As many as 80% of all pregnant women can experience some degree of nausea or vomiting during pregnancy – but how do you know if it is just morning sickness, or something more serious like hyperemesis gravidarum?
Listen as Gail McGillis, nurse with Allina Health Home Health – Mother & Newborn joins the show to provide us with the signs, symptoms and treatment options for those not-so-glamourous pregnancy moments.
Selected Podcast
Is My Morning Sickness Normal?
Featured Speaker:
Gail McGillis, RN – OB nurse
Gail McGillis is a Home Health – Mother & Newborn nurse. Transcription:
Is My Morning Sickness Normal?
Melanie Cole (Host): As many as 80 percent of all pregnant women can experience some degree of nausea or vomiting during pregnancy, but how do you know if it’s just morning sickness or something more serious like hyperemesis gravidarum? Today, my guest is Gail McGillis. She’s a nurse with Allina Home Health, mother of a newborn, who will provide us with the signs and symptoms of the difference between the hyperemesis and normal morning sickness. Welcome to the show, Gail. So tell us a little bit about what is the difference between morning sickness and HG or hyperemesis gravidarum.
C McGillis (Guest): Well, the biggest thing is the intensity and often the length of time. Morning sickness occurs in many of the pregnancies. It tends to be sometimes just nausea. People can eat off and on, snack throughout the day, and still gain weight and stay hydrated. They can drink fluids. They don’t usually get very dehydrated and they just can keep more down. But with the hyperemesis, it’s a smaller percentage. The patients that I talk with are so sick that I see some of the extremes and they almost always have severe vomiting. Many of them are dehydrated, needing IV hydration to help with that. For some reason, it’s harder to drink fluids than it is to eat food, but the nausea can be just overwhelming and constant all day long.
Melanie: Do we know what causes this?
C McGillis: No. There are various theories but there is no one “this is what causes it.” There are just too many things. A lot of people feel that the biggest part is just the hormone balance that’s so different in someone’s body.
Melanie: So does hyperemesis get better as the trimesters go along? Like usually with morning sickness, Gail, the first trimester, that’s kind of when it hits you and then it seems to taper off. Tell us a little bit about some of the symptoms and if they taper off as you’re more and more pregnant.
C McGillis: That’s really more individual. Some people do seem to get at times when a normal pregnancy, they would have hormone surges. If hormones especially are some of the reason they’re sick, they’re going to find that they’re much more intense. And I found over the years talking to people that we’re hitting a point where there’s more growth in baby and so now they’re feeling sicker again. Some just stay sick all the way through, there’s ebbing and flowing of that, but it’s so different for everybody it’s hard to tell. I’ve seen some that feel well enough to stop taking anything and then the other pregnancy, they kind of get hit again with the nausea and vomiting and not being able to drink. Others are on throughout their pregnancy, and depending on how they can handle the medication, they’ll do well and better and back and forth. So there’s somebody who’s doing well for a while. All of a sudden, they have that hit where they’re down again. You’re just not feeling great. There’s just not always reasons; it’s an ebb and flow for some people all the way through.
Melanie: So Gail, how does somebody know that they have HG? If they’re experiencing an increased heart rate, shivering, throwing up, they might think right away they have the flu.
C McGillis: And I think that does happen a lot. Typically, we see a lot of people with repeat pregnancies who will know right away “this is what it is.” Otherwise, they’re going in because they think they’ve got the flu. If it’s lasting any length of time longer than normal flu, their doctors are thinking, “Well, they’re pregnant. This might be the reason.” The shivering, I don’t see as much because I think that’s more of an early stage, but it’s the fact that they can’t keep fluids especially down, the food just tastes differently, or as soon as they’re eating, they are throwing up. The other thing is the weight loss. If they’re losing a percentage of their weight, that’s a real clue that this is hyperemesis, and after so much weight loss, you need to get in there and get them back up because you don’t want it to affect the baby’s growth.
Melanie: So can it affect the baby’s growth? Does this have any effect on the pregnancy?
C McGillis: It’s not something that I’ve seen a lot of because we try to check with patients after they have delivered and most of them do fine. The babies pretty much get what they need, but you find moms that feel that it’s difficult to be the mom they want to be while they’re pregnant to the baby that they’re growing, just like they feel that they’re not being able to spend the time thinking about what they can do for baby. It’s tough to be pregnant and feel that sick and enjoy being pregnant.
Melanie: Well, it certainly can make pregnancy very uncomfortable and difficult. So what can we do to really get some relief from HG?
C McGillis: Oh, one of the first things is to be hydrated. We found out that any medication that’s out there to be used works better if you’re hydrated. One of the first-line things that we often do is helping them out by letting them run IVs at home. And if they don’t have that option, if there’s not an agency where they are, a lot of times it’s going into an infusion center, maybe at the hospital. Or sometimes the freestanding urgent cares can do fluids for people – or even their clinic sometimes. But it’s routine, regular fluids every day. And then for a lot of people, for the food piece, it’s just grazing, eating something all the time. Many people say, “If I have something in my stomach, I do better.” And then the other thing is talking with their doctor. Sometimes people get very dizzy and lightheaded and if they can take a medication for that, that takes away some of the symptoms. Some people have excessive salivation. They are just always having a lot of saliva in their mouth and they’re spitting and they’re losing a lot of fluids by doing that. There are some things that can be done for that. They can always talk to their doctor about things. So it’s trying to take care of the symptoms. That’s really the best way to help people through this.
Melanie: And what about some alternative therapies? People think of chewing mint leaves or ginger tea or any of these things that are known to help with nausea.
C McGillis: Those are always good things to try. There are so many cases where there’s not just one therapy that works. There are several medications that are out there to use because one acts a different way than the other, so they work well together. It’s the same thing with some of those therapies. A lot of people, by the time I’m talking to my patients, they’ve already tried those things. But it’s sometimes a reminder that even on those days when it’s a little more tough to just maybe increase some of that to have it help out. The ginger tea is good. There are just so many things out that they can try. Some people just tell me what they’ve learned and I say then if that works, keep doing that food or that kind of thing if it’s something that their doctors have approved.
Melanie: When should you worry? When do you call your healthcare provider and say, “Okay, this is a little bit more severe than I thought”?
C McGillis: The biggest thing is when you are putting out urine, if it gets a strong odor or a strong, darker color, that’s the biggest sign that you’re dehydrated. It’s hard sometimes to gather how you feel and realize, “Oh, I’m not getting enough fluid.” You’re just thinking, “I am so sick.” But when you see that, that’s a sign you need to get in and get fluids or talk to your doctor about getting fluids. So it’s that. It’s just feeling you’re too weak to do anything and we see that a lot. People who are severely ill just don’t feel like they can even get out of bed and make it to the bathroom sometimes, or fix a meal. If they are needing help with these things, that’s a good time to say to the doctor, “I need to come in, be seen, what else can be done?”
Melanie: Does everybody get morning sick, Gail? There’s an old wives’ tale that if you’re morning sick, you’re having a girl, and if you’re not, you’re having a boy. Is there any truth to any of those kinds of things?
C McGillis: I don’t think there is. I think there’s always been a thought that having a girl increases hormones. I have talked with as many patients who were having boys that have morning sickness but not with their girls. So there are so many different reasons to have morning sickness or the hyperemesis. So it’s hard to tell that. For some people, it does seem to be that way but there are just enough differences out there that I don’t think you can say that. I’ve heard that maybe it means twins. Well, we don’t take care of that many people with twins but they are quite sick. So I think it’s one of those things that people always thought it would be nice to say that, especially someone who’s got three boys who’s hoping to have a girl. This is the reason but you never can be sure.
Melanie: No, you certainly can’t. And in just the last few minutes, Gail, would you give us some additional resources for women experiencing hyperemesis and your best advice for women that are newly pregnant and are starting to feel nauseous or sick and really what would you tell them if they came to see you?
C McGillis: If they were to call me, I would be saying, “Get in to see your physician.” Many of the physicians have nurses, nurse practitioners in the office who seem to have a lot of information at their disposal to be talking to people about that. Getting in to be seen, getting a baseline weight so people know if you’re losing or gaining, being very open to trying the different medications and things and seeing what will work, getting your family and friends to help you out. That’s a big issue for some people, getting help from people, being able to say, “I need help,” and “Can you do this or that for me?” Because that’s a very big thing, to tell your community to help you out with whatever you need.
Melanie: Thank you so much, Gail. It’s really great information for pregnant women, new mothers to be, and what an exciting time. For more information, you can go to allinahealth.org/homehealth or you can call (612)863-4478. You’re listening to the WELLcast with Allina Health. And as I said, for more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Is My Morning Sickness Normal?
Melanie Cole (Host): As many as 80 percent of all pregnant women can experience some degree of nausea or vomiting during pregnancy, but how do you know if it’s just morning sickness or something more serious like hyperemesis gravidarum? Today, my guest is Gail McGillis. She’s a nurse with Allina Home Health, mother of a newborn, who will provide us with the signs and symptoms of the difference between the hyperemesis and normal morning sickness. Welcome to the show, Gail. So tell us a little bit about what is the difference between morning sickness and HG or hyperemesis gravidarum.
C McGillis (Guest): Well, the biggest thing is the intensity and often the length of time. Morning sickness occurs in many of the pregnancies. It tends to be sometimes just nausea. People can eat off and on, snack throughout the day, and still gain weight and stay hydrated. They can drink fluids. They don’t usually get very dehydrated and they just can keep more down. But with the hyperemesis, it’s a smaller percentage. The patients that I talk with are so sick that I see some of the extremes and they almost always have severe vomiting. Many of them are dehydrated, needing IV hydration to help with that. For some reason, it’s harder to drink fluids than it is to eat food, but the nausea can be just overwhelming and constant all day long.
Melanie: Do we know what causes this?
C McGillis: No. There are various theories but there is no one “this is what causes it.” There are just too many things. A lot of people feel that the biggest part is just the hormone balance that’s so different in someone’s body.
Melanie: So does hyperemesis get better as the trimesters go along? Like usually with morning sickness, Gail, the first trimester, that’s kind of when it hits you and then it seems to taper off. Tell us a little bit about some of the symptoms and if they taper off as you’re more and more pregnant.
C McGillis: That’s really more individual. Some people do seem to get at times when a normal pregnancy, they would have hormone surges. If hormones especially are some of the reason they’re sick, they’re going to find that they’re much more intense. And I found over the years talking to people that we’re hitting a point where there’s more growth in baby and so now they’re feeling sicker again. Some just stay sick all the way through, there’s ebbing and flowing of that, but it’s so different for everybody it’s hard to tell. I’ve seen some that feel well enough to stop taking anything and then the other pregnancy, they kind of get hit again with the nausea and vomiting and not being able to drink. Others are on throughout their pregnancy, and depending on how they can handle the medication, they’ll do well and better and back and forth. So there’s somebody who’s doing well for a while. All of a sudden, they have that hit where they’re down again. You’re just not feeling great. There’s just not always reasons; it’s an ebb and flow for some people all the way through.
Melanie: So Gail, how does somebody know that they have HG? If they’re experiencing an increased heart rate, shivering, throwing up, they might think right away they have the flu.
C McGillis: And I think that does happen a lot. Typically, we see a lot of people with repeat pregnancies who will know right away “this is what it is.” Otherwise, they’re going in because they think they’ve got the flu. If it’s lasting any length of time longer than normal flu, their doctors are thinking, “Well, they’re pregnant. This might be the reason.” The shivering, I don’t see as much because I think that’s more of an early stage, but it’s the fact that they can’t keep fluids especially down, the food just tastes differently, or as soon as they’re eating, they are throwing up. The other thing is the weight loss. If they’re losing a percentage of their weight, that’s a real clue that this is hyperemesis, and after so much weight loss, you need to get in there and get them back up because you don’t want it to affect the baby’s growth.
Melanie: So can it affect the baby’s growth? Does this have any effect on the pregnancy?
C McGillis: It’s not something that I’ve seen a lot of because we try to check with patients after they have delivered and most of them do fine. The babies pretty much get what they need, but you find moms that feel that it’s difficult to be the mom they want to be while they’re pregnant to the baby that they’re growing, just like they feel that they’re not being able to spend the time thinking about what they can do for baby. It’s tough to be pregnant and feel that sick and enjoy being pregnant.
Melanie: Well, it certainly can make pregnancy very uncomfortable and difficult. So what can we do to really get some relief from HG?
C McGillis: Oh, one of the first things is to be hydrated. We found out that any medication that’s out there to be used works better if you’re hydrated. One of the first-line things that we often do is helping them out by letting them run IVs at home. And if they don’t have that option, if there’s not an agency where they are, a lot of times it’s going into an infusion center, maybe at the hospital. Or sometimes the freestanding urgent cares can do fluids for people – or even their clinic sometimes. But it’s routine, regular fluids every day. And then for a lot of people, for the food piece, it’s just grazing, eating something all the time. Many people say, “If I have something in my stomach, I do better.” And then the other thing is talking with their doctor. Sometimes people get very dizzy and lightheaded and if they can take a medication for that, that takes away some of the symptoms. Some people have excessive salivation. They are just always having a lot of saliva in their mouth and they’re spitting and they’re losing a lot of fluids by doing that. There are some things that can be done for that. They can always talk to their doctor about things. So it’s trying to take care of the symptoms. That’s really the best way to help people through this.
Melanie: And what about some alternative therapies? People think of chewing mint leaves or ginger tea or any of these things that are known to help with nausea.
C McGillis: Those are always good things to try. There are so many cases where there’s not just one therapy that works. There are several medications that are out there to use because one acts a different way than the other, so they work well together. It’s the same thing with some of those therapies. A lot of people, by the time I’m talking to my patients, they’ve already tried those things. But it’s sometimes a reminder that even on those days when it’s a little more tough to just maybe increase some of that to have it help out. The ginger tea is good. There are just so many things out that they can try. Some people just tell me what they’ve learned and I say then if that works, keep doing that food or that kind of thing if it’s something that their doctors have approved.
Melanie: When should you worry? When do you call your healthcare provider and say, “Okay, this is a little bit more severe than I thought”?
C McGillis: The biggest thing is when you are putting out urine, if it gets a strong odor or a strong, darker color, that’s the biggest sign that you’re dehydrated. It’s hard sometimes to gather how you feel and realize, “Oh, I’m not getting enough fluid.” You’re just thinking, “I am so sick.” But when you see that, that’s a sign you need to get in and get fluids or talk to your doctor about getting fluids. So it’s that. It’s just feeling you’re too weak to do anything and we see that a lot. People who are severely ill just don’t feel like they can even get out of bed and make it to the bathroom sometimes, or fix a meal. If they are needing help with these things, that’s a good time to say to the doctor, “I need to come in, be seen, what else can be done?”
Melanie: Does everybody get morning sick, Gail? There’s an old wives’ tale that if you’re morning sick, you’re having a girl, and if you’re not, you’re having a boy. Is there any truth to any of those kinds of things?
C McGillis: I don’t think there is. I think there’s always been a thought that having a girl increases hormones. I have talked with as many patients who were having boys that have morning sickness but not with their girls. So there are so many different reasons to have morning sickness or the hyperemesis. So it’s hard to tell that. For some people, it does seem to be that way but there are just enough differences out there that I don’t think you can say that. I’ve heard that maybe it means twins. Well, we don’t take care of that many people with twins but they are quite sick. So I think it’s one of those things that people always thought it would be nice to say that, especially someone who’s got three boys who’s hoping to have a girl. This is the reason but you never can be sure.
Melanie: No, you certainly can’t. And in just the last few minutes, Gail, would you give us some additional resources for women experiencing hyperemesis and your best advice for women that are newly pregnant and are starting to feel nauseous or sick and really what would you tell them if they came to see you?
C McGillis: If they were to call me, I would be saying, “Get in to see your physician.” Many of the physicians have nurses, nurse practitioners in the office who seem to have a lot of information at their disposal to be talking to people about that. Getting in to be seen, getting a baseline weight so people know if you’re losing or gaining, being very open to trying the different medications and things and seeing what will work, getting your family and friends to help you out. That’s a big issue for some people, getting help from people, being able to say, “I need help,” and “Can you do this or that for me?” Because that’s a very big thing, to tell your community to help you out with whatever you need.
Melanie: Thank you so much, Gail. It’s really great information for pregnant women, new mothers to be, and what an exciting time. For more information, you can go to allinahealth.org/homehealth or you can call (612)863-4478. You’re listening to the WELLcast with Allina Health. And as I said, for more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.