I’m almost to the second trimester of what will hopefully be my first viable pregnancy, and I was unprepared for the nausea when it hit at 6 weeks. To date I haven’t vomited, but that first week, I struggled through each work day and could only temporarily keep the nausea at bay with small, frequent meals. Since then I’ve managed the nausea better by taking over-the-counter vitamin B6 supplements and Unisom (doxylamine succinate), a combination that’s shown to be safe in pregnancy, and continuing to eat frequent meals and snacks. But I’ve also used my saved vacation time to work 6-hour days for most of the last few weeks, having told my boss about my morning sickness. I’ve teleworked as much as my company policy allows – up to 4 times monthly, though my boss would likely accommodate me if I needed to do it more often – and held meetings virtually whenever possible. The nausea might be improving, but it’s more slow than sure, and my vacation time runs out soon.
A few times I’ve broken down and
taken Zofran, which I already have on hand as a security banket for my
borderline-phobia of vomiting. I’ve mostly taken it at night, when the nausea is
worse and I can no longer eat my way out of it. One bad night, I tried toughing
it out, and I spent the next day at work miserable and sleep-deprived. By bedtime
I finally gave in and took Zofran again.
An estimated 80%
to 90% of pregnant
people experience nausea, at least in the first trimester, and at least 50% of
pregnant people vomit. As many women reading this will know, my morning
sickness – or, more accurately, nausea and vomiting of pregnancy (NVP) – is relatively
mild. The Pregnancy-Unique Quantification of Emesis (“PUQE”) scale rates
severity of NVP from 3 to 15, with “mild” being 3 to 6, “moderate” being 7
to 12, and “severe” being 13 or higher. Before I started taking B6 and Unisom,
my nausea was on the higher end of mild, maybe 6. (BTW, Gideon Koren, who developed the PUQE scale, should
be smacked for that acronym. Unless it was coined by a female grad student who
scored high on it herself during a pregnancy.) My nausea still feels close to 6
on some days, particularly if I’m more sleep-deprived than usual.
Source: https://www.researchgate.net/figure/Modified-Pregnancy-Unique-Quantification-of-Emesis-and-Nausea-PUQE-scoring-system-NVP_fig1_322522359
In pop culture, morning sickness
is often portrayed as funny or cute, a rite of passage to fondly swap stories
about. In movies and TV shows, a pregnant woman will throw up once, twice,
maybe a few times, but then she’ll be fine and partying with her friends again.
(Think Knocked Up or How I Met Your Mother.) Behind these sunny
pop culture images is a glaring silence about how much NVP impairs a pregnant person’s
functioning at work and at home. And on occasions when the silence is broken,
what you hear is terrifying. A professional woman writes on LinkedIn about "vomiting in between Zoom calls" - though another woman believes it's a vast improvement over vomiting between office meetings. A healthcare worker on a pregnancy forum
in the What to Expect app spoke of throwing up between patients. A hairdresser
told me how the nausea had lasted for her entire pregnancy with her daughter, forcing
her to leave her clients in her chair to throw up multiple times a day. It’s
mind-boggling that women are expected to power through this, and even more so
how many women actually do. But should we have to?
Until recently, I didn’t fully
appreciate how the women’s liberation movement and the Pregnancy
Discrimination Act of 1978 revolutionized the role of pregnancy in the
workplace. According to the
ACLU:
“Since 1978, when
Congress outlawed pregnancy discrimination under federal law, pregnancy has
become routine in the U.S. workplace. Women now comprise half the workforce,
and roughly 85 percent of working women will be pregnant at least once.”
It’s no longer routine or legally
acceptable to fire women for getting pregnant or systematically avoid hiring
women for fear they will get pregnant and quit (though, as the ACLU notes,
discrimination is still rampant both within and outside the law, with many
employers failing to provide reasonable accommodations). However, in our push
to normalize pregnancy at work, and to prove to those hostile to women’s career
advancement that we could tough it out, maybe we’ve lost sight of how
physically difficult it really is to work while pregnant. When those of us who
struggle with NVP power through or stay silent about our struggles, we
perpetuate a climate where other pregnant people feel guilty or frightened
about asking for accommodations.
This minimization comes through,
in varying degrees, in the litany of online guides for dealing with NVP. The many
lists
of home remedies like crackers by the bedside, ginger tea, and avoiding strong
smells, don’t capture what a constant waking disaster NVP is for many pregnant
people. When they do mention prescription meds, their recommendations are often
reserved for women with “severe” NVP or Hyperemesis Gravidarum (HG). One article
counsels women to build extra time into their morning
commute to throw up, and to have a change of clothes at work in case of
disaster. In fairness, though, some of these sources tacitly acknowledge how
limiting NVP is by advising women to take
sick
time or otherwise lighten their schedules if they can. It's an obvious travesty that many
pregnant people have no
paid sick time, and little room
for workplace accommodation. This is especially true for women of color, who are overrepresented in low-wage jobs with limited benefits.
(A note on the Fortune article:
if you get a paywall on your desktop, try clearing your browser history or reading
it on your mobile device.)
The medical establishment, for its
part, isn’t as helpful as it could be. Because NVP is so common among pregnant
people, and temporary for most, doctors and midwives sometimes
minimize it. They may also force women with “moderate” or even “severe” NVP
to jump through multiple hoops, vomit multiple times daily, or lose significant
weight before accepting that home remedies and over-the-counter meds don’t work
for them. As noted above, the PUQE scale threshold for “severe” nausea is 13 or
higher. To achieve this score, you likely need at least 6 hours of nausea and
over 7 instances of vomiting or retching per day. A lot of misery and lost work
productivity can happen below a score of 13.
If I were writing advice for
people with NVP, it would read something like this:
- Yes, it really is as bad as you think it is. Don’t let a partner, doctor, employer, relative, or friend tell you otherwise. (For the record, my own husband has been nothing but sweet and supportive.) And if you are being a wuss – so what? We all have our own capabilities and limitations.
- If you have PTO or work flexibility, don’t feel guilty about using it. Don’t think of it as being lazy and trying to work less – think of it as managing your energy so you can do your best work when you are on the clock.
- Make it clear to your healthcare provider if slow-pedal remedies aren’t going to work. If you can’t try snacking on saltines and sipping ginger tea because you spend half your day recovering from vomiting, tell them that. If you have little or no PTO and a job with no time for trial and error, tell them you need prescription meds ASAP to be functional. You know your nausea better than they do.
- If you’re really struggling, strongly consider asking for Zofran (ondansetron) and taking it if it’s prescribed. ProPublica has detailed the suspected links between Zofran and cleft palate or, worse, heart defects in your baby. But, as my midwife explained, the studies demonstrating these risks have been criticized for having inadequate control groups. Women with more severe nausea may be more prone to having babies with these defects whether or not they take Zofran. The design flaws in these studies don’t rule out that Zofran poses a real risk, which could be 1 in 333 for ventricular septal defects (VSD). Different women will have differing levels of aversion to that suspected risk, but many in the NVP trenches find that Zofran helps them hold down jobs, keep their houses sanitary, and take care of the kids they already have. (Weird thing – my midwife told me that insurance companies often want women to rule out other NVP remedies, including meds like Zofran, before approving Diclegis, a prescription B6 + doxylamine combination that has a better safety profile. Of course insurance companies can’t do anything logically.)
- Don’t rule out blackmail if your care provider won’t prescribe the good stuff in a timely manner. Threaten to use cannabis or even to terminate the pregnancy if you can’t get relief from the nausea. /IJS …
My other proposed solutions don’t
fit neatly into a bulleted list. They’re political and a much heavier lift. For
starters, the proposed Pregnant
Workers Fairness Act would strengthen protections for pregnant people, particularly
in regard to workplace accommodations, picking up where the Pregnancy
Discrimination Act left off. And we obviously need universal
paid sick time as well as universal
paid maternity leave. (Side note: I don’t have paid maternity leave, but I’m
fortunate to have 7 weeks of paid sick time as of today. Hopefully I won’t need
it for anything else.) But even in countries with the most progressive workplace
policies and welfare states imaginable, women with NVP struggle both at work
and at home. A study
of Norwegian women found that even those with “mild” NVP sometimes struggle
with work productivity, housework, and caring for older children, which may
result in conflict with their partners.
My own experience with even “mild”
NVP has reinforced my views on abortion. I’ve already had less energy to
distinguish myself at work or apply for other jobs, at a time when the grant funds
for my position are in jeopardy. And it’s not like I have a golden parachute –
having come of age in the Great Recession, I know how quickly you can
fall out of professional employment if you can’t find an employer who considers
you a “good fit.” So it’s clear how financially devastating a hard pregnancy
can be for a woman whose job has lower pay, fewer benefits, and a more
unforgiving schedule. The words
of Ruth Bader Ginsburg are clearer to me than ever:
“The decision
whether or not to bear a child is central to a woman’s life, to her well-being
and dignity. … When government controls that decision for her, she is being
treated as less than a fully adult human responsible for her own choices.”
As it happens, I have some issues
with RBG, as articulated by authors here
and here.
(Of note, she had one Black clerk in all her SCOTUS tenure, despite Howard
University, an HBCU, being located in Washington, DC.) But she nailed it when
she expressed how much forced reproduction limits women, even in progressive
countries like Norway. Women and their families need to deal with the world we
have, not the world we ought to have, and access to abortion is a necessary coping mechanism.
At the same time, we shouldn’t stop
fighting for that better world. I agree with those who criticize
mainstream feminists and Democrats for focusing so heavily on abortion at the
expense of a broader reproductive and economic justice agenda – even, or
especially, in the wake of Roe v. Wade being overturned. Women shouldn’t
have to get abortions to hold down their jobs. And while I’m a fan of
Zofran, I don’t think women should have to take it in order to be good
little workers who keep on going. We need to acknowledge that pregnancy and
capitalism are ill-suited bedfellows, and at least the first trimester of pregnancy
is a substantial limitation for many people with uteruses.
The risk of acknowledging this,
of course, is that we’ll go back to era when employers will systematically
avoid hiring women, for as long as they can get away with it before facing a
class-action lawsuit. That’s why we also need to fundamentally re-imagine how
we relate to work and caregiving. When someone can’t sustain employment during
or after a difficult pregnancy, both
a Universal Basic Income (UBI) and a Federal Job Guarantee (FJG) could buffer
their household budgets and help them get back into the workforce when they’re
ready. In the ferment of the ‘60s and ‘70s, Italian
feminists envisioned paying women for caregiving and household labor, while
Angela
Davis proposed a more radical approach of socializing housework, moving it
from the private sphere into the professional workforce.
Fundamentally, we also need a
greater cultural appreciation for women as full participants in society. As Avra
Siegel, a former Care.com employee, puts it:
“Let’s be real:
it’s not like women got pregnant on their own – there was another person 50%
responsible for that pregnancy. But men just happen to not be the biological
sex that bears the child, and so all the consequences of the pregnancy fall on
women because of our physical role in childbearing and rearing. When our laws
and workplace policies do not account for the reality of pregnancy and
childbirth, it is the height of gender inequality, not because pregnancy is a
disability, but because it is actually a condition that should be honored,
revered and celebrated. We are perpetuating the human race after all.”
(And if you’re one of those
population hawks whose answer is “We shouldn’t perpetuate the human
race,” I’d kindly invite you to go fuck yourself. Sexual species reproduce –
that’s what we do, and realistically that’s not going to change. Even in rich countries,
not all childbearing people are profligate greenhouse gas contributors in terms
of frequent air travel or other luxuries. They’re constrained by political and
corporate decisions about whether transit is available, how efficient cars are,
how food and electricity are produced, and so on. Moreover, if we don’t have
enough people in future generations to run the economy, they’ll be ill-equipped
to adapt to climate change.)
Women have an individual right to
pursue their talents and dreams in the paid workforce, and society is the
better for our contributions and perspectives. Even with progressive transformations
like a UBI and FJG, a household where both parents are attached to the workforce
are likely to be more secure, with more political clout
and power to shape the means of production.
Finally, while the physical
struggles of pregnancy are unique to people with uteruses, this isn’t all about
us – it’s at least as much a race and class issue as it is a gender issue. While
we push for greater accommodation of NVP and other pregnancy complications, we
can also push for better accommodation for people of all genders who face illness,
disability, and other obstacles. When struggling with NVP, we deserve better
than to vomit between clients, bring spare clothes to work, and struggle
through our day with our gag reflex and our sanity hanging by a thread. And the
political economy needs to make room for all workers dealing with the struggles
of the human condition.
