Pregnancy Problems

Pregnancy Problems

Pregnancy results in a lot of changes to your body. Some of the changes taking place will cause irritation or discomfort, and on occasions they may be very concerning to you.

If you are worried you should mention any problem that is worrying you to your midwife or doctor. If you think something may be seriously wrong contact your midwife or doctor straight away.

This section offers information on some of the more common problems:

Please choose from the following topics…

Constipation

You may become constipated very early in pregnancy because of the hormonal changes in your body. Constipation can mean that you are not passing stools (a poo) as often as you normally do, you have to strain more than usual or you are unable to completely empty your bowels.

Constipation can also cause your stools to be very hard, lumpy, large or small.

Avoiding constipation

There are a few things you can do to help prevent constipation.

These include:

  • eat foods that are high in fiber such as whole meal breads, wholegrain cereals, fruit and vegetables, and pulses such as beans and lentils
  • exercise regularly to keep your muscles toned
  • drink plenty of water
  • avoid iron supplements as they can make you constipated – ask your doctor if you can manage without them or change to a different type

Cramp in pregnancy

Cramp is a sudden, sharp pain, usually in your calf muscles or feet. It is most common at night. Nobody really knows what causes it or why it can occur in pregnancy.

Avoiding cramp, gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and may help to prevent cramp occurring. Try these foot exercises:

  • bend and stretch your foot vigorously up and down 30 times
  • rotate your foot eight times one way and eight times the other way
  • repeat with the other foot

How to ease cramp

It usually helps if you pull your toes hard up towards your ankle or rub the muscle hard.

Faintness in pregnancy

Some women can feel faint during pregnancy because of hormonal changes occurring in your body during pregnancy.

Fainting happens if your brain is not getting enough blood and therefore not enough oxygen.

You are most likely to feel faint if you stand up too quickly from a chair or out of a bath, but it can also happen when you are lying on your back.

Avoiding feeling faint

Here are some tips to help you cope:

  • try to get up slowly after sitting or lying down
  • if you feel faint when standing still, find a seat quickly and it should pass – if it doesn’t, lie down on your side
  • if you feel faint while lying on your back, turn on your side

The symptoms of fainting are: a sudden, clammy sweat, ringing in your ears and fast, deep breathing.

It’s better not to lie flat on your back in later pregnancy or during your labour.

Feeling hot in pregnancy

During pregnancy you’re likely to feel warmer than normal. This is due to hormonal changes and an increase in blood supply to the skin.

You’re also likely to sweat more. It helps if you:

  • wear loose clothing made of natural fibers, as these are more absorbent and breathe more than synthetic fibers
  • keep your room cool – you could use an electric fan to cool it down
  • wash frequently to help you feel fresh

Incontinence

Incontinence is a common problem, and it can affect you during and after pregnancy. Sometimes pregnant women are unable to prevent a sudden spurt of urine or a small leak when they cough, laugh or sneeze, or when they move suddenly, or just get up from a sitting position. This may be temporary, because the pelvic floor muscles (the muscles around the bladder) relax slightly to prepare for the baby’s delivery. Some women have more severe incontinence and find that they cannot help wetting themselves.

Doing your pelvic floor exercises can help.

Pelvic floor exercises

What is the pelvic floor?

The pelvic floor is like a hammock of muscles and ligaments between your legs which support the bladder, uterus (womb) and bowel. The openings from these organs, the urethra from the bladder, the vagina from the uterus and the anus from the bowel pass through the pelvic floor. The pelvic floor muscles attach to your pubic bone at the front and the tail bone at the back.

What do the pelvic floor muscles do?

When the pelvic floor is strong, it supports the pelvic organs to prevent problems such as:

  • Incontinence (the involuntary loss of urine or faeces)
  • Prolapse (lack of support) of the bladder, uterus and bowel

The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to ‘hold on’ until you reach the toilet.

What causes pelvic floor muscle weakness?

Some of the common causes of pelvic floor muscle weakness are:

  • childbirth – particularly following delivery of a large baby or prolonged pushing during delivery
  • being overweight
  • constipation
  • persistent heavy lifting
  • excessive coughing
  • changes in hormonal levels at menopause

or just growing older.

How do I strengthen my pelvic floor muscles?

It is recommended that all women exercise their pelvic floor muscles everyday throughout life, to prevent weakness or improve strength.

Exercising weak muscles regularly, over a period of time can strengthen them and make them work better. Regular gentle exercise, such as walking can also help to strengthen your pelvic floor muscles.

Exercise 1 (long hold for strength)

Step 1: Sit, stand tall, lie on your back with your knees bent and legs comfortably apart or kneel on your hands and knees.

Step 2: Close your eyes, imagine what muscles you would tighten to stop yourself from passing wind or to ‘hold on’ from passing urine. If you can’t feel a distinct tightening of these muscles, ask for some help from a physiotherapist. She will help you to get started.

Step 3: Now that you can feel your pelvic floor muscles working, tighten them around your front passage, vagina and back passage as strongly as possible and hold for three to five seconds.

Remember, the squeeze must stay strong and you should feel a definite ‘let go’. Repeat up to ten times. Rest for a few seconds in between each squeeze.

Steps one to three count as one exercise set. If you can, do three sets per day in different positions. Do your pelvic floor exercises everyday for the rest of your life.

Exercise 2 (quick squeeze for power)

Squeeze and lift your pelvic floor muscles as strongly and as quickly as possible. Do not try to hold on to the contraction, just squeeze and let go. Rest for a few seconds in between each squeeze. Repeat this 10 to 20 times.

If you can, do this exercise set one to three times per day.

What can I do to prevent damage?

To prevent damage to your pelvic floor muscles, avoid:

  • constipation
  • persistent heavy lifting
  • repetitive coughing
  • putting on too much weight

Make training part of your life by:

  • tightening your pelvic floor muscles every time you cough, sneeze or lift
  • doing some regular exercise, such as walking
  • progressing your exercises by doing them during the day in different positions e.g. standing, sitting or on your hands and knees

A weak pelvic floor or incontinence is curable.

If you are unsure of whether you are exercising your pelvic floor muscles correctly or you have urinary problems, you should make an appointment with a physiotherapist or your doctor.

When to get help

In many cases incontinence is curable. If you have got a problem, talk to your midwife or doctor.

Urinating a lot in pregnancy

Needing to urinate or pass urine often may start in early pregnancy.

Sometimes it continues throughout pregnancy. In later pregnancy it is the result of pressure from the baby’s head on your bladder.

How to reduce the need to pass urine

If you find that you need to get up in the night to pass urine, try cutting out drinks in the late evening. But make sure you drink plenty of nonalcoholic, caffeine-free drinks 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 womb on the bladder so that you can empty it properly.

When to get help

If you have any pain while passing water or you pass any blood in your urine, you may have a urine infection, which will need treatment. Drink plenty of water to dilute your urine and reduce pain. You should contact your GP within 24 hours of first noticing these symptoms.

Don’t take any medicines without asking your midwife or doctor.

Skin and hair changes

Hormonal changes taking place in pregnancy will make your nipples and the area around them go darker. Your skin colour may also darken a little, either in patches or all over.

Sometimes freckles or birth marks darken. Some women develop a dark line down the middle of their stomach. These changes will gradually fade after the baby is born, although your nipples may
remain a little darker.

If you sunbathe while you are pregnant, you may find you burn more easily. Protect your skin with a high-factor sunscreen and don’t stay in the sun for a long time.

Hair growth can also increase in pregnancy, and your hair may be greasier. After the baby is born, it may seem as if you are losing a lot of hair but you are simply losing the extra hair.

Varicose veins

When veins are swollen they are called varicose veins. Many women get varicose veins of the legs.

You can also get varicose veins in the vulva (area between your legs). They usually get better after the birth.

If you have varicose veins you should:

  • try to avoid long periods of standing
  • try not to sit with your legs crossed
  • Avoid too much weight as this increases the pressure
  • to ease the discomfort put your legs up when sitting down
  • try support tights
  • try sleeping with your legs higher than the rest of your body – use pillows under your ankles
  • try to keep up walking and swimming which will all help your circulation

foot exercises as follows:

  • bend and stretch your foot up and down 30 times
  • rotate your foot eight times one way and eight times the other
  • repeat with the other foot

Heartburn

Indigestion is also known as dyspepsia, this is partly caused by hormones in pregnancy and in later pregnancy by the growing uterus or womb pressing on your stomach.

If you have indigestion you can feel full, sick or nauseous, and burping. The symptoms usually come on after eating food.

Heartburn is a burning pain in the chest that is caused by stomach acid passing from your stomach into your oesophagus.

You can help ease the discomfort of indigestion and heartburn by making changes to your diet and lifestyle, and there are treatments that are safe to take in pregnancy for example antacids.

Talk to your midwife, GP or pharmacist.

Antacids are a type of medicine that can provide immediate relief from heart burn and indigestion. They work by neutralising the acid in your stomach.

Eat healthily

You are more likely to get indigestion if you are very full, so regularly eating large amounts of food may make your symptoms worse.

While you are pregnant, it can be tempting to eat more than you would normally, but this may not be good for you or your baby. You don’t need to “eat for two”:

  • it may help to eat smaller meals more frequently, rather than larger meals three times a day
  • avoid eating within three hours of going to bed at night
  • sit up straight when you eat because this will take the pressure off your stomach

Trigger foods

You may find that your indigestion is made worse by certain triggers, such as:

  • drinking fruit juice
  • eating chocolate
  • bending over

Make a note of any particular food, drink or activity that seems to make your indigestion worse and avoid them if possible. This may mean:

  • eating less rich, spicy and fatty foods
  • cutting down on drinks that contain caffeine, such as tea, coffee and cola

Prop your head up

When you go to bed, it may help to use a couple of pillows to prop up your head and shoulders.

The slight slope should help prevent stomach acid from moving up into your oesophagus while you sleep.

Leaking from your nipples

It is normal for some women to leak from their nipples during pregnancy.

In pregnancy, the breasts may start to produce milk weeks or months before you are due to have your baby. It can happen as early as 14 weeks of pregnancy.

If your nipples are leaking, the substance is usually colostrum, which is the first milk your breasts make in preparation for feeding your baby. Leaking is normal and nothing to worry about.

Nosebleeds in pregnancy

Nosebleeds are quite common in pregnancy because of hormonal changes. They are usually short but can be quite heavy.

During a nosebleed, blood flows from one nostril, and sometimes from both. It can be heavy or light and last from a few seconds to more than 10 minutes.

During pregnancy, you may also find that you experience a blocked nose more often.

How to stop a nosebleed

  • Sit down and firmly pinch the soft part of your nose, just above your nostrils, for 10 minutes
  • Stay upright, rather than lying down, as this reduces the blood pressure in the veins of your nose and will help to stop further bleeding
  • Maintain the pressure on your nose for up to 20 so that the blood clots
  • Avoid blowing your nose, bending down and strenuous activity for at least 12 hours after a nosebleed

If the bleeding doesn’t stop, seek medical advice.

Pelvic pain in pregnancy

Some women develop a condition called pelvic girdle pain (PGP) in pregnancy. This is sometimes called SPD (symphysis pubis dysfunction).

Simple Anatomy of the pelvis

The pelvic girdle is made up of three large bones – the sacrum (base of spine) and two large hip bones which form a joint in the front called the symphisis pubis. The joints they form with the sacrum at the back are called the sacro-iliac joints. The coccyx is the name of the small tail bone which is attached to the lower part of the sacrum.

The symphisis pubis like all joints in the body is stabilised by ligaments. In the case of the symphisis pubis the ligaments are mainly at the front and back of the joint (a disc of cartilage separates the bone ends to prevent them from grinding together.) The ligaments are a vital part of support for the joint and with the surrounding muscles make the joint strong.

Symphisis Pubis Dysfunction (SPD)

During pregnancy the body releases a hormone called relaxin which allows the ligaments of the body to relax and stretch slightly. This allows the pelvis to be a little more flexible and slightly larger in diameter during delivery in order to allow the baby to pass through more easily. Pregnancy will allow the symphisis pubis joint to increase in width. Many other joint symptoms can be partly due to this relaxation of ligaments.

SPD usually manifests itself as pain at the symphisis pubis joint and my be extremely tender to touch. Because the pelvis acts as a unit, if there is pain in the symphisis pubis joint there may also be pain at the sacro-iliac joints. Some pregnant mothers also experience pain in the hip joints. There is a lot of pressure on the above joints due to the extra weight being passed through them. Sometimes this weight is pressing in many directions causing pain in the joint.

Symptoms of SPD

Symptoms can occur at the beginning of pregnancy, improves in second trimester and then gets worse as the baby gains size and weight towards the end of pregnancy. It mostly begins in the later stages. In subsequent pregnancies symptoms may begin earlier. Pain is usually felt over the symphisis pubis joint which may be extremely tender to touch. It may become more sever getting into the car or turning from one side to the other in bed. Standing on one leg can also cause pain. Pain may be felt in the hips groin or lower tummy and sometimes radiates down the inner thighs.

Advice for Sufferers of SPD

  • Listen to your body – If you know a certain activity that increases pain, try to avoid it: e.g. strenuous exercise, prolonged standing or sitting, walking, driving or vacuum cleaning
  • Rest – Take the weight off your pelvis whenever possible: e.g. lie down instead of sitting when having a rest
  • Only lift when absolutely necessary. If possible get help to carry groceries or lift a toddler
  • If swimming avoid breast stroke
  • Stand with your weight evenly distributed through both legs
  • Avoid crossing your legs when sitting – sit evenly on both buttocks
  • Ensure that the curve in your lower back is well supported when sitting and if necessary use a pillow for this purpose
  • When turning in bed or getting in and out of bed, try to keep your knees together
  • When getting in and out of the car keep your legs together: i.e. when getting in place your bottom on the seat first and then bring your legs in together. Do the reverse when getting out
  • Avoid standing on one leg as when using the stairs or getting out of the car or bath
  • Avoid squatting as this places extra pressure through the symphisis pubis joint

Your physiotherapist may consider fitting you with a special belt to help support the weight of the growing baby. This can take the pressure off the symphisis pubis, mainly for use when walking or doing chores around the house. It is not helpful for use when sitting. If the pain is extremely severe it may be necessary to use crutches when walking.

LABOUR – Ensure that your midwife is aware that you have SPD so that she can avoid separating your legs beyond the point of comfort. It is particularly important that she is aware of your limitations if you have an epidural.

After delivery of your baby, much of the stress will be removed from the symphysis pubis.

Haemorrhoids (piles)

Haemorrhoids are also known as piles, are enlarged and swollen veins in or around the lower rectum and anus. Anyone can get piles – they don’t just happen in pregnancy. When you’re pregnant, piles
can occur because hormones make your veins relax.

Piles may itch, ache or feel sore. You can usually feel the lumpiness of piles around your anus. They may also bleed a little and can make going to the toilet uncomfortable or painful. You may also notice pain when passing a stool (a poo) and a discharge of mucus afterwards. Sometimes you may feel as though your bowels are still full and need emptying.

Piles usually go within weeks after the birth.

How to ease piles

Constipation can cause piles and if this is the case try to keep your stools soft and regular.

You can help ease piles, and prevent them, by making some changes to your diet and lifestyle:

  • Avoid constipation by eating plenty of food that is high in fibre, like wholemeal bread, fruit and vegetables, and drink plenty of water
  • Avoid standing for long periods
  • You may find it helpful to use a cloth wrung out in iced water to ease the pain – hold it gently against the piles
  • If the piles stick out, push them gently back inside using a lubricating jelly
  • Avoid straining to pass a stool as this may make your piles worse
  • After passing a stool, clean your anus with moist toilet paper instead of dry toilet paper
  • Pat, rather than rub, the area

There are medicines that can help soothe inflammation around your anus. These treat the symptoms but not the cause of piles. Ask your doctor, midwife or pharmacist if they can suggest a suitable ointment to help ease the pain.

Tiredness

It’s common to feel tired, or even exhausted, during pregnancy, especially in the first 12 weeks. Hormonal changes at this time can make you feel tired, give you nausea and make you feel emotional. It is really important to try to rest as much as possible.

Later on in pregnancy, you may feel tired because of the extra weight you are carrying. Make sure you get plenty of rest. As your bump gets bigger, it can be difficult to get a good night’s sleep. You might find it uncomfortable lying down or, just when you get comfortable, you have to get up to go to the toilet.

Feeling tired won’t harm you or your baby, but it can make life feel more difficult, especially in the early days before you’ve told people about your pregnancy.

Strange dreams

Some women have strange dreams or nightmares about the birth of their baby. This is normal. Talking about them to your partner or midwife can help you. Remember, just because you dream
something, it doesn’t mean it’s going to happen. Relaxation and breathing techniques may be helpful in reducing any anxiety you might be feeling.

Position for sleeping

Sleep however you feel comfortable. Lying on your back from the middle to the second half of pregnancy can be uncomfortable. Later on lying on your back can make you feel faint because the growing uterus presses on your main blood vessel.

Sleeping on your side might be more comfortable. You can try supporting your bump with pillows, and put a pillow between your knees. Towards the end of pregnancy, as your bump becomes heavy,
you might find it more comfortable to prop yourself up with pillows so that you’re almost in a sitting position.

If you aren’t sleeping well

A poor sleeping pattern will not harm your baby. If you can, nap during the day, and get some early nights during the week.

Avoid tea, coffee or cola drinks in the evening as the caffeine can make it harder to go to sleep.

Try to relax before bedtime so that you’re not too wide awake.

You could join an antenatal yoga class. Make sure the yoga teacher knows that you are pregnant. Exercise can help you to feel less tired, so even if you’re feeling tired during the day, try to get some activity, such as a walk at lunchtime or going swimming.

Pregnancy stretch marks

Stretch marks are narrow pink or purplish streak-like lines that can develop on the surface of the skin. If you get them, they usually appear on your tummy or sometimes on your upper thighs and
breasts as your pregnancy progresses. The first sign you notice might be itchiness around an area where the skin is becoming thin and pink.

What causes stretch marks?

Stretch marks are very common in the general population and don’t just affect pregnant women. They can happen whenever the skin is stretched, but hormonal changes in pregnancy can affect your skin
and make you more likely to get stretch marks.

It’s thought that stretch marks affect up to around 80% of pregnant women. Whether or not you get stretch marks depends on your skin type, as some people’s skin is more elastic. After your baby is born, the marks should gradually fade and become less noticeable, but they won’t go away completely.

Pregnancy weight gain

You are more likely to get stretch marks if your weight gain is more than average in pregnancy. Most women gain between 10kg and 12.5kg (22 to 28lb) in pregnancy, although weight gain varies a great deal from woman to woman. How much weight you gain depends on your weight before you were pregnant. It’s important that you don’t diet to lose weight when you’re pregnant, but you should eat a well balanced diet.

Stretch marks are not harmful. They don’t cause medical problems.

Preventing stretch marks

Some creams claim to remove stretch marks once they’ve appeared, but there is no reliable evidence that they work. There is also limited evidence about whether oils or creams help prevent stretch marks from appearing in the first place.

However, more research is needed into whether creams or massaging the skin can help to prevent stretch marks.

Teeth and gums in pregnancy

Gums may bleed in pregnancy because they get swollen and sore. Bleeding gums are caused by a build-up of plaque (bacteria) on the teeth. Hormonal changes during pregnancy can make your gums
more vulnerable to plaque, leading to inflammation and bleeding.

Your dentist will be able to help with this.

Keeping teeth and gums healthy

It’s important to keep your teeth and gums as clean and healthy as possible. The best way to prevent or deal with gum problems is to practice good oral hygiene. Go to the dentist so they can give your teeth a thorough clean and give you some advice about keeping your teeth clean at home.

Vaginal discharge in pregnancy

It is normal to have vaginal discharge in pregnancy.

Almost all women have more vaginal discharge in pregnancy. This is quite normal and happens for a few reasons. During pregnancy the cervix (neck of the womb) and vaginal walls get softer and discharge increases to help prevent any infections travelling up from the vagina to the womb.

Towards the end of pregnancy, the amount of discharge increases and can be confused with urine.

In the last week or so of pregnancy, your discharge may contain streaks of thick mucus and some blood. This is called a ‘show’ and happens when the mucus that has been present in your cervix during pregnancy comes away. It’s a sign that the body is starting to prepare for birth, and you may have a few small ‘shows’ in the days before you go into labour.

Increased discharge is a normal part of pregnancy, but it’s important to keep an eye on it and tell your doctor or midwife if it changes in any way.

When to seek help

Healthy vaginal discharge should be clear and white and 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.

The most common vaginal infection women get in pregnancy is thrush and it can be treated very easily.

Always talk to your doctor, pharmacist or midwife if you think you have thrush. You can help prevent thrush by wearing loose cotton underwear, and some women find it helps to avoid perfumed soap or perfumed bath products.

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