Transcript

Anne Nicholson Weber: 00:01:00 Our topic today is morning sickness and the less common, more extreme condition called hyperemesis gravidarum. My guests are four experts who bring quite different perspectives to this topic. Ashlie Martin is a licensed acupuncturist and national board certified herbalist, practicing traditional East Asian medicine. Her practice is called Moon Hill Acupuncture. She has a strong focus on women’s health, including gynecological issues, fertility, pregnancy concerns, and postpartum recovery. Anjalee Patel has a doctorate of acupuncture and Chinese medicine from Pacific College of Health and Science, and a BA in psychology from the University of Illinois at Chicago. In addition to her acupuncture and Chinese medicine practice, she’s a licensed physical therapist assistant. She practices with A Touch of Ginger. Sarah Stetina is a board certified nurse midwife with over a decade of experience. She specializes in integrative holistic trauma-informed care for women across all life stages. Last Nora Calhoun is a practicing RN and also a certified nurse midwife. She’s the mother of four and has suffered through hyperemesis with each pregnancy. So she brings the lived experience to our conversation . . . and she also just happens to be my daughter. So thank you all for joining me. Um, and let’s start maybe by, uh, explaining the difference between morning sickness and hyperemesis. Sarah, could you just kick us off with a little explanation?

Sarah Stetina: 00:02:30 Yeah. Morning sickness is kind of misnomer. Um, it doesn’t just occur in the morning. It can happen all day long in the middle of the night. And that’s typically the experience that a majority of pregnancies have, where you may be having some intermittent vomiting, a baseline nausea that kind of permeates your day or affects your ability to eat or drink sometimes. But vomiting is typically infrequent, maybe once or twice a day, um, maybe a couple times a week if that. You can also have morning sickness that doesn’t include any vomiting. And most traditional like remedies and simple measures like lifestyle changes will typically ease some of those symptoms. When we talk about hyperemesis, the more severe version, we talk about a condition that can last the entirety of the pregnancy, whereas morning sickness typically shows up in the first trimester only and then resolves with time. Hyperemesis can last the entire duration of the pregnancy. It’s extremely severe. Multiple episodes of vomiting, uh, very little tolerating of food, water. You may be losing weight significantly. It can lead to severe dehydration, malnourishment. So it just takes it to a whole nother level. And most of those simple remedies and lifestyle changes don’t touch it, and don’t fix it. So, uh, it can often require a lot more medical intervention and it can have a lot of implications, which we’ll talk about today.

Anne Nicholson Weber: 00:04:09 Nora, as someone who’s been through it, do you want to add anything to that description of hyperemesis?

Nora Weber Calhoun: 00:04:14 I guess I would say only that there isn’t one specific, like agreed upon set of diagnostic criteria ’cause it’s kind of a set of symptoms along a spectrum. But in general, um, I’ve been told that if you’re losing more than 5% of your body weight plus having symptoms of dehydration, we’re probably headed into that territory. And then it also just has to do with how intractable it is, meaning if we do stuff, does it get better or does it not respond?

Anne Nicholson Weber: 00:04:47 Yeah. And are the causes, uh, the same? Is hyperemesis a more severe version of the same syndrome, or is it caused, does it have a different, uh, etiology?

Sarah Stetina: 00:04:59 Yeah, I, I did a little research on that question because it’s still, I think, under research, but they do think  — there’s an organization called the HER foundation. They study hyperemesis and they found a gene, a hormone growth factor, essentially, that is produced by the placenta and it rises really rapidly in early pregnancy. And they think that people that have hyperemesis have a variation in the gene that codes for that growth factor, which essentially means they have abnormally high levels of that hormone, um, or an abnormal sensitivity. 

Nora Weber Calhoun: 00:05:34 Yeah, as you can imagine, I’ve been very interested in this topic because that study came out between my first and second pregnancy. So, I mean, it’s unfortunate, but if you can point to a genetic basis for an illness, it becomes more legitimized in the medical community. Mm-hmm <affirmative>. Um, and they, they were able to pinpoint two genes that I think to memory, it’s about 25% of the population has, but of people with hyperemesis, 85% of them have it. So there’s clearly a strong correlation there. And then there’s other things that are risk factors, but none of them would be causative. So it’s having either mother or sister with the condition, prior history of severe, — llike you’re much more likely to get motion sick, like in the car or mm-hmm <affirmative>. So there’s a few other things like that. But yeah, the genetic component seems to be the number one thing.

Sarah Stetina: 00:06:32 Hyperthyroidism as well, uh, seems to be strongly correlated with hyperemesis.

Ashlie Martin: 00:06:38 I have heard too that there might be a histamine reaction, like perhaps that’s part of what the, they’ve found in the genome where certain people are more histamine reactive to the HCG hormones, so there might be something to do with that.

Anne Nicholson Weber: 00:06:53 Mm-hmm <affirmative>. Great. So we’ve kind of mapped out, um, what the two conditions are. Let’s now go to morning sickness and focus on that for a little bit because it is so much more common. You’ve referenced lifestyle changes and some simple treatments, and I wonder maybe Ashlie and then Anjalee, if you could talk about the things that you have to offer for this condition. Sure.

Ashlie Martin: 00:07:14 Um, I mean, first trimester is really tough for many reasons. Morning sickness is one of them, but most people are quite fatigued as well. Um, and I think there’s a, there’s sort of a mental disconnect for a lot of women where they don’t feel like they’re really pregnant yet, and why would they be so tired? And, and I do think from a Chinese medical perspective, fatigue can increase the potential for nausea and just having like, lack of energy in the digestive system. So I think there is an element of like, you do actually need to rest <laugh>, um, even though you don’t look pregnant and you just found out or whatever it happens to be, but your body is growing a new human, it’s just beginning the process. The cells are dividing very rapidly and it takes a lot of energy. And so sometimes I think lifestyle wise, um, just getting my patients to stop the hecticness of their schedule, um, build in more rest, maybe reschedule some of their events that they didn’t intend to stop just right away, like right away, first trimester <laugh> just slow down. So I do think that’s one of the things I, I’m repeating often with my patients.

Anne Nicholson Weber: 00:08:30 Yeah. And Anjalee, what would you add?

Anjalee Patel: 00:08:33 Something that I usually tell my patients is to try to stick to smaller meals throughout the day. Instead of like breakfast, lunch, and dinner. Sometimes the appetite’s not there. They can’t have a full meal, so just having smaller meals throughout the day can be very beneficial. I also try to have them even sip on some, like chicken bone broth or beef bone broth, if that’s appetizing to them because it’s filled with nutrients. It does have a little bit of protein and it has gut healing properties as well. So I’ll try to start off by having them make those little changes. Um, especially if they’re working. I know a lot of moms, including myself, when I was having morning sickness all the time, it was hard for me to like, you know, rest throughout the day just ’cause of my schedule at work. Like, I couldn’t take off any time.

Anjalee Patel: 00:09:34 But I feel like eating the smaller meals and resting in between patients, like even lying down in the treatment rooms if there were empty, you know, just taking any kind of breaks, just like Ashlie mentioned, can be very beneficial. And then prioritizing sleep, because your body needs all the resources to grow a little human being and sleep is going to be beneficial. So making sure that you’re, you know, getting off, um, any kind of screens an hour before your bedtime and like doing a bedtime routine, making sure your body’s like rested enough to fall asleep easily and stay asleep. Um, which of course, acupuncture can help with any kind of sleep issues, which tend to happen in first trimester pregnancy anyways. So that’s like kind of the lifestyle changes that I’ll advise to my early pregnant women.

Anne Nicholson Weber: 00:10:24 I think both of you have made the point that in the first trimester, you’re kind of feel barely pregnant. And I don’t think our culture, I mean, we, we tend not to talk about our pregnancies until the second trimester, so nobody’s cutting us any slack. And I think maybe that also means that we tend not to cut ourselves any slack, not to recognize that actually our bodies are doing a huge amount of work, um, and need extra care, even though this is now kind of a private process that’s happening. So in addition to lifestyle changes, let’s talk about morning sickness that maybe is a little more severe and really causing anxiety and distress. What other, uh, kinds of interventions are available to try to help with that? Sarah?

Sarah Stetina: 00:11:07 Um, I did want to mention a couple other lifestyle tricks, uh, that I have seen work very well for folks. Um, a big one is cold. So cold fluids. Um, and cold food is sometimes better tolerated because it is not as odorous, it’s a little bit more refreshing. Now, there’s some cultures that would totally disagree with me, um, and would recommend warming foods only, so I totally respect that too. I just think that, um, finding what works for you is going to vary. So I think being open to trying different things and at different points in your first trimester to get relief is going to be really essential. Um, eating really slowly and as Anjalee mentioned, is like getting protein. So any food or meal that you can tolerate, prioritizing protein, um, will help even out those blood sugars, which I think have a big impact on morning sickness.

Sarah Stetina: 00:11:59 So having those small meals, having them with some kind of protein that you can tolerate, um, is a good way to kind of keep the nausea at bay. And drinking water, you know, in between meals. Plain water is also a big trigger for a lot of people. So I recommend either herbal teas and, uh, flavoring your water, putting lemon in it or, or something like that. Uh, electrolytes sometimes sit way better. Um, when I worked at the birth center, we had fruit-infused water in the fridge and people loved it because they were all first trimester and nauseous and we had something that they could really tolerate. But as far as next level, there’s some really good first-line evidence on vitamin B6 and the use of that for nausea and vomiting in pregnancy that does not, um, include hyperemesis. So that’s usually the first line.

Sarah Stetina: 00:12:56 It can be taken in a 25 milligram tablet in the morning, in the afternoon, and 50 milligrams right before bed. So essentially you’re getting about a hundred milligrams a day. Um, and then it’s not one of those kind of interventions that you do just when you’re nauseous, you do it, uh, consistently, and over the course of several days there’s usually an improvement. Um, and you can pair it with, uh, Unisom sleep tabs in the evening, uh, which combined together our, um, evidence shows even more effective. And it’s about 12.5 milligrams or a half a tab at bedtime. It will make you very tired. But as we were talking, prioritizing rest  is really essential in the first trimester.

Anne Nicholson Weber: 00:13:45 And so then Ashlie, um, sort of the Chinese medicine perspective on this, we were laughing, you were laughing when Sarah was saying no, not you, you’re, she’s saying cold and you’re nodding and saying no hot. Well,

Anne Nicholson Weber: 00:13:57 So tell us a little bit about that perspective.

Ashlie Martin: 00:13:59 Yes, I mean, there, Chinese medicine prioritizes warm foods for the health of the energy in the body in general. So it, warm foods help us, um, build our energy, build our qi on a regular basis. So if you’re tired and fatigued and pregnant and building a human, then you need a little bit more energy. So I would say prioritizing cooked foods rather than raw foods is better. It doesn’t necessarily mean that they have to be hot, they just need to be cooked and easier to digest. Um, often I will tell my patients, uh, I, I agree with you Sarah. I have a lot of people say like, I am, there’s no way I am drinking tea or bone broth. Like, it’s too, it smells. And for those people I recommend cold waters with fruit in them, like Spindrift. A lot of people feel like the bubbles really help them with, or like sparkling waters not to put a product placement on there, but <laugh>, um, sparkling waters with some fruit flavoring are really helpful.

Ashlie Martin: 00:14:58 And that helps sometimes with the burping or belching that they might have along with the morning sickness. Um, so that helps some people. Other people I’ve recommended doing like a ginger tea that they make themselves so that they can adjust how strong the ginger taste is for them. So you just slice a, a little bit of ginger, put it in a pot, boil it for a while, and then you can taste it like, do you want a little honey? Do you want a little lemon? And then you can keep that in the fridge to have cold. But the ginger itself, no matter how hot or cold your actual fluid is, the ginger itself will warm the digestive system. So give you more energy generally. So those are my, those are just my responses to <laugh>, you know, responding to this the cold thing. It’s true. Some people need cold fluids and that’s fine.

Anne Nicholson Weber: 00:15:53 And Sarah mentioned some kind of western medicine approaches. I would, you know, with the, uh, B6 — B12? — B6 um, and the Unisom.  Ashlie, are there things kind of the equivalent of those types of interventions that you use?

Ashlie Martin: 00:16:08 Well, I often recommend B6 too. Um, and then again, like I don’t do a lot of herbs with early, early pregnancy. Um, unless it’s needed for other reasons, mostly just because I feel like sometimes these people are having trouble keeping things down already. So it’s like complicating the situation if they also have to digest like an herbal pill. But I don’t do, maybe Anjalee is a little bit different. I don’t do the, um, the liquid herbal formulas. So I do pills in general, so that might be the difference in whether you use herbs or not. But I do recommend like the ginger, I call it ginger aid, it’s like making your own ginger aid lemonade sort of thing. But for the more severe things, like I, I like to send my patients home with a press needle on a specific point that helps with nausea.

Ashlie Martin: 00:17:00 That’s a great acupuncture point on kidney 27. It’s right underneath the clavicle, near the sternum. And that has made the biggest amount of mpact on my patients. Um, where they’ll come in with a, you know, we do a scale of one to 10, how horrible is your nausea today? They’ll come in with like a six or a seven and leave with like a two. And I leave the kidney 27 on there as a press needle, that, that it’ll stay, it’s a sticker. It stays for several days for most people. And I’ll send them home with replacements so that they can just put on another one if it falls off and they feel like they still need it. That has made a major difference in a lot of my patients’ lives.

Anne Nicholson Weber: 00:17:44 Great. Um, Anjalee, what would you add?

Anjalee Patel: 00:17:46 Yeah, so I usually do herbal medicine in early pregnancy. If it’s to a point where the morning sickness is terrible or especially for, um, hyperemesis, I will do —  we do granules here. Mm-hmm <affirmative>. So it ends up being kind of like a tea, uh, ’cause you put like hot water on it, it melts and you kind of sip on that throughout the day. You don’t have to take it right away. ’cause like Ashlie said, some people are already nauseous, you don’t want to gulp all this tea down. But I have seen it help a lot with patients that are experiencing the hyperemesis or morning sickness, um, to just keep it down so that they can like rest so that they can actually have a meal, um, that they can tolerate water, things like that. And then, yeah, uh, like point wise, sometimes I’ll leave patients with like ear seeds or yeah, we call them like intradermal needles, which are just like the stickers.

Anjalee Patel: 00:18:43 Like she, uh, Ashlie was talking about on like PC six, which is on the wrist, which is good for like motion sickness or just nausea in general. Paired with, um, stomach 36, which is on the lower legs. That can help with nausea as well. And I’ll have them just like massage it throughout the day or whenever they feel like they’re experiencing a little bit of that creeping up again, I’ll have them do that. And it’s been beneficial. Also, I’ll tell them to come regularly for their acupuncture at least once a week. Um, especially in the first trimester, that’s super important. And usually not just for morning sickness, like there’s other stuff going on, like trouble sleeping, they’re feeling hot, they’re feeling like crampy or bloated, they’re feeling vexed, like whatever it is. Or really stressed out and anxious. ’cause pregnancy is, you know, a whole mental health journey. So trying to do all the things. And acupuncture is so unique where you can treat all those things at the same time. So yeah, I’ll just, like I said, just have them come regularly. I’ll send them home with some stuff, do some dietary recommendations, and then usually they go home with herbs.

Anne Nicholson Weber: 00:19:51 So, two follow up questions on that. One is, I believe there is pretty good evidence for the efficacy of acupuncture for morning sickness. Is that something that you all can talk about or is it more anecdotal in your case?

Ashlie Martin: 00:20:05 I mean, I think that there have been some studies that indicate PC six, the one that, the point that Anjalee just mentioned is good for nausea in general. Um, and so then it also helps with nausea and pregnancy. But just from clinical experience, I’ve noticed major differences in acupuncture, being able to reduce the frequency of nausea or reduce the frequency of vomiting, especially in hyperemesis where the, the person is able to have a more calmer quality of life, like throughout their pregnancy. Yes, they might still be nauseous, but it might be reduced to a point where they can manage life a little bit easier, get a little bit more rest, calm their anxiety. They’re not worried about throwing up on the L or or you know, at work or whatever. ’cause they can manage it a little bit better if they’re using acupuncture on a regular basis. And I want to second Anjalee’s point about acupuncture needs to be a very weekly thing for this sort of situation. ’cause you’re pregnant, it’s not going away. Your body is responding this way to the pregnancy. And so we need to continually remind your nervous system in your brain and your body that you can calm this nausea down internally. Um, and so getting that reintroduction of that message on a weekly basis is really helpful.

Anne Nicholson Weber: 00:21:28 And the other thing I wanted to follow up on is, um, I think in general when you’re in your first trimester, you’re very, uh, anxious about anything you ingest and you want to know that, you know, these herbs are safe. So how, um, can you just talk about the safety of some of the herbs you use?

Anjalee Patel: 00:21:46 Sure. So, um, the herbs that we use specifically in this clinic, um, it’s from one source. We trust this company, um, for so many reasons. They do a lot of batch testing. Um, they make sure that their herbs have no lead, have no mold, pesticides, et cetera. Um, and so we, we really trust this company. We actually know the owner as well.

Ashlie Martin: 00:22:10 I, I want to mention too that these herbal formulas have been around for quite some time. So we’re talking like several hundred if not a thousand years <laugh>. Um, and so there’s clinical evidence and some research out of, um, the more Asian cultures have been doing more research on herbs. But the classic herbal formulas that we would be using for an early pregnancy situation where you need to improve your digestive energy, um, just lift the Qi in general, like help your body transform food better, like those sorts of things, those all would be very safe.

Sarah Stetina: 00:22:45 I did just want to add to working with an herbalist <laugh>, it makes it safer, right? You’re working with someone who has the expertise to know which herbs to use and which not. So, um, working specifically with an herbalist is probably the safest way to go about it. Um, as a midwife there are certain herbs that, um, and like remedies that I know that are evidence-based and safe. And then anything beyond that, I really default to the herbalists team. Um, but we know like lavender and ginger and lemon, these are safe that you can prepare and, and you know, at home. But really beyond that, if, if it’s not clear, you should be really connecting with an herbalist to get something tailored to you. Um, also magnesium, um, is something that I recommend a lot in the first trimester, um, because I find that it also helps, um, in addition to everything else that we’ve talked about. I don’t know if that’s something that you both also recommend, but

Ashlie Martin: 00:23:44 Yes, often I’m often telling people to take magnesium. Yes,

Anjalee Patel: 00:23:48 Yes.

Anne Nicholson Weber: 00:23:49 And I’ve just learned about, uh, transdermal magnesium. Um, there are, uh, preparations