How to cope with severe nausea and vomiting during pregnancy

When you first fall pregnant, feeling a little queasy in the morning can be a welcome sign that everything is progressing well. If it’s your first pregnancy it can even feel like an initiation into a special club - ‘yay, I’m really pregnant!’ you might say. But if the sickness hangs around longer than you expect, or it leaves you unable to live a normal life there’s not much to celebrate. So, how do you cope with severe nausea and vomiting during pregnancy?

We have a few tried and tested tips for coping with day-to-day sickness: 

  • Read as much about HG as you can find - visit our page of Useful Links for good, knowledgeable sources of information. Become an expert in what’s happening to your body and then educate your partner, children, parents, friends, co-workers and other caregivers. Yes, even your doctors may need you to provide them with further reading.

  • Keeping a diary can help you keep track of when are the best times for you to eat, how much you have managed to eat, and what fluids you have been able to retain. In the event you need to present to ED or check in with your GP, this will be an easy way to enlighten them about your condition

  • Rest is important to any pregnant woman, regardless of how well she is feeling. Many women with severe NVP and HG find that regular rests are key to help manage their symptoms. This kind of nausea is similar to motion sickness, where keeping still can offer a slight reprieve from the sickness

  • All pregnant women are encouraged to take a multivitamin that contains 400 micrograms of folic acid daily. However, some brands may exacerbate your HG symptoms - you may even find it difficult to swallow the tablet. This is something important to raise with your obstetrician, midwife or GP so that alternatives can be investigated

  • A lot of pregnant women experience a heightened sense of smell and this can be a particularly intense trigger for women with HG. The smell of cooking, especially fatty foods, coffee, tea, cigarette smoke, or perfume are the most common offenders. Try to avoid anything that heightens your nausea, or induces vomiting. Keep a list of your trigger smells handy and share it with anyone you spend time with

But how can you tell when it all goes a bit far - how do you know when it’s time to bring in the big guns and get some help for your symptoms? Let us break it down real simple for you: 

  1. Are your symptoms impacting your ability to live your life as normal?

  2. Are you unable to drink (or keep down) at least 500ml of water in 24 hours?

  3. Do you spend more time nauseous or vomiting than you do feeling tip top? 

If you answered yes to any or all of these questions then it’s time to go and talk to your doctor. You probably need a plan of action when it comes to managing your symptoms and controlling them to the point where you can begin to eat and drink a bit more normally. You can do this in one of two ways: 

1. Head to your GP or obstetrician

If you don’t feel like you need immediate attention (we’ll touch on how to decide this in the next section) then making an appointment with your GP or obstetrician ASAP is the way to go. You’ll want to make sure you have a few pieces of information when you go so that your doctor has all the information to treat you properly: 

  • How much you have been able to eat or drink (and keep down) each day

  • How often you vomit, the times you feel nauseous and how frequently your urinating

  • A list of the symptoms you’re having ie. nausea, vomiting, excess saliva, heartburn/acid reflux, food aversions, headaches, constipation

Your doctor is likely to recommend trying a regime of natural remedies in order to alleviate your symptoms. If you feel like this is a good option for you, that’s great. However, current research shows that ginger and vitamin b6 (the common alternative therapies recommended for pregnancy sickness) have no therapeutic effect - so you should feel confident in saying you’d like to progress straight to prescription medication. 

The first tier of treatment according to the Royal College of Obstetricians and Gynaecologists Green Top Guidelines for the Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum is as follows: 

  1. Doxylamine 12.5-25 mg orally at night OR Prochlorperazine 25mg suppository at night (first dose 20-30 minutes before getting out of bed, second dose 1-2pm)

  2. Metoclopramide 10mg orally twice daily OR Ondansetron 4mg orally twice daily (first dose 20-30 minutes before getting out of bed, second dose 1-2pm)

  3. Ranitidine 150mg orally twice daily

It is widely agreed that the best and most effective way to manage symptoms of HG and NVP is to layer multiple medications together each day. There are a number of factors that cause the symptoms of each of these conditions and each one needs to be targeted in order to achieve any kind of relief. To break it down even further: 

  • Doxylamine is an antihistamine that works to block naturally occurring substances in the body that trigger the nausea response

  • Metoclopramide is a dopamine antagonist that supports the stomachs natural emptying process to keep everything moving as it should

  • Ondansetron is an antiemetic that works to control your bodies natural vomiting reflex

  • Antacids like Ranitidine control bile production to keep acid reflux from contributing to symptoms

The earlier this regime of medications is started the sooner you’ll feel better. And, the sooner you’ll know whether you need to add more medications. 

2. Go to your hospital’s Emergency Department

If you feel like you need more immediate help than waiting for an appointment with your GP or OB then it is best to go to the ED. This can be a really daunting decision to make - we totally get that. But you have every right to seek help from the ED team at your hospital and they are there to help you. 

If you’re wondering about how you know whether it’s okay to go to ED here’s a helpful checklist: 

  • Have you been thinking you might need to go to the hospital? 

That’s literally it. Healthy people who have no need to be in the hospital do not spend their time wondering if they need to go to the hospital. If it has occurred to you that going to ED might be a possibility then you’re definitely sick enough to be there. Make sure you have the same details together as we suggested for visiting your GP above. 

When in hospital we recommend a slightly different regime of treatment based on the same recommendations from the RCOG: 

1. Fluid replacement with normal saline 1-2L over 1-4 hours

2. Antiemetics (try sequentially)

  • Metoclopramide 10mg IV or orally (if tolerating orally)

  • Prochlorperazine 10mg IM (intramuscular injection) or 25mg orally (if tolerating orally)

  • Ondansetron 4mg IV or orally (if tolerating orally)

3. IV potassium, magnesium, thiamine

4. Ranitidine 50mg IV or 150mg orally (if tolerating orally) 

Then, continuing with the same regime outlined above when you are discharged. If possible, arrange with your GP or OB to visit the hospital 2 or 3 times each week for the fluid top-ups with IV potassium, magnesium, thiamine plus IV antiemetics.

These recommendations are made by The Royal College of Obstetricians and Gynaecologists and enacted by all the major hospitals in Australia. However, many doctors, nurses and midwives don’t have direct experience with treating HG and NVP so these protocols are not always automatically applied. If you have any issue with receiving the treatment we recommend please get in touch so that we can work with you to get you the care you deserve.

Caitlin Kay-SmithComment