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MORNING SICKNESS

September 9th, 2009

Almost all pregnant women come across certain common symptoms of pregnancy due to the physiological changes taking place in the body. These symptoms are usually mild in intensity and do not affect the day-to-day activities of the carrying woman. During the first trimester, the most common subjective symptom is morning sickness. Morning sickness refers to nausea and vomiting with mild discomfort that many women get during their pregnancy. Statistics show that on an average 60 to 70% of pregnant women suffer from it. It is considered as a physiological phenomenon. It occurs at any time of the day, but more common in the early morning on waking. Rarely, some women may have nausea and vomiting throughout the their entire pregnancy. In certain cases, persistent and severe vomiting may affect the baby and the mother. It is said that the degree of morning sickness during one pregnancy does not predict the possibility of it in future pregnancies. However, in the first pregnancy the symptoms may be troublesome for many women due to apprehension. In majority of cases, certain factures like emotional stress, traveling, particular food items and odors can initiate or aggravate the vomiting.

Synonyms:

Various terms are used to denote morning sickness. Many consider the term ‘morning sickness’ as a misnomer since it occurs not only in the morning but can occur anytime. The following are certain synonyms.

·    Simple vomiting.

·    Emesis gravidarum.

·    Nausea and vomiting of pregnancy (NVP)

·    Pregnancy sickness

Facts about morning sickness:

1.    Morning sickness is a physiological phenomenon.

2.    Usually, it occurs during first trimester of pregnancy.

3.    It indicates the normal development of placenta and fetal membranes.

4.    The vomiting can occur at any time.

5.    Normally, morning sickness won’t cause any harm to the fetes or mother.

6.    The severity of morning sickness can be reduced by many precautionary measures.
7.    Severe form of morning sickness is called Hyperemesis gravidarum, which may be harmful to the mother or fetus, if not treated properly.

8.    By proper treatment, the complications can be prevented and the woman can continue a normal pregnancy.

Symptoms of morning sickness:

Before we diagnose morning sickness, the pregnancy has to be confirmed by several tests such as detection of HCG in the urine, sonography and clinical examination. If a pregnant lady complains of nausea and vomiting, it is usually diagnosed as morning sickness. Morning sickness, as the term indicates doesn’t occur only in the morning. It can occur at any time but more common in the early morning, especially on waking. The vomitus is clear or bile stained and causes a bitter taste, which itself can induce further vomiting. Usually, morning sickness is more common during first pregnancy than the subsequent pregnancies.

Along with nausea and vomiting complaints like fatigue, heartburn, eructation and aversion to certain food article may develop. Most of the women become sensitive to odors, especially to the odor of cooking. They may develop aversion to meat, fish or any other type of food items. They also develop some cravings, especially for sour unripe fruits. Some women may develop aversion to certain food items for which they had cravings earlier. The reverse thing is also noticed in some cases. Common symptoms such as metallic taste in mouth, loss of appetite, anorexia, constipation, tenderness of abdomen, tenderness of breasts, palpitations, breathlessness, giddiness, indigestion, increased sense of smell, sensitive gag reflex, increased salivation, difficult sleep etc. are often associated.

However, these physiological symptoms do not interfere with the day-to-day activities and cause no harm to the mother and the fetus. Once the frequency and severity of vomiting becomes worse then the term morning sickness or emesis gravidarum has to be replaced by another term hyperemesis gravidarum or pernicious vomiting.

What causes morning sickness?

The exact cause of morning sickness is not clearly understood yet. However, it is    clear that it is due to some physiological changes in the body as a result of pregnancy. Some causes are discussed here.

1.    It is due to some changes in the hormonal levels of the body associated with pregnancy. Sudden rise in the levels of hormones like human chorionic gonadotrophin (HCG) secreted by the placenta and other hormones like esostrogen and progesterone secreted by the ovaries are responsible. Several studies show that severity of vomiting coincides with the increased levels of HCG in the blood.

2.    The increased level of progesterone relaxes the stomach and increases the contraction of the gastro intestinal tract. Both conditions promote vomiting reflex.

3.    Some immunological reactions to certain placental secretions may be responsible.

4.    During pregnancy all body functions will be accelerated to certain limit. The digestive system also becomes more active and secretes more acids and digestive enzymes that can cause irritation of the stomach.

5.    A pregnant lady becomes more sensitive to the external stimuli. The gastrointestinal tract becomes hyperactive. Certain odors, scenes and even thoughts of certain food articles can initiate vomiting reflex.

6.    Vitamin B 6 deficiency is said to have close relation with many cases of morning sickness. In many cases of pregnancy vomiting vitamin B 6 supplement has reduced the severity of vomiting. But there are some cases of severe vomiting with normal vitamin B 6 levels in the body.

7.    Stress and fear of pregnancy can make the condition worse. Fatigue during pregnancy also plays a role.

8.    When the stomach is kept empty the HCL and the digestive juices initiate the vomiting reflex.

9.    Sudden distension of stomach can initiate vomiting reflex. Hence fast eating and drinking can make the condition worse.

10.    Women who are already having motion sickness or travel sickness get affected seriously during their pregnancy.

11.    It is more in twin pregnancies and high multiples due to increased hormone levels.

12.    Low sugar level is said to have a link with morning sickness.

13.    Many women have given history of severe vomiting in previous pregnancy. However the severity decreases in consecutive pregnancies.

14.    Contraceptive pill users and those who had undergone hormone replacement therapy (HRT)usually suffer from severe morning sickness.

15.    Iron tablets and some tonics having typical flavor can stimulate vomiting.

16.    Odor and type of food can also initiate vomiting reflex. Enhanced sense of smell aggravates the condition.

17.    Psychological factors and lack of moral support worsens the condition.

Ill effects of morning sickness:

Morning sickness as such will not cause any ill effects. But, when it leads to severe degree, it can cause several complications like low birth weight, pre-term labor, and small for gestational baby etc. Some women who had miscarriage say that they had no morning sickness during pregnancy that may indicate the possibility of improper development of placenta or fetal membranes. Therefore, vomiting is an indication of normal pregnancy. But, absence of vomiting may be normal and does not always indicate an abnormality in fetal development.

Hyperemesis gravidarum or pernicious vomiting:

It is the severe form of morning sickness resulting in consistent nausea and vomiting that prevents the women from eating and drinking and also affects their day-to-day activities. This condition may be dangerous to health of mother and fetus, if not managed properly. It can cause severe dehydration and electrolyte imbalances leading to collapse.

Predisposing causes of hyperemesis gravidarum:
·    Increased hormones like progesterone and chorionic gonadotrophin.
·    Allergy to products secreted by ovum.
·    Psychogenic causes.
·    Acid reflux disease and over active thyroid gland can predispose.
·    It is more in twin pregnancies, young maternal age and in obese.
·    History of hyperemesis gravidarum in the previous pregnancy.

Signs and symptoms:
1.    Initially, the symptoms are same as that of morning sickness, but become more severe and persistent with nausea and uncontrollable vomiting.
2.    Decreased urine output. Urine becomes dark.
3.    Increased thirst.
4.    Epigastric pain.
5.    Headache.
6.    Extreme fatigue.
7.    Secondary anxiety.
8.    Bloody vomiting.
9.    Mental restlessness.
10.    Fainting.
11.    Sleeplessness.
12.    Convulsions.
13.    Coma.
14.    Psychosis.

Signs:
1.    Anxious look.
2.    Sunken eyes
3.    Low blood pressure.
4.    Temperature may be raised.
5.    Loss of skin elasticity; pinch remains and snaps back very slowly. Skin becomes pale, dry and waxy.
6.    Ketone smell from the mouth.
7.    Dry and furred tongue with brown coating.
8.    Decreased salivation.
9.    Heart rate increased.
10.    Pulse weak and imperceptible.

Investigations: Investigations like complete blood count, blood sugar level, routine urine examination, serum electrolyte levels, ECG, opthalmoscopy etc are needed.

Complications of severe vomiting:

Severe and continuous vomiting of pregnancy can affect the fetus resulting in following complications.
·    Low birth weight.
·    Pre term birth.
·    Small for gestational age.

Vomiting can affect the mother resulting in following complications.
·    Chronic dehydration.
·    Weight loss.
·    Mal nutrition.
·    Hypokalaemia (Low potassium in the blood)
·    Hyponatraemia. (Low sodium in the blood)
·    Hypovolumic shock.
·    Convulsions.
·    Esophageal bleeding.
·    Gastric ulcers.
·    Aspiration of vomited matter in to the lung results in pneumonia.

Tips to manage morning sickness:

1. Before getting out of bed, take any one of the following eatables you like.
Biscuits, soda crackers, saltine crackers, wheat crackers, salty potato chips, gelatin desserts, frozen desserts, light snacks, dry toast, hard candy, ginger candy etc. Munching these items fifteen minutes before getting out of bed gives good results.

2. Get out of bed slowly so that the stomach won’t get disturbed.

3. Eat little by little without any hurry.

4. Take small meals throughout the day so that stomach is not kept empty. It is generally advised to have at least five to six small meals, rather than two or three large ones.

5. Eat well-cooked food so that digestion will be easier.

6. Fulfilling your food cravings can make you happy and improve the digestion.

7. Chew the food properly so that saliva gets mixed properly and the stomach gets less workload.

8. Do not lie down immediately after eating. After meals, sit in upright position, so that you can reduce the pressure on the lower esophageal sphincter, thereby reduce the vomiting tendency.

9. A bland food item like white rice, rice cakes, gruel, plan backed potato etc. cause less irritation to the stomach and the digestion is also much easier.

10. Low fat food is recommended during pregnancy. Almont butter is better than other fats.

11. Take fruits and vegetables that are rich in essential nutrients.

12. Plenty of fluids should be taken. The water intake has to be increased in order to maintain the water balance of the body. On an average a pregnant woman with morning sickness should take at least 2 to 5 liters in 24 hours.

13. Tender coconut water is a natural drink rich in electrolytes. Since it is free from harmful substances, its demand is increasing day by day.

14. Cold liquids and cold food items are useful because of less irritation to the stomach.

15. Drinks made of lemon such as lemonades and lemon soda in small sips can be useful.

16. Any fruit juice of your choice is beneficial.

17. If you feel intolerable to water you can try crushed ice or frozen ice pops.

18. Tasting small pieces of ginger can make the stomach calm at least for some time.

19. Diets containing high proteins and complex carbohydrates are known to fight nausea.

20. Fibrous food helps for a regular bowel movement and prevents constipation.

21. There are number of products that are specially made for morning sickness. Many use morning sickness pretzels, lozenges and lollipops.

22. Vegetable salts are available under different brands that can be taken with water. It is known to reduce hyperacidity and eructations.

23. Glucose(Dextrose) is an instant source of energy. Glucose powder dissolved in water can be taken little by little to maintain glucose and water levels in the body.

24. ORS solution is very useful in case of dehydration. Apart from glucose it contains electrolytes essential for the body functions. As a cheap alternative, home made ORS can also be used by mixing sugar, salt and a few drops of lemon juice.

27. If you are not comfortable with the vitamins and iron tablets you are taking, discuss it with your doctor. You may get some relief from vomiting by changing the brand of vitamins, iron and other food supplements.

28. When you feel nauseated you may get some relief by washing your face with icy cold water.

29. If you feel cooking intolerable you may take others help. If at all you cook keep the kitchen ventilated to air out cooking odors using exhaust fans.

30. Maintain personal hygiene and keep the surroundings neat and clean.

31. Keep your room ventilated so that you get fresh air.

32. If no relief from home remedies, do not hesitate to consult your doctor.

Homoeopathic Remedies:

Homoeopathy is a safe and effective mode of therapy for most of the pregnancy related ailments. Compared to other modes of treatments, it is much cheaper and causes no side effects.

The Synthesis Repertory has mentioned 74 drugs for vomiting during pregnancy, ranging from Acetic acid to Zincum met. Homoeopathy is against the selection of a specific drug for a specific condition or disease. The selection of the similimum depends on the totality, hence drugs other than these 74 drugs can be given, if indicated by signs and symptoms. After taking the case, the most suitable drug has to be selected on the basis of individual features. This is the unique feature of homoeopathy, the highest watermark of holistic medicine.

However, a few medicines are worth mentioning.

Ant.crud: Eructation with taste of ingesta; belching with bloating; thick white coating on tongue; ailments from sour items, overeating.

Ars alb: Intolerance to sight or smell of food; great thirst, drinks in sips; immediate vomiting after eating/drinking; burning pains>warmth; great weakness and fear; ill effects of ice water and watery fruits.

Cocculus.I: Vomiting after riding, looking at moving objects; aversion to food and drinks; vomiting<motion; metallic taste; muscular weakness.

Colchicum: Nausea & vomiting from smell of cooking food, especially fish; increased salivation; vomiting<by motion; coldness in stomach; craves many items but aversion when smelling.

Ferrum met: Vomit immediately after eating, but can eat again; intolerance of eggs; flatulent dyspepsia.

Ipecac: Nausea and vomiting with clean tongue; nausea continues even after vomiting; salivation; cutting pain in navel.

Kali carb: Flatulent dyspepsia; sour eructation; nausea>lying down; feeling asif stomach full of water; backache, stitching pains & sweating.

Kreosotum: Putrid odor; bitter taste; vomiting of sweetish water; vomits several hours after eating; fetid stools; feeling of ice water in stomach.

Lac acid: Copious salivation and waterbrash; morning sickness in pale anaemic woman; nausea> by eating; dry parched tongue.

Lycopodium: Craves sweets; dyspepsia after farinaceous items, cabbage; eating ever so little creates fullness; intolerance to oyster; flatulence; sour eructations; thirst for warm drinks.

Nat phos: Dyspepsia with acidity; sour eructations and vomiting; creamy coating at back of roof of mouth &tongue; flatulence.

Nux.mos: Drowsiness; fainting; dry mucus membrane & no thirst; cotton like saliva; flatulent dyspepsia; ailments from overeating.

Nux.vom: Ailments from seasoned food and stimulants; 1st half of tongue clean and posterior half coated; nausea after eating; weight in stomach<eating; wants to vomit but cant; stomach sensitive to pressure.

Petroleum: Gastralgia>constant eating; aversion to fat, meat; heartburn with sour eructations; emptiness in stomach; vomiting from riding, smell of petrol; day time diarrhea.

Phosphorus: Hunger soon after eating; thirst for cold water; water is vomited when it gets warm in stomach; cant drink warm drinks; craves ice, cold drinks; ailments from salt.

Psorinum: Very hungry; pregnancy vomiting; fetid stools; eructations like bad eggs.

Pulsatilla: Fear of pregnancy; dry mouth without thirst; coated tongue; altered taste; craves tonics, ice cream; aversion to fat, warm food/drinks; bitter taste; eructations; stony feeling in stomach; foul taste in the morning.

Sepia: Morning nausea before eating; all gone feeling not> by eating; nausea at smell or sight of food; everything tastes too salty; nausea<lying on side; <boiled milk; craves acids, pickles, bitter items.

Tabacum: Incessant nausea< by smell of tobacco/smoke; vomit on least motion; pregnancy vomiting with much spitting; sinking at pit of stomach; fainting; salivation; nausea and vomiting > by uncovering abdomen.

Veratrum album: Voracious appetite; thirst for cold water; vomit immediately after drinking; vomiting< drinking, least motion; craves ice, juice, fruits, salt; great prostration; cutting pain in abdomen; cold sweat on forhead.

Some useful Homoeopathic mother tinctures in pregnancy vomiting:

Symphorecarpus Q: Persistant vomiting of pregnancy; gastric disturbances; nausea; waterbrash; nausea< by motion; >by lying on back; aversion to food.

Zingeber Q: Debility in digestive tract; ailments from melons & impure water; acidity; great thirst; heviness in stomach.

Cajuputum Q: Swallowing difficult; flatulence; flatulent colic.

Robinia Q: Nausea; sour eructations; profuse sour vomiting; flatulent colic.

rafi Homoeopathy

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