Morning sickness

Hormone levels increase in the first 3 months to help maintain your pregnancy, but these increases can make you feel sick or throw up. Most women feel better by 12–16 weeks, but a few women may continue to have symptoms until their baby is born.

Normal morning sickness won't harm your baby's health as long as you are able to keep food down, eat a well-balanced diet and drink plenty of fluids. However, if you are pregnant and experience nausea and vomiting that is severe and ongoing, you should see your midwife or doctor. 

On this page you can find the following information:

• What are the symptoms of morning sickness?
• What can I do to feel better?
• When should I seek advice for morning sickness?
• Pregnancy and COVID-19
• What causes morning sickness?
• What increases my risk of morning sickness?
  
  

Image credit: 123rf

What are the symptoms of morning sickness?

Symptoms can occur at any time of the day and often include:

• nausea (feeling sick)
• vomiting (being sick)
• dry retching (like vomiting, but nothing is brought up) 
• food smell or sight sensitivity where certain smells or the sight of some foods can trigger nausea.

Not everyone experiences morning sickness in the same way.

• You may have only occasional queasy moments while others feel nauseous and sick almost constantly but never vomit.
• You may vomit now and again, while others vomit more frequently and feel better afterwards. 
• Sometimes the nausea and vomiting are severe and ongoing. You can't keep down fluids or food, causing you to lose weight and become dehydrated. This is called hyperemesis gravidarum and occurs in less than 2% of pregnant women (2 in every 100 pregnant women). Read more about hyperemesis gravidarum.
  

What can I do to feel better?

Tips to manage morning sickness:
Meals

• Have something to eat before getting out of bed in the morning (plain toast, dry cracker).
• Eat small meals regularly, as an empty stomach may trigger feeling sick or nauseous.
• Avoid foods that are fatty or make you feel nauseous. High-carbohydrate meals such as bread, rice, crackers and pasta are generally well tolerated.
• It might help to avoid cooking or preparing meals.     

Fluids and hydration

• Keep yourself well hydrated.
• If you find it difficult to drink water, try sucking on crushed ice.
• Many women find icy cold fluids easier to get down.
• Small frequent sips of water, between meals, are easier to keep down.
• Sometimes sips of flat lemonade, diluted fruit juice, cordial, weak tea, ginger tea, clear soup or beef extract drinks are helpful.

Ginger

• There's some evidence ginger may help reduce nausea and vomiting (check with your pharmacist before taking ginger supplements during pregnancy).
• Ginger taken as ginger tea, ginger-containing foods or ginger capsules (from a pharmacy) may help calm your tummy.

Vitamin B6 (pyridoxine)

• Vitamin B6 supplements can be useful, but doses above 200 mg per day can actually be harmful. Talk to your lead maternity carer first before taking vitamin B6 supplements.

Rest and relaxation

• Get enough sleep, take rests if needed and avoid getting over tired. 
• Don't try to maintain the same schedule or level of activity as you did before your pregnancy.
• Avoid stress and try stress-reduction techniques, like meditation.
• Fresh air might help make you feel better. Take a short walk if you're up to it, turn on a fan or try to sleep with a window open.
• Do not smoke cigarettes. Ask other people not to smoke around you.  

Clothing

• Wear comfortable clothes without tight waistbands.

Brushing your teeth

• Delay brushing your teeth in the morning if you find it makes you sick. Instead, wait to brush until your stomach feels more settled.
• Also, wait about half an hour after eating to brush your teeth. 

Acupressure bracelets or acupuncture

• Try sea-sickness acupressure bracelets or acupuncture. Some women find these helpful and there does not appear to be evidence of harm.

Midwife Kate Finch gives advice on how to deal with morning sickness. Click the image below and scroll to the bottom of the page to play video.

(NHS, UK, 2017)

When should I seek advice for morning sickness?

If you are vomiting and can’t keep any food or drink down, there is a chance that you could become dehydrated or malnourished.

Contact your GP or midwife immediately if you:

• have very dark-coloured urine (pee/mimi) or do not pee for more than 8 hours
• can't keep food or fluids down for 24 hours
• feel severely weak, dizzy or faint when standing up
• have abdominal (tummy) pain
• have a high temperature (fever) of 38°C (100.4°F) or above
• vomit blood
• have pain when passing urine or any blood in your urine (this may be a urine infection)
• are losing weight
• get symptoms of COVID-19 or are unwell with something other than COVID.

Pregnancy and COVID-19

If you're feeling well, it's important you go to all your appointments and scans for the health of you and your baby. However, being pregnant (hapū) during the COVID-19 pandemic has made many people anxious about their own health and that of their unborn or newborn baby. Here is some information to help you through this time.

What causes morning sickness?

The exact cause of morning sickness is unclear, but the symptoms are thought to be due to a combination of factors such as:

• High levels of pregnancy hormones, in particular, human chorionic gonadotrophin (hCG) and oestrogen.
• Fluctuations in blood pressure, particularly lowered blood pressure.
• Altered metabolism of carbohydrates.
• The enormous physical and chemical changes that pregnancy triggers.

Morning sickness may be more likely to happen:

• when you have an empty stomach
• if you are stressed or anxious
• if you experience strong smells.

What increases my risk of morning sickness?

You are more likely to develop morning sickness if: 

• it is your first pregnancy
• you experienced nausea and vomiting in a previous pregnancy
• your unborn baby is a girl
• you have a family history of nausea in pregnancy
• you have a history of travel or motion sickness
• you get nausea when using contraceptives
• your BMI is 30 or higher
• you have a multiple pregnancy, such as twins or triplets.

Learn more

Vomiting in pregnancy Ministry of Health, NZ
Nausea and vomiting New Zealand College of Midwives, NZ
Nausea and morning sickness NHS, UK
Pregnancy – morning sickness Better Health Channel, Australia

References

1. Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis. J Am Board Fam Med. 2014 Jan-Feb;27(1):115-22

Resources for healthcare providers