Fear of NVP
It is very common for women to be afraid of "morning sickness", especially if they have a fear of vomiting. Fortunately, it is currently estimated that less than half of women actually vomit during pregnancy – for any reason.
Even in extreme cases, relentless and uncontrollable vomiting due to NVP is very rare, and options for managing both nausea and vomiting are available during pregnancy, especially when assessed and treated early.
Regardless, women suffering through extreme anxiety regarding the possibility of severe NVP need to call their health care provider (HCP). A strong phobia of vomiting can lead to dangerous behaviors, especially while pregnant.
Reliable, accurate information is the best remedy against fear. Women who are not yet pregnant or who have just learned they are pregnant and are concerned about NVP, should talk to their HCP and read through our NVP section (including management options) to be as prepared as possible in the event they do experience nausea and vomiting – to any degree.
Background
Fear of vomiting is not uncommon, and it has been reported that some women will either delay or terminate a pregnancy due to a significant fear of vomiting.
Most women pregnant for the first time are significantly more worried about NVP than those who have previously been pregnant; this is likely due to more familiarity with the condition and knowing their ability to handle it.
Women afraid of experiencing NVP can read our entire NVP section, including management, hear from other women, and put themselves in a much better position from the onset.
It is also important for women to understand that not all women experience NVP, and even though the vast majority do experience nausea to some degree, only about half of those will vomit. That figure may also include individuals who vomited very infrequently, or maybe even only once.
Even though researchers do not know what causes NVP, or the most optimal treatment for it, we know more about NVP today than previous generations.
Women have more management options ranging from dietary changes, lifestyle modifications, medications, counseling, family support, and a network of women who have been there before. Women have many options to cope with their symptoms and do not have to experience any part of NVP alone.
Emetophobia and Pregnancy
Emetophobia (fear of vomiting) is an anxiety disorder in which individuals report clinical levels of fear that they may vomit, which can lead to symptoms ranging from mild concerns to severe panic attacks.
There is very little information regarding emetophobia during pregnancy, as in general, emetophobia is one of the least studied phobias. Females are four times more likely to be affected than males, but very little is known about how prevalent the phobia is among pregnant women, or those wanting to become pregnant.
Although no data on the behavior of pregnant women with a fear of vomiting exists, based on general information on emetophobia, women may engage in specific behaviors to avoid vomiting. Those with strong fears of vomiting may pay more attention to food safety, expiration dates, and cooking methods, and avoid eating in restaurants, traveling, or visiting someone with stomach complaints. They may also have a fear of vomiting during labor.
Women with a fear of vomiting may also have fears of feeling nauseous, seeing vomit, encountering vomit, or vomiting in public; symptoms of this condition can be emotional, mental, and physical. For a woman who wants to be pregnant, this can cause significant fear and anxiety.
Management
Because emetophobia is not well studied, there is very little information on treating it, and no data treating it during pregnancy.
But early identification of this disorder or fear in general is crucial to enable women a positive pregnancy and birth experience. Pregnant women should be forthcoming to their HCPs about any fears they have regarding NVP.
It may also be helpful for women with emetophobia to recognize that a super hypervigilance to gastrointestinal symptoms could make them feel worse.
Studies indicate that those with a fear of vomiting overestimate the risk of becoming ill, and due to a hypervigilance to gastrointestinal symptoms, they may perceive themselves as being sick, which leads to increased anxiety and worsening nausea, a self-fulfilling prophecy.
Further, nausea and vomiting are different entities, and just because someone experiences nausea, does not mean that individual will vomit.
Treatments of emetophobia that have been documented include cognitive behavioral therapy (see Resources), hypnotherapy, medication, and various exposure therapies.
There are numerous medication options used to control nausea/vomiting during pregnancy. However, it has been noted that individuals who suffer from emetophobia may engage in ritualistic ingestion of antacids, which could also be extrapolated to antiemetics (anti-vomiting medication) during pregnancy.
It is very important that pregnant women do not take any medication without talking to their HCP, and all prescribed medication needs to be taken exactly as directed. Taking more medication than prescribed can be dangerous.
Action
Some level of fear can by relieved through information, preparation, and action. Being prepared for NVP, to any degree, can help women better manage it while also preventing more serious symptoms.
Women who wish to become pregnant, or who are currently pregnant but experiencing significant anxiety due to the possibility of NVP, need to talk to their HCP. HCPs can help put together a plan in the event NVP becomes more than the woman can handle. Women can leave that appointment knowing a mutually agreed upon plan is in place, which can significantly relieve anxiety.
Women should also remember that not all pregnant women experience NVP, and others may only experience mild symptoms.
Women should also read through our NVP pages to more fully understand the numerous options available for managing nausea and/or vomiting:
Partners/Support
Pregnancy can already be a very scary time for women, even before possible nausea and/or vomiting sets in. Partners can have a beneficial impact on pregnant women through positive emotional support throughout all of pregnancy. Partners should let women know that no matter what happens or how they feel, they have someone who will help them get through it.
Partners should also learn everything they can about NVP as well, as their help will certainly improve women's abilities to manage and cope with their symptoms, which would in turn, benefit the whole family.
Resources
PDF regarding Cognitive Behavioral Therapy from the American Psychological Association.
Nausea and Vomiting of Pregnancy (Gastroenterol Clin North Am. 2011 Jun)
Nausea and Vomiting of Pregnancy-What’s New? (Auton Neurosci. 2017 Jan)
Morning Sickness: Nausea and Vomiting of Pregnancy (American College of Obstetricians and Gynecologists)
Nausea and Vomiting of Pregnancy: Committee Opinion 189; January 2018 (American College of Obstetricians and Gynecologists)
Problems of the Digestive System (American College of Obstetricians and Gynecologists)
Screening for Perinatal Depression: Committee Opinion 757 (American College of Obstetricians and Gynecologists)