Transcript episode #13: HOw to beat nausea and vomiting
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00:00 Nausea and vomiting during pregnancy can be the worst. I will help you get through it with the information in today's episode.
00:14 Welcome to the All About Pregnancy and Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified Ob Gyn physician and certified integrative health coach. Every week I break down topics, share birth stories or interview experts to help you have your very best pregnancy and birth. Quick note, the information is for educational purposes only and is not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.
00:44 Hey there. Welcome to another episode of the podcast. As always, I am so glad you're here. Now let me start off by sharing a quick story. It was a beautiful sunny day and I was sitting at my desk at work and I was just getting ready to sit down and get some stuff done. I had these really nice big windows in my office and I was looking forward to finally accomplishing some tasks while enjoying the sunny view and then it hit me. I had to throw up now. I was about 10 weeks pregnant at the time with my second daughter. Now thankfully, there was a bathroom across the hall from my office, so I made a beeline for the bathroom. I did make it to the bathroom, but unfortunately I did not make it to the toilet.
01:38 As soon as I hit the bathroom door, and it was one of those like single individual bathrooms so it wasn't huge, but it wasn't like small either. So as soon as I got to the bathroom door, what seemed like everything I'd ever eaten for my entire life. It came spewing out of me. And before I knew it, vomit was on three walls of the bathroom. Yes, three walls. It was like a little bit on the left, a little bit like above the toilet and then the one on the right. And none of the vomit was in the toilet. I was so embarrassed. I felt awful. Thankfully the housekeeper was really nice and she cleaned everything up. Now I hope you cannot relate to this story. I would not wish that type of vomiting on anyone, but based on how common nausea and vomiting of pregnancy is, that affects anywhere from 50 to 80% of pregnant women, chances are you can relate.
02:37 So today I will help you understand what you can expect with nausea and vomiting during pregnancy and I will give you both some non-medication options as well as some medication options to help. Now before I get into the episode, let me do a quick listener shout out. This is from JohnsonIn and she left me a review in iTunes that says, Doctor Nicole's podcast is amazing, very informative with professional information presented in a way that is comforting and assuring the podcast gives great advice to expecting mothers and those who are interested in knowing about the journey of pregnancy. Because of this podcast, I have confidence in my ability to ask my doctor all the right questions during my visits. Thanks doctor Nicole for a wonderful podcast. Thank you so much for that really nice review. I love, love, love doing this podcast and providing you this information and it feels good that you love it too.
03:41 Now you know what else I love? I love connecting with listeners in the podcast community Facebook group. It's a great place to connect with other pregnant women. I also share inspirational quotes related to pregnancy, and helpful tips for pregnancy and I do Facebook LIVE sessions where I answer your questions about pregnancy and birth. It's called the All About Pregnancy and Birth Podcast Community. So just search for that on Facebook and I will also link to it in the show notes.
04:10 Okay, so now let's talk about nausea and vomiting in pregnancy. Now we don't really know what causes nausea and vomiting in pregnancy. We do know there are some risk factors. Women with twins are at an increased risk of the extreme form of nausea and vomiting in pregnancy and that's called hyperemesis gravidarum. There are some other risk factors, including a history of motion sickness, having a history of migraine headaches or if you have a family history of other women in your family having nausea and vomiting in pregnancy.
04:45 And then of course like most conditions, if you had it in a prior pregnancy, you're at an increased risk of having it in a future pregnancy. One study found that about two thirds of women who described their vomiting as severe in one pregnancy, will have similar symptoms and another pregnancy. And about half of women who said their symptoms were mild in pregnancy, found that they had symptoms in the future pregnancy and even a little bit worse. Now one thing I want to clear up right away, we do call it morning sickness and we do that because the nausea and vomiting tends to be worse in the morning. However, as I'm sure you know, nausea and vomiting in pregnancy can occur in any time of the day or night. Nausea and vomiting in pregnancy also starts pretty early in pregnancy. Usually it begins around five or six weeks.
05:41 So just when you're finding out that you're pregnant. Now it tends to peak at about nine weeks. And for most women it will have completely resolved by 16 weeks. So once you get out of the first trimester for the vast majority of women, the nausea and vomiting will go away. However, for about 15% of women that nausea and vomiting will continue into the third trimester and for about 5% of women, unfortunately, it may continue until delivery. Now, extreme nausea and vomiting, as I mentioned, that is called hyperemesis gravidarum and there's not like a specific accepted definition for hyperemesis, but most believe that it's really persistent vomiting and it's accompanied by weight loss or changes in your nutrition like your electrolytes, your potassium and those kinds of things. And now, when you have hyperemesis it can get pretty serious. You can be hospitalized and even require a feeding tube or nutrition through your veins in very severe cases.
06:50 Now, although nausea and vomiting in pregnancy is extremely annoying and it can be downright miserable, unless it's very extreme and malnutrition becomes a problem, like what I talked about with hyperemesis, then generally it is not harmful to you or your baby. In fact, there is pretty strong evidence that women who have nausea and vomiting in pregnancy actually have a lower miscarriage rate. Again, not something that we understand why, but that's what studies tend to show. Now let's talk about what you can do for options that do not require medication.
07:32 Now, a key treatment for nausea and vomiting in pregnancy is actually trying to prevent it before it even occurs. There've been at least two research studies that have shown that women who were taking a multivitamin at the time that they got pregnant, they are less likely to need any treatment for vomiting during pregnancy. So taking a prenatal vitamin for at least one month before you get pregnant may help prevent you from developing nausea and vomiting in the first place. Now, if you're already pregnant, which of course many of you probably already are, you can start first with dietary changes.
08:16 Now, to be honest, there is not a lot of scientific evidence about how dietary changes can affect nausea and vomiting in pregnancy. There's no good data to show that by changing your diet you're going to improve the condition, but I have to say that in my experience, dietary changes can really help. Now, one of the things that we recommend is instead of eating three large meals, you just want to kind of snack throughout the day, so eat small meals every couple hours. This will help prevent your stomach from feeling either completely empty or getting too full. Actually both extremes, when your stomach feels really empty and when you feel really full, both extremes can aggravate nausea, so by eating those small snacks during the day, you avoid either of those extremes and you should also avoid spicy food and also avoid really fatty foods.
09:16 So kind of keep the diet on the bland side and that kind of makes sense. One small study did show that eating protein, may be helpful at reducing nausea and vomiting in pregnancy, so you want to stick with protein rich foods like almonds or eggs or Greek yogurt. You can even do lean chicken or turkey. Those are protein rich sources that may help calm down that nausea and vomiting. Now of course there will be some trial and error as you figure out what foods work for you. It can be frustrating because foods that you previously ate without any problem may now bother you. That was the case with honey nut cheerios for me. Honey nut cheerios with ice cold milk used to be like a go to breakfast for me back in the day and I used to eat them all the time before pregnancy. But as soon as I got pregnant with my second one, they made me throw up every single time I ate them up. I'm kind of hard headed I guess. Then it took me a while to learn before I finally stopped eating them because I was like, is this really happening that all of a sudden I'm vomiting every time I eat cheerios? Anyway, you may also find that there are foods that you ate before that you can't anymore.
10:31 You may also see that certain smells or motions may like, throw you over the edge. I remember a friend telling me, I want to say it was the smell of like chicken, would just tip her over the edge and just cause her to be nauseated. So you may have similar sort of things. Just do your best to avoid those types of triggers.
10:52 Now another non-medication option is ginger. Ginger has definitely been shown to help improve nausea. Now it really doesn't help improve vomiting, but it will improve nausea. You can use ginger lollipops, ginger chews, you can get those over the counter or you can drink gender tea. Gingerale is also an option, but with the fizzy bubbles that can often aggravate nausea. So if you're going to use gingerale, then open it up and let it get a little flat before you drink it.
11:23 Now the final non-medication thing that may be worth trying is an acupuncture or acupressure wrist band. You wear it on your wrist at the P6 point. That's a specific pressure point, and that may help with nausea and vomiting of pregnancy. Results from research studies are kind of conflicting. Some say that it works, some say it doesn't. However, this is a very low risk thing to do and you can these wrist bands over the counter, so I definitely think it's reasonable to give them a try.
11:58 Now let's go on to some medication options. I have to say, it is fairly common that non-medication options are not enough and women need medications to help them get through that nausea and vomiting during pregnancy. Now the first line of medication treatment is vitamin B6. It's Pyridoxine. Now I know you're like, wait, that's a vitamin, that's considered a medication? Actually it is because we're giving it in a different kind of way and it's more than what you normally take in your diet. So you can take vitamin B6 alone or you can take it in combination with an anti histamine called doxylamine. Diclegis is a prescription medication that is a combination of vitamin B six and doxylamine. However, both are available over the counter. So you can find vitamin B6 or again pyridoxine over the counter.
12:50 And doxylamne is the active ingredient in Unisom. So if you find Unisom or generic for Unisom, you can combine it like that. And now you want to check with your doctor for directions on how to take it. But roughly you start with a bedtime dose. And the reason we do a bedtime dose is because the doxylamine makes you sleepy. You know it's in Unisom. So you take it at night and then if you need to add it during the day, we add small amounts during the day. This actually works pretty well for a lot of women. Now if symptoms persist then other medications are added, not replaced. I think this is a key thing that people get confused about is that something does at work and they're still having an issue, so they stopp taking it. Actually, we need to add things, not replace things. That is more effective in helping control nausea and vomiting.
13:42 Now the typical next medications are promethazine. This is the generic, the brand name is Phenergan and then Zofran and the generic. I can never say this, ondansetron. I feel like that's not right. But anyway, Zofran, that's the other thing that we commonly try now. Promethazine or Phenergan is safe for you and your baby. However it may cause you to be sleepy. So you may again need to start taking it at night or just kind of see how you react to it. This can be given either orally or rectally. Now for those of you who were just like, I know she did not just say for me to be taking medications rectally, let me tell you, when you are puking your guts out and nothing seems to help, you need to consider, you will consider coming around to rectal medications is not as bad as you think and it may work and help you feel better.
14:38 So be open to giving it a try. Now, Zofran doesn't cause sedation. And you can take it, rhere's an oral dissolvable tablets was really easy to take orally, but recent data has shown that there is a small increased risk of causing problems for your baby, including heart malformations and a cleft palate. So we have to be careful about Zofran. The increased risk, again is very small, so if you do need to take it, then I think it's reasonable for you to take it. But just take it for the smallest amount of time possible and don't make it the first option that you choose.
15:19 And now another option that's also commonly used for nausea and vomiting in pregnancy is Reglan and or metoclopramide. I don't know why I can't say these generic medications today but Reglan and I don't think I've ever been able to say it anyway.
15:35 It's another medication that's used and it helps to improve motility so it helps move things through. Now in rare cases Reglan and can cause these weird sort of movement disorders in women who take it. But it does not appear to increase the risk for your baby. This is another medication that should be taken for the shortest amount of time possible. Now in addition to medicines that actually treat the nausea and vomiting, it is also helpful sometimes to have acid reducing medications so you don't have that, that burning sort of sensation when you vomit. It just makes it a little less uncomfortable. So you can take Tums, those are over the counter Zantac or Pepcid, all things you can get over the counter. Those are brand names you can get. The generics are perfectly fine. Those may also be helpful in addition to the nausea and vomiting medication.
16:31 The other thing that I see women do sometimes that gets them into trouble is going back to that wanting to limit the amount of medication that they take. They only take it when the nausea and vomiting gets really bad and in that case it's hard to catch up. So, and then you're like falling behind. So you don't want to wait until it gets really, really bad. You want to start taking things when you have those first symptoms, so don't let it get you know, to the point where it's so extreme and you're trying to play that catch up game. If you need to, just take the medication on a regular basis.
17:11 Now if it's so bad, that nausea and vomiting, that you get dehydrated, then you may need IV fluids. You may need to just pop into the emergency room and you know, get IV fluids and IV medications. Get your electrolytes replaced like sodium, potassium or sometimes you need to be hospitalized. If it gets to the point of that severe hyperemesis, then hospitalization is necessary. Even a feeding tube or IV nutrition may be necessary. That is not common that that happens. And it comes with significant risk because you have to leave an IV catheter in place for a long time and then the risk of infection is up to 60% and that can be very serious. So we try and avoid that if we have to, that IV nutrition piece.
18:02 Okay. So to sum things up for non medication options, you can first of all try and prevent it by taking your prenatal vitamin, dietary changes, small frequent meals, avoid spicy and fatty food, just kind of trial and error of what you eat and can't eat. You can try ginger with ginger lollipops, chews or tea, and then those acupuncture or acupressure wrist bands.
18:27 And if you need to go to medications, then first you want to start with that vitamin B6 and doxylamine or Unisom. The brand name is Diclegis and then move on to Phenergan. Zofran if you need it maybe Reglan if you needed. And then those acid reducing medications like Tums, Zantac or Pepcid. Okay, so that's it for this week's episode. Have you had trouble with nausea and vomiting? Let us know in the podcast community Facebook group, it's called All About Pregnancy and Birth. I'll link to it in the show notes if you are not already a part of the group. Also be sure to subscribe to the podcast in iTunes or wherever you listen to podcasts and if you feel so inclined I'd really appreciate you leaving an honest review on iTunes. It helps other women find my show and I can give you a shout out on a future episode.
19:12 Now next week on the podcast, it is a birth story episode. Y'all know that those are some of my favorites. I love talking to women about their stories of giving birth and next week's episode is no exception. We'll be talking to Linnea Taylor about her experiences with 4 cesarean births. She is really able to see the joy in what were some very challenging circumstances. So be sure to come on back next week. And until then, I wish you a healthy and happy pregnancy and birth.
19:47 Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan, as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.