Sick of Morning Sickness

I knew I had hit bottom the evening my husband approached me with the jar of spaghetti sauce. I was 10 weeks pregnant and hellishly ill from morning sickness--a misnomer if there ever was one. Like many other women, I was sick at all hours of the day and night--a predicament that lasted, in my case, for almost five months.

So there he was, walking determinedly across the room holding out the opened jar of spaghetti sauce, offering me a whiff of a pungent, possibly moldy sauce.

“This has been in the fridge for awhile. Do you think it’s spoiled?” he asked innocently.

“ Auughh !” I screamed. “Get that thing away from me!”

Upon which, I flew into the bathroom, vomited and threw myself on the bed for a long cry.

*

Every woman who has experienced morning sickness has these tales, of course. We are a sorority, united in our suffering.

We exchange horrid tales, aghast at what we endured. We have no sympathy for the pregnant woman who complains that she gets “a little queasy” when she brushes her teeth in the morning.

One reason we turn to each other for comfort is because obstetricians are infamous for not having solid answers when it comes to morning sickness.

But things are starting to change.

New research is exploring possible causes of morning sickness. And a small contingent of medical professionals--mostly dietitians--are finding new treatments and remedies. A growing number of women are unwilling to accept the usual advice to grin and bear it and are imploring obstetricians and midwives to take the condition seriously.

“I think more women are getting together and talking about it, and they are going to their physicians and saying, ‘This is what happened to me and this is what worked for me,’ ” says Miriam Erick, a registered dietitian at Brigham and Women’s Hospital in Boston who is one of the nation’s top authorities on the disorder.

“But I think there needs to be a lot more research. There are so many angry women who haven’t been taken care of seriously.”

Erick began studying morning sickness 12 years ago when she started working with pregnant women hospitalized for nausea and vomiting.

Like many health professionals who work with pregnant women, Erick’s entire training in treating morning sickness consisted of recommending salted crackers. When she cheerfully offered that advice to her first patient, “I was very poorly received,” she says sheepishly.

While crackers may help relieve the mild nausea experienced by about 70% of pregnant women, the remedy is useless for women who vomit relentlessly and lose 5% or more of their pre-pregnancy body weight, Erick says. This condition, called hyperemesis gravidarum, affects about 1.3% of pregnant women, far more than what is traditionally believed, she says.

With the nagging sense that she was missing something, Erick delved into the medical literature and discovered that none of the information jibed with what her patients were telling her.

“Ninety-nine percent of the literature was written by men,” she says. “I had a suspicion this was part of the problem.”

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Morning sickness is steeped in myths, many of which are perpetuated by the literature and promulgated by respected and well-meaning obstetricians, Erick says.

For example, not only are more women seriously ill than what is suggested, morning sickness lasts longer (the 17th week is average) than what women are typically told (the 14th week).

Moreover, 11% of women are sick throughout their pregnancies. And while about half are sick only in the morning, 36% feel sick all day, Erick says.

It is also untrue that morning sickness never carries serious consequences--although in most cases, the fetus thrives because it has first dibs on the mom’s nutrients.

“We can usually reassure our patients that the consequences to the fetus are rare. In general, the fetus is well-protected. It takes everything it needs,” says Dr. Jeffrey Ecker, a San Diego obstetrician and expert on morning sickness.

However, in women with hyperemesis gravidarum, the lack of nutrients can lead to ketosis, a disorder in which the body starts to consume its own tissues and produces toxins that can lead to coma. Women with ketosis are hospitalized to receive nutrients intravenously.

A more serious consequence, however, is the decision to abort because of the sickness. Among the women admitted over the past decade to the huge maternity ward at Brigham and Women’s for hyperemesis gravidarum, 9.4% had chosen abortion because they had become so sick during a previous pregnancy.

Erick believes this rate can be extrapolated nationwide.

“They are sick of being sick,” she says of the women who opt for abortion. “They are sick of platitudes. Sick from lack of support. And they are very worried about their health.” Even if abortion is out of the question, severe morning sickness results in high medical bills for hospitalization, lost career opportunities and work time.

*

Severe morning sickness is the reason the size of the Huget family of Ann Arbor, Mich., “will remain at two children,” says Lesa Doll Huget.

With both her pregnancies, Huget was hospitalized several times for treatment of dehydration because of vomiting. She ended up with two healthy daughters. But, she says: “The pregnancies were the hardest thing I’ve ever gone through. I felt very cheated from an experience my friends had spoken of as wonderful. I didn’t have that.”

When her sickness struck early in each pregnancy, Huget “was so desperate I would have tried anything.”

Crackers, ginger tea, vitamin B6 shots, Tums--nothing worked. She was forced to leave her job as a writer and, casting about for a reason to explain the sickness, began blaming herself--a response that is common in these women, Erick says.

“I felt it was just me. I was nervous. I had talked myself into the thought that everyone who is pregnant has morning sickness. But when it didn’t stop and I had to go on leave from my job, I became very depressed. It was a very bad time.”

Being hospitalized seemed to break the cycle of vomiting for a short period. But Huget hardly felt reassured. Placed in maternity wards, she saw women bearing healthy infants and worried about the health of her fetus.

“The nurses told me that they had women like me every week,” she says. “It made me angry because it’s a very dramatic thing that not only endangers you but the unborn baby. But I don’t know anyone working on why this happens or how to alleviate it.”

Experts admit that the obstetrics field has been woefully inadequate in its efforts to relieve women of their misery, even though about 50,000 women are hospitalized each year.

Part of the reason is because the cause is still a mystery.

Several books written in the mid-1980s--including some by feminist health writers--favored a theory espoused in a 1943 medical paper suggesting the disorder revealed a subconscious wish not to get pregnant and that “vomiting is an attempt to expel” the fetus.

“Psychological theories have been promulgated with no good evidence,” Ecker says. “Yet up to 50% of all obstetricians think this is the cause of nausea and vomiting.”

The most likely cause of morning sickness is the increase in estrogen, Erick says.

“Estrogen enhances the sense of smells--and it’s odors that make women nauseous.” She calls this phenomenon “the radar nose of pregnancy.”

All kinds of sensations--smell, taste, motion, heat and noise--combine to set stomachs reeling. “But smell,” she says, “is really the kick in the pants.”

In her book “No More Morning Sickness: A Survival Guide for Pregnant Women,” Erick describes the approach she uses at Brigham and Women’s Hospital to break the cycle of nausea and vomiting. The advice centers on removing the woman from anything that might trigger vomiting, such as smells and motion.

Then Erick urges her patient to think of a food that is appealing, even junk food.

“I try to let go of my biases and feed my patients atypical foods,” she says. “When in a crisis situation, any food should be used. If she asks for potato chips, she gets potato chips. It won’t be for any great length of time.”

Erick claims great success with her method, and the technique is starting to spread. Last month, she described her program to several hundred dietitians at the annual American Dietetics Assn. meeting in Anaheim. She has also begun fielding calls from obstetricians with inquiring minds.

*

Medical experts are loathe to use anti-nausea drugs during pregnancy because there are few studies to show whether a drug is safe to the developing fetus during the vulnerable early months of gestation.

Desperate for relief, some women take the over-the-counter insomnia medication Unisom and Vitamin B6 tablets. The combination duplicates the anti-morning sickness drug Bendectin, withdrawn from the market in 1983 because of fears from one study that it caused birth defects. That decision was controversial because several larger studies showed no problems with the drug, Ecker says.

Six months into her second miserable pregnancy, Huget began taking Unisom. And she began feeling better.

“It seemed to bring it under control,” she says. “But I was never convinced whether it was the . . . elixir or that the sickness had just run its course.”

Nancy Wong, a registered dietitian with the Public Health Foundation in Los Angeles, says she lucked onto the “crisis breaking” approach suggested by Erick. It not only helped her through a dreadful pregnancy, it changed the way she counsels women in a federal Women, Infants and Children program.

Wong became ill earlier this year while pregnant with her third child.

“Nothing I tried worked,” says the North Hills woman. “I knew the protocol is to eat crackers or dry food. I couldn’t stand crackers. I couldn’t stand the taste of cereal. All the toast in the world wouldn’t help. McDonald’s french fries were the only thing that would stay down. It was the strangest thing.”

Wong lost six pounds before rallying during the sixth month. Now she tells pregnant women with morning sickness they usually don’t need to worry about proper nutrition if they are seriously ill.

“What made me better was to break the rules. Experiment,” she says of her french fries solution. “That is how I changed my counseling. When you are sick, you feel so much responsibility to this little baby. You know what you do is going to affect the child. There is a lot of guilt. Now I feel bad about the way I counseled people in the past because I probably added to their guilt.”