Morning misery

For Joeline Kuenkler, it was as if a switch had been flipped.

One day she was fine and then, six weeks into her first pregnancy, nausea and vomiting hit her with a hurricane’s vengeance.

“I just started throwing up quite a few times a day,” says Kuenkler, a 29-year-old Hayden, Idaho, resident.

A week later, she could no longer work and ended up taking what would become a six-week leave of absence from her job as a doctor’s office receptionist.

She couldn’t keep down water or vitamins, let alone food. She lost 10 pounds, became dehydrated and wound up being hospitalized for two days.

“There was always the fear of ‘I’m starving my baby and my baby’s not going to live,’ ” Kuenkler recalls. “I laid there on the couch trying to drink water and throwing that up, thinking ‘I’m going to lose this baby.’ “

“Morning sickness” sounds almost quaint, more of an annoyance than a real malady, like a hang nail or a splinter or a touch of a cold.

And for many women, that’s exactly what it is – an icky but quickly subsiding reality of early pregnancy.

In fact, about 80 percent of all pregnant women will experience some nausea and vomiting in the first trimester. (It’s called “morning sickness” because symptoms most often show up in the morning, when a woman’s stomach is empty.)

Most women just feel a little queasy, may vomit a few times, or have aversions to certain foods.

A little morning sickness is actually a good thing, experts say. It’s a sign that important pregnancy hormones are on the rise.

But for others, such as Kuenkler, morning sickness becomes the debilitating all-day sickness known as hyperemesis gravidarum. It can even last the entire nine months.

It’s estimated that 0.5 percent to 2 percent of all pregnant women suffer this extreme form of morning sickness, according to the American College of Obstetricians and Gynecologists. But some studies have indicated that as many as 10 percent of pregnancies lead to hyperemesis.

It’s the leading cause of hospitalization during early pregnancy and is second only to preterm labor as the most common cause of hospitalization during pregnancy, according to ACOG.

“It can range from mild and annoying to quite severe, where people actually have to be in the hospital on intravenous fluids,” says Dr. Anne Montgomery, who practices family medicine in Spokane at the Sacred Heart Maternity Clinic. “It’s all-day sickness.”

Montgomery knows her subject all too well. She was hospitalized for hyperemisis 15 years ago while pregnant with her son.

“Cream of wheat cereal and macaroni and cheese are what I lived on for 10 weeks,” she says.

There are a variety of ways to help alleviate the symptoms of morning sickness.

“The No. 1 thing is that they have to eat really small meals really often,” says Inga Arts, a certified professional midwife who operates Day Spring Midwifery Services in Hayden, Idaho. “Never let yourself get hungry. Don’t let that vicious cycle start.”

Arts suggest eating something with protein – a few nuts, a little cheese – every hour.

Drinking small amounts throughout the day also seems to work.

“The only thing that really seemed to help was my husband would make a smoothie-type drink,” says Jenny Piazza, a 29-year-old mom of two who lives in Hayden. “I would just sip on that all morning, sip on it little by little. It got worse when I didn’t eat.”

At Mother’s Haven, a store for moms and babies in Coeur d’Alene, owner Margaret Hildahl sells Preggie Pops and Preggie Drops, suckers and lozenges with natural ingredients to combat nausea. She also carries a new product, Morning Sickness Magic, a liquid that contains ginger, Vitamin B6, chamomile and folic acid.

And some women get relief from BioBands, a bracelet that hits pressure points on the wrist, she says.

“I’ve had people say, ‘That helped me by the time I got to the parking lot,’ ” Hildahl says.

Last year, ACOG released its recommendations for how best to treat nausea and vomiting in pregnancy.

The group urges doctors to take morning sickness seriously, as it can become worse if not treated promptly.

Taking a multivitamin before conception might decrease symptoms later on, ACOG says.

Taking Vitamin B6 or Vitamin B6 with an antihistamine should be considered the first line of defense once symptoms start, according to the group.

ACOG also considers ginger a safe option that may work in some women.

Several other anti-vomiting drugs, particularly Zofran, are used in severe cases, but there are concerns, of course, with taking any drug in pregnancy.

With hyperemisis, though, such drugs can be a lifesaver.

“You get so desperate,” says Kimber MacGibbon, of Boring, Ore. “You can’t function. You can’t take care of your family. You can’t take a shower. You can’t do anything.”

MacGibbon suffered through hyperemisis throughout her two pregnancies. After extensively researching the condition, she founded the Hyperemisis Research Foundation (www.helpher.org) in 2000.

“This is not psychological,” she says. “That’s something that was said around the turn of the century.

“We want women to know this is something serious. This needs to be taken care of. It does not need to be ignored.”

Along with feeling terrible physically, many women worry that severe morning sickness will hurt their babies.

In most cases, losing weight in the first trimester will not harm the fetus.

“They don’t need a lot of calories or anything,” Montgomery says. “They do need a lot of micronutrients.”

That’s why it’s important to try to take a multivitamin, even if it’s difficult to keep food down.

Extended dehydration can be dangerous for both mom and baby, though, so it’s important to contact your doctor if vomiting and nausea does not subside.

After surviving severe morning sickness in her first pregnancy, and giving birth to a healthy, 7-pound-4-ounce daughter at home 21 months ago, Joeline Kuenkler is now pregnant again.

Exactly six weeks into this pregnancy, the nausea and vomiting struck again, she says.

“I was nervous,” she says. “I was very nervous.”

She still got sick a few times, but nothing like her first pregnancy.

“I ate so much better, more whole foods and whole grains,” Kuenkler says. “The key for this pregnancy for me was eating a lot more whole, natural foods and eating constantly. I just find things that work for me.”

She’s due on Sept. 29 and feels well enough to work part time and take care of her young daughter.

“Every pregnancy is different,” she says. “I can’t tell you all the stuff I’ve done this time would’ve worked (the first time). You just try everything.”