Morning sickness

Morning sickness is the common name for nausea and vomiting during pregnancy. Despite the name, it can happen at any time of the day or night, and some people feel sick for much of the day.

It often begins early in pregnancy, usually between weeks 4 and 7. For most people it settles by 16 to 20 weeks, although it can last longer. Symptoms vary considerably. Some people mainly feel nauseous, some vomit, and others experience both.

If sickness is making it difficult to eat, drink or manage everyday life, you do not have to simply put up with it. A midwife or GP can assess your symptoms and discuss treatment.

What does morning sickness feel like?

Pregnancy sickness can range from occasional nausea to repeated vomiting. You may find that certain smells or foods suddenly make you feel sick, or that symptoms are worse at particular times.

The term “morning sickness” can be misleading because symptoms are not limited to the morning. RCOG uses the term nausea and vomiting of pregnancy and notes that symptoms can occur at any time of the day or night.

For some people, the symptoms are unpleasant but manageable. For others, they can interfere significantly with eating, drinking, sleeping, working and normal daily activities.

Feeling very unwell with pregnancy sickness can also affect your mood and emotional wellbeing. RCOG recognises that nausea and vomiting in pregnancy can affect work, home life and social life. If you are struggling emotionally as well as physically, tell your healthcare team.

When does morning sickness start and stop?

RCOG states that nausea and vomiting of pregnancy usually starts between the fourth and seventh week of pregnancy.

For most people, symptoms improve as pregnancy progresses. The NHS says morning sickness usually clears up by weeks 16 to 20. RCOG reports that symptoms have settled by 20 weeks in 9 out of 10 affected pregnant women.

Some people continue to experience symptoms beyond this point.

If vomiting starts for the first time after 16 weeks, RCOG advises that other possible causes should be considered. Speak to your midwife or GP if you develop new vomiting later in pregnancy rather than assuming it is morning sickness.

What causes morning sickness?

The exact reason some people experience more pregnancy sickness than others is not fully understood.

Hormonal changes associated with pregnancy are thought to play an important role. RCOG also notes research suggesting that genetic differences and levels of a hormone called GDF-15 may help explain why symptoms are more severe in some pregnancies.

Certain factors are associated with a greater chance of pregnancy sickness. RCOG notes that it is more likely if you have experienced it in a previous pregnancy or if you are expecting more than one baby.

None of this means you have caused your sickness through something you ate, did or failed to do.

What can help with morning sickness?

There is no single approach that works for everyone, and it may take some experimentation to find foods, drinks and routines you can tolerate.

The NHS and RCOG suggest measures that may help with mild pregnancy sickness, including:

getting enough rest, as tiredness can make nausea worse
avoiding foods or smells that trigger your symptoms
eating small amounts more frequently
choosing foods that are easier to tolerate
trying plain, carbohydrate-rich foods such as bread, rice, crackers, pasta or potatoes

NICE says ginger can be considered as a non-medicine option for mild to moderate nausea and vomiting if you would like to try it.

What feels manageable can change from one day to another. If your usual balanced diet becomes difficult for a while, focus on discussing persistent problems with your maternity team rather than feeling guilty about what you can or cannot eat.

Can you take medicine for morning sickness?

Yes. Anti-sickness medicines can be used during pregnancy when appropriate.

If lifestyle changes are not enough, or nausea and vomiting are interfering with your daily activities, speak to your GP or midwife. NICE recommends that healthcare professionals discuss the advantages and disadvantages of different anti-sickness medicines and take your preferences into account.

RCOG states that several anti-sickness medicines are available for nausea and vomiting during pregnancy. The right option depends on your symptoms and individual circumstances.

Do not start, stop or change medication based only on general online advice. Your GP, midwife or pharmacist can discuss which medicines are suitable for you.

What is hyperemesis gravidarum?

Hyperemesis gravidarum, often shortened to HG, is a severe form of nausea and vomiting in pregnancy.

RCOG describes HG as sickness severe enough to stop someone carrying out normal daily activities and prevent them from eating and drinking normally. It can cause dehydration and may require assessment or treatment in hospital.

Possible signs of dehydration include feeling very thirsty or dry, becoming drowsy or unwell, passing less urine, or having urine that becomes dark yellow or brown.

HG is different from having an unpleasant day of ordinary pregnancy nausea. If you are struggling to keep fluids or food down, losing weight or becoming dehydrated, seek medical advice.

Does morning sickness harm the baby?

According to RCOG, there is no evidence that mild to moderate nausea and vomiting has a harmful effect on the baby.

Severe pregnancy sickness is different. RCOG notes that severe nausea and vomiting or HG can be associated with a baby having a lower than expected birthweight, and additional growth scans may sometimes be offered.

If your sickness is severe, the priority is to get assessed and supported rather than trying to judge the severity yourself.

What if morning sickness is affecting everyday life?

Pregnancy sickness can be exhausting even if you are not vomiting constantly. Difficulty eating, unpredictable nausea and sensitivity to smells can make work, commuting, cooking and social plans harder.

RCOG specifically recognises the impact that pregnancy sickness can have on mood, work, home and social life.

Tell your midwife or GP if symptoms are stopping you from carrying out normal activities. You do not need to wait until you are severely dehydrated before asking about support or treatment.

If the experience is affecting your mental wellbeing, mention that too. Physical symptoms and emotional wellbeing both deserve attention.

When to get professional advice

Contact your midwife, GP or NHS 111 if you are vomiting and have very dark urine or have not passed urine for more than 8 hours, cannot keep food or fluids down for 24 hours, feel very weak, dizzy or faint when standing, have abdominal pain, have a high temperature, vomit blood or have lost weight. These are warning signs listed by the NHS that need medical assessment.

You should also seek advice if your nausea or vomiting is severe enough to stop you managing your normal daily activities, or if symptoms are not settling. RCOG advises contacting your GP or midwife when symptoms do not settle, and hospital assessment may be arranged if needed.

New vomiting that begins after 16 weeks should also be discussed with a healthcare professional because other causes may need to be considered.

Contact your maternity unit promptly for any urgent pregnancy concern. NHS 111 can advise if you cannot reach your maternity service or are unsure where to seek help. Call 999 in a life-threatening emergency.