Pregnancy nausea and vomiting--the role of the midwife.

Seventy five-80 per cent of pregnant women get some degree of nausea and vomiting of pregnancy (NVP) and it becomes severe in about 30 per cent of women with symptoms. Calling it 'morning sickness' is both inaccurate and damaging as it can be seen to trivialise the condition. Severe NVP can cause depression, feelings of inadequacy, loss of time at work, admission to hospital and termination of pregnancy. It is important for midwives to treat women with NVP with understanding and empathy, and for midwives to be able to assess women with NVP and refer for admission those developing hyperemesis gravidarm.

Blood tests for investigating maternal wellbeing. 4. When nausea and vomiting in pregnancy becomes pathological: hyperemesis gravidarum.

Nausea and vomiting in pregnancy (NVP) is commonplace, with many midwives frequently counselling women in their care. But how do midwives know when NVP becomes pathological? Although hyperemesis gravidarum (HEG) is less common, midwives must be able to recognise and differentiate between these two conditions, especially as HEG has the potential to have a detrimental effect on maternal and fetal wellbeing. The physiological impact of HEG is well documented but what often goes unacknowledged is the psychological, social, occupational and familial impact it also has on a woman's life. Knowledge about the aetiology of HEG and treatment options available is essential but a timely initial diagnosis is paramount. For this to occur the midwife must be skilled in history taking, clinical examination and utilisation of serum blood tests--specifically electrolytes and urea. An understanding of how electrolyte levels can cause pathology is vital if the midwife wishes to interpret blood tests for women with this condition.

Experience of Taiwanese women living with nausea and vomiting during pregnancy.

Two common symptoms of pregnancy are nausea and vomiting, which, for some women, cause great discomfort and profoundly impact daily life. A descriptive phenomenological method was used to understand how Taiwanese women deal with nausea and vomiting during pregnancy. A purposive sample of 10 expectant mothers participated in the study. A transcription of each informant's verbal description of her nausea and vomiting experience was made and analyzed using Colaizzi's phenomenological methodology. Four themes emerged from the interview data after inductively analyzing the narrative content concerning nausea and vomiting: 1) understanding nausea and vomiting, 2) finding coping strategies, 3) psychosocial adaptation, and 4) needing support. The results also indicated the importance of social support to pregnant women's health, including instrumental and emotional forms of support. Health professionals, however, were not mentioned in the mothers' narratives as a source of support. The issues of social support, language translation, and western and eastern perspectives on nausea and vomiting and cultural differences in perceptions of their severity are discussed.

Acupuncture for nausea and vomiting: an update of clinical and experimental studies.

The objective of this overview is to summarize existing knowledge about the effects of acupuncture-point stimulation on nausea and vomiting. Systematic reviews on postoperative nausea and vomiting, chemotherapy-induced nausea and vomiting, and pregnancy-related nausea and vomiting exist. Several randomised trials, but no reviews, exist for motion sickness. For postoperative nausea and vomiting, results from 26 trials showed acupuncture-point stimulation was effective for both nausea and vomiting. For chemotherapy-induced nausea and vomiting, results of 11 trials differed according to modality with acupressure appearing effective for first-day nausea, electroacupuncture appearing effective for first-day vomiting, and noninvasive electrostimulation appearing no more effective than placebo for any outcome. For pregnancy-related nausea and vomiting, results were mixed. Experimental studies showed effects of P6-stimulation on gastric myoelectrical activity, vagal modulation and cerebellar vestibular activities in functional magnetic resonance imaging. There is good clinical evidence from more than 40 randomised controlled trials that acupuncture has some effect in preventing or attenuating nausea and vomiting. A growing number of experimental studies suggest mechanisms of action.

Acupuncture versus pharmacological approach to reduce Hyperemesis gravidarum discomfort.

AIM: Several reports have suggested the use of acupuncture as a useful treatment for hyperemesis gravidarum (HG), in particular the effects on nausea intensity was underlined. The aim of this study was to compare the efficacy of acupuncture sessions plus acupressure with a metoclopramide/vitamin B12 treatment. METHODS: In this study we randomized 88 pregnant patients suffering from HG to receive either acupuncture sessions plus acupressure (acupuncture group) or metoclopramide infusion (metoclopramide group) supplemented by vitamin B12 complex. Somatic symptoms and the ability to achieve the daily routine activity (functioning) were evaluated. Acupuncture sessions were performed at the hospital twice a week for 2 weeks according to the traditional Chinese medicine criteria. Acupression was applied for 6-8 h/day. In the metoclopramide group, patients received at hospital metoclopramide infusion (20 mg/500 mL saline for 60 min) twice a week for 2 weeks. An oral supplementation with vitamin B12 complex (30 mg/day) was also prescribed. RESULTS: Both treatments reduced vomiting episodes and then nausea intensity with a consequent improvement in the rate of food intake. The effect of acupuncture seems to be progressive, increasing at the end of treatment whereas pharmacological approach has a prompt effect in responders remaining stable thereafter. Moreover, acupuncture was significantly more effective than drugs in improving functioning. CONCLUSIONS: In our study for the first time acupuncture, applied accordingly to Chinese formula, was compared to drugs demonstrating the same effect of both treatments on HG symptoms. Interestingly, functioning was significantly improved just by acupuncture. Even if the effect of acupuncture on HG discomfort remains to be confirmed, the reports on the effect of acupuncture on psychosocial variables could represent a further advantage of acupuncture application and provide an incentive to widen the base of the research.

The physiological basis of reflexology and its use as a potential diagnostic tool.

Ill-health changes the anatomy and physiology of affected organs, some of which can be observed visually, elicited through physical examination or confirmed through biomedical analysis. Understanding how anatomical changes contribute to physiological signs and symptoms will help practitioners identify the pathology, appreciate its origin and development and justify prescribed interventions in a way which can be upheld by critical external scrutiny. Reflexology contributes to an holistic approach to care and has recently improved its credibility as a discipline which supports orthodox care. Several research publications have identified possible theories and principles for the mechanism of action of reflexology, but more research to explain its contribution in identifying ill-health and diseases, as well as appropriate treatment modalities, is needed. This paper explores the physiological basis of reflexology, some of the theories for the mechanism of action and its potential as a diagnostic tool.

The use of CAM by women suffering from nausea and vomiting during pregnancy.

BACKGROUND: Nausea and vomiting during pregnancy (NVP) affects two-thirds of pregnant women to varying degrees and over the years many modalities have been used to try to alleviate this often debilitating condition. There is a paucity of information in the literature about the use or efficacy of complementary and alternative medicine (CAM) for the treatment of this condition that affects so many women. Our primary objective was to examine the prevalence of CAM usage by women suffering from NVP. Our secondary objective was to ascertain if women had any supervision in the use of these treatments. METHODS: Women who called The Motherisk NVP helpline, were asked after the counseling session to complete a questionnaire, which included demographic data as well as information about their CAM use. RESULTS: Seventy women completed the questionnaire. 61% reported using CAM therapies, of which the three most popular were: ginger, vitamin B6 and acupressure. 21% of those who reported using CAM, had consulted CAM practitioners, 8% their physicians or pharmacists and 71% discussed the usage with family, friends and other allied health professionals. Women who did not use CAM stated they would probably use these modalities if there was more information about the safety in pregnancy. CONCLUSION: Pregnant women with NVP are mirroring the trend in the general population of the use of CAM. They are also using CAM therapies with little supervision from practitioners experienced in the use of these modalities.

Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study.

Hyperemesis gravidarum, severe vomiting, develops in about 1-2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting. The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum. Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS). The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture. This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.

What do we know about herbal morning sickness treatments? A literature survey.

OBJECTIVE: A literature survey investigating the use of herbs to treat morning sickness, with particular reference to what is known about their safety. DESIGN: All major English language medical, nursing and scientific databases as well as 300 World Wide Web sites, Internet newsgroups, books and magazines were searched for information about the use and safety of herbs in pregnancy. FINDINGS: A search of medical databases failed to locate any articles which specifically reported investigations of the safety of herbs used during pregnancy. Of 300 non-medical sources studied 75 cited the use of herbs in pregnancy. The most commonly cited herbs for morning sickness were ginger, chamomile, peppermint and raspberry leaf (55, 37, 44 and 63% cited respectively). There was no consensus in the popular literature about whether or not each of these herbs was safe for use in pregnancy. Seven sources (6%) cited chamomile and peppermint as unsafe, while 16 (12%) cited the use of ginger and 11 (15%) the use of raspberry leaf as unsafe during pregnancy. CONCLUSIONS: Herbal remedies are often seen as safe, 'drug-free' treatments for morning sickness. However, the contradictory information and dearth of original research related to their safety indicates that these compounds should be used with caution.

Treatment of nausea and vomiting in pregnancy. When should it be treated and what can be safely taken?

Nausea and vomiting are both common in early pregnancy. Most cases are mild and do not require treatment. However, persistent vomiting and severe nausea can progress to hyperemesis if the woman is unable to maintain adequate hydration, and fluid and electrolyte as well as nutritional status are jeopardised. Hyperemesis gravidarum is a diagnosis of exclusion, characterised by prolonged and severe nausea and vomiting, dehydration, ketosis and bodyweight loss. Investigation may show hyponatraemia, hypokalaemia, a low serum urea level, metabolic hypochloraemic alkalosis and ketonuria. The haematocrit is raised and the specific gravity of the urine is increased. There may be associated liver function test abnormalities and abnormal thyroid function tests, with biochemical thyrotoxicosis with raised free thyroxine levels and/or suppressed thyroid-stimulating hormone levels. The pathophysiology of hyperemesis is poorly understood. Various hormonal, mechanical and psychological factors have been implicated. Studies have demonstrated a direct relationship between the severity of hyperemesis, the degree of biochemical hyperthyroidism and the levels of human chorionic gonadotrophin (hCG). Management of hyperemesis should include hospitalisation, intravenous fluid and electrolyte replacement, thiamine (vitamin B1) supplementation, use of conventional antiemetics and psychological support. Most patients improve spontaneously with the help of the above measures without long term sequelae. Conventionally, antiemetics are not usually prescribed, especially before 12 weeks gestation, except for women with hyperemesis. This reluctance relates to fears which are often unfounded concerning the teratogenic effects of antiemetics. Severe hyperemesis, refractory to conventional management with intravenous fluids and antiemetics is a rare, miserable and disabling condition, associated with multiple hospital admissions, time away from work and the family, and psychological morbidity. If inadequately or inappropriately treated, it may cause Wernicke's encephalopathy, central pontine myelinolysis and death. In extreme cases, women may request, or their obstetricians recommend, termination of the pregnancy. There are uncontrolled data supporting a beneficial effect of corticosteroids in these women, and a randomised placebo-controlled trial is currently in progress.