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Ugh, “morning sickness” – the dreaded ick that plagues the early months of so many pregnancies. You might be wondering, “What does morning sickness FEEL like?” Morning sickness can be different for different people but generally it is a recurrent or persistent sense of nausea that sometimes progresses to vomiting.  Though it is known as “morning sickness”, the truth is it doesn’t just happen in the morning (though for some it is worse in the early part of the day).  You may notice nausea or vomiting, but you might also notice aversions to certain foods or smells. Episodes of vomiting often have a trigger such as a strong smell, but sometimes they come out of nowhere. To be sure, nausea in early pregnancy can be awful – it leaves you feeling terrible, complicates your relationship with food, makes living in a city with strong smells a harrowing experience.  It can be difficult and even depressing to feel unwell, day after day, week after week, but knowing what to expect and how best to manage this difficult phase of pregnancy can help you to soldier through.


What causes morning sickness?

The symptoms of nausea in pregnancy are related to increasing hormone levels – HCG (human chorionic gonadotropin) and estrogen – which are particularly high in early pregagnancy. It is interesting to know that people who are pregnant with multiples (twins or more) often have more severe nausea in early pregnancy because HCG levels are higher in multiple gestations. As your placenta forms around 11 or 12 weeks those hormones level out and, in most people, the symptoms start to subside.


How soon does morning sickness start?

Nausea in pregnancy usually starts in the first trimester – often around five or six weeks


When does morning sickness peak?

Nausea in pregnancy usually peaks around week nine. This means that you may notice a worsening of symptoms before they start to improve. For some, the symptoms of nausea or vomiting seem to go off like a light switch, but for most those symptoms will gradually decline.  There are some pregnancies plagued by a more severe form of nausea and vomiting called “hyperemesis gravidarum” which can, unfortunately, last the entire pregnancy.  Recently, some celebrities have spoken out about their experiences with hyperemesis (HE) – Amy Schumer and Princess Kate Middleton have both suffered from HE and have been open about their experiences to bring light to this difficult condition.


What can help me manage morning sickness?

Morning sickness is treatable so be sure to discuss your symptoms with your Oula midwife.  Often our patients are able to manage their symptoms with some lifestyle adjustments.  If your symptoms are worst in the morning, try keeping some bland carbohydrates like saltine crackers on your nightstand to munch on as soon as you wake up and before you get up for the day.  Often nausea is worse on an empty stomach so it’s helpful to eat early and eat often – instead of eating two or three big meals per day, switch to lots of small meals. It helps to know your triggers – if you notice that certain smells or foods are triggering to you, feel free to ban those things from your home – garlic or onions, strong fragrances like perfume or cologne, and meat or eggs are sometimes things that you will need to avoid until this phase of your pregnancy passes. And beware that your prenatal vitamin may also be a trigger – if you suspect that these vitamins are bothering you, try to switch your schedule to take the vitamin at night before bed instead of first thing in the morning, or talk to your Oula care team about pausing your prenatal vitamin until after the first trimester.  It also helps to stay very well hydrated – remember to drink plenty of water throughout the day and experiment with adding some electrolytes to help your body maintain hydration (coconut water, gatorade, pedialyte, or electrolyte packets). Some people find that flavors like ginger or citrus can help stave off pregnancy nausea, so try drinks or candies with these flavors to see if that helps manage your symptoms.


Are there medicines I can take to help morning sickness?

If you continue to suffer from morning sickness even after trying these lifestyle changes, please know that there are some medications you can try.  An “over the counter” option is to take B6 vitamin (10-25mg up to three times a day) plus a medication called doxylamine at night (this is the active ingredient in Unisom sleep tablets – take 12.5-25mg at bedtime). If this over the counter combination isn’t cutting it, please reach out to your Oula care team so we can discuss some prescription medications that might be more helpful.


First trimester and the symptoms that come with it can be a tough phase in pregnancy, but for most people, it is just that – a phase.  The nausea/vomiting, food aversions, breast tenderness, fragile emotions, and crushing fatigue that are part of early pregnancy are all VERY real. While it is challenging to feel so “off”, especially during a time when you’re not always eager to disclose to the people around you that you’re pregnant, these symptoms can be a good reminder that it’s OK to slow down and acknowledge, to yourself and those closest to you, that your body is going through a significant change.  Trust that by the second trimester you will feel more like yourself, but that in the meantime it’s OK to rest and speak up for the things you need to get through these hard early weeks and months.  At Oula, we’re eager to have a real conversation about how you’re feeling so we can offer guidance and ideas about how to get through your first trimester.

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