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Without drugs include relaxation and breathing exercises, as taught in many childbirth classes hypnosis or self-hypnosis massage counterpressure changes of position and immersion in warm water. In many cases, a woman needs to start learning and practicing these techniques months or weeks before she gives birth.
An algorithm of treatment would depend on the women's preferences and the availability of the different modes of therapy. It would seem sensible to start treatment with dietary measures, lifestyle modifications and vitamin Bj,. It' symptoms persist, treatment with meto-clopramide or diclectine (if available) should be started. The first-and some of the second-generation antihistamines are a good option, and if they fail then ondansetron would be the next choice. Intractable cases arc best treated with intravenous antiemetics and steroids, and rehydration therapy in severe cases, parenteral nutrition should be considered. Vitamin B1 should be administered in severe protracted cases in order to prevent thiamine deficiency. Alternative or complementary therapy such as acustimulation, hypnosis, and ginger can be considered at any stage. Hypnosis has proved efficient in a small number of trials, and the evidence for acustimulation as treatment of NVP is mixed. Ginger is safe and efficient...
Vis ua I i zati on i s a powerfu I tool u sed by many athletes to en ha nc e th e i r performance. It can be used in conjunction with hypnotherapy to improve mind-set. I see many women stuck in a negative mind-set in early pregnancy. Th ey a r e a nx i o u s a bo u t h avi n g s c a n s o r, i f t h ey 've h a d a miscarriage previously, they doubt their ability to carry a b a by to t e r m.
Psychosocial factors such as a history of abuse should be addressed by the physicians caring for these women in a sensitive manner. Some women may require additional psychiatric or psychological intervention. Some of these include relaxation therapy, hypnosis, cognitive behavioural therapy and biofeedback techniques.
From the start, pregnancy features as a curious sub-text in the history of psychoanalysis. The first case history, on which the method of psychoanalysis was based, was that of 'Anna O' (Bertha Pappenheim), a young woman who was treated for hysteria by Joseph Breuer from 1881 to 1882. In the account of the case published in Studies on Hysteria (1895), Breuer explains that the cure for Anna O's wide range of hysterical symptoms, which included paralyses and hallucinations, was found almost by accident. Breuer spent many hours listening to her and recording her symptoms, but the breakthrough came when she described under hypnosis the 'psychic events' which had precipitated a particular symptom, and was immediately relieved of it. Breuer then devoted himself to the task of letting her 'talk away' her symptoms and the case apparently came to a successful conclusion in June 1882. By this time Anna O was 'free from the innumerable disturbances which she had previously exhibited'.36
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