Women's responses to nausea and vomiting in pregnancy

Abstract

Objective

to explore women's experiences of nausea and vomiting in pregnancy.

Design

secondary (thematic) analysis of data collected by narrative interviews for two wider studies about antenatal screening and about pregnancy for the DIPEx website (www.dipex.org).

Participants and setting

a maximum variation sample was recruited throughout the UK. Data from the 73 women interviewed have been analysed. Interviews took place between October 2003 and December 2004, mostly in the home.

Findings

sickness is considered a typical and almost inevitable feature of pregnancy. Against this backdrop, a new framework for understanding women's responses to nausea and vomiting in pregnancy, and the meanings they attach to it, is suggested: nausea and vomiting as something to be expected, survived, resisted, resented, and acknowledged by others.

Key conclusions

the concepts of loss of self and biographical disruption from the field of chronic illness seem to resonate with the women's experiences, and may perhaps be extended to transient as well as chronic health conditions. People's experiences of their bodies in health as well as illness need to be more widely studied.

Implications for practice

many women would appreciate greater acknowledgement of the distress nausea and vomiting in pregnancy causes them, information about remedies and strategies other women have found helpful, and reassurance. Expressions of empathy by health-care professionals are frequently lacking and particularly desired.

Introduction

‘Morning sickness’ has become an almost ritualised part of Western expectations of pregnancy. In literature and the media, pregnancy is often heralded by the image of a woman retching in secret, or rejecting food and running from the table. The advent of home pregnancy testing kits may have added a new image of the woman holding the positive test stick out to her partner, but sickness remains a powerful marker of pregnancy in the popular imagination. In her study of Australian women's experiences of a first pregnancy, Schneider (2002) reported that two women in her sample ‘felt like frauds because they had not experienced nausea or vomiting’ (p. 243).

It is indeed a common experience, with some sources estimating that at least 80% of women experience a degree of nausea or vomiting in pregnancy, or both (Gadsby et al., 1993). Deuchar (1995) even goes so far as to argue that ‘while mild and moderate NVP [nausea and vomiting in pregnancy] can be viewed as physiologically and epidemiologically normal, both severe NVP and the total absence of NVP are probably abnormal’ (p. 8, our emphasis).

The causes of nausea and vomiting in pregnancy remain a contested area, and one which we do not propose to examine in detail here. It has been argued that sickness can be related to poor psychological adjustment to pregnancy or difficult family or sexual relationships, among other factors (Semmens, 1971; Deuchar, 1995). However, for most women, the notion that it is somehow ‘all in the mind’ is difficult to reconcile with the daily physical reality of sickness (O’Brien and Naber, 1992), and may lead to their symptoms being inappropriately dismissed by health professionals as trivial or attention-seeking (Munch, 2000).

Others argue that physiological explanations are also important, and that nausea and vomiting may even be a by-product of physical processes that help protect the foetus from rejection (Coad et al., 2000). Goodwin (2002) suggests that some women may have a genetic predisposition to nausea and vomiting, which means that pregnancy hormones are more likely to trigger sickness in them than in other women. Interestingly, Goodwin also identifies a potential but rather different psychological mechanism, namely ‘anticipatory nausea’. This has been well researched in studies of cancer chemotherapy, but not yet in pregnancy. In the same way that people expect (and fear) sickness after chemotherapy, normative cultural expectations of pregnancy may lead to a degree of anticipatory nausea: ‘I should feel sick, therefore I do’.

An additional factor affecting women's experience and perceptions of nausea and vomiting is the dilemma of treatment. The discovery that the anti-sickness drug thalidomide was causing fetal malformation in the 1960s led to extreme caution in prescribing drugs during pregnancy, and advice to pregnant women stresses that they should avoid medication of any sort. Both women and their professional carers may therefore assume there is nothing to be done about the sickness, and the consensus that it is a normal part of pregnancy reinforces this assumption. Yet, for women with more prolonged or severe sickness or hyperemesis, medical intervention may be essential.

In this paper, we propose a new framework for understanding women's responses to nausea and vomiting and the meanings they attach to it against this backdrop of sickness as a typical and almost inevitable feature of pregnancy. We then discuss these responses with reference to the concepts of loss of self and biographical disruption from the field of chronic illness.