Nausea and vomiting in pregnancy leaflet

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Coping with Nausea and Vomiting in Pregnancy

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Table of contents

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What is Hyperemesis Gravidarum?

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Who can help and support you?

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How do you know when it is time to seek help?

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Treating Hyperemesis Gravidarum

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Medication

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Fluid

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Food

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Rest and coping with daily activities

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Survival kit for going out and about

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Useful websites and resources

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Food and drinks diary

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Gestational Weight Gain chart

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Notes (blank page)

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My shopping list (tear and share)

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Dietitian contact details

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What is Hyperemesis Gravidarum?

Nausea and vomiting in pregnancy are common. You may feel sick, often in the morning. This passes and you feel well enough to go about your day. Hyperemesis Gravidarum (HG) is a much more severe form of morning sickness. You may feel sick all day, vomit many times in a day, lose weight and may need fluids and vitamins through I.V. (intravenous drip).

It is not known why some women have HG and others do not. You may be more likely to be sick if your mother or sister were sick during pregnancy. If you were sick in a past pregnancy, you are also more likely to be sick in future pregnancies.

Nausea and vomiting are not likely to harm your baby if you get treatment and support. However, you need nutrients and fluid to stay well and help baby grow. If you have HG, and are not eating and drinking enough, the dietitian will look at different ways of keeping you and your baby nourished.

Who can help and support you?

You have a team of staff who can help you on this journey. Each one has a special role. Know who to ask for information to help you make the decisions that are right for you:

Obstetrician

Mental Health support

Dietitian

Midwives

You Pharmacist

Do not suffer in silence! We are here to help

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How do you know when it is time to seek help?

Sometimes it is hard to decide when you are “sick enough” to come into hospital. You can use these questions to score your symptoms.

If your total score is over 7, come to the Emergency Room.

24-hour Score (PUQE Score)

1. On average in a day, for how long have you felt nauseated or sick to your stomach?

Symptom Not at all 1 hour or less 2-3 hours 4-6 hours > 6 hours Score

(1)

(2)

(3)

(4)

(5)

2. On average in a day, have you vomited or thrown up...

Symptom

Score

7+ times

5-6 times

3-4 times

1-2 times

Did not throw up

(5)

(4)

(3)

(2)

(1)

3. On average in a day, how many times have you had retching or dry heaves without bringing anything up?

Symptom Score

Not at all

1 -2

3 -4

5 -6

7 or more

(1)

(2)

(3)

(4)

(5)

Add scores from questions 1-3: _______ Score key: ≤ 6 = 7-12 = ≥ 13 =

Mild Moderate Severe

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Treating Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy There are 4 ways to treat your sickness:

1. Medicine

2. Fluids

3. Food

4. Rest

1. Medicine Most women worry that medicines for nausea and vomiting in pregnancy may not be safe for their babies. Fortunately, there are now many safe anti-sickness medicines that can be taken in pregnancy. Some options may work better for you than others. Talk to your obstetrician or GP about medicines to help control your nausea and vomiting.

If your prescription is not helping you to feel better, ask your obstetrician or GP if you can try a different one, or a combination that may work better.

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2. Fluids Getting enough fluids (staying hydrated) will help you feel better. Many women find it hard to drink.

Write down all the fluids you manage to drink each day. This tool can help you to decide if you are getting enough fluid and how to improve your hydration:

Check your Hydration A: Match the colour of your urine to a colour on the colour chart below.

B: Are you hydrated (1 - 3 on the chart)?

A cup is 200ml, like the one below

C: Are you drinking 11 cups of fluid each day?

This is the minimum amount of fluid that you need each day.

If the answer is NO to questions B and C, you are dehydrated and need more fluids.

Step 1: Drink more fluid. See suggestions on the next page Step 2: If you are not able to drink more, call one of the following: 

Hospital Switch Board (24 Hour): (01) 637 3100

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Dietitians (08:30–16:00, Mon–Fri): (01) 6373314

Did you know? Thirst is not a good way to tell if you are dehydrated

Ask for the Emergency Room

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If you are dehydrated, you need to: Drink one glass (200ml) every hour for the next 10 – 11 hours The following fluids are suitable:  Half orange juice + half water is an ideal fluid to rehydrate you  Sports drinks or isotonic drinks (Powerade®, Lucozade® Sport)  Slightly fizzy drinks – use normal sugary versions of soft drinks (e.g. 7up, lemonade)  Fruit juice (apple or orange)  Some people find ginger, peppermint or fruit teas helpful – add sugar or honey  Diluted fruit squash (Mi Wadi® or Kia Ora®)

These foods have a high water content: Melon

Slice (130 g)

120 ml

Tinned fruit

3 tbsp. (120 g)

105 ml

Grapes

Small bunch (100 g)

82 ml

Jelly

Half cup (100 g)

84 ml

Ice lollies

100 g

78 ml

Ice cubes

Half cup

100 ml

Soup

Small bowl (150 g)

143 ml

Custard

3 tbsp. (105 g)

82 ml

Yoghurt

1 pot (125 g)

103 ml

Sugary drinks help to give you energy and fluid when you are struggling to eat food.

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3. Food Try to eat small amounts often. Not letting your stomach get too empty helps you feel better.

What type of food might be easier to eat? Think of the way the food may look, taste or feel:    

Take a 400µg folic acid tablet daily and ask the dietitian about other vitamin supplements

Texture (dry, soft, crunchy, wet or smooth) Flavour (sweet, savoury, tart/sour/bitter, bland or fruity) Temperature (hot, cold, room temperature or frozen) Shape or size (sliced, tiny cubes or wafer-thin)

What I fancy

Sweet or fruity

Savoury

Crunchy

What I might try         

Hard boiled sweets Jelly babies Cake Tinned fruit in natural juice Ice cream Sorbet Frosted Flakes (dry or with milk) Jam Jelly

        

Crisps Bread sticks Tortilla chips Crackers Roasted nuts Clear soup or stock cube broth Marmite on toast Instant flavoured noodles Flavoured rice cakes or Snack a Jacks®

      

Crackers/crisp bread Crisps Dry cereal (Cornflakes, Special K®) Popcorn Celery or carrot sticks Rusks Biscotti

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Some women find if they eat a food too often, they can’t face it again. Try to choose a variety of different foods to have to hand at home and change it up often.

What I fancy

What I might try     

 

Thin slices of green apple Sour Jelly Babies® Lemon sorbet Tinned grapefruit 7-up® or Sprite® with fresh lemon or lime juice Pickles Salt + vinegar crisps Carrot or celery sticks dipped in vinegar Cranberry juice Raspberries

Bland/soft

           

Mashed potatoes Plain white rice Pasta or noodles Thin rice noodles Custard Ambrosia rice Cottage cheese Porridge Plain pancakes Oven chips Beans Hummous

Smooth

        

Petit Filou® or fromage frais Ice cream Mashed potatoes Ready Brek® Polenta Peanut butter Cheese spread Custard Smoothie

Sour/bitter

Nothing is off the menu!

  

Allow yourself to eat whatever food you fancy.

You can eat healthier choices when you are feeling a bit better

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4. Rest and coping with daily activities You may feel more unwell when you are uncomfortable, tired or overwhelmed. Rest when you can and make your surroundings as comfortable as possible.

These are some tips that some women have used to cope: 

Listen to soothing sounds or music. Try a meditation app on your phone.



Wear soft, comfortable clothing. Use unscented laundry detergent if scents bother you.



Avoid bright lights, loud noises, strong smells.



Keep the air in your room fresh by opening a window.

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Keep the room temperature comfortable-not too warm or too cold.

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Ask people around you not to wear perfume, cologne or scented deodorant or smoke if the smells bother you.



Be kind to yourself: take naps or rest when you feel tired.

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If you feel well enough to get out, ask friends or family to meet in a place other than a restaurant if you can’t be around food smells.

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It is common to feel sick when brushing your teeth. Try using a mild mouth wash instead and brush your teeth when you feel able. Mints or chewing gum may help lessen a “bad taste” in your mouth.



Prepare your clothes or your kids’ clothes, take a shower and make your kids’ school lunches at night to avoid rushing around in the morning if you have to go to work or take the kids to school.



Let other people know what they can do to help you when you are having a bad day, such as: o o o o o

Mind the kids Do some laundry Make a meal Grocery shop School runs.

People may think their comments or suggestions are helpful, but it may be hard to understand how awful HG feels unless they’ve been through it.

They may need a little guidance from you!

Tell them how they can help you!

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Survival kit for going out and about Being out in public, in a car, bus or train can be a challenge when you feel sick. It helps to have a few things in your handbag to help you manage when out of the house:

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Small leak-proof bags in case you vomit

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Cleansing wipes for face and hands

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A handkerchief with a scent that you find soothing (essential oil or fresh cut lemons). You can put this up to your nose to block out smells that make you feel ill.

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Snacks

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Single-serving cartons or bottled drinks

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Mints, hard boiled sweets or chewing gum

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Lip balm

Be prepared!

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Useful websites and resources Hyperemesis organisations and forums Hyperemesis Ireland

www.hyperemesis.ie

Pregnancy Sickness Support UK

www.pregnancysicknesssupport.org.uk

International Colloquium on Hyperemesis Gravidarum Hyperemesis Education and Research Foundation

www.hgconference.org www.helpher.org

General pregnancy advice, infant feeding and food safety information

Healthy Eating in pregnancy

For more information on healthy eating in pregnancy please read the HSE Healthy Eating for Pregnancy booklet, available on the healthpromotion.ie website and provided in your booking pack

HSE My child

www2.hse.ie/my-child

Safe Food

www.safefood.eu/Healthy-Eating/Recipes.aspx

Breastfeeding support and information HSE Breastfeeding

www.breastfeeding.ie

The National Maternity Hospital

www.nmh.ie/paediatrics/breastfeeding.1530.html

For your children’s nutrition: HSE

www2.hse.ie/babies-and-toddlers/

Irish Nutrition and Dietetics Institute:

www.indi.ie

Book about children’s nutrition

Feed Your Child Well by Therese Dunne, Phyllis Farrell and Valerie Kelly Nutrition advice for children 0-5 years Available in book stores and your public library

The websites and resources listed have been reviewed and are trusted by the dietitians.

Other sites may give advice or nutrition information that is not accurate.

Ask the dietitians about other resources to be sure the information is safe and reliable.

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Food and drinks diary Writing down the type and amount of food you eat may be useful to track your progress and discover which foods and drinks help you feel your best.

Meal

Food Describe with as much detail and portion size

Breakfast

Mid-morning

Lunch

Midafternoon

Evening meal

Before bed

PUQE score today:

Drinks Describe how much in ml or litres

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Meal

Food Describe with as much detail and portion size

Breakfast

Mid-morning

Lunch

Midafternoon

Evening meal

Before bed

PUQE score today:

Drinks Describe how much in ml or litres

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Meal

Food Describe with as much detail and portion size

Breakfast

Mid-morning

Lunch

Midafternoon

Evening meal

Before bed

PUQE score today:

Drinks Describe how much in ml or litres

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Gestational Weight Gain chart Tracking your weight in pregnancy is a good way to make sure you are eating enough food Category BMI <18.5 18.5-24.9 25.0-29.9 â&#x2030;Ľ30.0 Gestation 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Total weight gain 12.5-18.0 11.5-16.0 7.0-11.5 5.0-9.0 Weight

Mean weight gain 2nd and 3rd Trimesters kg/week 0.51 (0.44-0.58) 0.42 (0.35-0.5) 0.28 (0.23-0.33) 0.22 (0.17-0.27) Weight gain Rate weight gain

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Notes

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My shopping list Make a list, tear it out and let a partner or friend to do the shopping

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My shopping list Make a list, tear it out and let a partner or friend to do the shopping

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Developed by the Dietitians Department of Clinical Nutrition & Dietetics The National Maternity Hospital Holles Street, Dublin 2 Email: dietitian@nmh.ie

Call us: 01-6373314 If we donâ&#x20AC;&#x2122;t answer, leave us a voicemail.

Go to the Emergency Room at NMH if you are unwell!

Department of Clinical Nutrition & Dietetics, National Maternity Hospital, Holles Street, Dublin 2.

For review: May 2022