NCH July 2012 Webinar

No More Morning sickness:

Relief, Prevention and SafetyFor Nausea and Vomiting

of Pregnancy

by Karen Allen CCH

Roadmap for Us

● Why do pregnant women get morning sickness?● Are there characteristic symptom patterns?● Review 10 common homeopathic remedies● Recognize potentially serious conditions● Describe common adjuncts to help● Practice what we have learned with cases

What Happens in Pregnancy?

● During early pregnancy, sweeping hormonal changes take place, including steep rises in hCG and estrogen

● Research suggests that these hormonal shifts heighten a woman's sensitivity to smell/odors which can trigger a gag reflex, and increases sensitivity of the GI tract

● Symptoms can begin as early as 4 weeks, usually starts about 6 weeks. Most feel relief by 14th - 18th week

● Affects about 75% of pregnant women in 1st trimester – some just get nausea, about half experience nausea and vomiting

● Misnamed – not just mornings!

Who is most likely?

Nausea and Vomiting of pregnancy is most likely to affect women who:

– have a history of motion sickness– experienced nausea/vomiting with birth control pill– have a family history (mom/aunt/sisters etc) of it– have a history of migraine headaches– are pregnant with twins / multiples– had morning sickness with a prior pregnancy– inadequate nutrition prior to conception; taking multivitamin

while trying to conceive has been shown to reduce symp-toms after conception

Homeopathy for a Common Complaint – WE MUST LOOK FOR A PATTERN...

● All health disturbance begins on the level of the vital force! The vital force creates a characteristic pattern of symptoms that ex-press its disturbance.

● These patterns are matched to homeopathic remedies (homeo = same / pathos = suffering) linked through provings

● To the extent that we match the PATTERN of HER SYMPTOMS with the PATTERN of a homeopathic REMEDY, she will experi-ence improvement...

● The PATTERN is a constellation of symptoms:– triggers, aggravations, ameliorations– time of day, sensations, mental/emotional experience

● Each woman has HER way of experiencing morning sickness

Homeopathic Core Concepts

● Samuel Hahnemann, German Physician● Disturbance of Vital Force creates symptoms● Symptoms are the language of disease● Like cures like – the 'Similia Principle'● Homeopathic remedies made from natural substances● Potentization removes toxicity, allows safe use ● Provings define the 'like' that a remedy can relieve● Match the client's symptom pattern to a remedy pattern● Minimum Dose

Eliciting Information from Her...

● Open ended questions● Capture her own words, write it down● Avoid leading questions / don't ADD info, just identify● Gather the full constellation of symptoms:– What brings on the nausea/vomiting? When?– What makes you feel better or worse?– What do you experience with the nausea/vomiting?– How are you feeling about all this? – Is there anything else that comes on with these symptoms?

● Our job is to accurately observe and document HER way of ex-periencing morning sickness – write it down

Remedy Options...

● A good constitutional remedy may resolve these symptoms – if the woman has been given a constitutional remedy that has been helpful in the past, it may be the best option

● There are remedies with a strong affinity to the GI tract and hormonal change

● Let's look at the patterns for 10 of these

Sepia: from the cuttlefish

CONSTANT nausea, relieved by eating Worse in morning, and again 3-5pm

Especially aggravated by food odors, cooking foodVomiting leads to dry heavesWants sour foodsBelching with backwashGrumpy, weepy, sadVERY tired, fatigue out of proportion

This is one of the strongest options: Sepia / Colchicum / Nux vomica / Symphoricarpus are the most likely unless specific indicators of other remedies appear.

Ipecacuanha:from the ipecac root

CONSTANT nausea, NOT relieved by eating or vomiting Vomits food as soon as it is eaten, undigested / bile

Vomiting triggers more vomitingNausea with increased salivationFeeling as if the stomach is hanging downRepulsion toward foodRuddock suggests this can be alternated with Sepia

Kreosotum: from creosote wood tar

NAUSEA with profuse salivation Bitter taste in the mouth after drinking water

Worse from cold foods, better warm foodsStomach feels FULL soon after eatingVomiting 1-2 hours after meal, undigested foodVomiting does NOT relieve the nauseaConcomitant: urinary stress incontinence – has to

run to bathroom, urination begins quickly

Nux vomica: from the 'poison nut'

Nausea with retching, and bitter/sour burpingVomits food as soon as it is eatenNausea is worse from odors (food, chemicals, exhaust)Dizziness with the nauseaConcomitants: irritable, constipated, oversensitive CNSThis is one of the strongest options: Sepia / Colchicum /

Nux vomica / Symphoricarpus are the most likely unless specific indicators of other remedies appear.

Tabacum: from the tobacco plant

Consider especially with history of motion sicknessNausea and vomiting accompanied by sweatNausea is worse from odors (food, chemicals, exhaust)Motion aggravates symptomsQueasy feeling all day without vomitingSymptoms continue on past first trimester

Petroleum: from crude oil

Unrelenting nausea, vomiting may or may not be presentHas a desire to eat to relieve the nausea, may feel a need

to get up and eat in the night; feels better when eating very frequently, worse when the stomach is empty

Nausea accompanied by heartburnAversion to or aggravation from meat / fatsHistory of motion sickness

Pulsatilla: from the anemone flower

Nausea better outside, worse afternoon / eveningWorse in heat, desires coolNausea accompanied by heartburn, worse eating fatsNo thirst, may be averse to drinking anythingAltered sense of taste – bitter or sour or rotten taste of

food that previously was enjoyedMay ask for reassurance, weepy, wants comfort/hug

Colchicum:from the meadow saffron

Nausea from - looking at / smelling / thinking of food - especially eggs and fish Nausea but not vomiting – or vomiting of bile followed by

dry heaves Vomiting from swallowing saliva Nausea worse from riding in a car This is one of the strongest options: Sepia / Colchicum /

Nux vomica / Symphoricarpus are the most likely unless specific indicators of other remedies appear.

Symphoricarpus: from the snow berry

Covers the full range from queasiness to the most severe cases with continuous nausea and vomiting Vomiting is violent, gagging and retchingThought of food is nauseating, smell of food unendurableNausea relieved by laying still, flat on her back in bed,

worse from moving or raising the armsLoss of appetite, indifferent to foodThis is one of the strongest options: Sepia / Colchicum /

Nux vomica / Symphoricarpus are the most likely unless specific indicators of other remedies appear.

Aletris: is made from star grass

Consider especially when nausea is accompanied by: - exhaustion / fatigue - fainting - dizzinessMost likely in cases with poor nutrition, concomitant gastro-intestinal issues (eating disorder history) or a history of long illness prior to pregnancyMay have a sense of heaviness in the uterus or history

of recurrent miscarriage

WOW, OKAY, so much data!

● Each remedy pattern has lots of details – how do I remember all that?!?!

– Commit facts to memory through repetition

– Mnemonic devices – mental image / cartoon / story

– Develop differential comparisons between remedies

Be Friendly:

Get to knowyour data!

Homework - you choose

3 symptoms

Once we have chosen -How to give the remedy?

● Start with 30c potency, consider 200c with sym-phoricarpus, or with any remedy if 30c helps but does not hold or complete the improvement

● Ways to give the remedy:- a few pellets under the tongue- put a few pellets into a cup of water and sip on it

● Try Hahnemann's method for acute care: give a dose every 15 minutes for an hour and then re-evaluate her symptoms

● Repeat as needed; remember minimum dose

What are the Warning Signs Calling for Referral?

● Severe or prolonged vomiting is linked to increased risk of pre-term birth, low birth weight. Women with weight gain of at least 15-16 pounds have same outcomes as women without severe nausea/vomiting. ??Ask how much weight gain for mom when symptoms continue into 2nd / 3rd trimesters??

● Warning signs to call her midwife / FNP / OB– can't keep ANYTHING down over 24 hours (food or drink)– vomiting blood– fainting

● Some symptoms of dehydration include:– Dark, strong smelling urine, infrequent urination (less than 4-6 hrs)– Dry mouth, crying with no tears

What Else (other than a well chosen remedy) can help?

● Care about WHEN she eats:– Symptoms are often worse in the morning, so keep food (crackers / nuts) by

the bedside, and eat on waking, then rest for 15-20 minutes before rising– Small frequent (high protein) meals through the day – Take prenatal vitamins WITH food, not on empty stomach

● Care about WHAT she eats:– Avoid foods with strong odors / fried / spicy / acidic – eat foods that are cold or

room temperature (reduces smells), bland, simple, eg. watermelon– Stay hydrated – sip on sparkling water with ginger or cell salts added– Take Vitamin B6, 25mg three times daily with plenty of water (EmergenC)

● Care about her ENVIRONMENT:– Avoid scented self-care / home-care products – fragrances can trigger nausea– Fresh air is almost always helpful to reduce symptoms

What About Iron?

● Some women have difficulty with the high iron dosage in prenatal vitamins (nausea / disrupted digestion / constipa-tion)

● Iron is crucial for fetal development – but demands are not excessive in the 1st trimester when nausea/vomiting tends to be the worst, so it may help to opt for a lower iron content in the prenatal vitamin during the early months

● Eat iron rich foods (see www.ironrichfoods.org )

● Remember ferrum phosphoricum 6x cell salts to help with uptake of iron – included in cell salt formulas like Bioplasma and Biophos that are great support for pregnant metabolism

A Few More Suggestions...

● Acupressure bands around the wrist (similar to the ones used for people who have seasickness)

● Acupressure point Neiguan P6: on the left wrist, measure 3 finger widths up from the line of the wrist, and find the point in the hollow between the bones and tendons – likely to be slightly sore to touch. Press firmly while exhaling, and release while inhaling. Repeat for 6-8 breaths.

● Aromatherapy: essential oils of lemon and chamomile in a dif-fuser can help reduce nausea. (Be aware that many essential oils are contraindicated during pregnancy! Check with a reli-able source.)

Review of Strategy Suggestions:

● Elicit clearly detailed symptoms – remember each woman experiences morning sickness in her own way, and one size definitely does not fit all!

● Match symptom picture to best indicated remedy; if unsure choose one of the 4 most likely remedies suggested here.

● Give remedy – sipped in water sipped on waking works well● Monitor response – the vital force may change the symptoms, based

on its reaction to the remedy. It is a dialogue!● No improvement? Try a second choice after a few hours● Once a helpful remedy is found, symptoms should recede; repeat as

needed, remembering the minimum dose● Educate about suggestions given here for eating, environment, iron,

adjuncts to help her in addition to the remedy.

Case Example: KR27 yo / pg: 7 wks

● This is the 3rd week of nausea, it is worsening each week. I have not vomited, just nausea all day and night.

● I fainted twice this week after getting out of bed in the morning, feel so dizzy and weak, so tired. I am sleeping a lot – 14 hrs/day

● I'm eating very little. The nausea makes food unappealing, drink-ing water and a healthy meal powdered drink each day, snack-ing on some crackers and apple slices.

● Husband is worried about my lack of appetite – in my teens I was anorexic, and have been thin since then, do not have an easy relationship with food in general

● What is the pattern? What do we give? In what way?

Case Example: MP36 yo / pg: 8 wks

● I am so glad to be pregnant after all we went through to con-ceive, but I feel awful for the first 2 hours after I wake up each morning. I vomit even though my stomach is empty, just fluid and dry heaves - ugh!

● By 9 or 10 am, I feel ok, can have some light breakfast and then feel like myself again.

● I am wanting to eat grapefruit all day – the midwife said have some, but not a lot because it is quite acidic

● I can't cook dinner – going in the kitchen and smelling the food makes me gag. But I can eat dinner ok, if we sit on the patio and there are no strong smells.

● What is the pattern? What do we give? In what way?

Case Example: JT19 yo / pg: 5 wks

● I'm still trying to get used to the idea of being pregnant – feels great and awful. We just got married 2 months ago - my hus-band is a soldier, being sent to Afganistan, did not want to wait. I am living with my family here until he gets back in 6 months – thank goodness, seems like all I do since I found out is cry and miss him, and throw up after lunch and dinner.

● I feel ok in the morning, but after I eat lunch, I get horrible burn-ing in my stomach and chest. My mom cooks a lot of fried food, and I think that makes it worse. Not so bad if I eat toast or fruit.

● I think I have thrown up everything I ate for lunch or dinner this week. Seems like I can keep down breakfast. My mom is always bringing me cups of tea, but I don't want to drink anything.

● What is the pattern? What do we give? In what way?

Case Example: BL25 yo / pg: 10 weeks

● This is my 2nd pregnancy – with my first I had a little nausea the first few weeks, but this time has been much worse.

● I don't throw up at all, but I'm queasy whenever it is more than 30 minutes since I have eaten. So I try to eat every half hour, but if I miss that time window, it gets bad quick.

● The nausea starts with a queasy burning feeling in my stomach, and then I have to sit still and eat something. Walking around, or especially turning around makes the nausea worse, and I can start to gag.

● Nights are bad because I wake up with the nausea and have to eat something quickly – I keep almonds and crackers by my bed.

● What is the pattern? What do we give? In what way?

Case Example: TV33 yo / pg: 9 wks

● With my last pregnancy I had vomiting through the 8th month – my husband had to give me injections of a medication twice daily so I could eat and keep any food down. My doctor was up-set because I was gaining so little weight. Now I am worried that it will be the same again.

● My stomach is upset all the time, and I vomit 6-8 times every day, also sometimes in the night, wake up gagging and vomit.

● Any smell of food makes me gag – I can only eat things that have very little odor.

● I have to lay still in bed for an hour after I eat anything or I vomit

● What is the pattern? What do we give? In what way?

Case Example: AP31 yo / pg: 7 wks

● I felt great the first two weeks after finding that I was pregnant, but now the morning sickness is horrible for the past 10 days. I feel queasy, and after I eat, I begin to burp, get a bitter awful taste in my mouth, and then within 10 minutes or so am vomiting... again and again long after there is anything in my stomach

● I work as an attorney, have been throwing up in the bathroom at the courthouse, and a few times in my wastebasket at my desk. Seems like it is worse in the morning and I am ok by 1 or 2 pm.

● Sometimes with the queasiness, I get really cranky, my husband says I have been grouchy and snappy.

● What is the pattern? What do we give? In what way?

Case Example: NY29 yo / pg: 8 wks

● Ugh – I never want to do this again – I feel terrible. I have vomited more in the past 2 weeks than I have in my entire life.

● Any odors – food smells, body odors, room fresheners, perfume, even smells from the plants in the garden – make me gag. It is as if the smells are a thousand times more powerful than usual and it overwhelms me. I can't even think of eating or I gag.

● The smells give me that funny feeling in your throat you get when you know you are going to vomit, and then I start swallow-ing almost constantly, and then I gag and have dry heaves.

● Even if I am not smelling anything, it is bad in the car – I can't drive at all because I start gagging, like being motion sick.

● What is the pattern? What do we give? In what way?

SO... are you readyto do this?

● Review these notes and put them in a place where you can find them when you need them!

● If you do not already have a remedy kit on hand, consider order-ing one... or purchase these specific remedies from one of the homeopathic pharmacies.

● When the opportunity comes to you to help a woman with morn-ing sickness, take the symptoms carefully with full detail, then choose an appropriate remedy. Try it and follow up.

● Remember that nausea from other causes may also respond well to some of these remedies.

● Questions?

SO... are you ready?You can do this!

● Let me know how you do - if you have a successful case, email me:

Info@karenallenhomeopathy.com● Thanks for your attention and particip-

ation today – best wishes for your con-tinued homeopathic studies