Forget 'Morning Sickness' -- Let's Talk About NVP

I thought that a woman found out she was pregnant because one morning, out of nowhere, she surprised herself by barfing. I was under the impression that pregnancy puking was an isolated, one-and-done kind of event and that the hard part of pregnancy came at the end, when a woman was huge and swollen and then ultimately, in labor.

Boy was I wrong.

Everyone in the world is a product of a woman’s discomfort and pain and we don’t talk enough about how much of that suffering comes in the first months of pregnancy—in fact, with the common use of the term “morning sickness,” we lie about it.

I am sensitive to those who would love the problems I’m describing. If you’re struggling to have a baby, I’m sorry that you’re going through such a heart-wrenching experience. If you’re a woman who didn’t have “morning sickness,” I’m jealous. If you’re having another child, however, you might not be so lucky the next time. Even if you were never pregnant, you were the result of pregnancy and women around you may likely at sometime be pregnant. Awareness of the physical and psychological difficulties of pregnancy is important for everyone to have so that we can better support women.

The term “morning sickness” is bullshit: a widely used, openly acknowledged misnomer. Women are sick morning to night. I have asked multiple pre-natal nurses and doctors to give me a medical term for this soul-crushing, constant queasiness and no one had an answer. Severe morning sickness, which is rare and requires hospitalization, is “hyperemesis gravidarum,” but your every day, run-of-the-mill, constant pukiness is just “morning sickness.”

One 2011 Gastroenterology Clinics of North America article refers to “morning sickness” as “nausea and vomiting of pregnancy (NVP),” but none of the doctors I’ve consulted had heard of the term. In their article, Drs. Noel M. Lee and Sumona Saha estimate that 70–80% of pregnant women experience NVP and that NVP isn’t confined to the first trimester. Symptoms of NVP peak between 10 and 16 weeks of pregnancy and are usually gone by 20 weeks. Up to 10% of unlucky women, however, are sick past 22 weeks.

For those who haven’t experienced NVP, let me fill you in. It’s as if the worst hangover of your life had a hate child with the stomach flu. Here’s how it goes (for me anyway, but I’m not an outlier): you wake up nauseated and exhausted. You spend your day nauseated and exhausted, randomly gagging and spitting in the street and in sinks because your body is producing extra saliva and drinking saliva when you are on the constant verge of puking isn’t awesome. You don’t want to talk/think about/look at/smell food, and yet you have to consume something to stay alive and to feed children, if you already have them (I smear Vicks VapoRub under my nose to feed my toddler buttered noodles).

Dehydration isn’t uncommon because of all the spitting/vomiting/aversion to liquids. You might sleep next to a bucket in case you puke in the middle of the night. Everyone suggests that you should “just eat some crackers,” and you want to kill them for it. This goes on for months.

It is problematic that there isn’t a more open dialogue about NVP. Women doing the physical, emotional, and mental work of creating new life need support. NVP is draining. I signed up for emails from a website that provides advice, community, and support to expectant parents. One of their recent emails included a depression-screening survey: “I have felt sad or miserable” (“Yes, quite often”). The screening “diagnosed” me with depression. Of course, it did. It’s hard not to feel depressed when you have a vomit hair-trigger for months.

Many women suffer NVP in silence. Because of fear of miscarriage, employer reprisal, or other idiosyncratic reasons, women often don’t tell people they’re pregnant until they’re out of the worst of NVP. Partners, family, and friends who do know should be aware of what women are experiencing during this time so that isolation doesn’t compound their physical discomfort and so they can better support a woman’s mental and emotional needs.

We should be teaching boys and girls, men and women, about NVP in sexual education classes so that people can make informed decisions about getting pregnant and better know what to expect when women become pregnant. I have talked to adult women who think “morning sickness” means women are only nauseated in the mornings. Minimizing the grueling reality of NVP is unfair to women who are experiencing it or may experience it.

Often a first pregnancy appointment isn’t until weeks 8-10 of pregnancy, leaving first time expectant mothers confused about whether their symptoms are “normal.” This confusion can send women straight to the Internet — the very worst place for a pregnant woman to be. Women might also want to try to make different life choices (if possible, which it often isn’t) if they have accurate information about NVP. A woman working in the food service industry, for example, might try to move into a different position or line of work before becoming pregnant if she understands that there is an 80% chance that the smell of food will make her want to vomit for the first 2-3 months of her pregnancy.

NVP should also be a part of the abortion debate. If a woman does not want to endure the very real physical effects of pregnancy—including NVP, which starts around weeks 5 or 6—she should have the choice to terminate the pregnancy. The medical symptoms and complications of pregnancy, including NVP, should not be downplayed or obfuscated as inconveniences. Women’s bodily autonomy needs to be respected.

Until we have policies and laws that better support families in America, it’s unlikely that working women will be able to come forward and be open about pregnancy during the period of time they are most struggling with NVP. In many instances, working women can’t stay home from work on days they feel ill and debilitated with NVP.

In 2017, USA Today reported: “Millions of Americans aren’t offered a single day off work following the birth or adoption of a child, and 1 in 4 new moms go back to work 10 days after childbirth.” Many women can’t use sick days even when they are acutely sick with NVP because they need to save them for when the baby comes, leaving women vomiting in work bathrooms and wastebaskets. (I’ve been there.)

In so many ways, we discount or dismiss women’s suffering. Continuing to use the term “morning sickness,” even though it is inaccurate and misleading is one way in which people, including the medical profession dedicated to serving women, fail to adequately address and recognize women’s health issues. Being more open about NVP, and dropping the term “morning sickness” is one small way we can start to better respect and appreciate the physical, emotional, and mental burden women carry as mothers.