for women and families
Introduction (news source: mater mother's hospital)
Your body has a great deal to do during pregnancy. Sometimes the changes taking place will cause irritation or discomfort, and on occasions they may seem quite alarming. There is rarely any need for concern but you should mention anything that is worrying you to your doctor or midwife. If you think that something may be seriously wrong, trust your own judgement and get in touch with your doctor or midwife straight away.
Common problems in pregnancy
Anaemia
Anaemia means you have a low level of red blood cells in your body. Your red blood cells carry oxygen to all of the cells in your body, including to the placenta. During pregnancy it is very common for women to become anaemic. Whilst there are many causes of anaemia, the most commonest cause is not having enough iron.
Iron is essential for making red blood cells. During pregnancy, your total blood volume increases significantly; therefore, you need more iron to make more red blood cells. Your growing baby and placenta also require extra iron. Many women become pregnant, without adequate stores of iron to meet the increased demands of their body and their baby, particularly later in pregnancy.
Good dietary sources of iron include red meats, fortified breads and cereals, green leafy vegetables, legumes and some nuts. You can help your body absorb more iron from non-meat sources by including Vitamin C rich foods at the same meal e.g. tomato, capsicum, citrus fruits and kiwifruit.
It can be hard to get enough iron from your diet. An iron supplement could be useful and may be recommended by your dietitian, midwife or doctor.
Backache
During pregnancy ligaments become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis which can cause backache. As your baby grows, the hollow in your lower back may increase and this may also cause backache.
To avoid backache during pregnancy:
- avoid heavy lifting
- bend your knees and keep your back straight when lifting
- carry heavier loads close to your body
- move your feet when turning round to avoid twisting your spine
- wear flat shoes as these allow your weight to be evenly distributed
- work at a surface high enough to prevent you slouching
- try to balance the weight between two bags if you are carrying shopping
- sit with your back straight and well supported.
A firm mattress can help to prevent and relieve backache. If your mattress is too soft, a piece of hard board under it lengthways will make it firmer. Massage can also help, or you might like to try a support corset—these can be prescribed by your doctor. Make sure you get enough rest, particularly later in pregnancy.
If your backache is very painful, a physiotherapy consultation may help. A physiotherapist will be able to give you some advice and suggest some helpful exercises. The use of heat to relieve discomfort is also very useful. To prevent burns, ensure it is not too hot.
Constipation
You may become constipated very early in pregnancy because of the hormonal changes going on in your body, which tend to make your bowel work more sluggishly.
Make sure you include plenty of fibre in your diet through eating foods like wholemeal breads, wholegrain cereals, fruit and vegetables, and pulses such as beans and lentils. Exercise regularly to keep your muscles toned and make sure you drink plenty of water.
Avoid iron tablets if they cause constipation—ask your doctor whether you can manage without them or change to a different type.
If problems persist, a physiotherapy consultation may be beneficial.
Cramp
Cramp is a sudden, sharp pain, usually in your calf muscles or feet. It is most common at night, but the cause is generally unknown. It usually helps if you pull your toes hard up towards your ankle, provide warmth or rub the muscle firmly. Regular, gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and may help to prevent cramp occurring.
Feeling faint
Pregnant women often feel faint. This happens when not enough blood is getting to the brain. If the oxygen level gets too low, you may actually faint. It’s more common in pregnancy because of hormonal changes taking place in your body. You are most likely to feel faint if you stand still for too long or get up too quickly from a chair or hot bath. It often happens when you are lying on your back due to the weight of the uterus.
Try to get up slowly after sitting or lying down.
If you feel faint when standing still, find a seat quickly and the faintness will pass. If it doesn’t, lie down on your side.
If you feel faint while lying on your back, turn on your side. It’s better not to lie flat on your back in later pregnancy or during labour.
Feeling hot
During pregnancy you are likely to feel warmer than normal. This is due to hormonal changes and to an increase in blood supply to the skin. You’re also likely to sweat more.
To stay cool, wear loose clothing made of natural fibres, as these are more absorbent and ‘breathe’ more than synthetic fibres. Keep your room cool consider using an electric fan or an air-conditioner and wash frequently to stay fresh.
Haemorrhoids
Haemorrhoids are swollen veins around the anus which may itch, ache or feel sore or even bleed a little. They can also make opening your bowels uncomfortable or even painful. Haemorrhoids occur in pregnancy because your veins relax under the influence of pregnancy hormones. They usually resolve shortly after delivery.
If you experience haemorrhoids you should:
- increase your intake of dietary fibre, such as wholegrain bread, fruit and vegetables
- drink plenty of water—this will help prevent constipation, which can make haemorrhoids worse
- avoid standing for long periods
- do regular exercise to improve your circulation
- use an ice pack to ease discomfort, holding this gently against the haemorrhoids, or use a cloth wrung out in iced water
- push any haemorrhoids which stick out gently back inside using a lubricating jelly
- ask your doctor, midwife or pharmacist if they can suggest a suitable ointment
- consider giving birth in a position where the pressure on your anus is reduced—kneeling, for example.
Headaches
Some pregnant women find they get a lot of headaches due to the elevation in pregnancy hormones. A brisk walk may be all you need, as well as a little more regular rest and relaxation. Although it is wise to avoid drugs in pregnancy, an occasional paracetamol tablet is considered safe. If you often have bad headaches, tell your doctor or midwife so that they can advise you. Severe headaches may be a sign of high blood pressure, and you should inform your GP, midwife or obstetrician, who may order further investigation.
Indigestion and heartburn
Many women start getting heartburn and indigestion in the second half of their pregnancy. The burning sensation that is associated with heartburn often extends from the lower throat to the bottom of your breastbone. It usually comes and goes until your baby is born.
Heartburn is caused by both hormonal and physical changes to your body. During pregnancy, the placenta produces the hormone progesterone, which relaxes the smooth muscles of the uterus. Progesterone also relaxes the valve that separates the oesophagus from the stomach, allowing gastric acids to seep back up the oesophagus, which causes that uncomfortable sensation of heartburn. The hormone also slows the wavelike contractions of the stomach, making digestion sluggish. As time goes on in your pregnancy, your baby crowds the abdominal cavity, slowing the emptying of your stomach and pushing up the stomach acids into your throat.
If you suffer from indigestion:
- try eating smaller meals more often
- sit up straight when you are eating as this takes the pressure off your stomach
- avoid particular foods which cause trouble, for example fried or highly spiced ones, but make sure you are still eating well.
Heartburn is more than just indigestion. It is a strong, burning pain in the chest. It is caused by the valve between your stomach and oesophagus relaxing in pregnancy, so that stomach acid passes into the oesophagus. It is often brought on by lying flat.
Heartburn can be made worse by:
- tight clothing
- smoking
- stress
- bending down too soon after eating
- slumped sitting posture
Foods that may trigger symptoms and are best to avoid include:
- alcohol
- caffeine (coffee, tea, cola drinks, chocolate)
- spices
- citrus juices, tomatoes and peppermint may cause discomfort in more severe cases.
Other strategies to help avoid heartburn include the following:
- eat small, frequent meals
- eat slowly and chew well
- avoid having late meals, allow two to three hours before going to bed or lying down
- drink fluids in between meals, rather than with them
- elevate the head of the bed (15 to 20 cm) or use pillows to prop up your head
- don’t bend over directly after meals; keep upright.
- sit with good posture, lean back into chair and don’t cross your legs
- try drinking a glass of milk or eating six to seven almonds
- ask your doctor or midwife for advice;
- don’t take antacid tablets or mixture before checking that they are safe in pregnancy.
Itching
Mild itching is common in pregnancy because of the increased blood supply to the skin. In late pregnancy the skin of the abdomen is stretched and this may also cause itchiness. Wearing loose clothing may help.
Itching can, however, be a sign of a more serious problem called obstetric cholestasis. If itching becomes severe; particularly in the palms of your hands and/or the soles of your feet, see your doctor. Itching which is associated with a rash may also need treatment if it is severe.
Ligament pain
Ligament pain can be a sharp pain or a feeling of discomfort in the lower abdomen or the right or left side of your abdomen. It can be quite uncomfortable and is most likely to occur between 16 and 20 weeks. It is a sign that your body is stretching to allow your baby to grow and you should not be alarmed. It is common and normal to have ligament pain in the second trimester.
Nausea and morning sickness
Nausea and vomiting in pregnancy is extremely common and is usually referred to as morning sickness, although the nausea and vomiting can occur at any time of day. Studies estimate that nausea and vomiting occurs in 50 to 90 per cent of pregnancies. For the majority of cases morning sickness is not a serious condition and does not place the mother or baby at risk.
The most severe form of nausea and vomiting in pregnancy is called hyperemesis gravidarum. This condition can place the mother and baby at risk because the nausea and vomiting prevent the mother form retaining and utilising food and fluid. This occurs in approximately one per cent of pregnant women and can start between four to six weeks of pregnancy. Symptoms usually resolve from about 15 to 20 weeks but occasionally last the whole pregnancy.
Nose bleeds
Nose bleeds are quite common in pregnancy because of hormonal changes and while usually short in duration can be quite heavy. To help the bleeding stop, press the sides of your nose together between your thumb and forefinger just below the bony part of your nose for ten minutes. Repeat for a further ten minutes if this is unsuccessful. As long as you don’t lose a lot of blood, there is nothing to worry about. Blow your nose gently and try to avoid explosive sneezes. You may also find that your nose gets more blocked up than usual. You should inform your GP, midwife or obstetrician if the nose bleeds persist as further investigations may be required.
Passing urine often
Needing to pass urine often is an early sign of pregnancy. Sometimes it continues right through pregnancy. In later pregnancy it is the result of your baby’s head pressing on your bladder. If you find that you have to get up in the night, you could try cutting out drinks in the late evening but make sure you keep drinking plenty during the day. Later in pregnancy, some women find it helps to rock backwards and forwards while they are on the toilet. This lessens the pressure of the uterus on the bladder so that you can empty it properly and you may not need to pass urine again quite so soon.
If you have any pain while passing urine, or pass any blood, you may have a urinary tract infection which will need treatment. Drink plenty of water to dilute your urine and reduce any irritation. You should contact your General Practitioner within 24 hours.
Sometimes pregnant women are unable to prevent a sudden spurt of urine or a small leak when they cough, sneeze or laugh, or when moving suddenly or just getting up from a sitting position. This may be temporary because the pelvic floor muscles relax slightly to prepare for your baby’s birth and your growing baby will increase pressure on the bladder. If you find this a problem, you can improve the situation by doing exercises to tone up your pelvic floor muscles. Ask a midwife or physiotherapist for advice. Pelvic floor exercises should be exercises for life.
Skin and hair changes
Hormonal changes taking place in pregnancy may make your nipples and the area around them go darker. Your skin colour may also darken a little, either in patches or all over. Birthmarks, moles and freckles may also darken. Some women develop a dark line down the middle of their stomachs. These changes will gradually fade after your baby has been born, although your nipples may remain a little darker.
If you sunbathe while you are pregnant, you may find you tan more easily. Protect your skin with a good, high-factor sunscreen and do not stay in the sun for very long.
Hair growth is also likely to increase in pregnancy. Your hair may also be greasier. After your baby is born, it may seem as if you’re losing a lot of hair. In fact, you’re simply losing the increase in hair that occurred during pregnancy.
Sleeplessness
Late in pregnancy it can be very difficult to get a good night’s sleep. You’re uncomfortable lying down, or just when you’re beginning to get comfortable, you have to get up to go to the toilet. Some women also have strange dreams or nightmares about their baby and about the birth—talking about them can help you. The relaxation and breathing which are taught in antenatal classes can be helpful.
Stretch marks
These are pink or purplish lines which usually occur on the tummy or hips and sometimes on the upper thighs or breasts. Some women get them, some don’t. It depends on your skin type. Some people’s skin is more elastic. You are more likely to get stretch marks if your weight gain is greater than average. After your baby is born, the marks should gradually pale and become less noticeable. It is very doubtful whether oils or creams actually help prevent stretch marks.
Swollen ankles, feet and fingers
Ankles, feet and fingers often swell a little in pregnancy because the body holds more water than usual. Towards the end of the day, especially if the weather is hot or if you have been standing a lot, the extra water tends to gather in the lowest parts of the body.
You should:
- try to avoid standing for long periods
- wear comfortable shoes
- put your feet up as much as you can
- try to rest for an hour a day with your feet elevated.
Teeth and gums
Bleeding gums are caused by a build-up of plaque (bacteria) on the teeth. During pregnancy, hormonal changes in your body can cause the plaque to make the gums more inflamed. They may become swollen and bleed more easily.
To keep your teeth and gums healthy, you should:
- pay special attention to cleaning your teeth. Ask your dentist to show you a good brushing method to remove all the plaque
- avoid having sugary drinks and foods too often. Try to keep them only to meal times,
- discuss with your dentist whether any new or replacement fillings should be delayed until after your baby is born.
Vaginal discharge
Almost all women have more vaginal discharge in pregnancy. It should be clear and white and it should not smell unpleasant. If the discharge is coloured or smells strange, or if you feel itchy or sore, you may have a vaginal infection. Tell your doctor or midwife. The most common infection in pregnancy is thrush, which can be treated easily. You can help prevent thrush by wearing loose cotton underwear as well as avoiding perfumed/scented soaps, shower gels and bubble baths if you are susceptible to vaginal thrush infection. If vaginal discharge, of any colour, increases a lot in later pregnancy, tell your doctor or midwife.
Varicose veins
Varicose veins are veins which have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in the vulva (vaginal opening). They usually improve after the birth of your baby.
You should:
- try to avoid standing for long periods of time
- try not to sit with your legs crossed
- try not to put on too much weight as this increases the pressure
- sit with your legs up as often as you can to ease the discomfort
- try support stockings, which may also help support the muscles of your legs—you can buy them at most pharmacies
- try sleeping with your legs higher than the rest of your body—use pillows under your ankles or put bricks or books under the foot of your bed
- exercise such as walking, cycling and swimming, which will help your circulation,
- massage your legs in an upward movement.
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