Morning Sickness: What Helps, When It Ends and When It's Hyperemesis

How can you ease morning sickness?

You can ease morning sickness with small, frequent, bland meals, plenty of fluids and rest, and ask about vitamin B6 or other medicine if that is not enough. The NHS says no single treatment works for everyone. If your sickness is not too bad, it says, your GP or midwife will first suggest lifestyle changes, and may recommend medicine if those do not work or your symptoms are more severe.

ACOG suggests dry toast or crackers before you get out of bed, five or six mini meals a day so your stomach is never empty, and bland, low-fat foods such as bananas, rice, applesauce, toast and tea. The NHS adds cold foods instead of hot ones if the smell of hot meals makes you feel sick.

ACOG says dehydration can make nausea worse, and the NHS suggests sipping fluids little and often, which may help prevent vomiting. For smells, ACOG suggests using a fan when cooking and having someone else empty the trash.

ACOG also recommends taking a prenatal vitamin, because studies show that taking one before and during pregnancy reduces the risk of severe nausea and vomiting. If the vitamin itself upsets your stomach, MedlinePlus suggests taking it at night with a little food or trying a different brand. Prenatal vitamins covers what they should contain.

When does morning sickness start and end?

Morning sickness usually starts before 9 weeks of pregnancy and eases by 14 to 20 weeks, though for some it lasts longer. ACOG says it usually starts before 9 weeks and goes away by 14 weeks for most women, though it lasts several weeks or months for some and the whole pregnancy for a few. The NHS says it usually clears up by weeks 16 to 20.

Despite the name, ACOG and the NHS both say it can happen at any time of day, and the NHS says some people feel sick all day long. Around 8 out of every 10 pregnant women feel sick, are sick, or both, according to the NHS.

ACOG says nausea and vomiting that start for the first time after 9 weeks can point to another condition, such as an ulcer, a food-related illness, or thyroid or gallbladder disease.

Are vitamin B6 and doxylamine safe for morning sickness?

ACOG says vitamin B6 and doxylamine, taken alone or together, have been found safe to take during pregnancy, with no harmful effects on the fetus. ACOG describes vitamin B6 as a safe over-the-counter treatment that may be tried first, with doxylamine, a medicine found in over-the-counter sleep aids, added if B6 alone does not relieve symptoms. A prescription drug that combines the two is also available.

Before you start, ACOG says your ob-gyn will want to rule out other medical causes, and MedlinePlus says not to take any medicine for morning sickness without talking with your provider first. Ask your doctor, midwife or pharmacist what dose to take.

If B6 and doxylamine do not help, ACOG says antiemetic (anti-vomiting) drugs may be prescribed. Many have been shown to be safe in pregnancy, ACOG says, but others have limited or conflicting safety information: ondansetron is highly effective, but studies are not clear about its safety for the fetus, so the decision rests on whether the benefits outweigh the risks. In the UK, the NHS says that if sickness is severe and lifestyle changes have not helped, a GP may recommend a short course of an anti-sickness medicine that is safe in pregnancy, often a type of antihistamine.

Does ginger help with morning sickness?

Ginger may help with morning sickness. ACOG says ginger can help settle your stomach and suggests ginger capsules, ginger candies, ginger ale made with real ginger, or tea made from fresh-grated ginger. The NHS says there is some evidence that ginger may help reduce nausea and vomiting, and advises checking with your pharmacist before taking ginger supplements in pregnancy.

What is hyperemesis gravidarum?

Hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting in pregnancy, and it needs treatment. ACOG says it occurs in up to 3 in 100 pregnancies and may be diagnosed when you have lost 5% of your prepregnancy weight and have other problems from dehydration. The NHS says it affects around 1 to 3 in every 100 pregnant women.

The NHS says HG may not get better by 16 to 20 weeks, and may not clear completely until the baby is born, although some symptoms may improve at around 20 weeks. ACOG's risk factors include carrying more than one baby, nausea and vomiting in a previous pregnancy, a mother or sister who had severe symptoms, motion sickness or migraines, and carrying a female fetus.

ACOG says experts recommend early treatment so that HG does not become severe. The NHS says treatment can include anti-sickness medicines and steroids, which can be used in pregnancy, and a hospital stay for fluids through a drip if the vomiting cannot be controlled. If you have had HG before, the NHS suggests asking your doctor about starting medicine early next time.

The NHS says HG is not the result of anything you have or have not done. MedlinePlus says it can cause anxiety and depression in some women that lingers after the pregnancy, and the NHS suggests telling your midwife or doctor how HG is affecting your life and how you feel.

Can morning sickness harm the baby?

Morning sickness usually does not harm the baby. ACOG says nausea and vomiting of pregnancy usually does not harm your health or your fetus's health and does not mean the fetus is sick, and the NHS says morning sickness does not put your baby at any increased risk. ACOG also says morning sickness does not cause miscarriage.

The risk comes with weight loss: ACOG says that if you cannot keep down food or fluids and begin to lose weight, it can sometimes affect the baby's weight at birth. The NHS says HG is unlikely to harm your baby if it is treated effectively.

When should you call your doctor or midwife about vomiting?

Call your doctor or midwife when you cannot keep fluids down, show signs of dehydration, or are losing weight.

Call your doctor or midwife if you are vomiting and you have:

• signs of dehydration: a small amount of dark urine, no pee in more than 8 hours, or feeling very weak, dizzy or faint when you stand up (ACOG, NHS)
• a racing or pounding heartbeat (ACOG)
• been unable to keep fluids down for more than 12 hours (MedlinePlus); the NHS gives 24 hours for food or fluids
• vomiting that will not stop, or sickness that has not improved with home remedies (MedlinePlus)
• blood in your vomit, or vomit that looks like coffee grounds (MedlinePlus)
• lost weight; MedlinePlus says to call if you lose more than 2 pounds (1 kg) in a week
• belly pain, a fever, a headache or swelling in the front of your neck, which ACOG says can point to another cause
• nausea and vomiting that affect your daily life or worry you (ACOG)

MedlinePlus lists managing morning sickness among the topics to raise at your first prenatal appointment.