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Not Morning Sickness: Is our vocabulary diminishing the suffering of women?

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After researchers labelled the term ‘morning sickness’ as ‘inaccurate’, a pledge campaign is calling for the phrase to be replaced.

Nausea and vomiting in pregnancy is usually called ‘morning sickness’, but a recent study led by the University of Warwick has shown that the term tends to trivialise the condition. Symptoms have been described as occurring both before and after noon and referring to them simply as ‘morning sickness’ is inaccurate, simplistic and unhelpful, the researchers have found.

They analysed hourly diaries kept by women in early pregnancy, finding that 94.2 per cent experienced nausea and/or vomiting and they concluded that the term ‘pregnancy sickness’ would be more suitable.

“If you are one of the 80 per cent of pregnant women who suffer from it every year, you will know all too well that pregnancy sickness doesn’t just occur in the morning. It can strike at any time of the day”, say Nicola Cutcher and Charlotte Howden, the founders of the ‘Not Morning Sickness‘ campaign which calls on health professionals, the media, retailers and the public to stop using the term ‘morning sickness’.

As part of the ‘Not Morning Sickness’ campaign, the two founders are asking people to make pledges in support of it, using the hashtag #NotMorningSickness and detailing how they can help to change the language. They are encouraging women who have suffered from pregnancy sickness to share their personal stories to help raise awareness of the condition and to express their exasperation with the language surrounding it.

Health professionals are also asked to respect the severity of the condition and stop using ‘morning sickness’ in written materials and in consultations with patients.

“Let’s take the Oxford English Dictionary’s definition of morning sickness,” encourages Nicola Cutcher. “It says it is a sign of pregnancy, occurring at any time of day’. Since when did ‘morning’ mean ‘any time of day’? This is broken language and women shouldn’t put up with it anymore.

“When I was ill during my pregnancy, I told a friend that I’d had a miserable day and thrown up lunch and dinner, and she replied, ‘sounds more like an all-day sickness’. I had to bite my hand to stop myself from screaming ‘it is an all-day-sickness’. I can’t blame my friends for taking words at face value,” she adds.

“The terminology of ‘morning sickness’ diminishes the suffering of women and misleads those around us to think of pregnancy sickness as a minor inconvenience confined to the mornings. This is so wrong. I know that there are a lot of problems in the world but this one has an easy fix: just change the language!”

Charlotte Howden says she was diagnosed with Hyperemesis Gravidarum. “It is a potentially life-threatening and debilitating form of severe pregnancy sickness. I’ve shared my story with the media many times to help raise awareness of just how life-changing this condition is. When I would then see my story reported as ‘really bad morning sickness’, I would feel incredibly disappointed and frustrated.

“No account of how many times a day I was being sick could undo the damage of that misleading headline. Morning sickness doesn’t cover it. We have to change the language and call it what it is— pregnancy sickness.”

Flo Health, the creator of the women’s health app Flo, is joining forces with Cutcher and Howden, replacing the term ‘morning sickness’ with ‘nausea and vomiting’.

Flo replaces the term ‘morning sickness’ on its platforms

“Flo is committed to creating a better future for female health and this includes providing women with accurate and accessible health information,” says Cath Everett, VP of product and content at Flo Health. “Over 28 million women have logged pregnancy while using Flo, and while morning sickness sounds like something that is confined to just one part of the day, nausea and vomiting in pregnancy can occur at any time of the day. Given that the term is outdated and medically incorrect, we are joining in on the effort to put an end to this term.

“From this point forward, all new content found within the Flo app will refer to ‘morning sickness’ as ‘nausea and vomiting’. We hope that this shift in language will reflect the symptoms more accurately and encourage a greater sense of self-advocacy among those who experience this condition.”

Putney MP Fleur Anderson has also shown her support, tweeting: ‘I fully support this campaign to stop use of ‘morning sickness’ and say ‘pregnancy sickness’. I was sick all day, everyday, through every pregnancy. This change will make a huge difference in understanding, support and expectations.”

Terminology and using the correct language can have a huge impact on how people deal with what they are going through, Charlotte Howden adds. “If someone, anyone, had said to me “I am so sorry that your pregnancy sickness is so extreme and I can see how much you are suffering”, it would have gone a long way to help me understand that what I was going through wasn’t normal. Morning sickness doesn’t cut it anymore. So let’s just change it and call it what it is.”

Use #notmorningsickness hashtag to share your own experience and help end the term ‘morning sickness’.

@notmorningsick

 

Sorina Mihaila is the Femtech World editor, covering technology, research and innovation in women's health. Sorina is also a contributor for the neuro-rehabilitation magazine NR Times.

Pregnancy

From OB/GYN to entrepreneur: the Kenyan doctor rethinking maternal health

Maternal and newborn deaths are still a major public health problem in Kenya

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Dr Lorraine Muluka, OB-GYN and founder of Malaica

Kenya has one of the highest maternal mortality rates in the world. In 2020, the maternal mortality ratio in the East African country was 530 deaths per 100,000 live births – much higher than the global average of 223 maternal deaths per 100,000 live births. The ratio of babies who die in the first month of life is also higher than the global average.

However, as Dr Lorraine Muluka, a Nairobi-based OB-GYN and founder of the health tech start-up Malaica, has found out, most of these deaths can be prevented if women have access to safe and affordable maternal health services.

Here, the consultant-turned-entrepreneur tells us why she thinks innovation will prove to be essential in bridging the health gaps in the Kenyan healthcare system.

Hi Lorraine, could you tell us a bit more about your background?

My name is Dr Lorraine Muluka and I am an OB-GYN. I am also the co-founder and CEO of Malaica, a health tech start-up that focuses on maternal health in Kenya. I hold a master’s degree in medicine in obstetrics and gynaecology from the University of Nairobi and have worked in various private and mission hospitals in Kenya’s maternal healthcare sector.

Over the past decade, I have been involved in several healthcare start-ups, driven by my passion for innovating and improving the Kenyan healthcare system. I have also been practising as a consultant obstetrician at my private practice in Nairobi. In 2021, I decided to fully commit to my vision of improving maternal health in Kenya by co-founding Malaica.

What inspired you to create Malaica?

The birth of Malaica was driven by a shared passion by the co-founders for safe motherhood and an aspiration to transform the narrative of maternal and neonatal mortality ratios in Sub-Saharan Africa.

Personally, as an OB-GYN several times it was very frustrating seeing mothers lose their lives to preventable causes. A need to fix the gaps and delays in maternal healthcare that lead to poor pregnancy outcomes is at the core of Malaica and the inspiration behind its creation.

The delays women experience begin with a woman’s decision to seek care, extend to her access to the appropriate healthcare facility and also the quality of care she receives once there. These gaps result from the various challenges women face which include limited access to quality care, lack of continuous support and high healthcare costs among others.

By recognising and addressing these gaps, Malaica aims to provide a holistic, affordable, and supportive environment for expectant mothers, ultimately improving maternal and neonatal health outcomes.

How would you describe Malaica in a few words?

Malaica provides a dedicated online support team for expectant mothers, making the journey of pregnancy happier, more affordable, and safer. With Malaica by their side, expectant mothers can rely on the invaluable companionship and guidance they need throughout their pregnancy.

What makes Malaica different?

Malaica offers a unique approach to pregnancy support that focuses on the holistic wellbeing of expectant mothers, including physical health, mental wellness, and delivery readiness. Our online platform offers personalised care for each woman at an affordable cost, with a personal nurse midwife assigned to provide support throughout pregnancy.

We provide access to obstetricians/gynaecologists, educational content, and a nurturing online community moderated by supamums for peer support. In Nairobi, we offer both virtual and in-person ANC clinics and birth preparation classes.

What sets us apart is our unwavering empathy, creating a warm and supportive environment for expectant mothers. Malaica adapts to evolving needs, making us the ideal choice for pregnancy support.

Women’s health comes with a lot of stigma. How has this impacted you as a founder?

In all my years of practising medicine, especially in obstetrics and gynaecology, I have noticed that there is a lot of stigma surrounding women’s health, especially during pregnancy. This stigma can take many forms, from societal taboos to misunderstandings about women’s health issues. Sometimes, it’s challenging to remove these barriers and create an open and supportive environment where soon-to-be mothers can access the care and assistance they need.

However, this awareness of the problem has become a powerful motivation for me. It has encouraged me to work even harder to break down these obstacles and create a safe space where women can receive the care and support, they require without being judged. It has reinforced Malaica’s commitment to empathy and understanding, ensuring that we remain a platform that is free from stigma, where mothers-to-be can access the care and guidance they need with dignity and respect.

What obstacles have you encountered on this journey?

As pioneers in the industry, we face a unique set of challenges as a remote company. One of our main challenges is proving to potential clients that our services are genuine and essential. We also strive to provide high-quality care while managing costs, which can be difficult for affordable programs like Malaica’s.

Providing physical services in remote or underserved areas poses a logistical challenge, especially considering the competitiveness of the healthcare and pregnancy support industry. Many other providers are offering similar services, so we must work hard to stand out.

As a tech company, we require ongoing technological investments and cybersecurity measures to maintain a reliable online platform for our subscription program and telehealth services.

Another challenge we face is health education. Educating expectant mothers about the importance of maternal health and the services available to them can be difficult, particularly in areas with limited health literacy.

Finally, ensuring the financial sustainability of the business, especially when offering affordable subscription programs, can be quite challenging. However, social enterprises like Malaica play a vital role in improving maternal health and supporting expectant mothers. Our dedication to our mission can lead to positive outcomes for both the business and the community it serves.

What lessons have you learned?

My journey as the founder of Malaica has taught me several vital lessons. I’ve come to understand that empathy is the cornerstone of effective support for mums-to-be. Recognising the diversity of experiences among our users and tailoring our services accordingly is crucial.

Building a strong community of support through supamums and support groups is powerful. The world of women’s health is ever-evolving, necessitating continuous adaptation and improvement.

Challenging the stigma surrounding women’s health is essential, and affordability should never be compromised. Collaboration with experts enhances the quality of care, and unwavering passion fuels dedication to our mission. These lessons guide our commitment to making pregnancy safe, convenient, and stigma-free for women worldwide.

Where are you with Malaica now?

Malaica has come a long way since its inception. We are now a reliable and easily accessible online platform for pregnancy support services, with a reach across the nation. Our commitment to providing comprehensive care, including access to nurse midwives, specialists like gynaecologists, paediatricians, psychologists, and support groups, has cemented our position as a go-to resource for expecting mothers. We strive to eliminate the stigma surrounding women’s health and continue to evolve and grow.

Malaica’s commitment to affordability and inclusivity ensures that we remain a beacon of support for women worldwide. Although our journey is ongoing, we are proud of the progress we have made.

Where do you see the company in the future?

We are committed to expanding Malaica’s reach and improving the pregnancy journey for expectant mothers in Kenya and beyond. Our ultimate goal is to ensure that even more mothers have access to better support and care throughout their pregnancy.

As a health tech company, we will continue to leverage advanced technology for telehealth services, making our services more accessible and convenient, especially for mothers in remote areas.

We also aim to foster connections among mothers and provide a strong network of emotional support through our expanding community of expectant mothers. Additionally, we are building partnerships with healthcare institutions, NGOs, and government bodies to strengthen our impact on maternal health and reach underserved populations.

Education and advocacy are major challenges in the pregnancy healthcare space, and we will continue to engage in initiatives that raise awareness about maternal health issues and promote healthy pregnancy practices.

Overall, we are optimistic about Malaica’s future as we adapt to the changing healthcare landscape and provide essential support to expectant mothers.

 

Dr Lorraine Muluka holds a master’s degree in medicine with a specialisation in obstetrics and gynaecology. Driven by a passion for improving the Kenyan healthcare system through innovation, Dr Muluka has played significant roles in several healthcare start-ups over the past decade, while also maintaining her role as a consultant obstetrician at her private practice in Nairobi. At the end of 2021, Muluka co-founded the health tech start-up Malaica. She is currently serving as the CEO of the company.

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NHS England to boost health support for new mums

New mums in England will benefit from personalised postnatal care to support their physical and mental health

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All new mums in England will receive better mental and physical check-ups from their GP in the weeks after giving birth, as part of a significant NHS guidance update. 


GPs will carry out the comprehensive postnatal check-up six to eight weeks after women give birth, covering a range of topics such as mental health, physical recovery and breastfeeding.

Around 600,000 women give birth in England every year and they are all entitled to a postnatal check-up after they give birth, in addition to the newborn check-up.

The new NHS guidance written in collaboration with the Royal College of GPs will ask family doctors to provide personalised postnatal care for their physical and mental health and support them with family planning.

One of the country’s most senior GPs said the guidance would boost postnatal care and encouraged women to attend the important check-up.

Dr Claire Fuller, NHS medical director for primary care and the NHS’ lead GP in England said:“More than 600,000 women give birth every year in England, and so it is vital that they can get the right NHS mental health and physical support at what can be a hugely pressured moment in their lives.

“GPs are perfectly placed to offer new mums a welfare checks six to eight weeks after giving birth – for not only their physical health but also their mental wellbeing and this new NHS guidance published today ensures that family doctors have the resources to provide this comprehensive support.

“If you are a new or expectant mum and struggling with your mental health, the NHS is here to help so please come forward through your GP practice or midwifery team”.

The routine check-up is hoped to be an opportunity for GPs to better assess and support women in their physical and mental recovery post-birth, making sure they can be referred, if necessary, to a specialist straight away.

Health and Social Care Secretary, Victoria Atkins, said: “Mothers should be supported after giving birth. This includes being able to get the mental and physical health support needed for a healthy recovery – while giving new-borns the best start in life. The postnatal check provides an important opportunity for GPs to listen to women in a discrete, supportive environment.

“This builds on part of a wider scheme of support – including making new maternal mental health services available across all areas of England by March 2024 and £25 million to expand women’s health hubs”.

Women’s Health Ambassador, Dame Lesley Regan, said: “Supporting GPs to advise on contraception after giving birth makes it more convenient and easier for women to make safe, effective choices about the many benefits of spacing their future pregnancies.

“This new advice for GPs around the long-term health implications of conditions that may first appear during pregnancy, such as gestational diabetes, hypertension, and depression, will mean women are offered guidance about conditions that may develop or become more severe later in life.

“This guidance will empower women to be able to make more informed decisions about their own health and their babies’ welfare.”

She added: “A major focus of our women’s health strategy is to make the healthcare system work better for women. Having access to a comprehensive post-natal check by a GP will mean women can get on with their day to day lives swiftly. I think this guidance is a great step in the right direction.”

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Motherhood

Federally funded non-profit approves US$80.5m for maternal health research

The funding is hoped to help researchers evaluate multicomponent interventions that address healthcare and social determinants of health

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A federally funded non-profit has approved US$80.5m for research tackling the social and clinical care factors that contribute to maternal health inequities.

The Patient-Centered Outcomes Research Institute (PCORI) has awarded the funding to support four comparative clinical effectiveness research (CER) studies focused on the healthcare and social factors that contribute to inequities in maternal morbidity and mortality. The trials are among 30 CER studies and related projects recently approved for PCORI funding.

The four CER studies will focus on populations disproportionately experiencing adverse maternal health outcomes, including Black people, Hispanic and Latin American individuals, those living in rural areas and individuals with lower incomes.

The projects aim to evaluate multicomponent interventions that address both healthcare and social determinants of health.

For each study, dual principal investigators from research institutions and community organisations will co-lead assessments of approaches intended to address the health challenges that impact maternal health in different communities.

“The usual approaches to health research and healthcare have not sufficiently addressed the alarming and worsening national crisis of maternal death and severe illness,” said PCORI executive director Nakela L. Cook.

“Patient-centred comparative clinical effectiveness research that responds to the many challenges concurrently facing pregnant individuals and those who care for them has the capacity to answer questions about which combinations of approaches can best resolve some of these complex maternal healthcare challenges that have for too long defied solutions.”

The studies, Cook said, will be conducted across a broad swath of the United States, including rural and urban areas and states in the Northeast, Midwest, Mid-Atlantic and the South. They will compare a range of practice-level and community- and home-based interventions that address common, frequent challenges facing pregnant individuals and new mothers.

Each of these studies are hoped to generate evidence to inform which approaches work best, for whom and in what circumstances.

Harv Feldman, PCORI deputy executive director for patient-centred research programmes, said: “These funding awards mark an important advancement of PCORI’s longstanding leadership in engaging patients and those who care for them in all aspects of comparative clinical effectiveness research to ensure that results are relevant, useful and impactful.

“We look forward to seeing the impact the studies’ findings will have for maternal health across the United States, particularly among populations that continue to disproportionately experience adverse outcomes.”

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