MINOR COMPLAINTS OF PREGNANCY

A pregnant woman is more prone to physical discomforts than the nonpregnant. Some of these are occasioned by pregnancy, others exaggerated by it.

Nausea and Vomiting Since nausea and vomiting are usually mild, confined to the first few waking hours, and self-limited to five or six weeks, they rarely require specific medication. Nevertheless there are a few hints which may prove valuable even for those mildly affected.

Before going to bed place a couple of dry, crisp crackers in a tin box on the bedside table. Upon awakening, eat the crackers without raising your head from the pillow and continue lying on your back for twenty minutes, then get up.

If washing your teeth on arising induces or exaggerates the queasiness, postpone that ritual until later in the day when your stomach feels settled; in the interim simply rinse your mouth.

If the nausea persists after the dry-cracker routine, eat the following: 1. A light breakfast—for example, oatmeal (or, if preferred, a poached, shirred, or boiled egg); unbuffered toast with marmalade, jelly, or honey; and a cup of coffee or tea. 2. At midmorning, crackers, cake, or toast with a glass of milk or a cup of cocoa. 3. Luncheon, some broth or soup with crackers or toast; rice or a baked potato sprinkled with salt (a baked potato is the nauseated gui’s best friend); a salad without oily dressing; and a roll or slice of toast 4. Midafternoon, crackers, zwieback, or toast with a glass of fruit juice. 5. Dinner, lean meat or seafood; a green vegetable; baked, mashed, or boiled potato; salad; a dessert of ice cream, sherbet, or any other sweet which you feel confident you can keep down; plus bread, toast, or crackers according to taste. 6. Before bed, crackers, cake, or toast with a glass of milk, a cup of cocoa, or a malted milkshake.

Additional fluids should be taken throughout the twenty-four hours. Over a short period fluids are more important to health than solids. Very often iced liquids are best tolerated. Many woman in early pregnancy find plain water nauseating, but if a little lemon or orange juice is added it becomes drinkable. Almost all patients, no matter how nauseated, can take teaspoons of crushed ice flavored by fruit juice, which is a splendid source of fluids. The same may be said for sherbet or water ice, which makes an excellent midafternoon supplement; ginger ale, Coca-Cola, and Pepsi-Cola are valuable drinks since they are rich in carbohydrates.

There are other aids beside diet. Your physician may prescribe a sedative such as Vz grain phenobarbital three or four times a day, or 10 milligrams of Compazine with the same frequency. If cooking your husband’s breakfast ag- gravates the condition, temporarily cease being domestic. Going out into the air frequently makes you feel better. Don’t feel sorry for yourself, keep occupied, and remember the condition is self-limited in duration and almost always a memory by the twelfth week. Keep going; if you have a job, continue working if possible. Carry some crisp salt crackers, graham crackers, or zwieback to munch if a wave of nausea strikes you while on the bus or at the office. Eat small amounts often, not much at one time, to prevent your stomach from becoming empty.

The nausea and vomiting of pregnancy usually does not clear up dramatically. Improvement is gradual with the appearance of good days which soon gain the ascendancy over the bad days, and then the bad days become fewer and fewer and finally disappear.

A cardinal rule in the control of nausea and vomiting of pregnancy is to avoid foods that you think you cannot keep down, no matter how nutritious and beneficial they are. Substitute any food you think you can retain, no matter whether it is crabmeat or pig’s feet While you are plagued with nausea and vomiting, all the rules of diet are temporarily suspended; but should be in force as soon as the condition clears up.

If you lose ten pounds or more, or find yourself unable to retain any fluids or solids during a twelve-hour period, notify your doctor immediately.

One patient in several hundred vomits drastically enough during early pregnancy to require hospitalization. In such severe cases treatment is aimed at keeping the patient’s body fluids at normal levels by adinmistering glucose solution (sugar) into the vein. The glucose not only serves as food but also protects the liver from the changes of starvation. Vitamins, particularly C, Blt Ba, and B^, are given by injection or added to the intravenous fluids to prevent vitamin lack which may cause nerve inflammation, muscular weakness, etc. All foods and fluid by mouth are withheld for twenty-four to forty-eight hours, and then small feedings are begun every hour or two, particularly of dry foods. Attempts are also made to correct the psychic factor, if any is present, through strictly isolating the patient from the stimuli of family, friends, newspapers, radio, and television. Siifficient sedation is given to keep the patient sleeping three-quarters of the twenty-four hours.

In particularly stubborn cases psychiatric help is useful.

A quarter of a century ago a fair proportion of those admitted to hospitals with this complaint defied treatment so utterly and completely that pregnancy had to be interrupted by abortion. This was done with only one goal, to save the patient’s life. However, in the past two decades at the three institutions with which I have been intimately associated—the Johns Hopkins and Sinai Hospitals of Baltimore, and now the Mount Sinai Hospital of New York—not a single therapeutic abortion for vomiting of pregnancy has been found necessary in more than 125,000 pregnancies.