Pregnancy Vomiting: Care at Home

What is Hospital Displaced Care?

Hospital relocated care means that the treatment can take place at your home. This is possible because we work together with a number of home care organizations in this region (Icare, Carinova and Verian). They can provide this nursing care at your home. The Isala gynaecologist remains ultimately responsible for your treatment. The gynecologist will have daily contact with you to discuss the treatment and your situation. Is an adjustment in your treatment necessary? Then the gynecologist will discuss this with you and your home care nurse.

Nausea is a normal phenomenon in the first weeks of pregnancy:

• Usually there is mild nausea with occasional vomiting. Usually in the morning.
• In case of excessive vomiting during pregnancy, we speak of hyperemesis gravidarum: excessive (hyper) vomiting (emesis) during pregnancy (gravidarum).

It is not known exactly why some women do and others do not experience (excessive) vomiting during pregnancy. There is a connection between the number of hormones and vomiting. Therefore, the risk of excessive vomiting is higher if you are pregnant with multiple births. Did you also suffer from excessive vomiting in a previous pregnancy? Then you have a higher chance of vomiting excessively in a subsequent pregnancy. Sometimes it is due to spiritual factors.

Physical symptoms of (excessive) pregnancy vomiting include dehydration, weight loss and malnutrition. And therefore abnormalities in blood and urine results. It has been scientifically proven that your baby usually does not suffer from this. Your body ensures that your baby gets what he or she needs. Very occasionally the mother is so malnourished that the baby is also deficient in nutrients. But excessive vomiting certainly affects your condition and how you feel.

The symptoms often go away on their own when you are further along in your pregnancy. We do not prescribe medicines for mild nausea very quickly. But to women who vomit excessively and cannot keep anything down without medication. Of course we choose medicines that are not harmful to your baby.

In case of excessive pregnancy vomiting, you may be hospitalized. We also offer this form of care at home. The treatment mainly consists of giving extra fluids through an IV. This will take several days. If an infusion with extra fluid is not sufficient, tube feeding (feeding through a tube) may be desirable. Through nutritional advice you can try to reduce (excessive) vomiting.

What can you do yourself?

• Morning sickness is sometimes reduced by eating a cracker or rusk before you get up. Lie down for another half hour and then get up slowly.
• Do you wake up at night? A snack can keep you from feeling so nauseous in the morning.
• Nausea can also come or be made worse by an empty stomach. Have a small meal every 2 to 3 hours. For example a cracker or (half) sandwich or a little custard or yogurt.
• A lack of fluids worsens nausea. So try to drink enough every day. That is 1.5 to 2 liters of fluid per day. Think of full (butter) milk or yogurt drink and fruit juice. It is better to drink this than water, tea, coffee and broth. Because these drinks not only provide moisture, but also nutrients.
• If you eat less than usual, it is important that you mainly use products that give you energy. Preferably take full-fat products, such as full-fat yogurt, full-fat cottage cheese, butter or margarine.
• Sometimes cooking makes you nauseous. Maybe someone else can cook for you. Or possibly use ready-made products.
• If you prepare a meal in the microwave, you will be less bothered by cooking odors.
• Eat a cold meal if necessary. Cold food smells less. Think of bread, cheese, pasta, potato or vegetable salad, cold meat such as all kinds of meats or fish.
• Avoid strong odors that make nausea worse. Such as highly spicy foods, coffee, cigarettes and toothpaste.
• A bad taste in the mouth can be caused by drinking too little. Sometimes this disappears by eating something with a strong taste, for example a peppermint. Or suck on something sour, such as a slice of lemon or a piece of pickle.
• Sometimes nothing tastes; then try to eat something. Eating and drinking is important to stay in good shape.
• Do not drink caffeine and alcohol. But drink a glass of mint tea after dinner, for example.
• In consultation with your midwife/doctor and dietician, supplement vitamins and minerals with a dietary supplement. A dietary supplement especially for pregnant women.
• If necessary, supplement 10 µg of vitamin D during your entire pregnancy. Dietary supplements for pregnant women usually contain 10 µg of vitamin D.

Other advice:

• Provide a well-ventilated (bed) room.
• Do everything at a leisurely pace and take the time to get up in the morning.
• Rest several times a day. Even after exercise, such as a long walk or shower.
• Get up slowly and avoid sudden movements.
• Sit down for a while after eating.
• Try not to smoke! This is not only harmful to you and your baby, but also negatively affects your appetite.
• Provide as many distractions as possible. Because the more you think about the nausea, the worse it gets. Just make sure it’s not too busy for you. Reading, doing puzzles or other (quiet) hobbies can also be a distraction.

tube feeding

Doesn’t reduce nausea and vomiting? Then tube feeding may be desirable. That is nutrition through a tube (tube). The tube is inserted through the nose into the stomach. The food is administered drop by drop. This can be done at home with the help of home care. The dietician, together with you and the gynaecologist, will determine whether tube feeding is necessary. This happens during the telephone consultation or an outpatient appointment. During hospital relocation, you will have contact with a primary care dietitian at home. As soon as you are admitted to hospital, you will have contact with an Isala dietician.

Will my treatment be reimbursed by the dietitian?

Yes, from your basic package for a maximum of 3 hours per year. This also applies to telephone and/or e-mail consultations. The deductible also applies to outpatient consultations. More information about reimbursements for dietary advice per health insurer can be found on Zorgwijzer.nl and on Independer.nl.

Before you go home:

• we will examine you in the hospital to determine the treatment. We will draw blood, ask questions about your complaints and situation, make an ultrasound and together we decide that you will go home with home care.
• you will be given an IV needle (venflon) in your arm: a thin plastic tube that is inserted into your arm. The fluid supply is connected to this by the home care via an IV. Be careful with putting on and taking off clothes and doing household chores. The venflon must be well glued. Do you have any doubts about this? Consult with your home care nurse.
• you will receive confirmation that you can go home as soon as all examinations have been completed and the gynaecologist has discussed the treatment plan with the home care provider. The doctor will register you for the BeterDichtbij app, which you can use to make video calls with your doctor.
• you may receive a prescription from the gynecologist for medicines against nausea.
• collect the infusion fluid yourself at the pharmacy of Isala. Please note: this is a 9 kilo box! If necessary, use a wheelchair to bring it to your car. The wheelchairs are in the Central Hall.
• pick up the infusion pump from the Isala pharmacy or from your home care organisation. We will agree this with you in advance. You will also receive all the supplies for the infusion pump. Also a backpack in which you can take the pump with you, for when you go out.
• you will receive the written transfer information that you must provide to the home care. The gynecologist also sends this information digitally to the home care organisation.

When you’re back home

• Home care will visit you twice a day for care.
• The gynecologist will call you in the morning for an appointment by phone between 8.30 and 10.00.
• The physician assistant will call you between 4 pm and 5 pm to discuss how you were doing that day.
• The dietitian may also contact you for nutritional advice.
• Your infusion treatment can be reduced and stopped after 1 or more days.

Contact with home care

Do you have any questions? Please ask your home care nurse for an explanation.

Contact with gynecologist

If you still have questions between the two contact moments with the gynaecologist that cannot wait until the next telephone appointment, then the (on-duty) gynaecologist is your practitioner.

Do you have a question that is not urgent?

Would you prefer:

1. Make an e-consultation yourself in MijnIsala or BeterDichtbij.
2. Mail to [email protected]. You will receive an answer the same (working) day.

Do you have urgent questions?

Then call the gynaecologist on duty:

• on working days until 5 p.m., via the Gynecology outpatient clinic: 088 624 56 04
• in the evenings, night or weekend: 088 624 50 00 (ask for the gynaecologist)

We recommend that you put your questions on paper.

Do you have questions for the dietician?

In that case, call directly via the number you have already received from them.