Let's talk… nausea and vomiting in pregnancy.

For so many women it's one of the very first signs of pregnancy and it comes with a lot of questions. When will it start? When will it end? Is this normal? Should I be worried about my baby?

Before we go any further, there's one thing I really want you to know. Nausea and vomiting in pregnancy sits on a really big spectrum of normal. Some people never experience it at all. Some feel a little queasy for a few weeks. And others (like me) experience it very severely.

As a registered midwife and a mum who had hyperemesis gravidarum (HG) in both of my pregnancies, this topic is so close to my heart. So let's work through the most common questions, one at a time.

In this post, we will talk through:

• What causes nausea and vomiting in pregnancy
• How common it is (and why HG is likely more common than we think)
• When it usually starts and when it settles
• Whether it's just a morning thing
• Whether it's a sign your baby is healthy, and what it means if you don't have any
• Whether it can harm your baby
• The difference between morning sickness and hyperemesis gravidarum
• When to call your GP, midwife or hospital

What causes nausea and vomiting in pregnancy?

The honest answer? We still don't fully understand it.

What we do know is that it's linked to the hormonal changes of early pregnancy. More recent research has also pointed to a hormone called GDF15, which is made by the placenta. Research has also found that nausea and vomiting in pregnancy tends to run in families. So if your mum or sister had it, you may be more likely to experience it too. 

BUT there is nothing available at the moment that clearly tells us that if you have XYZ then you will definitely get nausea and vomiting during pregnancy.

What it isn't is a sign of weakness, or of anything you have done wrong. Your body is going through enormous changes and for many women nausea and vomiting is simply part of how their body responds to them.

How common is it?

Around 70% of pregnant women experience some nausea and/or vomiting, so if you're in it right now, you are far from alone.

Hyperemesis gravidarum (HG) is less common and is often quoted as affecting around 1–3% of pregnancies. But I believe the real number is likely to be higher than that.

HG often goes undiagnosed. Sometimes it's missed by healthcare professionals and sometimes mums themselves assume what they're going through is just normal pregnancy nausea and vomiting, without realising that how severe it is means it's no longer normal or that hyperemesis is even a thing.

Part of the challenge is that there are no specific guidelines on the diagnostic criteria for HG. The criteria used varies between healthcare professionals and researchers, which makes it much harder to get a clear picture of how many women are really affected.

This is exactly why I want to talk about the spectrum. Whether your symptoms are mild, moderate or severe, your experience matters and you deserve to be listened to.

When does it start and when does it usually settle?

For most people, nausea and vomiting starts somewhere between 4 and 10 weeks of pregnancy.

Many women find it starts to ease towards the end of the first trimester and for the majority it has settled by around 20 weeks.

But around a quarter of women still have symptoms later in pregnancy and for some it continues for the whole pregnancy. Yep, that was me 🙃

If yours is lasting longer than you expected, or it's getting worse rather than better, let your midwife or GP know so they can support you.

Is it just a morning thing?

Not at all! "Morning sickness" is a pretty misleading name.

Nausea and vomiting in pregnancy can happen at any time of the day or night. Some women find it's worst first thing in the morning, others notice it builds through the afternoon and evening and for some it's there all day long.

So if your morning sickness doesn't check the clock, you're definitely not alone, and it's completely normal.

Is it a sign my baby is healthy? And is it bad if I don't have any?

You may have heard someone say that feeling sick is a "good sign". There is some research behind this - a large study published in 2016 found that women who experienced nausea and vomiting in early pregnancy had a lower risk of pregnancy loss.

But please hear this: having no nausea is normal too.

Plenty of women have little or no nausea and go on to have healthy pregnancies and healthy babies. Not having symptoms is not a bad sign and it isn't something you need to worry about.

And if your nausea eases and you find yourself feeling unsure about it, that's okay too. Reach out to your midwife or GP, they are there to support you.

Every pregnancy is different, even for the same woman. This is one of those areas where there really is a big spectrum of normal.

Can it harm my baby?

This is such an understandable worry, especially when you're barely keeping anything down, so let's be really clear.

Regular nausea and vomiting in pregnancy, in most cases, will not harm your baby.

Hyperemesis gravidarum is different. HG can harm both you and your baby if it's left unmanaged. The biggest concern is when you are unable to keep any food or water down for long periods of time.

This is why it's so important to know the signs (I'll go through these below) and to reach out for help early. There is support available and the sooner you ask for it, the sooner you can start getting some relief.

What's the difference between morning sickness and hyperemesis gravidarum?

Morning sickness and HG are so often lumped in together, but they are completely different experiences.

Hyperemesis gravidarum is a potentially life-threatening pregnancy complication. The severe nausea and vomiting may cause weight loss, malnutrition, dehydration and debility (extreme physical weakness), and it may also cause long-term health issues for both mum and baby.

HG is often brushed off as "just morning sickness", but the reality is so much harder.

For me, pregnancy meant constant, unrelenting nausea and vomiting multiple times a day every single day from 5 weeks until birth. HG stole the joy I thought I would feel and left me feeling isolated, misunderstood and exhausted.

And the impact isn't only physical. A 2012 study looking at pregnant patients with HG found:

• 35.1% had mild depression
• 26% had moderate depression
• 17.8% had severe depression

This was significantly higher than in pregnant patients without HG, with the risk of depression increased 76-fold in patients with hyperemesis.

The impact of HG doesn't disappear the second your baby is born either. Over 50% of women have post-traumatic stress symptoms following an HG pregnancy, with approximately 18% of HG mothers meeting the full criteria for post-traumatic stress syndrome (PTSS). Some mothers were still showing symptoms of post-traumatic stress up to 7 years after their pregnancy.

I share these numbers because HG deserves to be taken seriously – by healthcare professionals, by the people around you and by you. If you're struggling, physically or emotionally, please tell your midwife or GP. You deserve support for both.

When should I call my GP, midwife or hospital?

Please reach out to your GP, midwife or hospital if you:

✔️ Can't keep food or fluids down

✔️ Are vomiting non-stop

✔️ Feel dizzy

✔️ Notice your urine is dark

✔️ Are losing weight

✔️ Find the nausea and vomiting is stopping you from getting through your day

It's also important to get checked if you have nausea and vomiting along with a fever, abdominal pain or a headache. These symptoms can point to something other than pregnancy nausea and vomiting, so they always need to be looked into.

Your GP can prescribe stronger anti-nausea medications, keep an eye on your hydration and nutrition, and recommend IV fluids if you're at risk of dehydration.

If you're not sure whether what you're experiencing is "bad enough", please reach out anyway. There is no prize for suffering in silence and asking for help early is always okay.

Final thoughts

Nausea and vomiting in pregnancy can look so different from one person to the next. Some sail through without a single queasy moment, some have a few rough weeks and some, like me, spend their pregnancy just trying to get through each day.

Wherever you sit on that spectrum, your experience matters. You deserve to be listened to, taken seriously and supported. 💕

If you're in it right now and looking for practical ways to make things a little more manageable, I've shared the tips that helped me in 10 Midwife-Approved Ways to Manage Nausea and Vomiting in Pregnancy.

And if you're navigating your first trimester and wondering what actually matters right now, my free guide I'm Pregnant! What Now? walks you through what to focus on now and what can wait.

Have you experienced nausea and vomiting in pregnancy? I would love to hear what it was like for you - share in the comments below.

I'm here for you,

Tam xx