Morning Sickness, Which Is Rarely Just Morning

The name is a lie. Nausea in pregnancy usually begins before you are properly awake, peaks in the late afternoon, and eases around week 14, though a minority of women are still nauseated at 20 weeks. Knowing the shape of it helps, because the useful strategies depend on when it lands.

What has evidence behind it

Small, frequent meals with some protein in each one. Cold or room-temperature food, which smells less. Ginger in any tolerable form. Vitamin B6, and the combination of B6 with doxylamine at night, which is the first-line treatment in most national guidelines and has a long safety record in pregnancy. If you are offered medication, it is the standard next step when the simple measures are not enough.

• Eat something dry before you get up, if mornings are the worst stretch.
• Keep a bland snack within arm's reach all day, not just at mealtimes.
• B6 alone, or B6 with doxylamine at night, is the standard first-line option.
• Call the same day if you cannot keep fluids down for a full day.

When it stops being ordinary sickness

Losing weight, dark urine, dizziness on standing, or vomiting that keeps you from work for days are signs of hyperemesis, which is a diagnosis and not a personality trait. It is treated with fluids, antiemetics and sometimes a short admission, and it is worth being pushy about because dehydration makes nausea worse, which makes dehydration worse.

One thing to leave behind: the idea that being sicker means the pregnancy is healthier. There is no reliable relationship, and treating it early tends to shorten the whole episode rather than prolong it.