How to use the personalised care and support plans
Personalised care and support plans help you to explore, understand and record your individual choices for pregnancy, birth and early parenthood.As you work your way through the personalised care and support plans, refer to the revelant sections in the app. You can change your preferences at any time.Your midwife and/or doctor can help you to complete or adapt your personalised care and support plans at any point, and you are encouraged to share your plans and preferences with them throughout pregnancy.It is important to remember that a plan is just that – and that things may need to be reviewed and changed around your needs and the needs of your baby, to ensure care is always high quality and safe.You can print out your personal care and support plan(s) and keep them with your maternity notes, and share them with your maternity team as you wish.
Nausea and vomiting are common symptoms of pregnancy and affects 8 in 10 women. It usually starts early in pregnancy and resolves by the end of the first trimester, although in some cases it can last for longer. Some women have more severe symptoms, particularly if:
they had it before: or
are having multiple pregnancy like twins or triplets; or
an uncommon condition known as a molar pregnancy.
Sometimes the symptoms of nausea and vomiting are due to causes such as infection of your bowel, kidney or appendix, or inflammation of your stomach. It is important that these other causes are excluded particularly if you have unusual symptoms such as fever, blood in your vomit, abdominal pain, or loose stools. It is important to consider these other causes if your symptoms only start after your 11th week of pregnancy.
What is Hyperemesis Gravidarum (HG)?
This a severe form of nausea and vomiting in pregnancy, where you become dehydrated, lose a significant amount of weight, and have abnormal blood tests. It may affect 1 to 3 in 100 pregnant women. Women with this condition may need to be attend hospital for rehydration. For many women, HG settles by 20 weeks (5 months) but occasionally it can last until the end of pregnancy.Nausea and vomiting of pregnancy can sometimes affect your mood and all aspects of your normal day and home life. In some women, the symptoms can be so severe that they become depressed and need extra support such as counselling. If you find that you persistently feel down then you should seek help and speak to your GP, midwife or local Early Pregnancy Unit (EPU).
What treatment do I need?
Most women with mild symptoms will be able to manage their symptoms themselves. You should eat small amounts often and avoid any foods or smells that trigger symptoms. Some women find eating or drinking ginger products helps. Complementary therapies such as acupressure or acupuncture may also be helpful.If this does not help, you should see your GP, who will prescribe anti-sickness medication. These are safe to take in pregnancy.If your symptoms do not settle despite oral anti sickness medication, and you have any of the following symptoms, you should attend your local Accident and Emergency (A&E) department or speak to the EPU at your local hospital:
You are not able to tolerate any food or water.
You feel dehydrated (thirsty, dry mouth, dark urine).
You have lost weight (losing 5% or more of your pre-pregnancy weight is a concern).
You have fever, blood in your vomit, abdominal pain, or loose stools.
You have a medical condition which requires you to take tablets you can no longer take due to vomiting e.g anti-epileptic drugs.
You have a medical condition such as a heart or kidney problem or diabetes.
In the hospital, you will be offered fluids through a drip as well as anti-sickness medication through a drip or as an injection. If these have not helped after regular use, corticosteroids may be added to your treatment, also through a drip. You may also be given some vitamin replacement drips and a blood thinning injection to reduce your risk of blood clots. You will also have some blood tests done and your urine tested to look for infection and to see how dehydrated you are.If you feel better with these, you can go home and return the following day for some more fluids and medication. This can be continued on a daily basis and avoid the need for admission. But if you are very unwell with your symptoms, you may be offered admission for closer monitoring and treatment.You will also be offered a non-urgent early pregnancy scan to check if you have a multiple pregnancy, or a molar pregnancy.
What will this mean for future pregnancies?
You are at a higher risk of developing this in future pregnancies, so do seek help early if you find that you are struggling with your symptoms.
Where can I find out more information about this condition?
Normal pregnancy sickness is short spells of nausea and occasional vomiting usually during the early stages of pregnancy. It is common in many pregnancies, normally beginning around 4-6 weeks and eases between 12-20 weeks. It can affect you at any time of the day or night, and some people feel sick all day long. It is usually well managed through diet and lifestyle changes. In general, there are no bad physical or mental side effects as it’s a normal part of pregnancy.
Coping strategies
If your sickness isn’t too bad, you can try some lifestyle changes:
Get plenty of rest as tiredness can make nausea worse.
Avoid foods or smells that make you feel sick.
Eat dry toast or a plain biscuit before you get out of bed.
Eat small, frequent meals of plain foods that are high in carbohydrate and low in fat (such as bread, rice, crackers and pasta).
Eat cold foods rather than hot ones if the smell of hot meals makes you feel sick.
Drink plenty of fluids, such as water (sipping them little and often may help prevent vomiting).
When to seek help
When your quality of life is being affected and you’re not able to manage your usual activities
If your symptoms are much worse than you were expecting them to be
If you are not keeping down any food or drink, or only a very small amount
If you’ve lost weight
If you have signs of dehydration such as dry mouth, dry lips, headaches or feel dizzy, weak or confused. Changes in urine (wee) being darker, not going as much or only weeing a small amount.
Please see the following information about Hyperemesis Gravidarum if you suspect you are suffering with a more severe form of pregnancy sickness.
What is Hyperemesis Gravidarum?
Hyperemesis Gravidarum (HG) is severe sickness and nausea in pregnancy where medical treatment and emotional support is needed. It can lead to a lot of weight loss and dehydration. Around 10,000-20,000 pregnancies a year are affected by this condition. It can start very early, even before a positive pregnancy test. Symptoms are usually the worst at 9-13 weeks, and get a bit better around 16-24 weeks, but it can go on all the way through the pregnancy for some people.
When to seek help
If you are being sick often and cannot keep food down, tell your midwife or doctor, or contact the hospital as soon as possible. There is a risk you may become dehydrated, and it is important you get the right treatment as soon as possible.You should always seek help if you suspect you have HG, or severe nausea and vomiting, or if you have any of the following symptoms:
Prolonged or constant nausea and/or vomiting affecting your day-to-day activities, like being about to go to work, look after your home or other children, or look after yourself.
You have signs of dehydration, such as a dry mouth, dry lips, headaches, dizziness, weakness, feeling confused. If your wee changes, for example if it is darker, you are not going as much, passing only a small amount.
If you’ve lost weight, this could be an indicator of HG.
Your symptoms are affecting your mental health and you are struggling to cope.
If you have had HG before, unfortunately, it’s likely you will get it again in another pregnancy. If you decide on another pregnancy, it can help to plan ahead, such as arranging childcare so you can get plenty of rest. Talk to your GP about starting medicine early. Medication can be prescribed before symptoms even begin.
Other symptoms of HG:
Sensitive to smells
Excessive saliva production
Headaches and constipation from dehydration
Loss of bladder control
Tiredness
Acid reflux
Sensitive to lights/noise/movement
Coping strategies
Rest! There may be times where symptoms have eased and you feel like you can do more, but it’s important to still rest as much as possible.
Avoid triggers of nausea as much as possible. If that means avoiding cooking and being as far away from the kitchen as possible while someone else is cooking, then that is what you must do. It’s okay to ask that your family, colleagues or friends avoid certain foods whilst you are around them. Other sensory stimulation such as noises, moving, screens, or bright lights may be triggers too and should be avoided if they make your symptoms worse.
Try to avoid getting dehydrated. If drinking triggers vomiting or nausea, then sucking ice cubes made of juice or drinking very slowly through a straw may be the only way to stay hydrated. Bottled water may taste better than tap water. If you can’t keep fluids down, then be prepared for a hospital admission to have fluids through a drip. This is vital for you and your baby’s health and can make you feel much better.
Keep a diary. Tracking your food and drink intake will be helpful for the doctor to assess what treatment you need and for you to see if you have any food triggers. Tracking your symptoms may show a pattern and show you when is the best time to eat. It can also help you prepare for when you know your symptoms will be worse.
There are several effective anti-sickness medications that can be taken in pregnancy, if needed. Hyperemesis Gravidarum (HG) is usually worse in the first trimester and it is important medication is started without delay.Most effective medications for nausea and vomiting are not licensed in pregnancy. This does not mean the medication is unsafe or can’t be used. Taking medicine in pregnancy is about weighing the possible benefits of the medication with the possible risks of either taking the medication or leaving the person without treatment. It is important to remember that untreated HG can be dangerous for mum and baby so generally, the benefits of taking medication outweigh any possible risks.Taking more than one type at a time can be more effective. There isn’t a cure, but you should know within 48 hours if the medication that you have been prescribed is helping or not. If the medicine isn’t helping enough, then you can go back to your GP to talk about what other medicines you could try.
Having a good support network can really help some of the physical and emotional symptoms of Hyperemesis Gradidarum (HG).Making sure you have supportive people who can help you at home and help you take care of yourself and other children you may have can relieve a lot of the stress that having HG is likely to cause. It can be hard to ask for help but it is important to remember that HG is a serious illness and, if your friend had it, you would want to help them, so ask for help and let other people help you.You’re likely to need time off work when suffering with HG and your employer has a duty of care to support you with this. Sick leave for pregnancy conditions must be recorded separately and you cannot lose your job because of pregnancy sickness.Pregnancy Sickness Support have a confidential forum where you can chat with other people who have suffered with pregnancy sickness or HG. The charity offers a helpline or webchat where you can get more specific information about the medication options, services in your area and self-help strategies.You can also get peer support from Pregnancy Sickness Support by calling the helpline: 07899 245001 Mon-Fri 9.00-17.00.
Having a good support network can really help some of the physical and emotional symptoms of Hyperemesis Gradidarum (HG).
Making sure you have supportive people who can help you at home and help you take care of yourself and other children you may have can relieve a lot of the stress that having HG is likely to cause. It can be hard to ask for help but it is important to remember that HG is a serious illness and, if your friend had it, you would want to help them, so ask for help and let other people help you.
You’re likely to need time off work when suffering with HG and your employer has a duty of care to support you with this. Sick leave for pregnancy conditions must be recorded separately and you cannot lose your job because of pregnancy sickness.
Pregnancy Sickness Support have a confidential forum where you can chat with other people who have suffered with pregnancy sickness or HG. The charity offers a helpline or webchat where you can get more specific information about the medication options, services in your area and self-help strategies.
You can also get peer support from Pregnancy Sickness Support by calling the helpline: 07899 245001 Mon-Fri 9.00-17.00.
