How can I deal with morning sickness?

Dear Doctor,
I’m pregnant with my second child and get really bad morning sickness. Are there any home remedies I could try to feel better?  Natasha


Dear Natasha,
Pregnancy is a joyous occasion for many women all over the world. However, this pleasure is affected by morning sickness, that is, the nausea and vomiting associated with pregnancy.  Many women feel sick during pregnancy. The nausea and vomiting usually occur during the first trimester and subside as pregnancy advances. But in some women, it may occur throughout pregnancy or may be even more during second and or third trimester. Though known commonly as “morning sickness”, it is not restricted to morning. A woman may get sick and vomit even in the evenings or only in the evening. There is much individual variability from one woman to another in the pattern of morning sickness of pregnancy.
Exact cause of morning sickness is not known. It is presumed to be due to high levels of HCG (human chorionic gonadotropin), during pregnancy. A woman may experience morning sickness during one pregnancy and experience none of it in second pregnancy. One may feel sick during pregnancy due to constipation and or dyspepsia, as well.
Intake of food of a pregnant woman is affected due to morning sickness. This affects the nutritional status of the mother-to-be and also the foetus in the uterus. Severe vomiting can lead to dehydration and electrolyte imbalance, which if untreated can be fatal. 
If morning sickness is mild and subsides by itself, no treatment is required for it. However, if severe or persistent, it has to be controlled.  If the nausea and vomiting is associated with heartburn, antacid drugs that neutralise the acid produced from the stomach are useful. Drugs that reduce acid production, or those that stop vomiting by acting on the vomiting centre of the brain, are also useful.
Since nausea occurs more on an empty stomach, it is advisable to take small frequent meals to overcome these problems. One would gradually know from experience as to what foods/drinks would cause nausea and vomiting. These can be avoided. Use of whole grains, fresh green vegetables and fruits provides fibre, which aids in digestion and prevents constipation. Regular light exercises done within one’s physical ability are also useful in this regard.
There are several home remedies for prevention and treatment of morning sickness. Use of ginger helps in overcoming the nausea and prevents vomiting. Sour foods or drinks, like sucking on a lemon or sipping lemonade, makes one feel good and helps in reducing the sickness. Changing the eating pattern helps some women.  Eating as per the food cravings helps some feel better. Use of soothing smells is said to work for some pregnant women in getting relief from morning sickness. 
Due to the wide variability in the pattern of sickness during pregnancy, there cannot be a single tailor-made approach that suits all pregnant women. Hence, a pregnant woman may try changing the diet. If that does not work, over-the-counter remedies can help.
Dr. Rachna   Pande is a specialist in internal medicine. 
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