Mental health concerns occur as a direct result of Nausea and Vomiting of Pregnancy (NVP); they are not the cause of NVP .
NVP can significantly affect a woman’s mental health and overall quality of life. Women tolerate nausea differently. The effect of NVP on a woman depends on her support system, her employer, whether she takes care of other family members, her day-to-day responsibilities, as well as the severity of her symptoms and many other factors.
Fighting nausea weeks on end is physically draining, mentally challenging, and utterly stressful; further, relationships can become strained, family dynamic can change, and the entire family can feel overwhelmed. Even when there is whole and complete understanding among family and friends, frustration can occur when no one knows what to do or how to help.
NVP – especially Hyperemesis Gravidarum – can be traumatic and lead some women to experience posttraumatic stress symptoms, as well as signs as of anxiety and depression, sometimes years later. Some studies have reached this conclusion even with mild and moderate cases. A lack of recognition can compound these issues.
It has been reported that women with severe NVP can experience a higher level of anxiety than those with mild symptoms. Therefore, it is important for HCPs to identify these women very early in pregnancy to offer the resources they need to effectively manage symptoms to avoid future complications.
It is imperative that women find an HCP who understands the true reality of this condition, and treats not only its physical symptoms, but the emotional and mental health aspects as well.
Lack of Research
Part of the resistance among various HCPs (counselors, psychologists, obstetricians) regarding mental health treatment of NVP is that there are no clear guidelines or recommendations for the best type of therapy or prevention method.
There are no standardized treatment or management plans for reducing anxiety, stress, or depressive symptoms in women with NVP, and current studies assessing possible strategies fall short in evidence quality. This is despite the knowledge that a reduction in these symptoms is strongly correlated with a decrease in the physical and emotional symptoms of the condition.
Although there is a significant lack of data, current psychological interventions for NVP mainly fall into four categories: general counseling, behavioral therapy, mindfulness-based cognitive therapy, and progressive muscle relaxation.
For some women, counseling may be a strong, beneficial management strategy for all aspects of NVP.
Further, women who are experiencing moderate to severe symptoms and wish to avoid medication may find utility in various types of counseling that could help them better cope with their physical symptoms.
Some women may get to the point where they feel nothing is working; no matter what they eat, drink, how much they sleep, or how much they prepare, they cannot get any relief from their symptoms. Therefore, if women cannot seem to help themselves physically, they should consider trying to help their mental and emotional state. This is NOT because anxiety, depression, guilt, or frustration causes NVP, but a reduction in these emotional symptoms could help them better cope with their physical symptoms.
Emotional support is imperative – especially in women with severe NVP. The goal of any type of therapy or counseling can be as basic as simply providing an outlet for stress and frustration. This allows women to feel better understood, there is recognition to how they are feeling, and they really do have the strength to get through this condition.
However, researchers have noted that counseling may not be the best option for all women. Certain women may be stressed out further, with no interest in answering questions regarding their physical, mental, or emotional states while they are experiencing such symptoms; in that case, it is possible this exposure could worsen their symptoms overall.
Women who feel they could use an outlet and have symptoms moderate enough to sit through a session (or even online/on the phone), should talk to their HCP and ask for counseling recommendations.
Types of Therapy
Behavioral therapy may be a very effective tool to reduce symptoms in women with moderate NVP.
With behavioral therapy, women may be trained on techniques such as problem solving, self-monitoring, relaxation, communication skills, and skills for coping with nausea and vomiting.
Relaxation and progressive muscle relaxation is a form of behavioral therapy that is simple, practical, useful, and easily learned.
At least one study noted that compared muscle relaxation and medication, muscle relaxation reduced the number of medications (overall) needed to control nausea and vomiting.
Mindfulness-based cognitive therapy is a newly developed therapy that entails special and directed attention to a current situation, free of prejudices and judgment. It is aimed at educating women on adopting new attitudes and eliminating negative moods.
There are very few studies conducted on mindfulness-based cognitive therapy for NVP. However, one study from 2015 evaluated the technique for NVP and reported a reduction in the frequency of symptoms among women who were 6 to 12 weeks into their pregnancy.
Women also should not discount the beneficial effect that talking to family, friends, or another woman who experienced NVP can have on anxiety and frustration. Although not an "official" form of therapy, support from friends can have a long lasting impact on a woman's ability to cope with her symptoms when she knows she has people in her corner ready to help her.
Women who feel they could use an outlet and have symptoms moderate enough to sit through a session (or even online/on the phone), should talk to their HCP and ask for counseling recommendations. Women also need to call their HCP immediately if they are becoming increasingly anxious, overwhelmed, helpless, and/or depressed.
Counseling does not indicate failure. It is not a management technique used because a woman has hit rock bottom – it is meant to be used to avoid rock bottom (and even well before that).
Counseling, and its related therapies, can make women feel stronger, more confident, and help them realize they can handle their symptoms.
Women should also find a friend or family member they can talk to comfortably and without judgment. Complaining about NVP does not mean the woman is ungrateful to be pregnant; complaining is an outlet. It helps individuals vent, release frustration, and manage their emotions in a positive way.
Women should also visit our Experiences pages and consider sharing their own experience regarding their mental health while dealing with NVP. These pages are strictly reinforced as a place for support and unique points of view for all of pregnancy.
NVP is hard; it is frustrating, it is overwhelming, and for some women, can be very surprising. Some women may go into pregnancy knowing they can handle moderate to severe symptoms until they happen, and then it is much harder than they anticipated. This is normal. Therefore, some women may need more help than either partner expected.
Partners should provide any and all support necessary for a woman's physical symptoms. This is important to avoid complications that could result in an Emergency Department visit or hospitalization.
However, women also need mental and emotional support. Women need to understand that as they manage their nausea and vomiting (and many other symptoms), they have a partner who recognizes their suffering, realizes she is having a difficult time, offers her positive emotional support, and supports the change in family dynamic so she can solely focus on coping with her symptoms.
Partners can show their support simply by asking:
How are you doing?
Do you need anything?
Do you want to talk?
Do you want me with you or do you want to be left alone?
Should we call the HCP?
Is there anything you are thinking about that I can handle for you?
How are you mentally coping?
Are you getting enough sleep?
Do you feel depressed? Frustrated? Anxious? Guilty?
What can I do to help you mentally/emotionally feel better?
How Aware Are You of Your Own Mental Health? (American College of Obstetricians and Gynecologists)
What Is Cognitive Behavioral Therapy? (American Psychological Association)
Screening for Perinatal Depression: Committee Opinion 757 (American College of Obstetricians and Gynecologists)
Nausea and Vomiting of Pregnancy: Committee Opinion 189; January 2018 (American College of Obstetricians and Gynecologists)
Morning Sickness: Nausea and Vomiting of Pregnancy (American College of Obstetricians and Gynecologists)
Pregnancy sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum) (Royal College of Obstetricians and Gynecologists)