Vomiting
While vomiting can occur with NVP – not every woman will vomit. Some women can remain nauseous the entire first trimester (or longer), and never vomit. However, some women may vomit regularly, or even every day during early pregnancy.
Vomiting – even a few times a week – can potentially cause serious complications, and women should not hesitate to ask for help. The earlier women can prevent complications, the easier they can cope with their symptoms.
Women should also remember that NVP is not a "stomach bug", therefore they have a bigger toolbox in dealing with their symptoms and should not limit themselves to normal strategies individuals use to recover from vomiting when not pregnant.
Further, while some women can tolerate vomiting well, others have a more difficult time recovering from episodes. Women need to remember they need to take care of themselves, make their lives as comfortable as possible, and contact their health care provider if they are unable to keep fluids down or experience significant weight loss.
Background
It is estimated that among women who vomit during early pregnancy, about 50% experience vomiting by itself – without nausea – which is usually sudden. Fortunately, nausea and vomiting are partially separate physiological processes and vomiting tends to be much easier to treat than nausea.
Although part of the vomiting process is involuntary, there are some things women can do before, during, and after episodes that can help them better cope. This page – along with the entire management section, can help women learn to:
Be prepared for possible vomiting
Stay hydrated
Avoid complications
Better mentally cope
Feel more comfortable
Recover faster from episodes
Potentially prevent vomiting episodes/cycles through distraction and the avoidance of triggers
Get their HCP involved early in the process
Remain positive as much as possible
Vomiting vs. "Stomach Bug"
Vomiting – in general – is an involuntary process that normally cannot be avoided or stopped if it needs to occur (bacteria, virus, or other toxin; known as gastroenteritis).
The true, physiological process of how pregnancy causes or leads to vomiting is not yet known. However, the cause of NVP in general is currently assessed to be multifactorial, and different women will experience different combinations of these factors, the origins of which are unique from other GI illnesses.
Despite the obvious acknowledgement that pregnancy is not a virus or bacteria that leads to GI infections (“stomach bugs”), the same techniques used for these infections are often recommended for NVP. Although the symptoms are the same, the causes are different – which is why most techniques that work for GI illnesses are often very ineffective for NVP.
Some of these strategies (plain diet, crackers) are logical when the body is experience vomiting. Eating bland foods and sipping water can help the stomach and related muscles rest and recover, but this is mostly meant for the short-term as most GI illnesses run their course in a matter of days.
The mechanisms that control nausea and vomiting in NVP are complex, and largely involve the brain; but the GI tract, endocrine system (hormones), and the vestibular system (motion, balance) also play a role. Therefore, women should not completely limit themselves to management techniques that are used to manage stomach illnesses.
Depending on the vomiting trigger, it is possible that eating has nothing to do with either relieving or worsening symptoms (but could), and strictly limiting a diet to carbohydrates may do more harm than good, especially in the long-term (several weeks).
A simple carbohydrate diet, although easy to digest, lacks many valuable nutrients, especially protein and fiber. A lack of fiber can compound early pregnancy constipation, which worsens nausea.
Although some women may have no choice but to strictly limit their diet due to frequent vomiting, HCPs can then help women through resulting symptoms (constipation, acid reflux, nutrition).
Mentally Coping
Frequent vomiting episodes can be traumatic for some women. It may be helpful (albeit slightly) for women to remind themselves that the vomiting will eventually stop. Even in the most extreme cases (hyperemesis gravidarum/HG), delivery always leads to a dramatic reduction of symptoms.
Although a small percentage of pregnant women can experience months of vomiting, women should not automatically assume or fear they will vomit their entire pregnancy.
NVP cannot be mentally handled looking weeks or months ahead. It is too daunting to think, “How am I going to get through X more days/weeks of vomiting?”. Women should focus on one day at a time, even hour by hour if necessary. Further, nausea and vomiting has been known to suddenly stop in some women, and it is completely possible that tomorrow will be better than today.
Vomiting, especially when accompanied by endless nausea, can prevent women from doing anything else for as long are symptoms are present. Women should try not to focus on what they cannot get done. This can cause significant mental anguish, guilt, stress, and frustration, all of which can contribute to waves of nausea and vomiting.
Women should ask a family member or friend to help with household responsibilities as much as possible, to include meals and even childcare. When this is not possible, women should focus on only what is necessary to accomplish, leaving everything else for another day. Women should read more on mental health here.
Further, if women are able to only focus on their symptoms, and keep their mind in the present (rather than the evening's dinner, tomorrow's work, or how to finish the laundry), they may be more successful with certain techniques.
Breathing
Research has shown that deep breaths taken at a slow and steady pace can help to ease feelings of nausea and relax the sympathetic nervous system – which responds to stress (and vomiting) with an increased heart rate, tightened muscles, and sweating (“fight or flight"). These are also known as prodromal signs of vomiting, as they often appear just prior to an episode.
Controlled breathing techniques may help women get through nausea waves and sudden urges to vomit. Taking slow and controlled breaths at three seconds per inhale and exhale, and breathing in through the nose and out through the mouth creates better control and can slow down heart rate.
Further, controlled breathing has also been shown to be very effective in studies assessing aromatherapy and nausea. While aromatherapy studies assess different scents and their potential effectiveness, these same studies have determined that the controlled breathing required to "smell" a scent may be more powerful than the scent itself (read more).
After vomiting, and attempting to recover, women can run very warm water over their hands to help them stop shaking (especially if they are very cold afterward). They should take slow, deep breaths at the same time. Warm showers and baths can do the same thing, but women should avoid making the water too hot.
Mental distraction techniques may be essential for some women as an additional strategy to controlled breathing. This helps women focus on something other than their nausea or impending urges to vomit.
Location
Women should also be open to considering where they vomit:
Women should consider vomiting in a location that is not the toilet, as this location can trigger additional vomiting for some women; there is no rule that vomiting must occur in a toilet. Buckets, bowls, towels, or bags also work.
A disposable item for vomiting can make episodes easier and prevent possible additional vomiting since women do not need to put their head close to a toilet seat; this method also keeps women on the couch or bed and off the bathroom floor.
If the bathroom is preferable, women should prepare it:
Toilet cleaner in the bowl or tank that produces a chemical smell such as bleach should be removed/avoided.
A deodorizer in the room can help absorb anything malodorous.
A preferred scent or other pleasant, more tolerable fragrance can be plugged in to a wall outlet.
Since bathroom floors tend to be cold, women should put down a small rug or towel (or two) so they can comfortably sit or lie down if necessary.
An additional towel or small pillow can also be considered so women do not have to fold their arms underneath their head to lie down, or put their head on the wall.
These changes may seem small or obvious, but even small degrees of improvement can help women get through additional waves or vomiting episodes. Women can read more about preparing their bathroom here.
Complications
The biggest immediate complication of vomiting is dehydration and electrolyte imbalance that can lead to an emergency department visit or hospitalization.
Women should read detailed information regarding hydration techniques to prevent these complications, which can assist women with mild, moderate, and severe symptoms.
Burst blood vessels in and around the eyes (subconjunctival hemorrhage) and face is common from intense vomiting which can cause extreme pressure to the eye cavity. Any burst vessels should clear up on their own within a few weeks.
Some sources indicate the possibility of an esophageal rupture, but this is incredibly rare. As of 2002, only four cases had been published regarding esophageal tears due to severe vomiting in pregnancy.
NVP can pose a problem for maintaining oral hygiene for many women, particularly those suffering extreme NVP. Sometimes the simple act of brushing teeth can trigger the gag reflex, retching, or vomiting.
Women should not brush immediately after vomiting, as this can spread stomach acid around the teeth, leading to tooth decay (affects the upper canines/front incisors most often). Instead of brushing, women should rinse out their mouth with water, a fluoride mouth rinse, or 1 teaspoon of baking soda dissolved in 1 cup of water (which neutralizes acid).
Women should visit their dentist during the first trimester for a routine cleaning. Research has shown possible links between gum (periodontal) disease and premature birth. A dentist can provide a prescription strength fluoride toothpaste (safe) if deemed necessary.
Women should also:
Not rinse after brushing and just spit out excess toothpaste.
Brush the teeth slowly and softly, avoiding contact with the back or roof of the mouth.
Purchase trial sized bottles of fluorinated mouthwash for home, work, car, and to keep in a purse.
Experiment with different sizes and styles of toothbrushes – with or without vibration (which can both ease or cause a gag reflux), shorter toothbrushes, smaller heads, bristle strength, and even toddler style brushes.
Experiment with toothpaste flavor, from minty to fruity, as well as texture (paste, gel, foam).
Brush the back teeth first, which can potentially avoid the toothpaste flavor coming into direct and immediate contact with the taste buds at the front of the tongue. Worst case scenario, avoid toothpaste, but try to brush vigorously enough to remove plaque.
Try to limit sugar in the diet during this time, especially beverages, which can hasten tooth decay. However, if sugary food items and beverages help curb nausea, then good oral hygiene is necessary, and women should use straws when drinking these beverages to further avoid contact with the teeth.
Action
Women who cannot keep any fluids down for 12 o 24 hours need to call their HCP to avoid further dehydration. Signs of dehydration include:
Extreme thirst
Less frequent urination
Dark-colored urine
Dizziness (especially when standing)
Confusion
Dry mouth
Weak pulse
Rapid pulse
Disorientation
Women also need to call their HCP immediately if they throw up anything that looks like blood (it could look black), and/or experience significant pain in their eyes, ears, chest, or throat. This is critical not only to prevent complications, but HCPs will want to rule out other possible causes of severe vomiting in early pregnancy.
Women taking antiemetics or medications while vomiting and are concerned they may have “vomited up” a dose need to call their HCP. Women should not take additional doses of any medication without talking to their HCP first. Women should also ask their HCP about antiemetics that dissolve under the tongue (sublingual).
Women may also find numerous strategies to combat vomiting, lack of appetite, and dehydration in the following pages:
Women should also consider sharing their experiencing (below) regarding vomiting with NVP. This can be an intolerable symptom in early pregnancy and any offered learning points or management methods are incredibly valuable for other women currently experiencing this symptom.
Partners/Support
It may be helpful for partners of women experiencing vomiting during early pregnancy to remember/imagine what it’s like to vomit continuously. Everyone is familiar with the awful feeling, and how much help they would want in that situation.
Women should have someone who can check on them often, especially during extended periods of vomiting. Not only is this a good idea for safety, but it can provide a better understanding of what she is going through if her partner/support is there with her and playing an active role in making her feel better.
Sometimes there is nothing the partner can do but tell the woman she is not alone and does not have to worry about any other responsibilities except for feeling better.
Further, having a family member check on her occasionally gives her the opportunity to ask for things she may need, such as water, a cold wash rag, or anything else she may want without having to get up, walk to another room or floor, pick up the phone, or yell.
Partners should also ask if the woman wants someone with her while vomiting, as some women may prefer it, while others prefer to be left alone.
Resources
Dehydration (Mayo Clinic)
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)