Frequently Asked Questions

The exact cause of pregnancy sickness is not fully understood, but research points to several key factors. The strongest link is to rising levels of human chorionic gonadotrophin (hCG), a hormone produced by the placenta after implantation. This is why sickness often peaks between weeks 8 and 12, when hCG levels are at their highest.

Other contributing factors include elevated oestrogen and progesterone levels, changes in the gastrointestinal system (such as slower gastric emptying), a heightened sense of smell, and genetic predisposition. Recent groundbreaking research has also identified the protein GDF15 as playing a significant role — women with lower pre-pregnancy exposure to GDF15 may be more sensitive to the surge during pregnancy.

Pregnancy sickness typically begins around week 6 of pregnancy, sometimes as early as week 4. Symptoms usually peak between weeks 8 and 12, when hCG levels are at their highest.

For the majority of women, nausea and vomiting improve significantly by weeks 14 to 16, as the placenta takes over hormone production and hCG levels stabilise. However, around 10% of women continue to experience symptoms beyond week 20, and some have nausea that persists throughout the entire pregnancy.

Hyperemesis gravidarum can last the full duration of the pregnancy in the most severe cases, though symptoms often become somewhat more manageable in the second and third trimesters even if they do not fully resolve.

No. The term "morning sickness" is widely regarded by medical professionals and sufferers alike as misleading and harmful. Research shows that only about 2% of women experience nausea exclusively in the morning. The majority of women with pregnancy sickness feel nauseous throughout the day and night, with symptoms often worsening in the evening.

For women with hyperemesis gravidarum, sickness is typically relentless and around the clock — there is no "good time of day." The name "morning sickness" unfortunately contributes to the condition being trivialised by employers, family members, and sometimes even healthcare providers who may not understand that a woman can be incapacitatingly ill for the entirety of each day.

Some studies suggest a statistical association between nausea in pregnancy and a lower risk of miscarriage. However, this does not mean that the absence of sickness indicates a problem. Many women have perfectly healthy pregnancies without any nausea at all. Equally, having severe sickness does not guarantee a healthy outcome.

Every pregnancy is different. If your sickness suddenly stops in the first trimester and you are worried, contact your midwife for reassurance, but try not to use the presence or absence of sickness as a barometer for your baby's wellbeing. Ultrasound scans and standard antenatal checks are far more reliable indicators.

Pregnancy sickness exists on a wide spectrum, from occasional mild queasiness to the life-threatening severity of hyperemesis gravidarum. The severity you experience is influenced by multiple factors:

• Genetics: If your mother or sisters had severe sickness, you are more likely to as well
• Hormonal sensitivity: Individual sensitivity to hCG and GDF15 varies enormously
• Multiple pregnancies: Carrying twins or more often means higher hCG levels and worse sickness
• Medical history: A history of migraines, motion sickness, or sensitivity to hormonal contraception increases risk
• Thyroid function: hCG can stimulate the thyroid, and temporary thyroid changes may worsen symptoms

It is not a matter of willpower, tolerance, or attitude. Comparing your experience to others is neither fair nor helpful. You are not failing — your body is reacting differently.

Normal nausea and vomiting of pregnancy (NVP) affects up to 80% of pregnant women and, while unpleasant, typically allows women to keep down some food and fluids and continue with daily activities, even if they are difficult.

Hyperemesis gravidarum (HG) is the severe end of the spectrum, affecting approximately 1-3% of pregnancies. HG is characterised by:

• Persistent, excessive vomiting (often many times per day)
• Weight loss of more than 5% of pre-pregnancy body weight
• Dehydration and electrolyte imbalance
• Ketosis (the body breaking down fat for energy due to starvation)
• Inability to tolerate food or fluids
• Inability to carry out normal daily activities

HG often requires hospital admission for IV fluids and medication. It can be life-threatening if untreated and has a profound impact on mental health, relationships, and quality of life. It is not simply "bad morning sickness" — it is a serious pregnancy complication that requires medical management.

Yes, this can happen and you are not imagining it. Some women experience a period of relief in the second trimester only to find that nausea returns later in pregnancy, often in the third trimester. This can be related to:

• The growing uterus putting pressure on the stomach
• Hormonal fluctuations later in pregnancy
• Acid reflux and gastro-oesophageal reflux disease (GORD), which becomes more common as the baby grows
• Reduced stomach capacity

For women with HG, symptoms may wax and wane throughout the pregnancy, with better and worse periods. If your sickness returns after a break, contact your midwife or GP — you may benefit from resuming medication or trying a different treatment approach.

If you experienced NVP in a previous pregnancy, there is approximately a 75-85% chance of it recurring. For hyperemesis gravidarum, the recurrence rate is estimated at 15-20% for severe HG, though some studies place it higher.

The severity can vary between pregnancies — some women find it milder the second time, others find it worse, and some have it severely with one pregnancy but not another. There is no reliable way to predict this in advance.

Yes. Several antiemetic (anti-sickness) medications have been used safely in pregnancy for decades and are recommended by NICE (the National Institute for Health and Care Excellence). The most commonly prescribed include cyclizine, promethazine, prochlorperazine, metoclopramide, and ondansetron. These have well-established safety profiles supported by extensive research and real-world use.

First-line medications:

• Cyclizine — An antihistamine and often the first choice in the UK. Available as tablets or injection.
• Promethazine (Avomine) — An antihistamine with a sedative effect. Available over the counter. Useful if sickness is worst at night.
• Prochlorperazine (Stemetil) — Blocks dopamine receptors. Available as tablets, buccal tablets (dissolve on the gum, useful when you cannot keep tablets down), or injection.
• Metoclopramide (Maxolon) — Speeds gastric emptying and blocks the vomiting centre. Usually limited to 5 days at a time.

Second-line medications:

• Ondansetron (Zofran) — Very effective, originally developed for chemotherapy patients. Widely used for HG.
• Domperidone (Motilium) — Speeds gastric emptying with fewer side effects than metoclopramide.
• Corticosteroids — Reserved for the most severe, treatment-resistant HG. Usually started in hospital.

NICE guidelines support combining multiple medications when a single drug is insufficient. For detailed information, see our Treatments page.

Ondansetron is widely used in pregnancy, particularly for hyperemesis gravidarum, and is considered a second-line treatment in UK guidelines. It is one of the most effective antiemetics available.

Some studies have suggested a very small possible increase in the risk of cleft palate when used in the first trimester — approximately 3 additional cases per 10,000 births — though other large studies have not confirmed this association. The absolute risk, even if real, remains very small.

For many women with severe HG, ondansetron is genuinely life-changing and enables them to continue their pregnancy, keep down some nutrition, and function at a basic level. The decision should be made with your doctor, weighing the small theoretical risk against the very real and serious consequences of untreated severe sickness, which include dangerous dehydration, malnutrition, and mental health crisis.

Ginger has some evidence for providing modest relief from mild nausea in pregnancy. It can be consumed as ginger tea, ginger biscuits, flat ginger ale, or standardised capsules (250mg four times daily is the studied dose). It is generally considered safe in pregnancy.

However, ginger is not an adequate treatment for moderate to severe pregnancy sickness, and it is wholly insufficient for hyperemesis gravidarum. No woman should be told that ginger is a substitute for proper medical treatment. If you are vomiting multiple times a day, unable to keep fluids down, and losing weight, ginger biscuits are not going to solve the problem — you need medication.

At best, ginger may take the edge off mild queasiness as a complement to other measures. At worst, being told to "just try ginger" delays access to effective treatment and minimises the reality of what you are going through.

You should attend A&E or an Early Pregnancy Assessment Unit (EPAU) if you experience any of the following:

• You cannot keep any fluids down for 12-24 hours
• Your urine is very dark or you have not passed urine for more than 8 hours
• You feel faint, dizzy, or have a racing heartbeat
• You have lost significant weight since becoming pregnant
• You have abdominal pain or fever alongside vomiting
• You have blood in your vomit
• You feel seriously unwell or frightened

At A&E, you should be triaged and assessed. The typical process includes:

• Weight check — to assess how much weight you have lost
• Urine test — to check for ketones (a sign of dehydration and starvation) and rule out urinary tract infection
• Blood tests — to check your electrolytes, kidney function, liver function, and thyroid
• Clinical assessment — your blood pressure, pulse, and hydration status will be checked

If you are dehydrated, you will be given intravenous (IV) fluids, usually normal saline with added electrolytes. You should also receive thiamine (vitamin B1) to prevent Wernicke's encephalopathy, and you will be prescribed antiemetic medication. Some hospitals have dedicated hyperemesis pathways or early pregnancy assessment units with specialist knowledge.

IV fluids are needed when you are clinically dehydrated, which is determined by clinical assessment and urine ketone testing. Signs that you may need IV fluids include:

• Very dark, concentrated, or infrequent urine
• Dry mouth, cracked lips, and reduced skin elasticity
• Dizziness, fainting, or feeling lightheaded when standing
• Rapid heartbeat
• Presence of ketones in your urine (2+ or higher is significant)

IV rehydration typically involves normal saline with added potassium and thiamine. Some women with recurrent HG benefit from regular planned IV fluid infusions — sometimes called "day case" admissions — to prevent them from becoming critically dehydrated between episodes. This is a legitimate and appropriate treatment approach, and you should not feel that you are being a burden for needing it.

Yes. As with all medical treatment, you have the absolute right to informed consent and the right to refuse any treatment. No one can force you to take medication or accept IV fluids against your will.

However, it is important to understand the risks of refusing treatment for severe pregnancy sickness, which can include dangerous dehydration, electrolyte imbalances, nutritional deficiencies, and in extreme untreated cases, Wernicke's encephalopathy (a serious and potentially permanent neurological condition caused by thiamine deficiency).

If you have concerns about a specific medication — for example, worries about side effects or safety — discuss alternatives with your healthcare team rather than refusing all treatment. Your doctor should explain the benefits and risks of each option so you can make a fully informed decision that you are comfortable with.

When eating feels impossible, the priority is survival, not nutrition. Balanced meals can wait. Here are strategies that many women find helpful:

• Eat tiny amounts frequently (every 1-2 hours) rather than attempting full meals
• Cold foods are often better tolerated than hot because they have less smell
• Plain, starchy foods are usually easiest — crackers, plain pasta, toast, rice cakes, breadsticks, or plain rice
• Keep something by your bed to eat before you get up in the morning
• Sip fluids between meals rather than with them
• Ice lollies, frozen grapes, and ice chips can help with hydration when drinking is difficult
• Avoid cooking smells — ask someone else to cook, or rely on cold foods and pre-prepared meals

Eat whatever you can keep down, even if it is the same thing every single day. There is no judgement here. Proper balanced nutrition can resume once you feel better. For detailed guidance, see our Coping page.

In the first trimester, your baby's nutritional needs are very small and are largely met by your existing nutrient stores. Babies are remarkably efficient at extracting what they need from your body. If you can only manage crackers and water, that is enough for your baby in the early weeks.

Most babies born to mothers who had severe pregnancy sickness, including HG, are born at healthy weights. Research consistently shows that mild to moderate NVP does not adversely affect birth outcomes.

However, severe and prolonged malnutrition and dehydration do carry risks — including low birth weight and, very rarely, other complications — which is why treatment is important. The greatest risk to your baby is you not getting the treatment and support you need. Looking after yourself is looking after your baby.

This depends entirely on the severity of your symptoms and the nature of your work. Many women with mild to moderate NVP continue working, sometimes with adjustments such as:

• Flexible start and finish times
• The ability to eat at their desk or workstation
• Access to a private space if they need to be sick
• Reduced exposure to triggers (smells, certain environments)
• Working from home on the worst days

For women with severe NVP or HG, working may be impossible, and you should not feel guilty about taking sick leave. Pregnancy-related sickness absence should be recorded separately from other absence and cannot lawfully be used against you in disciplinary or redundancy processes under the Equality Act 2010. Your health and your baby's health come first. For more details, see our Workplace Rights page.

Under UK law, you have strong protections as a pregnant employee:

• The Equality Act 2010 classifies pregnancy-related illness as a protected characteristic — it is unlawful to treat you unfavourably because of it
• Your employer must carry out a workplace risk assessment for pregnant employees
• Pregnancy-related sickness absence must be recorded separately and cannot trigger absence management procedures or disciplinary action
• You cannot be selected for redundancy because of pregnancy-related absence
• Your employer should consider reasonable adjustments — flexible working, additional breaks, temporary changes to duties, or working from home
• You are entitled to paid time off for antenatal appointments

For the first seven days of absence, you can self-certify (your employer may have a form for this, or you can write a simple statement).

After seven consecutive calendar days of absence, you need a fit note (formerly called a sick note) from your GP. Your GP can issue this during a standard appointment. Explain the severity of your symptoms and specifically how they prevent you from working.

The fit note can state that you are:

• "Not fit for work" — meaning you need to be off work entirely
• "May be fit for work with adjustments" — such as altered hours, lighter duties, amended work environment, or working from home

If your GP is reluctant to issue a fit note, explain in concrete terms how your symptoms affect your ability to do your job — for example, "I am vomiting 15 times a day and cannot be more than a few steps from a toilet." You are entitled to Statutory Sick Pay (SSP) from day four of absence, and many employers offer enhanced sick pay beyond this.

This is extremely common, and you should not panic. Large prenatal multivitamin tablets are among the hardest things to keep down when you are nauseous. Here are some alternatives to try:

• Take folic acid alone — it is a much smaller tablet and often easier to tolerate
• Try different brands or formulations — chewable, gummy, or liquid vitamins may be better tolerated
• Take vitamins at the time of day when your nausea is least severe
• Try taking them with a small amount of food if you can
• If the iron in your prenatal vitamin is making nausea worse, try a formulation without iron (discuss with your midwife)

This is one of the most distressing aspects of severe pregnancy sickness, and the guilt can be overwhelming. Here is what you need to hear: you are not a bad parent.

• Accept all offers of help — from your partner, family, friends, and neighbours. Now is not the time for pride.
• Screen-time rules can be relaxed — your children will not be harmed by extra television or tablets for a few weeks. This is survival mode.
• Stock up on easy foods they can access themselves if they are old enough — fruit, sandwiches, cereal, yoghurts.
• Ask for help with school runs — other parents are usually willing if you explain you are unwell.
• Consider family sleepovers — grandparents, aunts, uncles, or close friends taking the children for a night or weekend gives you time to rest.

If you have no support network, speak to your health visitor or GP about local support services. Some areas have Home-Start volunteers who can help families with young children. Remember that this is temporary, and your children will not remember these weeks as vividly as you will.

Contact your midwife or GP if any of the following apply:

• Nausea and vomiting are affecting your ability to eat and drink
• You are losing weight
• Your urine is dark or you are passing less than usual
• You feel dizzy, faint, or your heart is racing
• You are unable to work or care for yourself or your children
• Your mental health is suffering — you feel depressed, anxious, or hopeless
• You have tried self-help measures without improvement
• You simply feel that you need help

Do not wait until things are desperate. Early treatment is more effective and can prevent the condition from worsening into a crisis. You should never feel that you are wasting anyone's time. Pregnancy sickness is a legitimate medical condition that deserves proper assessment and treatment, just like any other illness.

Pregnancy sickness is one of the most widely trivialised medical conditions in existence. There are several reasons for this:

• The misleading name "morning sickness" makes it sound mild, brief, and time-limited
• It only affects pregnant women, and conditions affecting women have historically been under-researched, underfunded, and dismissed by the medical establishment
• Most people's reference point is mild nausea that resolved quickly — they have no frame of reference for the severe end of the spectrum
• There is a pervasive cultural narrative that suffering in pregnancy is normal, natural, and should be endured stoically and gratefully
• It is invisible — you may look "fine" while feeling desperately ill

This trivialisation causes real harm. It stops women seeking help, discourages doctors from prescribing treatment, and leaves women feeling isolated, guilty, and ashamed for "not coping." Your suffering is real, it is valid, and it is not your fault.

Many women describe HG as being like the worst food poisoning or norovirus they have ever had — except it does not stop after 24 hours. It is relentless nausea that never fully lifts, combined with violent vomiting, bone-deep exhaustion, and an inability to eat, drink, or function normally.

Ask your partner to imagine their worst stomach bug, then imagine it lasting for weeks or months with no end in sight, while being told by well-meaning people to "try ginger" and "enjoy this special time."

Practical steps that can help your partner understand:

• Share information from this website and our Partners page, which is written specifically for them
• Invite them to attend a GP or hospital appointment with you, where the doctor can explain the medical reality
• Encourage them to read accounts from other partners on support forums
• Contact our helpline (024 7569 0504) — we also support partners and family members

Absolutely, and it is critically important that you know you are not alone in this. Research consistently shows that women with severe pregnancy sickness have significantly higher rates of:

• Depression — the isolation, physical suffering, and loss of normal life take a severe toll
• Anxiety — worrying about your baby, your health, your job, your relationships, and whether it will ever end
• Post-traumatic stress disorder (PTSD) — which can develop during the pregnancy or after birth
• Suicidal thoughts — in the most severe cases, women may feel that they cannot endure any more

You are not weak, and feeling depressed does not mean you do not want your baby. These are normal psychological responses to an abnormal level of physical suffering. Speak to your midwife or GP about how you are feeling — you may benefit from talking therapy, counselling, or in some cases, antidepressant medication, which can be safely prescribed in pregnancy. For more information, see our Mental Health page.

This is more common than many people realise, and you should not feel ashamed. Research indicates that a significant proportion of women with HG consider termination specifically because of the severity of their symptoms — not because they do not want their baby, but because the suffering feels unbearable and endless.

If you are having these thoughts, please reach out for support before making any decisions:

• Contact the Pregnancy Sickness Support helpline on 024 7569 0504
• Speak to your GP or midwife urgently about escalating your treatment
• Ask for a referral to an obstetrician or a specialist HG clinic if you have not already seen one
• Request hospital admission if you are not coping at home

In many cases, more aggressive treatment — including medication combinations, IV fluids, and sometimes hospital admission — can make the symptoms manageable enough to continue. You deserve every possible treatment option before reaching that point. No woman should be driven to end a wanted pregnancy because she was denied adequate medical care.

Many women with HG worry about bonding, particularly if they have had thoughts about ending the pregnancy or have felt resentful towards the baby for "causing" their suffering. These worries are completely understandable.

The good news is that the vast majority of women do bond with their babies, though for some it takes longer than expected. Bonding difficulties after HG are a recognised phenomenon, and they are not your fault — they are a consequence of the physical and emotional trauma you endured.

If you are struggling to bond after birth:

• Speak to your midwife, health visitor, or GP — they can refer you for support
• Postnatal counselling or therapy, particularly trauma-focused approaches like EMDR or CBT, can be very effective
• Peer support from other HG survivors who understand can be invaluable
• Be gentle with yourself — bonding is not always instant, even for women who had straightforward pregnancies

Delayed bonding does not mean you love your baby any less. It means you have been through something incredibly difficult, and you need time and support to heal.

This is one of the most frustrating and demoralising aspects of having severe pregnancy sickness. People usually mean well, but their advice reveals a profound ignorance of the severity of your condition. You have several options:

• Educate calmly: "I appreciate the suggestion, but my condition is a recognised medical disorder called hyperemesis gravidarum. Ginger cannot treat it, just as ginger cannot treat chemotherapy-induced vomiting."
• Set a firm boundary: "I know you mean well, but unsolicited advice about ginger and crackers is not helpful right now. What I actually need is practical support — could you help with [specific task]?"
• Disengage: If you do not have the energy to educate, a simple "thank you, I'll bear that in mind" and a change of subject is perfectly acceptable.
• Share resources: Send them a link to this page or to the Pregnancy Sickness Support website so they can educate themselves.

You do not owe anyone an explanation, and it is perfectly acceptable to say "I don't want to discuss it." Protecting your energy and mental health is more important than being polite to people who are minimising your suffering, however well-intentioned they may be.