As if our bellies weren’t feeling full enough, what with the whole baby-living-in-there-24/7 thing, constipation during pregnancy can make you feel truly awful. While constipation is one of the most common pregnancy symptoms that can hit during any trimester (and definitely one of the most annoying), it’s also one of the least discussed.
There are several reasons you’re likely to experience constipation at some point in your pregnancy. The first, and most obvious, is that carrying a baby around in an already crowded abdomen can put a lot of pressure on your intestines. As your organs start to shift around to accommodate your growing uterus, things tend to get squeezed which can slow down the movement of stool through the intestinal track.
To add insult to injury, high levels of progesterone that occur during pregnancy tend to relax smooth muscle—which just happens to be the kind of muscle responsible for moving food and waste through your digestive track. As the muscles relax, transit time slows, and things have a tendency to… well, back up.
Another common constipation culprit, both in pregnancy and at other times, is supplementing with elemental iron. This is the form of iron found in most prenatal vitamins and it can cause all sorts of digestive problems in women who are sensitive to it. I’ve written on the ways that prenatal vitamins containing this form of iron can contribute to morning sickness, but they can also slow bowel transit times and contribute to constipation.
Fortunately, there are several easy, natural ways to treat constipation during pregnancy.
If you’re taking a prenatal vitamin that contains iron and are having trouble with constipation, consider switching supplements. Many women who have adequate iron stores going into pregnancy don’t need to supplement with higher levels and can get away with taking a high quality multivitamin along with extra B6, B12, and folate (this is the combo I take during pregnancy). If you’re concerned with anemia or your doctor has suggested taking additional iron, try a food-based prenatal that contains a form of iron that is more easily absorbed by your body and less likely to cause digestive problems.
Just be aware that not all so-called food-based supplements are created equal… Since the term “food-based” is unregulated when it comes to supplements, many brands just throw a couple of true food-based nutrients into their existing mix of synthetic vitamins, slap a new label on the bottle, and jack up the price accordingly. Two brands I trust are Innate Response and New Chapter.
Change Your Diet
In addition to switching your prenatal, be sure you’re you’re getting enough veggies and fruit which contain the fiber and water needed to keep you regular. If you’ve been following the traditional advice for lessening morning sickness in your first trimester (i.e. eat lots of starchy carbs all day long to keep your blood sugar steady and avoid upsetting your stomach), your diet is probably significantly contributing to your constipation. Click here to find out what you should be eating instead to really keep morning sickness at bay.
Drink More Water
Along those same lines, drinking enough water is also necessary to keep things moving in your digestive track. Be sure you’re drinking enough to keep from getting thirsty and if you’re experiencing constipation, try adding in a few extra glasses throughout the day. Walking more can also help with constipation, but be sure to increase your water intake even more as you increase your activity level.
Load Up On Probiotics
Probiotics can also help with constipation. Try adding some full-fat, unsweetened yogurt or kefir to your diet, or add in more fermented traditional foods like sauerkraut, kimchi, kvass, or kombucha.
There’s been a lot of controversy lately over whether or not probiotic supplements can be trusted after one independent research study found that many brands contained ingredients not listed on the label and another found evidence of fungal contamination. Other studies have found that many supplements don’t contain the levels of bacteria they claim to. Since researchers aren’t naming the brands they tested, I can’t currently recommend any widely available supplements and I suggest getting your probiotics from food (kefir is my personal favorite).
There are a few brands of high-quality probiotics I trust that are available through licensed healthcare practitioners. Unfortunately, they all require continuous refrigeration, so shipping on these products can often be two to three times the cost of the product itself. If you can find a local practitioner that carries them though, I like probiotics from Innate Response, Klaire Labs, and Thorne Research.
Supplement With Magnesium
If your diet is up to par, you’re getting enough activity, and you know you’re drinking enough water to prevent getting dehydrated, you might want to try taking powdered magnesium citrate. Most pregnant women are deficient in this mineral and it’s my secret weapon for combatting all sorts of pregnancy symptoms, from morning sickness to insomnia, anxiety, nighttime leg cramps, and more.
To use magnesium citrate to treat constipation in pregnancy, start by taking a half teaspoon in warm water before bedtime and gradually increase your dose until you’re having normal bowel movements that are comfortably soft, but not loose. If you get to the point where you’re taking more than a teaspoon, you can divide your dose so you’re taking half in the morning and half at night. Magnesium can also help with insomnia though, so if you’re having trouble sleeping you might find that taking your entire dose at night helps.
Take magnesium at least two hours away from any calcium supplements or calcium rich foods (i.e. don’t take it with a glass of milk). And although magnesium is usually safe to take at normal dosages during pregnancy, be sure to check with your midwife or OB before adding this (or any) supplement to your daily regimen.
Finally, avoid taking stimulant laxatives during pregnancy, including herbal formulas or teas. Many herbal laxatives contains senna or cascara sagrada, both of which are unsafe to use during pregnancy.
One of the most common causes of nausea and vomiting in early pregnancy isn’t a result of morning sickness at all… Your symptoms may actually be caused by something you probably think are doing nothing but good things for you and your developing baby: your prenatal vitamins.
Many women (including yours truly) are sensitive to the elemental iron contained in most prenatal vitamins. But unless they’ve tried taking high dose iron supplements before getting pregnant, they may have no idea their vitamins are what’s making them sick.
I found out about my sensitivity the hard way in my early twenties… I started taking prenatals in an attempt to get my hair to grow faster and soon was puking every morning before heading out the door to work. It took me a few weeks to connect the two, but once I stopped the vitamins my stomach issues disappeared almost instantly. When I asked my doctor about the reaction she told me that iron sensitivities are extremely common and to look for an iron-free prenatal.
While it’s true that your need for iron increases as your blood volume increases during pregnancy, not all women need to supplement their diets with iron. Many women who enter pregnancy with adequate iron stores have no problem keeping up with this demand through their normal diets.
Additionally, your iron requirement really only increases when your body starts to step up red blood cell production, which doesn’t occur until sometime in the second trimester. In fact, your body’s need for iron actually decreases in the first trimester since you’re no longer losing blood through menstruation. Your body’s ability to absorb iron also increases the farther along you are in your pregnancy, correlating to your increased need for the mineral.
If you’re extremely sensitive to iron, talk to your practitioner about whether or not you really need to be supplementing it. If your red blood cell counts are in the normal range and you’re not having any symptoms of iron-deficient anemia (many of these symptoms can be confused with normal symptoms of pregnancy, such as fatigue, dizziness and headache, but others such as brittle nails, mouth sores, paleness and cold hands and feet should act as red flags), you may not need to take iron during your pregnancy. Increasing your intake of red meat or cooking in a cast iron pan may even be enough to keep your levels where they need to be. If this is the case for you, rather than a true prenatal I’d recommend a high quality food-based supplement combined with extra folate, B6 and B12 (this is the combination of supplements I’ve taken throughout my pregnancy).
If you do need to supplement with iron, wait until your morning sickness symptoms have begun to subside and then try a food-based prenatal that contains a form of iron that may be easier on your stomach. I’m completely unable to take elemental iron in any amount, but have no problem with moderate doses of iron found in food-based supplements. My favorite high quality food-based supplements are made by the brand Innate Response (available online or through health care practitioners), but I also recommend those made by New Chapter which can be easier to find locally and are carried in most natural food stores.
Are you sensitive to iron-containing supplements? What ways have you found to increase your iron intake that don’t irritate your stomach? Let me know in the comments below!
One point that’s commonly recommended for morning sickness is called P6 (or Neiguan) and is located a couple of inches above the wrist on the inside of the arm. Many people even recommend Sea-Bands for morning sickness which are bands made to combat motion sickness and are designed to stimulate this point.
While P6 is a great all-purpose point for nausea, it’s not the best choice for morning sickness specifically. There is another point called KD27 (or Shufu) that is a much better (if lesser known) option. This is the point I credit with keeping me sane during my first trimester… While it didn’t completely eliminate my nausea, wearing tacks designed to constantly stimulate this point kept my discomfort to a minimum and relegated my morning sickness to the evening hours, allowing me to work comfortably all day. If I took the tacks off for too long, I’d be hit with all day queasiness that would make me want to curl up in bed all day and hide.
While I strongly recommend seeing an acupuncturist to locate this point properly (see www.POCAcoop.com to find a low-cost community acupuncture clinic near you), you can locate and stimulate these points on your own if that’s not a possibility.
How to locate KD27:
To locate the point, stand in front of a mirror and locate your clavicle (the horizontal bone that runs along the top of your chest and connects your breastplate to the top of your shoulders). Feel along the top of the clavicle toward the center of your chest until you feel the place where the clavicle meets the breastbone on each side. Now move your fingers down and slightly outward until you feel a slight indentation where the bottom of your clavicle meets the breastbone. Press around in this area until you find a a point that is more sensitive than the rest of this area. The sensitive point in this indentation is KD27.
How to stimulate Kd27:
There are several ways to stimulate this acupuncture point.
First, you can use basic acupressure techniques. When feeling nauseated, locate this point and use the tip of your index finger to rub it firmly, using a small circular motion. You can also press on the point, applying firm pressure for at least 30 to 45 seconds. Acupressure at this point may help relieve acute nausea, but will probably not do much to prevent feelings of morning sickness unless you are stimulating this point constantly throughout the day.
The next most effective technique is to apply seeds or beads that will keep constant pressure on the points. These seeds (commonly called “ear seeds” since they’re often used to stimulate points on the ear) are available through acupuncturists, or they can be ordered on Amazon. Traditionally the seeds used by acupuncturists are from the vaccaria plant and are attached to a paper or woven adhesive backing, similar to a band-aid. Some acupuncturists now use beads made of gold, silver, or even magnets instead of vaccaria seeds, although I prefer the traditional seeds myself. These seeds can be applied to KD27 and worn for extended periods, then replaced when the adhesive backing comes loose from the skin.
The third option, which is by far the most effective, is using tiny acupuncture tacks that pierce the skin and can also be worn long term. Similar to vaccaria seeds, the needles are attached to an adhesive backing and can be replaced when the adhesive starts to lose its stickiness. Although I highly recommend having tacks initially placed by an acupuncturist (you can replace them yourself after your initial treatment), they are also readily available on Amazon.
You may feel a small pinch when the tacks are first applied, but they are completely painless once in place. Although infection at the needling site is extremely uncommon (I’ve never seen an infection from acupuncture needles or tacks during my ten years in practice), the skin should be wiped clean with alcohol to remove bacteria before inserting the tacks.
Each of these methods can be used continuously until morning sickness begins to subside, usually around 12 to 14 weeks.
Have you tried using acupuncture or acupressure for morning sickness? Did it work? Let me know in the comments below!
I’ve read several explanations regarding the mechanism by which magnesium lessens the symptoms of morning sickness, but frankly, none of them really stand up to close scrutiny. The most popular theory I’ve run across online credits magnesium’s ability to lower cortisol levels. While it’s true that magnesium supplementation has been shown to reduce levels of this hormone, cortisol production actually peaks later in pregnancy. That means that if cortisol was to blame for morning sickness, we’d be feeling nauseated later in pregnancy, not in the first trimester.
Regardless of how it works, I have found that using a magnesium supplement can reduce the symptoms of morning sickness. For me, it seemed to take away the feeling that my digestive tract was super-irritated which was one of the worst parts of morning sickness for me. It can also lessen nausea and aversions to foods and smells.
There are several ways to increase your intake of magnesium. The best is probably to up your intake of magnesium-rich foods such as nuts and seeds, spinach, and black beans. The magnesium found in foods is most readily absorbed by your body, so if you can tolerate eating foods that are high in magnesium, consider adding them to your daily diet. It’s likely however, that you may require additional supplementation if your morning sickness symptoms are severe.
While there are many forms of magnesium supplements available, I prefer powdered magnesium citrate, taken before bedtime. The most popular and widely available brand of magnesium citrate is probably Natural Calm, but independent testing of this supplement has shown it may contain unsafe levels of lead. Not the best thing to be ingesting while pregnant (or at any time for that matter). It’s entirely possible that the lead issue had been resolved, but just to be safe, I prefer Magnesium Serene (manufactured by Source Naturals and available in several flavors — I’m partial to the tangerine).
Start by taking a half teaspoon in warm water before bedtime and gradually increase your dose until you start to experience loose stools. Then back down a bit until you’re having normal bowel movements and stay at that dose. Take it at least two hours away from any calcium supplements you may be taking, or calcium rich foods (ie don’t take it with a glass of milk). And although magnesium is usually safe to take at normal dosages during pregnancy, be sure to check with your midwife or OB before adding this (or any) supplement to your daily regimen.
The last option is topical magnesium oil or gel. Topical magnesium is gaining in popularity, but may people find that it’s irritating to their skin. It has been purported that topical magnesium is better absorbed by the body and some people swear by it, but I have personally never had great results with it for morning sickness. I do recommend it for leg cramps that may occur later in pregnancy.
Have you used magnesium to combat morning sickness symptoms? What form have you found to work best for you? Let me know in the comments below!
Ginger has long been recognized for its ability to quell nausea. In addition to morning sickness it’s been widely studied and proven useful for motion sickness, nausea resulting from chemotherapy treatment, food poisoning, and even the nausea can that sometimes accompany migraines.
The exact mechanism by which ginger reduces nausea is unknown, but it can be taken in many forms including fresh (you can find the root in the produce section at the grocery store), dried in capsules or as tea, crystallized, or as an ingredient in foods or drinks. Most ginger ales, famously given to sick kids with the stomach flu and as a staple on airplanes everywhere, contain much more sugar than ginger. In fact many brands don’t contain any actual ginger at all these days, having been replaced years ago with “natural” or artificial ginger flavoring.
A much better option is ginger tea, made with grated or sliced fresh ginger, or bought in bags as a tea that’s available online and at most health food stores. I find the warmth of the tea is soothing to many women experiencing nausea and drinking it in liquid form gets the ginger into your system to start relieving nausea quickly.
To make a tea from the fresh root, take several thin slices of ginger or about a tablespoon of freshly grated root and add to a cup of hot water. Let the tea steep for three to five minutes and add a squeeze of lemon if desired. You can also nibble on the slices or gratings themselves after the tea is gone.
Although I typically recommend limiting sugar, especially during the first trimester when it can aggravate morning sickness, crystallized ginger or natural ginger chews can easily be stored in your purse for times when nausea strikes and you’re out and about.
If using the fresh leaves, rub gently between your fingers to release the plant’s natural oils and then rip them into smaller pieces before adding a couple of tablespoons to a cup of hot water. Alternately, add about a tablespoon of the dried herb to hot water and let steep for three to five minutes before drinking.
Again, I recommend avoiding sugar during your pregnancy, but for emergencies natural mint candies can be a lifesaver when you’re out and about and don’t have another option. Just be sure to check the label and avoid anything that contains artificial sweeteners.
Try experimenting with both ginger and peppermint to see how you react to each. Some people find that one will sometimes bring on heartburn, but are ok with the other. I personally found that ginger relieved my nausea more quickly, but peppermint kept it at bay longer. Try them both to see what works for you!
Do you use ginger or peppermint to relieve your morning sickness? Which form works best for you? Let me know in the comments below!
Willetts K, Ekangaki A, Eden J. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Aust N Z J Obstet Gynaecol2003;43:139–144. http://www.ncbi.nlm.nih.gov/pubmed/14712970
Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynaecol 97;2001:577–582. http://www.ncbi.nlm.nih.gov/pubmed/11275030
Although the exact cause of morning sickness remains unknown, it can be greatly aggravated by falling blood sugar. Many women notice that if they go too long without eating, morning sickness returns with a vengeance. The advice to eat saltines when you start to feel nauseated is based on this fact and the idea is that a fast infusion of glucose into the bloodstream will quickly raise blood sugar and relieve the resulting queasiness.
The problem with this advice, as most people now know, is that empty, white-flour carbs (like those found in saltines) will cause a blood sugar spike and subsequent crash that may leave you feeling even worse once the initial effects of the carbs wear off.
Alternately, a diet higher in protein and lower in quickly absorbed carbs (sugar, white flour, etc) will help keep blood sugar at a more consistent level throughout the day. In fact one study published by the University of Michigan Medical Center showed that meals high in protein decreased nausea and digestive dysrhythmia much better than meals that emphasized carbohydrates or fats.
Although many women experience strong aversions to meat and eggs during their first trimester (probably a biological left-over from the days before refrigeration when these types of foods spoiled quickly), if you can stomach them, they’re great sources of the healthy protein your body needs to grow a baby. Don’t worry if you find it difficult (or impossible) to eat meat and eggs, you still have plenty of other good protein options available.
Smoothies made with fruit, milk and whey, egg, rice, or pea protein can satisfy cravings for sweets while also upping your protein intake. Just make sure the protein powder you choose doesn’t contain any sugar, artificial sweeteners, or additives. I feel comfortable recommending limited amounts of stevia-sweetened powders to my pregnant patients (and consuming them myself), but check with your midwife or OB if your pregnancy is high-risk or if you have concerns regarding stevia. My favorite all natural, stevia-sweetened protein powder comes in egg and whey varieties and can be found here.
Many women with food aversions can tolerate dairy products, so Greek yogurt and hard cheeses can be another good protein option. Choose full-fat dairy products that are organic and / or grassfed when possible. As Greek yogurt has increased in popularity, so have knock-offs that contain far more sugar than protein. Look for plain, unsweetened versions that contain at least twice the amount of protein as carbs. My personal favorite is Fage Total (check out their store locator to find the Classic Plain at a store near you).
Nuts are another good source of protein and can also help with salt cravings. Raw unsalted nuts pack the biggest nutritional punch, but roasted salted nuts can be a great substitute for those nutrient deficient saltines everyone keeps trying to push on you. Choose dry-roasted nuts when possible and be sure to check labels for added sugars, sweeteners, and additives.
Sometimes when you’re experiencing morning sickness you’re just going to have to eat whatever you can get (and hopefully keep) down, but if you aim to keep your protein intake high on most days while keeping sugar (including honey, maple syrup, agave nectar, etc) and starchy carbs to a minimum, you’ll greatly reduce the nausea most women experience during the first trimester.
What diet changes have you made that have helped with your morning sickness?
Jednak MA, Shadigian EM, Kim MS, et al. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am J Physiol. 1999;277(4 Pt 1):G855–G861. http://www.ncbi.nlm.nih.gov/pubmed/10516152
Your sense of smell can be greatly heightened during pregnancy, probably to help you more easily detect and avoid rotten foods and other substances that may be harmful to your growing baby. Since most of a baby’s physical development occurs during the first trimester, this is the time that those substances can do the most damage. Not surprisingly, this is also the time that smells can be the most off-putting.
While this increased sense of smell can be great for avoiding things can hurt your baby, it’s not so great when it makes you go running for the bathroom every time you walk by the meat counter in the grocery store or catch a whiff of the Italian take-out your coworker is eating for lunch.
One of the most effective ways to combat the effects that bad smells can have on your stomach is to carry around a small bottle of citrus-scented pure essential oil. The clean, astringent smell of the citrus can instantly calm nausea for many women. Small bottles can easily be carried in pockets or purses and can be pulled out and discretely sniffed when you encounter unpleasant odors. You can also apply a few drops to a tissue or handkerchief to carry with you instead of a full bottle.
Personally, during my first trimester, I carried around a small bottle of grapefruit essential oil that I sniffed any time I felt nauseous, whether the nausea was smell-related or not. I always felt as though the clean, astringent scent calmed both my stomach and my mind, helping ward of fatigue and pregnancy-brain as it quelled my nausea.
On days that I was feeling particularly sensitive, I kept the bottle open on my desk which seemed to help dissipate other smells in the area. This can also be accomplished through the use of an oil diffuser, kept close-by and used to help diffuse the scent throughout your personal space. I also recently cam across this essential oil jewelry which I really wish I had known about when I was pregnant. I don’t normally wear jewelry, but having something this close to constantly diffuse a citrus scent would’ve been a life saver!
Natural air fresheners can also be used for this purpose, especially when room smells are bothering you. (I kept cans in both the bathroom and the kitchen and instructed my husband to use them frequently!) While artificially scented sprays can actually aggravate nausea, natural citrus sprays will eliminate smells and act similarly to essential oils.
There are a few essential oils that may be unsafe to apply topically to your body while pregnant, all citrus oils are completely safe. I recommend grapefruit, orange, lemon, lime or tangerine. Just be sure to choose one that is 100% pure essential oil to avoid any unsafe additives.
Do you have a favorite essential oil that you’ve found works especially well to calm your morning sickness? Let me know in the comments below!