library. You may also find that using your own selection of music is more relaxing. People dealing with a whole range of unpleasant symptoms, such as chronic pain, find that learning the skill of relaxation can significantly reduce their experience of pain. Partly this can work by learning to focus on positive images and thoughts rather than the distressing symptom, which can reduce their experience of pain. Learning to relax certainly won't make the sickness and fatigue go away but at the very least it may just encourage you to take ten minutes out every day to put your feet up after all, the weeks when sickness occurs are crucial in the development of the baby.

Risks to the Woman

Potential obstetrical complications that are seen more frequently in women with epilepsy include vaginal bleeding, anemia, and hyperemesis gravidarum (HG), a rare disorder characterized by severe and persistent nausea and vomiting during pregnancy that may necessitate hospitalization. As a result of frequent nausea and vomiting, affected women experience dehydration, vitamin and mineral deficit, and the loss of greater than 5 of their original body weight. Difficulties during labor and delivery include premature labor, failure to progress, and an increased rate of cesarean section, which may become necessary to protect the well-being of the mother or baby.

Feeling better

Beginning to feel better physically will clearly contribute to the feeling of having entered a new stage of the pregnancy. Therefore, if we think of there being a 'psychological' mid-phase of pregnancy, this will coincide with beginning to feel better physically and this could occur anywhere from 12 to 20 weeks. Morning sickness often begins abruptly but usually trails off, with a gradual reduction in the nausea and a feeling that you are less tired and more able to carry out your life tasks as you did before. For some women this can actually move into a stage of feeling better than they have ever done. Pregnant women are often described as 'blooming' at this time. It can be a time of feeling physically and emotionally very good. How much of this shift is due to physical changes and how much is due to the emotional fact of having accepted the pregnancy is not clear.

Causes

HCG-dependent hyperthyroidism Human chorionic gonadotrophin (HCG) shows a degree of homology with TSH, and can act as a weak TSHR agonist. Conditions characterised by raised concentrations of HCG may cause hyperthy-roidism. The commonest is hyperemesis gravidarum which results in transient hyperthyroidism in one third of cases. Trophoblastic tumours such as hydatidiform mole may rarely cause thyrotoxicosis1.

981 Assessment

Have you had morning sickness Inquiry about eating behaviors may also uncover related issues such as food cravings or aversions, timing and triggers of intake, and fasting and ritualistic behaviors. These may be linked to dental problems, morning sickness, hyperemesis gravidarum, gastrointestinal symptoms, and mood changes during pregnancy.

What is pain

In the section on morning sickness we talked about the interplay of physical and emotional factors and clearly a mixture of physical and emotional factors will affect the whole experience of labour. For example, as you approach labour you will probably be anxious which will cause physical effects such as your muscles tightening, your breathing becoming shallower which will release adrenalin and further speed up your physical arousal. Psychological research has shown that the more physically relaxed you are and the more able you are to think non-panic thoughts, the lower you will rate your experience of pain. Consequently, your experience of labour will be more positive and probably less painful if you can be aware of your fears and not let them take over completely. It may be that for most of us this is not easy, especially in your first labour.

21813 Iron

Iron (II) salts are well-absorbed after oral intake, and are suitable for supplementation during pregnancy. The addition of vitamins and trace elements to oral iron (II) preparations has no proven value. Combination preparations with folic acid cannot be recommended, because iron absorption with these preparations is reduced by up to 60 . About 15-20 of the patients who take iron (II) preparations complain of gastrointestinal problems, which may force a change to another preparation or even cessation of iron supplementation, especially in the presence of morning sickness. Parenteral administration of iron preparations (Singh 2000) such as iron (Ill)-glu-conate complex is only indicated with marked anemia, for instance, and, in combination with other anti-anemics, eliminates, lor the most part, the need for transfusions in pregnancy.

Caries Dental Decay

Being pregnant by itself does not cause dental decay, but the symptoms associated with it may indirectly result in caries. Morning sickness and tiredness in the first trimester can result in dental neglect and poor oral health. This increases one's risk to caries. In addition, food cravings during pregnancy may result in higher or more frequent sugar intake, also increasing the risk of developing caries.

Epilogue

And in one more week, she'd tell the family about the baby, after she'd surpassed the most vulnerable time of the pregnancy. So far she'd felt great, no morning sickness at all and only a little fatigue. Whit had been so supportive and so careful when he'd made love to her, which hadn't been nearly enough. But they'd both agreed to err on the side of caution, despite her doctor's assurances that lovemaking wouldn 't hurt a thing, something he'd told her at her appointment today. Something she couldn't wait to tell Whit, among other things.

Practical Points

Hyperemesis gravidarum complicates a small proportion of all pregnancies but has life-threatening implications if not treated early and aggressively. 2. Hyperemesis gravidarum is a diagnosis of exclusion. 5. Folate supplementation is important in hyperemesis gravidarum as nutrition deficiency is a major problem.

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