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The Morning Sickness Companion

The Morning Sickness Companion

by Elizabeth Kaledin, Lynn Friedman

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It's frustrating and a nuisance--and it can be a major obstacle to experiencing the joy of pregnancy. But morning sickness doesn't always strike in the morning, and for many women it doesn't even strike--it's an ever-present part of their pregnancy, with symptoms ranging from mild nausea and exhaustion to crippling depression and physical illness.

We all know


It's frustrating and a nuisance--and it can be a major obstacle to experiencing the joy of pregnancy. But morning sickness doesn't always strike in the morning, and for many women it doesn't even strike--it's an ever-present part of their pregnancy, with symptoms ranging from mild nausea and exhaustion to crippling depression and physical illness.

We all know the standard suggestions--crackers and tea, Jell-O and ginger ale--but when they don't seem like enough, what can women really do to manage their symptoms and recover the happiness their pregnancy should bring? As debilitating as morning sickness is, we don't hear much about it. But finally, just when it seems as though there's nothing out there, women have somewhere to turn.

Elizabeth Kaledin's The Morning Sickness Companion is a book by and for women suffering morning sickness. Morning sickness is a reality of pregnancy--many women are affected--and this book is dedicated to them. It fills a major void in pregnancy literature, providing a brief history of morning sickness, all the latest scientific thinking, research on its emotional toll, and lots of reassuring tips and advice from other women about what they ate, how sick they really were, sources of relief, and how to survive, since the fact is it is nearly inevitable. Engaging, warm, often funny, and always informative, The Morning Sickness Companion offers women who are suffering the wisdom and comfort they really need.

Editorial Reviews

Publishers Weekly
Pregnant women will sigh with relief (likely in between retches and dry heaves) when they read Kaledin's breezy been-there, done-that look at an under-examined aspect of pregnancy. The medical correspondent for the CBS Evening News deftly dispels the myth of crackers as a panacea for morning sickness in the first few pages, and then goes to address other, ahem, misconceptions about the illness, including that it occurs only in the morning and that copious vomiting must harm a fetus. Beyond this, the book offers a slew of personal anecdotes from women who have suffered through what's known clinically as Nausea and Vomiting in Pregnancy (NVP), and some practical advice for coping with prolonged nausea: the suggested stretches with accompanying photos and the Morning-Sickness Survival Kit are especially useful. Readers looking for hard science, though, should turn elsewhere. While it contains some data and medical facts, "[t]he whole point of this book," as Kaledin puts it, "is to make people feel better." By that measure it succeeds: those who are already expecting will appreciate the sisterly reassurances, while those who are still considering pregnancy will wonder why this grittier side of the nine-month glow is rarely discussed. The structure is somewhat loose, and the proliferation of bold words in capital letters followed by exclamation points seems at times a bit, well, hysterical, but this is nevertheless a valuable collection of advice, ideas and plain, old-fashioned sympathy. (Apr.) Copyright 2003 Reed Business Information.

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The Morning Sickness Companion

By Elizabeth Kaledin

St. Martin's Press

Copyright © 2003 Elizabeth Kaledin
All rights reserved.
ISBN: 978-1-4668-8256-0


So You're Starting to Feel a Bit Queasy

The term "morning sickness" was probably coined by a man. Perhaps he only saw his wife vomiting on his way to work in the morning and was oblivious to her suffering the rest of the day.


Talk about a rude awakening! You're still basking in the new and miraculous knowledge that you're pregnant — dreaming of little booties, and chubby cheeks smeared with strained sweet potatoes — when all of a sudden, you wake up one morning and just the thought of a cup of coffee leaves you feeling clammy and nauseous. Your first thought (poor deluded soul) is that maybe you have the flu. Wrong. Guess what: it's morning sickness, and it's here to stay for a while. It's a queasiness that instead of getting over, you're going to have to get used to.

Now let me say from the outset that morning sickness is different for every woman. Though it's estimated that anywhere from two-thirds to three-fourths of all pregnant women suffer some degree of pregnancy-related nausea or vomiting, no two women I have spoken to shared the exact same experience. In general, it strikes at about six or seven weeks, and in general, it starts to go away by about week twelve. Some women feel only a persistent but mild queasiness. Some women vomit every single day. Some women have to be hospitalized with a serious condition called Hyperemesis Gravidarum. And then, curiously enough, some women don't get it at all. Not even a hiccup. We hate them. (Allright, perhaps "envy" would be a more charitable word. But we secretly hope their labor and delivery lasts for days!)

The reality is that what we know about morning sickness pales in comparison to what we don't know. In fact, there's so little hard, empirical data on the topic that you might think morning sickness is a medical mystery. There are several reasons for this. First, it's a woman's problem. I don't mean to be cynical here, a basher of the male medical establishment, but even male doctors have told me that if morning sickness happened to men, we'd know a lot more about it by now. Second, studying, researching, and testing pregnant women presents many ethical problems. We can't recreate symptoms of nausea and vomiting in human subjects to see how they work and how to modify them. Third, nausea, like pain, is a highly subjective phenomenon and very difficult to measure in a meaningful way. And fourth, we know that morning sickness most often signifies a viable pregnancy leading to the birth of a healthy baby, so there's little incentive and few research dollars — in a world plagued by cancer, Alzheimer's disease, and AIDS — to study it in depth.

Research has also been hampered by the fact that there is no good animal model to study. Whether you're an animal-rights person or not, the truth is that when it comes to great medical discoveries, some animal in some lab somewhere has made the sacrifice for we humans. But so far, a kindred animal suffering morning sickness has yet to surface. Apes have not provided reliable information when monitored in captivity, because their diets are controlled by people. And according to Jane Goodall — who devoted an entire career to observing chimpanzees, our closest relatives, in the wild — there's little to suggest that pregnant females are ill. There is anecdotal evidence that when domestic dogs become pregnant, their appetites drop significantly around the third week, but this has not been substantiated. We are on our own, at least as a species.

We can take some comfort in knowing that morning sickness is a global phenomenon. Women in unheard-of nomadic tribes and in industrialized superpowers can become members of a new U.N.: that is, United in Nausea. To the!Kung San hunter-gatherers of the Kalahari Desert, the first sign of pregnancy is the onset of vomiting and the unexplained dislike for certain foods. Japanese women suffer the highest reported rates of morning sickness in the world. Though no two women may have the same experience, and it varies from culture to culture and country to country, it is everywhere!

Because of a lack of hard, scientific data, there's plenty of morning-sickness folklore. The first legend, of course, is that crackers make it go away. Another tall tale is that you can determine the sex of your child by the severity of symptoms. Depending on who you talk to, girls cause more trouble than boys. A survey of more than three thousand Swedish women found that those with the most severe form of morning sickness, known as Hyperemesis Gravidarum, had more female infants. There is no study showing a link between male infants and morning sickness. I have one of each and was much sicker with my son.

And, of course, if there's one whopper of an untruth, one myth that must be debunked, it is that morning sickness happens in the morning. Nothing could be further from the truth. Studies show that fewer than 2 percent of women have symptoms only in the morning. If you're like me, the late-afternoon into early evening hours are intolerable, making dinnertime an utter chore. Other women feel a gnawing nausea at all hours, to be relieved only by sleep. Morning sickness became known as "morning sickness" because the stomach is emptiest in the morning, when stomach acids are believed to make nausea and queasiness more potent. But in fact, many women report that the symptoms are exacerbated by stress and fatigue, which often make it worse later on in the day.

Attempts have been made to give it a new name. Pregnancy sickness is one. Vicki Iovine, in her book The Girlfriend's Guide to Pregnancy, calls it "progesterone poisoning," but it's not really the progesterone that's causing the problems. The medical establishment, never too quick with a catchy phrase for the lay public, has come up with Nausea and Vomiting in Pregnancy, or NVP. A little clinical. Some have suggested pregnancy wellness and pregnancy insurance, since research has now linked morning sickness with a decreased risk of miscarriage and with one of the first signs of a healthy pregnancy.

But nothing really sticks like calling it plain old-fashioned morning sickness, so for the purposes of historical continuity and name recognition, I am titling this book The Morning Sickness Companion. But let's be clear: it's not happening in the morning, and — perhaps most important — you're not sick! In fact, though you may not believe it during these grueling, horrid months of vomiting, strange cravings, and powerful aversions, if there's one thing we do know for sure about morning sickness, it is that it means you are quite well. Your body is functioning beautifully.


It's Just Hormones

I was very emotional. Getting stuck in traffic would put me in tears ... then I'd laugh at how silly I was for crying. I felt all alone at times.


I don't know about you, but I tend to bristle at the notion that when women are having problems in life, it's always blamed on hormones. It's as if we can't control our emotions and behavior but are slaves to a complex and fickle chemical soup bubbling through our veins, making us crazy or weepy or bitchy or sleepy. Last time I checked, men had endocrine systems, too! But here's one case where hormones can take the rap, and I'm okay with it.

We can map the human genome, clone sheep, and send an e-mail to Timbuktu, yet no one knows for certain what causes morning sickness. There are simply too many ethical constraints involved in doing research on pregnant women, so in fact, we may never know the exact mechanism. But we do know that there are more than thirty hormones involved in maintaining a healthy pregnancy. Among the most notable and notorious: estrogen, progesterone, and HCG (Human Chorionic Gonadotropin). HCG, known as "the pregnancy hormone," is the stuff that turns the little pink line in your home-pregnancy test pink and starts to run amok the second an egg is fertilized and implanted in the uterine lining. It is well documented that the early weeks of pregnancy are accompanied by a sharp increase in levels of HCG in the blood, and starting around week twelve, the end of the first trimester, the levels begin to decrease. The spike and subsequent lull of HCG so perfectly parallel most bouts of morning sickness that most doctors believe HCG is the main culprit. Estrogen and progesterone are also highly suspect and responsible for other symptoms: breast tenderness, the one-degree temperature elevation associated with pregnancy, and an increased risk of blood-clot formation, to name a few. As I said, we don't know for a fact that HCG is causing all the nausea and vomiting, and we don't really know how it works, either. Some speculate that HCG upsets the gastrointestinal tract. Others believe the hormones are meddling with the vomiting centers of the brain, or the vestibular canals in the ear that regulate balance and equilibrium. We just don't know, but in this poorly understood phenomenon, hormonal havoc in the name of HCG is the best explanation medicine has to offer.

For years, before the hormonal links emerged, the prevailing wisdom (if you can call it that) was that morning sickness was caused by psychological problems. Women complaining of nausea and vomiting during pregnancy were thought to be either rejecting their pregnancies, rejecting their femininity, depressed about an unplanned pregnancy, too dependent on their mothers (my favorite wacky theory!), or repulsed by the idea of sex, marriage, and childbearing. Believe it or not, these neurosis-based theories remained popular until the mid-twentieth century. Some people still believe it's all in our heads.

Once the body became suspect, all kinds of potential causes were floated. There was a belief that morning sickness was the result of problems with the reproductive system such as endometriosis, deep cervical tears, and "incarcerated retroflexed uteruses," which, I guess, had to be freed from jail in order for the symptoms to go away.

So here we are in the twenty-first century, blaming hormones, and of course, the placenta, which excretes them. The problem is that because women differ hormonally and their reactions are so variable, as we've mentioned, no two women will have the same experience; morning sickness is nearly impossible to generalize. No matter how many "books" and "experts" say you should be feeling better right around week twelve, you may not be. In fact, some doctors believe the average time frame for symptoms to go away is more like seventeen to eighteen weeks. Or, if you're one of the unfortunate ones like me, you may feel nauseous and rotten well into your sixth month, and have that awful taste in your mouth right up until the moment your cherub appears. Or maybe you're carrying twins or more! Your morning sickness may be doubly bad for twice as long.

What I'm getting at is, don't mark the calendar and expect that on the morning of the first day of your thirteenth week, you are going to wake up and want that cappuccino. That's what I did, and it only led to a lot of dashed hopes and unmet expectations: never good things on the best of days, let alone when you are chronically on the verge of vomiting. Let your hormones and your body do their thing, and don't feel bad that you continue to feel bad. It's not unusual.


What's Normal?

The emotional toll was overwhelming. I remember attending the first-time parenting class with my husband and ten other couples. I was the only one there who did not enjoy being pregnant, because I was so sick. I thought at least one other first-time mom would empathize with me; certainly I couldn't be the only one. But I was. And that was a very lonely feeling.

— ANN F.

Here's another myth about early pregnancy if you're a morning sickness sufferer. You may be perfectly healthy, but there is no glow. Glow? I think that if I was ever glowing, it was from the beads of perspiration constantly bursting out on my brow and upper lip as I fretted about where I would be able to puke in public without completely humiliating myself. I was more a shade of dull grayish green those first few weeks. There were days I was so miserable I had to wonder: is it normal to be so sick? Am I hurting the baby with all this nausea and vomiting and the unrelenting craving for Blimpie's turkey subs? The answer is, it is normal. And you will not hurt the baby by subsisting on cheeseburgers for four months if that's what helps. Morning sickness has, after all, been around for a while. It was described in detail as early as the first century A.D. by a Greek physician, Soranus of Ephesus. He wrote:

... those with this condition are affected with the following: a stomach which is upset, indeed full of fluid; nausea and want of appetite, sometimes for all, sometimes for certain foods. Appetite for things not customary like earth, charcoal, tendrils of the vine, unripe and acid fruit; excessive flow of saliva, malaise, acid eructation, slowness of digestion and a rapid decomposition of food.

Other than wanting to eat earth and charcoal (which some women really do in a rare condition called "pica"), does this sound like you? I find it amazing and quite comforting that as long as two thousand years ago, pregnant women were experiencing the same misery ... with no ginger ale and crackers to fall back on.

Things haven't changed much. Here is the modern list of basic symptoms you are likely to experience if you have garden-variety morning sickness. You may have some of them, or, God help you, all of them. And remember, they will vary in degrees from woman to woman, so run everything you are feeling by your doctor!

Are we having fun yet?

Abdominal pain and tenderness, fever, and headache are not considered typical symptoms of morning sickness, and if you are experiencing these things, you should see your doctor.


If are you vomiting all day long and unable to keep any food down, you may have a condition called Hyperemesis Gravidarum: an extreme form of morning sickness that afflicts about 1 percent of pregnant women. THIS IS NOT NORMAL OR HEALTHY, AND YOU SHOULD SEE YOUR DOCTOR RIGHT AWAY. How do you know if you have hyperemesis and not an average case of morning sickness? Other than the obvious inability to keep any food or liquid down, the first measurable sign of a serious problem is weight loss of greater than 5 percent of your pre-pregnancy weight. Pregnant women should always be steadily gaining weight, not losing it. Also, your doctor should do tests to see if there are ketones in your urine. Excessive ketones in the urine (known as ketonuria) are a sign that the body is not using carbohydrates from food for fuel and instead, is trying to break down fat for fuel. Ketonuria is often the first physical symptom of starvation.

Left untreated, hyperemesis can lead to dehydration, electrolyte imbalances, neurologic problems, liver and kidney damage, and yes, even death for the mother, although that is very rare in this day and age. In the old days, not only did women die during childbirth, but many died as a result of hyperemesis as well. Charlotte Brontë, the British author of Jane Eyre, is said to have died of hyperemesis. And although hyperemesis has been associated with an increased risk of fetal loss and low birth weight, it is generally considerred more of a risk to the mother than to the unborn baby.

No one is quite sure what causes hyperemesis. Some believe that if morning sickness were graded on a bell curve, the women with hyperemesis would simply represent the worst possible cases. It is seen more often in first pregnancies and in pregnancies of multiple babies, i.e., twins and triplets. Because it can be very serious, hospitalization and intravenous hydration are often necessary, but several doctors with whom I have spoken assure me that the condition is easily recognized and that treatment is available and effective. There are drugs on the market that can control the vomiting and are considered safe for the baby. (More on that in the chapter on treatment.) I want to emphasize that most of the information in this book may not apply to women with hyperemesis. I am trying to provide tools for managing the average case of morning sickness, but the most severe cases will need constant medical intervention.


Excerpted from The Morning Sickness Companion by Elizabeth Kaledin. Copyright © 2003 Elizabeth Kaledin. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Meet the Author

Elizabeth Kaledin is the medical correspondent for CBS Evening News with Dan Rather. Prior to covering medical news, she was a general assignment reporter in CBS's northeast bureau starting in 1996. She lives in New York City with her husband and children.

Elizabeth Kaledin is the medical correspondent for CBS Evening News with Dan Rather. Prior to covering medical news, she was a general assignment reporter in CBS’s northeast bureau starting in 1996. She lives in New York City with her husband and children.

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