A man named Soranus may have been the first to write about morning sickness. In about 2000 B.C., he described - on papyrus - the phenomenon of women vomiting when they were pregnant. They vomited more, Soranus said, if they were carrying a boy.
Modern medical studies have disproved Soranus' theory about the sex of the fetus influencing the severity of sickness. Still, that particular myth persists. Some 4,000 years after Soranus' death, you can hear his theory repeated at just about any baby shower.You can see why the idea has persisted. There is a logic to the theory that whatever body chemistry is causing the nausea is a female chemistry, as female as pregnancy itself, and therefore must be in conflict with whatever chemistry is forming the body of a male fetus.
If there is logic to that particular idea, perhaps there is logic, also, to the theory that morning sickness is psychological, or that the women who vomit the most are women who didn't want to be pregnant in the first place. Certainly this theory has persisted over time.
The theory blossomed in the 1950s when psychologists looked for and found a correlation between the severity of a woman's morning sickness and how emotionally distant she felt from her doctor and/or her husband. They concluded that women who had poor communication skills were more likely to be sick. They also concluded that women who were dependent on their mothers were more likely to be sick.
As recently as 1988, a psychological study of pregnant women confirmed the conclusions of the 1950s. Only very recently have researchers begun to look at the same data from the opposite perspective - that the sicker a woman is, the more her relationships are likely to suffer.
Not only are her relationships with her husband and doctor likely to suffer, one recent Canadian report concludes, but her children, her housework and her paid employment are likely to suffer, too. Only in the past few years have researchers begun to conclude that the sicker a woman is the more she is going to need to depend on her mother - or someone - to clean the house, fix the meals and take care of the other children.
There are still myths and mysteries surrounding morning sickness. It is still not clear why some women have mild nausea and others get violently ill. It is not clear why most women are fine after the first three months while a few go on being nauseated for four or five or even nine months.
But there are some things medical researchers pretty much agree on today about morning sickness. These are the facts: Three-fourths of all pregnant women feel nauseated, at least sometimes, during the first trimester of pregnancy. Half of all pregnant women vomit. Twenty percent of all pregnant women vomit 40 times or more. And some small number, probably fewer than 5 percent of all pregnant women, get so sick that they can die of dehydration and starvation.
Pregnant women actually did die of morning sickness, routinely, before 1940, when doctors began understanding more about electrolyte imbalances and began using intravenous feedings to keep women from getting dehydrated.
A British study shows that 159 pregnant women per million died during the 1930s, while only three pregnant women per million died during the 1940s.
"Morning sickness is not `all in your head,' " says Dr. Fred Langeland, a Salt Lake obstetrician. "Though we don't know the exact cause it seems to correlate with the levels of HCG in the body." Langeland explains that human chorionic gonadotropin is a hormone that is found in increasing levels beginning at conception and rising steadily for 10 to 11 weeks, at which time the placenta is becoming viable and able to maintain the pregnancy. At week 13, the level of HCG begins slowly to drop off.
Study after study has confirmed that high levels of HCG, while they may be making the mother sick, are also preventing her from miscarrying. "HCG is the hormone you measure when you do a pregnancy test," says Langeland. He says he has some patients so sensitive to the way HCG makes them feel that they can tell they are pregnant within a day or two of conception.
The whole time she was vomiting, Rebecca Gardiner tried to console herself with the thought that her hormones were actually protecting the pregnancy. "It was a nightmare," she recalls. "I thought I was going to die. Literally."
The Salt Lake woman, whose baby is due in April, already has two children, ages 4 years and 21 months. She'd had severe morning sickness with both of her previous pregnancies and had been on an IV occasionally, to prevent dehydration.
But this time it was worse. She got sick earlier in the pregnancy and was constantly fighting dehydration, with IVs administered on an outpatient basis. Because she didn't want to leave those two babies she already had, Gardiner didn't want to go into the hospital. Her obstetrician offered her the choice between hospitalization for round-the-clock IV feedings and having a feeding tube inserted through her nose so she could stay at home and feed herself by bypassing her stomach and pumping a formula directly into her small intestine.
Gardiner chose the tube. It was awful, she says. And she was so disabled, by the nausea that never went away and the pump she was attached to day and night, that her children had to be farmed out to the neighbors anyway and she didn't see them from 7 in the morning until 7 at night.
Even with the feeding pump, she lost weight. She was down to 99 pounds when, at 17 weeks into the pregnancy, the nausea began to pass.
"People were incredibly supportive," she says. Every woman in the neighborhood offered concern and - while she was still trying to eat - advice on what worked for them. They talked about tomato juice, vitamin B6, carbohydrates, proteins. Gardiner tried it all - as well as every method she could find in books and magazines.
There are two types of morning sickness, says Langeland. Women who have the milder forms do better to keep small amounts of food in their stomachs at all times. Women who are severely ill find that eating can make it worse. Lange-land tells all his patients to carry a water bottle with them and sip small amounts all day.
The liquid that stayed down the best for her, says Gardiner, was herbal tea. Tea was suggested to her by a neighbor woman who was born in Japan.
But ultimately, it was not the food or drink her neighbors suggested, but the understanding they expressed, that helped the most Gardiner says.
Not one person said, "It's all in your head," she says, although only one of the women she knew could recall ever having been that sick herself. Gardiner's neighbor, Marjorie Knudsen, had her first child in 1947 and her second three years later. She was so sick that she had to be on IVs and decided not to go through another pregnancy. She and her husband had adopted two more children when, some years later, they heard about an anti-nausea pill called Bendectin.
Knudsen got pregnant twice more. She took the medication and it helped, significantly. Her last two children were perfectly healthy. However, later she heard Bendectin had been taken off the market because it causes birth defects. Knudsen said she would never have taken medication, never have had those last two children, had she known the risks.
Langeland says most obstetricians do recommend anti-nausea drugs for patients who are in danger of becoming dehydrated. And the medications that are being prescribed today contain pretty much what Bendectin contained: an antihistamine and vitamins B6, C and K. "Bendectin wasn't a bad idea. It was a good drug, but the company got sued and couldn't afford to keep it on the market. We don't know why the combination of antihistamine and B6 works so well," he says. But the combination works better than either remedy works alone.
It is not clear to some researchers whether or not there was a statistically significant increase in birth defects with Bendectin. Nor is it clear what role, if any, a mother's weight loss has to do with birth defects.
When a woman's body begins to think it is starving, it produces an abnormally high amount of metabolic acids called ketones. Ketones pass through the placenta and the fetus uses them for energy. It was previously thought that ketones were fine for the fetus, but new research on diabetic mothers (who also produce ketones) is somewhat confusing.
More research needs to be done, on medical as well as social aspects of morning sickness. Meanwhile, perhaps women who get morning sickness can take some comfort in the fact that at least the "all in your head" theory is slowing disappearing. Morning sickness is reported throughout history and across all cultures and, new studies are showing, women who are happy about being pregnant are actually more likely to talk about their nausea than are women who don't want to be pregnant.
Other new theories are emerging:
- Women who are carrying twins are more likely to be sick. This also seems to be linked to the fact that the more fetuses the higher the levels of HCG.
- Acupressure helps. Studies in San Francisco, Italy and Belfast, Ireland, all report some women find some relief from nausea (though not necessarily from vomiting) with acupressure.
- There is a link between nausea and fatigue. The more tired a woman is, if she is prone to nausea, the more likely she is to vomit. Conversely, the more she is vomiting, the more likely she is to report being tired.
Sleep studies in Australia and Japan find that sleep is interrupted most often during the first trimester, more often even than at the end of the pregnancy. And the cause of the interruptions? Nausea and heartburn.
- Morning sickness really is worse before noon, but it is almost as bad in the afternoon. Four patterns of nausea have been identified: morning peak, evening peak, two peaks, all day long. Only 18 percent of women report feeling sick in the middle of the night, but those who do have the more severe form of "morning" sickness.
- Morning sickness is embarrassing. A study in Canada that attempted to measure how quality of life is affected by morning sickness found that women who vomited frequently soon start limiting their social life. Several women said they were embarrassed when they had to stop the car while driving in order to vomit. Another found people were critical, implying that she could control her vomiting, so she didn't want to be around people.
- Morning sickness has a bigger impact on the family and on society than is widely acknowledged. Twenty-eight percent of women in the Canadian quality of life study reported having to change their lifestyle significantly because of morning sickness.
In a recent study done in England, 73 out of 206 women had to miss work because they were sick. They missed an average of 62 hours.
In the Canadian study, a woman who was self-employed and had to cut back on the hours she worked explained it this way: "It's hard communicating with people when you are nauseated. You try to smile, act cordial, but sometimes you run to the bathroom to throw up. I just wasn't really into my work."
Others were sad because they couldn't care for their children or play with them the way they wanted to. "I tended to tell my daughter to go away," one woman said. And another said, "If my son would come in and climb all over me, which he is used to doing, that would make me very nauseated."
Cooking was next to impossible for women with severe morning sickness. Some women in the Canadian study reported that their husbands were supportive. Others felt alone because their husbands thought they weren't trying hard enough to be healthy. One husband frequently worried aloud about what all this vomiting was doing to the baby.
The Canadian and British studies reveal that driving, working, caring for children, enjoying a meal or some conversation with your husband - even the simplest things can be difficult when you feel like throwing up.
Late in the fall of 1978, President Jimmy Carter came to Utah to speak at a national conference on families. Marie Osmond and other famous Utahns were on hand to greet him as he addressed an audience in the Salt Lake Tabernacle. Temple Square was crowded, as hundreds waited patiently to catch a glimpse, shake his hand, be part of an historic moment with the president and Marie.
And at the front of crowd, separated by only a chain from the sidewalk where the president would soon be walking, stood a young, pale, distressed-looking woman. She'd been waiting for more than an hour, sometimes leaning against an older woman who might have been her mother. And, then, sadly, she could wait no longer. She leaned forward, over the chain and a bit to the side of the walkway, and began vomiting into a flower bed.
The quiet crowd grew quieter, with sympathy. The older woman embraced her and when she'd finished throwing up they left together, eyes cast down. Many people in the crowd probably understood her problem and didn't want to see her leave, after having waited so long. Yet they understood why she was going. She probably felt she'd humiliated herself in front of several hundred people. She probably thought she had defiled the temple grounds and narrowly missed splashing on the president of the United States.
She probably felt like going home, retreating to her bed. There, while sucking on soda crackers and holding as still as possible, she could think about more dignified and happier times to come. There, she could give herself over to a quiet joy about the baby who, in spite of its mother's discomfort, was being nourished and comforted within her body. She could shut her eyes and rest her hands gently on her stomach and think about the miracle within the morning sickness.
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Additional Information
What makes morning sickness worse?
In a study of 117 pregnant women, nursing professors from the University of Alberta in Canada and Rush University in Chicago asked women what made their nausea and vomiting worse. The women's answers are ranked in order from most to least dangerous. In other words, 49 of the pregnant women found certain foods made them more sick, but only one reported that brushing her teeth made her more queasy. Some women reported more than one problem. *
Eating certain foods or beverages **: 34 percent
Not eating: 26 percent
Standing up too quickly or standing up at all: 16 percent
Smelling something: 16 percent
Hearing something (or thinking about something gross): 6 percent
Seeing something (like garbage, or even bright lights): 2 percent
Being too warm: 2 percent
Brushing teeth: 0.7 percent
* Percentages total more than 100 because of rounding up.
** Proteins and carbohydrates seem to be the safest foods. But unfortunately, the safe foods don't necessarily stay safe. A pregnant woman may like milk one week, but finds it makes her sick the next week.