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Coping with intense nausea
Q: My doctor prescribed a prenatal vitamin and a pill for nausea. One of the vitamin's side effects is nausea, so my pill should work for that. However, I've been throwing up to the point of losing my breath, and my pill doesn't seem to counteract it. My doctor said this is normal. However, with my first child, I threw up only in my third month. I'm now 15 weeks pregnant and have been throwing up since my sixth week. What can I do to keep from vomiting?
A: Morning sickness is common in 80% of early pregnancies. A much smaller percentage of women continue to have nausea and vomiting beyond the first trimester. It's important to assess the severity of your problem. Are you usually able to hold down your meals, with only a small amount of food loss during the day? Are you gaining weight appropriately and feeling well in general? Or are you vomiting after every meal, potentially causing dehydration, weight loss and nutritional deficiencies? If the latter is true, you must seek medical attention immediately. If your problem is less severe, try some of the following suggestions.

1) Since prenatal vitamins are one source of problems, I'd recommend stopping them for a week to see if your symptoms subside. Also, think about any other medication or supplements that could be playing a role in your nausea. If your nausea improves when you're off the prenatal vitamins, ask your doctor for another formulation or ask whether you could take folic acid alone rather than a multivitamin pill. If all vitamins cause nausea, your doctor may allow you to postpone taking them for several weeks.

2) Eliminate rich, oily, greasy, fried and acidic foods from your diet. Notice which foods are most easily tolerated and emphasize them in your diet. Eat small, frequent meals throughout the day, preferably before you feel hungry. Foods that are high in carbohydrates (bread, crackers, rice) are often preferable.

3) Ginger has been shown to be helpful in many cases. You could take ginger candy, ginger capsules or choose drinks containing ginger such as ginger ale and ginger tea.

4) Some women find that an acupressure point on the wrist is helpful to relieve nausea. An acupressure bracelet could ease your symptoms. It holds a plastic button against your acupressure point on the inside of your wrist.

5) A number of medications can be tried but only after careful discussion with your doctor. Over-the-counter treatments include vitamin B-6 and doxylamine succinate, the active ingredient of Unisom. Benadryl is sometimes helpful. Prescription drugs include Phenergan, Reglan, Zofran and Compazine. All of these medications have side effects and potential risks; your doctor can help you decide whether the possible benefits outweigh the risks.
Laura E. Stachel M.D. Obstetrician & Gynecologist