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9 Problems
Y
        our 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 alarm 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.
  We have listed, in alphabetical order, the changes you are most likely
to notice and their causes – where these are known – plus suggestions
on how to cope.



COMMON                    M I N O R P RO B L E M S

BACKACHE
                                                                                  If during or after birth you
During pregnancy ligaments become
softer and stretch to prepare you for
                                         •  work at a surface high enough
                                            to prevent you stooping;
                                                                                  have pain in the hips, groin,
                                                                                  lower abdomen and inner
labour. This can put a strain on the                                              thighs and have difficulty
joints of your lower back and pelvis     • between two baskets if you are
                                           try to balance the weight
                                                                                  walking or climbing stairs,
which can cause backache. As the                                                  you should inform your GP,
                                            carrying shopping;
baby grows, the hollow in your                                                    midwife or hospital doctor.
lower back may increase and this
may also cause backache (see box).
                                         • well supported. straight and
                                           sit with your back                     This may be due to a gap in
                                                                                  a joint in the pelvic girdle
                                                                                  not closing up. This gap
To avoid backache:                       A firm mattress can help to prevent       appears naturally during the
                                         and relieve backache. If your            birth to allow for the baby’s
                                         mattress is too soft, a piece of
• avoid heavy lifting;                   hardboard under its length will
                                                                                  head. This condition is
                                                                                  known as Symphysis Pubic
• back straight when lifting or
  bend your knees and keep your          make it firmer.
                                            Massage can also help, or you
                                                                                  Dysfunction (SPD).
                                                                                  It affects very few women
   picking up something from the         might like to try a support corset –     but early diagnosis and
   floor;                                 these can be prescribed by your          appropriate treatment will
                                         doctor. Make sure you get enough
• heavy, do haveclose to your body;
  if you
         hold it
                  to carry something
                                         rest, particularly later in pregnancy.
                                                                                  help to minimise the pain
                                                                                  and avoid long-term
                                            If your backache is very painful,     discomfort. If you are
• round your feettwistingturningspine;
  move
         to avoid
                  when
                           your
                                         ask your doctor to refer you to an
                                         obstetric physiotherapist at your
                                                                                  diagnosed with SPD, you
                                                                                  can contact The Pelvic
                                         hospital. He or she will be able to      Partnership (see page 150)
• weight toshoes as these allow your
  wear flat
             be evenly distributed;
                                         give you some advice and suggest         for support and information.
                                         some helpful exercises.




                                                                                                              77
Problems



           CONSTIPATION                         CRAMP

           You may become constipated very      Cramp is a sudden, sharp pain,
           early in pregnancy because of the    usually in your calf muscles or feet.
           hormonal changes going on in your    It is most common at night, but
           body. It will help to:               nobody really knows what causes it.
                                                It usually helps if you pull your toes
           • fibre in your diet through eating
             make sure you include plenty of    hard up towards your ankle or rub
                                                the muscle hard. Regular, gentle
             foods like wholemeal breads,       exercise in pregnancy, particularly
             wholegrain cereals, fruit and      ankle and leg movements, will
             vegetables, and pulses such as     improve your circulation and may
             beans and lentils;                 help to prevent cramp occurring.

           • muscles toned up;to keep your
             exercise regularly
                                                LEAKING FROM YOUR NIPPLES

           • water;sure you drink plenty of
             make                               This is colostrum and is the first
                                                milk your breasts make in
                                                preparation to feed your baby.
           • constipation – askthey cause
             avoid iron pills if
                                 your doctor
                                                However, see your doctor or
                                                midwife if it becomes bloodstained.
             whether you can manage without
             them or change to a different
             type; if not, you may have to      FAINTNESS
             accept having constipation.
                                                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’re 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.

                                                • or lyingget up slowly after sitting
                                                  Try to
                                                           down.

                                                • still, find a faintquicklystanding
                                                  If you feel
                                                               seat
                                                                     when
                                                                            and the
                                                   faintness will pass. If it doesn’t,
                                                   lie down on your side.

                                                • your back, faint while lying onIt’s
                                                  If you feel
                                                              turn on your side.
                                                   better not to lie flat on your back
                                                   in later pregnancy or during
                                                   labour.
78
Problems



FEELING HOT IN PREGNANCY

During pregnancy you’re likely to          or highly spiced ones, but make
feel warmer than normal. This is           sure you are still eating well
due to hormonal changes and to an          (see pages 8–12 for information
increase in blood supply to the skin.      on healthy eating).
You’re also likely to sweat more. It
helps if you:                           Heartburn is more than just
                                        indigestion. It is a strong, burning
• natural fibres, as these are more
  wear loose clothing made of           pain in the chest. It is caused by the
                                        valve between your stomach and the
   absorbent and ‘breathe’ more         tube leading to your stomach
   than synthetic fibres;                relaxing in pregnancy, so that
                                        stomach acid passes into the tube.
• using your room cool – consider
  keep
        an electric fan;
                                        It is often brought on by lying flat.
                                        To avoid heartburn you could:

• wash frequently to stay fresh.        • raisingwell propped your– bed with
                                          sleep
                                                  the head of
                                                              up try

                                           bricks or have plenty of pillows;
HEADACHES

Some pregnant women find they get
                                        • onedrinking bed in of milk –wake
                                          try
                                              by your
                                                      a glass
                                                              case you
                                                                       have

a lot of headaches. A brisk walk may       with heartburn in the night;
be all you need, as well as a little
more regular rest and relaxation.
Although it is wise to avoid drugs in
                                        • few hourseating oryou go to bed;a
                                          avoiding
                                                    before
                                                             drinking for

pregnancy, an occasional paracetamol
tablet is generally considered safe.
   If you often have bad headaches,
                                        • advice; doctor or midwife for
                                          ask your

tell your doctor or midwife so that
they can advise you. Severe
headaches may be a sign of high
                                        • mixture before checking that they
                                          don’t take antacid tablets or

blood pressure (see page 84).              are safe in pregnancy.


INDIGESTION AND HEARTBURN               ITCHING

This is partly caused by hormonal       Mild itching is common in pregnancy
changes and later by the growing        because of the increased blood
womb pressing on the stomach.           supply to the skin. In late pregnancy
If you suffer from indigestion:         the skin of the abdomen is stretched
                                        and this may also cause itchiness.
• often; smaller meals more
  try eating                            Wearing loose clothing may help.
                                           Itching can, however, be a sign of
                                        a more serious problem called obstetric
• eating straighttakes the pressure
  sit up
         as this
                  when you are          cholestasis (see page 84). If itching
                                        becomes severe, or you develop
   off your stomach;                    jaundice (yellowing of the whites of
                                        the eyes and skin), see your doctor.
• cause trouble, forfoods which
  avoid particular
                      example fried
                                        Itching which is associated with a rash
                                        may also need treatment if it is severe.
                                                                                        79
Problems



           NAUSEA AND MORNING
           SICKNESS
                                                    • Remedies containing ginger
                                                      may be helpful.

           Nausea is very common in the early
           weeks of pregnancy. Some women
                                                    • Wear comfortable clothes.feel
                                                      waistbands can make you
                                                                                Tight

           feel sick, some are sick. Some feel         worse.
           sick in the mornings, some at other
           times, some all day long.                If you are being sick all the time and
              The reasons are not fully             cannot keep anything down, inform
           understood, but hormonal changes         your doctor or midwife. Some
           in the first three months are probably    pregnant women experience severe
           one cause. Nausea usually disappears     nausea and vomiting. This condition
           around the 12th–14th week. Nausea        is known as hyperemesis gravidarum.
           can be one of the most trying            (See page 149 for the support group
           problems in early pregnancy. It          Blooming Awful.)
           comes at a time when you may be
           feeling tired and emotional, and         NOSE BLEEDS
           when many people around you may
           not realise you are pregnant and         Nose bleeds are quite common in
           expect you to be your normal self.       pregnancy because of hormonal
                                                    changes. The nose bleeds are usually
           • morning, give yourself time to
             If you feel sick first thing in the     short but can be quite heavy. To help
                                                    the bleeding stop, press the sides of
              get up slowly. If possible, eat       your nose together between your
              something like dry toast or a plain   thumb and forefinger just below the
              biscuit before you get up. Your       bony part of your nose for ten
              partner could bring you some          minutes. Repeat for a further ten
              sweet tea.                            minutes if this is unsuccessful. As
                                                    long as you don’t lose a lot of blood,
           • whenever yourest and sleeptired
             Get plenty of
                           can. Feeling
                                                    there is nothing to worry about.
                                                    Blow your nose gently and try to
              can make the sickness worse.          avoid explosive sneezes. You may
                                                    also find that your nose gets more
           • thansmall amountsmeals, but don’t
             Eat
                  several large
                                often rather        blocked up than usual.

              stop eating.
                                                    PASSING WATER OFTEN
           • Drink plenty of fluids.                 Needing to pass water often is an
                                                    early sign of pregnancy. Sometimes it
           • support. close to you for extra
             Ask those
                                                    continues right through pregnancy.
                                                    In later pregnancy it’s the result of
                                                    the baby’s head pressing on the
           • can. Often the nausea getsasworse
             Distract yourself as much you
                                                    bladder.
                                                       If you find that you’re having to
              the more you think about it.
                                                    get up in the night, you could try
                                                    cutting out drinks in the late
           • make you feel worse.smells that
             Avoid the foods and
                                  It helps if
                                                    evening but make sure you keep
                                                    drinking plenty during the day.
              someone else can cook but, if
                                                    Later in pregnancy, some women
              not, go for bland, non-greasy
                                                    find it helps to rock backwards and
              foods, such as baked potatoes,
                                                    forwards while they are on the toilet.
              pasta and milk puddings, which
                                                    This lessens the pressure of the
80            are simple to prepare.
                                                    womb on the bladder so that you
Problems



can empty it properly. Then you
won’t need to pass water again quite
                                           • your regular exercise to improve
                                             take
                                                  circulation;
so soon.
   If you have any pain while passing
water, or pass any blood, you may
                                           • slightly raised on booksthe bed
                                             sleep with the foot of
                                                                       or bricks;
have a urine infection which will
need treatment. Drink plenty of
water to dilute your urine and
                                           • discomfort,pack to ease gently
                                             use an ice
                                                         holding this
reduce irritation. You should contact         against the piles, or use a cloth
your GP within 24 hours.                      wrung out in iced water;
   Sometimes pregnant women are
unable to prevent a sudden spurt of
urine or a small leak when they
                                           • gentlypiles stick out, push them
                                             if the
                                                    back inside using a
cough, sneeze or laugh, or when               lubricating jelly;
moving suddenly or just getting up
from a sitting position. This may be
temporary because the pelvic floor
                                           • pharmacist if theymidwife or a
                                             ask your doctor,
                                                                can suggest
                                                                                    If you sometimes can’t help
                                                                                    wetting or soiling yourself,
muscles relax slightly to prepare for         suitable ointment;                    you can get help.
the baby’s delivery.                                                                Incontinence is a very
   The growing baby will increase
pressure on the bladder. If you find
                                           • where thegiving birth in a position
                                             consider
                                                       pressure on your back
                                                                                    common problem. It can
                                                                                    affect anyone, sometimes
this a problem, you can improve the           passage is reduced – kneeling, for    during and after pregnancy.
situation by doing exercises to tone          example.                              In many cases it is curable,
up your pelvic floor muscles (see                                                    so if you’ve got a problem
page 16). Ask a midwife or obstetric                                                talk to your doctor,
physiotherapist (see pages 62 and 63)      SKIN AND HAIR CHANGES                    midwife or health visitor,
for advice.                                                                         or ring the confidential
                                           Hormonal changes taking place in         Continence Foundation
PILES                                      pregnancy will make your nipples         helpline on 0845 345
                                           and the area around them go darker.      0165, Monday to Friday,
Piles, also known as haemorrhoids,         Your skin colour may also darken a       9.30am to 1pm.
are swollen veins around the back          little, either in patches or all over.   www.continence-
passage which may itch, ache or feel       Birthmarks, moles and freckles may       foundation.org.uk
sore. You can usually feel the             also darken. Some women develop a
lumpiness of the piles around the          dark line down the middle of their
back passage. Piles may also bleed a       stomachs. These changes will
little and they can make going to the      gradually fade after the baby has
toilet uncomfortable or even painful.      been born, although your nipples
They occur in pregnancy because            may remain a little darker.
the veins relax under the influence             If you sunbathe while you are
of pregnancy hormones. Piles usually       pregnant, you may find you tan
go shortly after delivery. If you suffer   more easily. Protect your skin with
from piles you should:                     a good, high-factor sunscreen.
                                           Don’t stay in the sun for very long.
• fibre, like wholemeal bread, fruit
  eat plenty of food that is high in           Hair growth is also likely to
                                           increase in pregnancy. Your hair may
   and vegetables, and you should          also be greasier. After the baby is
   drink plenty of water – this will       born, it may seem as if you’re losing
   prevent constipation, which can         a lot of hair. In fact, you’re simply
   make piles worse;                       losing the increase that occurred
                                           during pregnancy.
• avoid standing for long periods;                                                                                 81
Problems




It might be more comfortable
to lie on one side with a
pillow under your tummy and
another between your knees.
                                 SLEEPLESSNESS                           to gather in the lowest parts of the
                                                                         body. You should:
                                 Late in pregnancy it can be very
      IF YOU AREN’T
      SLEEPING WELL
                                 difficult to get a good night’s sleep.
                                 You’re uncomfortable lying down,
                                                                         • periods; standing for long
                                                                           try to avoid

                                 or just when you’re beginning to get
 • you.not to let it bother it
   Try
        Don’t worry that
                                 comfortable, you have to get up to
                                 go to the toilet. Some women have
                                                                         • wear comfortable shoes;
     will harm your baby – it
     won’t.
                                 strange dreams or nightmares about
                                 the baby and about the birth. Talking
                                                                         • – tryyourrest for an muchaasday with
                                                                           put
                                                                                 to
                                                                                     feet up as
                                                                                                hour
                                                                                                        you can

                                 about them can help you. Just because      your feet higher than your heart;
 • comfortable to lie on
   It might be more              you dream something, it doesn’t mean

     one side with a pillow
                                 it’s going to happen. The relaxation
                                 and breathing which are taught in
                                                                         • pageto17) –your foot exercises (see
                                                                           try do
                                                                                       these will help.
     under your tummy and        antenatal classes might be helpful.
     another between your
     knees.                                                              TEETH AND GUMS
                                 STRETCH MARKS
 •   Relaxation techniques
     may help. Your antenatal    These are pink or purplish lines
                                                                         Bleeding gums are caused by a
                                                                         build-up of plaque (bacteria) on the
     class (see pages 64–5)      which usually occur on the tummy        teeth. During pregnancy, hormonal
     may teach relaxation        or sometimes on the upper thighs or     changes in your body can cause the
     techniques, or you could    breasts. Some women get them,           plaque to make the gums more
     borrow a cassette from      some don’t. It depends on your skin     inflamed. They may become swollen
     your library.               type. Some people’s skin is more        and bleed more easily. To keep your
                                 elastic. You are more likely to get     teeth and gums healthy, you should:
 • warm bath, somedrink, a
   A warm, milky                 stretch marks if your weight gain is
                   gentle
     exercise or some restful
                                 more than average.
                                    It’s very doubtful whether oils or
                                                                         • yourspecial attention to cleaning
                                                                           pay
                                                                                teeth. Ask your dentist to
     music before bedtime may    creams help to prevent stretch marks.      show you a good brushing
     help.                       After your baby is born, the marks         method to remove all the plaque;
                                 should gradually pale and become
 • canrest duringtothe day
   A
       help you feel
                                 less noticeable.                        • foods too often. Try drinks and
                                                                           avoid having sugary
                                                                                                to keep them
     less tired.                                                            only to meal times;
                                 SWOLLEN ANKLES, FEET
 •   Talk to your partner,
     a friend, doctor or
                                 AND FINGERS                             • is free whilethat dentalpregnant
                                                                           remember
                                                                                          you are
                                                                                                    treatment

     midwife.                    Ankles, feet and fingers often swell a      and for a year after your baby’s
                                 little in pregnancy because the body       birth, so have a check-up now;
                                 holds more water than usual. Towards
                                 the end of the day, especially if the
                                 weather is hot or if you have been
                                                                         • any newwithreplacement fillings
                                                                           discuss
                                                                                   or
                                                                                       your dentist whether

                                 standing a lot, the extra water tends      should be delayed until after your
82                                                                          baby is born.
Problems



VAGINAL DISCHARGE                                                                      TI R E D N E S S

Almost all women have more vaginal
discharge in pregnancy. It should be
                                          • crossed;to sit with your legs
                                            try not                               In the early months of
                                                                                  pregnancy you may feel tired
clear and white and it should not                                                 or even desperately
smell unpleasant. If the discharge is
coloured or smells strange, or if you
                                          • weight as this increasesmuch
                                            try not to put on too
                                                                     the
                                                                                  exhausted. The only answer
                                                                                  is to try to rest as much as
feel itchy or sore, you may have a           pressure;                            possible. Make time to sit
vaginal infection. Tell your doctor or                                            with your feet up during the
midwife. The most common
infection is thrush, which your
                                          • youwith your legs updiscomfort;
                                            sit
                                                can to ease the
                                                                 as often as      day and accept any offers of
                                                                                  help from colleagues and
doctor can treat easily. You can help                                             family. Towards the end of
prevent thrush by wearing loose
cotton underwear.
                                          • alsosupport tights,the muscles of
                                            try
                                                 help support
                                                                which may         pregnancy, you may feel
                                                                                  tired because of the extra
   If vaginal discharge, of any colour,      your legs – you can buy them at      weight you are carrying.
increases a lot in later pregnancy,          most pharmacists;                    Make sure you get plenty
tell your doctor or midwife.                                                      of rest.
                                          • thansleeping with your legs–higher
                                            try
                                                  the rest of your body use
VARICOSE VEINS                               pillows under your ankles or put
                                             bricks or books under the foot of
Varicose veins are veins which have          your bed;
become swollen. The veins in the
legs are most commonly affected.
You can also get varicose veins in
                                          • andfoot exercises (see page 17)
                                            do
                                                other antenatal exercises,
the vulva (vaginal opening).                 such as walking, cycling and
They usually get better after delivery.      swimming, which will all help
You should:                                  your circulation.

• periodsavoid standing for long
  try to
           of time;



MORE              S E R I O U S P RO B L E M S

SLOW-GROWING BABIES

Many of the tests in pregnancy check        In the last weeks of pregnancy you
the growth of your baby. If you have      may also be asked to keep track of
previously had a very small baby, or if   your baby’s movements. If you
you smoke heavily, the midwives and       notice your baby’s movements
doctors will already be monitoring        becoming less frequent or slowing
your pregnancy closely. Blood             down, or if they stop, contact your
pressure checks may also pick up          midwife or doctor immediately.
signs of trouble. If there is concern       If tests show that your baby is not
about your baby’s health, further tests   growing well in the womb, early
may be carried out and more               delivery by induction of labour or
frequent monitoring of your baby          Caesarean section (see pages 101–2)
may be recommended.                       may be recommended.

                                                                                                             83
Problems



                                     HIGH BLOOD PRESSURE AND                        Bleeding after about five months
     OTHER     SYMPTOMS              PRE-ECLAMPSIA                               may be a sign that the placenta is
                                                                                 implanted in the lower part of the
 You should contact your GP          During pregnancy your blood
                                                                                 uterus (placenta praevia) or that it
 if you have a sudden ‘acute’        pressure will be checked at every
                                                                                 has started to separate from the
 illness like diarrhoea,             antenatal appointment. This is
                                                                                 uterus (placental abruption). Both of
 vomiting, abdominal pain or         because a rise in blood pressure can
                                                                                 these can be dangerous for you and
 a high fever.                       be the first sign of a condition
                                                                                 the baby, so contact your midwife or
                                     known as pre-eclampsia – often
                                                                                 doctor immediately.
                                     called pregnancy-induced
                                                                                    The cells on the surface of the
                                     hypertension (PIH) or pre-eclamptic
                                                                                 cervix often change in pregnancy
                                     toxaemia (PET) – which can run
                                                                                 and make it more likely to bleed,
                                     in families and affects 10% of
                                                                                 particularly after intercourse. This is
                                     pregnancies. Your urine will also
                                                                                 called a cervical erosion. Vaginal
                                     be checked for protein.
                                         If you do have pre-eclampsia, you       infections can also cause a small
                                     will probably feel perfectly well.          amount of vaginal bleeding.
                                     Some women experience such                     Some causes of vaginal bleeding
                                     symptoms as headaches, visual               are more serious than others, so it’s
                                     disturbances, swelling and abdominal        important to find the cause straight
                                     pain. Pre-eclampsia can still be            away. The most common sort of
                                                                                 bleeding in late pregnancy is the
     DEEP VEIN                       severe, however, without any
                                                                                 small amount of blood mixed with
  THROMBOSIS (DVT)                   symptoms at all. Although most
                                     cases are mild and cause no trouble,        mucus, known as a ‘show’. This is a
 DVT is a serious condition          it can get worse and be serious for         sign that the cervix is changing and
 where clots develop, often in       both mother and baby. It can cause          becoming ready for labour to start. It
 the deep veins of the legs. It      fits in the mother (eclampsia) and           may happen a few days before
 can be fatal if the clot travels    affect the baby’s growth, and be            contractions start or during labour
 from the legs to the lungs.         life-threatening if left untreated.         itself. You should always report this
                                     That is why routine antenatal               to your doctor or midwife as soon as
 Flights over five hours where                                                    it occurs.
 you sit still for a long time       checks are so important.
 may increase the risk.                  Pre-eclampsia usually happens           SEVERE ITCHING AND
                                     towards the end of pregnancy, but           OBSTETRIC CHOLESTASIS
 Pregnant women and women            problems can occur earlier. Rarely, it
 who have recently had a baby        can happen after the birth. The earlier     Although itching is very common
 are amongst those more at           in pregnancy it starts, the more severe     in normal pregnancy, severe
 risk. If you intend to travel by    it is likely to be. If it does get worse,   generalised itching, without a rash,
 air, consult your GP or mid-        the treatment ranges from rest at           particularly in the last four months
 wife before the trip. Get advice    home or in hospital to drugs to lower       of pregnancy, may be the only sign
 on in-seat exercises to keep        the high blood pressure, or,                of an uncommon condition called
 your circulation active. After      occasionally early delivery of the baby.    obstetric cholestasis. This is a
 the 28th week of pregnancy,                                                     potentially dangerous liver disorder
 most airlines require a letter
                                     VAGINAL BLEEDING                            which seems to run in families,
 from your GP or midwife to          Bleeding from the vagina at any time        although it can occur without any
 say that you are fit to travel.      in pregnancy can be a danger signal. In     family history. It is important to
                                     early pregnancy, bleeding may be a          contact your doctor if you have
 If you develop swollen                                                          troublesome itching because
                                     sign of an ectopic pregnancy or a mis-
 painful legs or have breathing                                                  obstetric cholestasis may lead to
                                     carriage (see pages 104–5), although
 difficulties after the trip, go to                                               premature labour, stillbirth or serious
                                     many women who bleed at this time
 your doctor or your nearest                                                     health problems for the baby, and
                                     go on to have normal and successful
 Accident and Emergency                                                          to an increased risk of maternal
                                     pregnancies. If you have bleeding with
 department immediately.                                                         haemorrhage after the delivery.
                                     pain, contact your GP straight away.
84

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Pregnancy problems

  • 1. 9 Problems Y our 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 alarm 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. We have listed, in alphabetical order, the changes you are most likely to notice and their causes – where these are known – plus suggestions on how to cope. COMMON M I N O R P RO B L E M S BACKACHE If during or after birth you During pregnancy ligaments become softer and stretch to prepare you for • work at a surface high enough to prevent you stooping; have pain in the hips, groin, lower abdomen and inner labour. This can put a strain on the thighs and have difficulty joints of your lower back and pelvis • between two baskets if you are try to balance the weight walking or climbing stairs, which can cause backache. As the you should inform your GP, carrying shopping; baby grows, the hollow in your midwife or hospital doctor. lower back may increase and this may also cause backache (see box). • well supported. straight and sit with your back This may be due to a gap in a joint in the pelvic girdle not closing up. This gap To avoid backache: A firm mattress can help to prevent appears naturally during the and relieve backache. If your birth to allow for the baby’s mattress is too soft, a piece of • avoid heavy lifting; hardboard under its length will head. This condition is known as Symphysis Pubic • back straight when lifting or bend your knees and keep your make it firmer. Massage can also help, or you Dysfunction (SPD). It affects very few women picking up something from the might like to try a support corset – but early diagnosis and floor; these can be prescribed by your appropriate treatment will doctor. Make sure you get enough • heavy, do haveclose to your body; if you hold it to carry something rest, particularly later in pregnancy. help to minimise the pain and avoid long-term If your backache is very painful, discomfort. If you are • round your feettwistingturningspine; move to avoid when your ask your doctor to refer you to an obstetric physiotherapist at your diagnosed with SPD, you can contact The Pelvic hospital. He or she will be able to Partnership (see page 150) • weight toshoes as these allow your wear flat be evenly distributed; give you some advice and suggest for support and information. some helpful exercises. 77
  • 2. Problems CONSTIPATION CRAMP You may become constipated very Cramp is a sudden, sharp pain, early in pregnancy because of the usually in your calf muscles or feet. hormonal changes going on in your It is most common at night, but body. It will help to: nobody really knows what causes it. It usually helps if you pull your toes • fibre in your diet through eating make sure you include plenty of hard up towards your ankle or rub the muscle hard. Regular, gentle foods like wholemeal breads, exercise in pregnancy, particularly wholegrain cereals, fruit and ankle and leg movements, will vegetables, and pulses such as improve your circulation and may beans and lentils; help to prevent cramp occurring. • muscles toned up;to keep your exercise regularly LEAKING FROM YOUR NIPPLES • water;sure you drink plenty of make This is colostrum and is the first milk your breasts make in preparation to feed your baby. • constipation – askthey cause avoid iron pills if your doctor However, see your doctor or midwife if it becomes bloodstained. whether you can manage without them or change to a different type; if not, you may have to FAINTNESS accept having constipation. 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’re 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. • or lyingget up slowly after sitting Try to down. • still, find a faintquicklystanding If you feel seat when and the faintness will pass. If it doesn’t, lie down on your side. • your back, faint while lying onIt’s If you feel turn on your side. better not to lie flat on your back in later pregnancy or during labour. 78
  • 3. Problems FEELING HOT IN PREGNANCY During pregnancy you’re likely to or highly spiced ones, but make feel warmer than normal. This is sure you are still eating well due to hormonal changes and to an (see pages 8–12 for information increase in blood supply to the skin. on healthy eating). You’re also likely to sweat more. It helps if you: Heartburn is more than just indigestion. It is a strong, burning • natural fibres, as these are more wear loose clothing made of pain in the chest. It is caused by the valve between your stomach and the absorbent and ‘breathe’ more tube leading to your stomach than synthetic fibres; relaxing in pregnancy, so that stomach acid passes into the tube. • using your room cool – consider keep an electric fan; It is often brought on by lying flat. To avoid heartburn you could: • wash frequently to stay fresh. • raisingwell propped your– bed with sleep the head of up try bricks or have plenty of pillows; HEADACHES Some pregnant women find they get • onedrinking bed in of milk –wake try by your a glass case you have a lot of headaches. A brisk walk may with heartburn in the night; be all you need, as well as a little more regular rest and relaxation. Although it is wise to avoid drugs in • few hourseating oryou go to bed;a avoiding before drinking for pregnancy, an occasional paracetamol tablet is generally considered safe. If you often have bad headaches, • advice; doctor or midwife for ask your tell your doctor or midwife so that they can advise you. Severe headaches may be a sign of high • mixture before checking that they don’t take antacid tablets or blood pressure (see page 84). are safe in pregnancy. INDIGESTION AND HEARTBURN ITCHING This is partly caused by hormonal Mild itching is common in pregnancy changes and later by the growing because of the increased blood womb pressing on the stomach. supply to the skin. In late pregnancy If you suffer from indigestion: the skin of the abdomen is stretched and this may also cause itchiness. • often; smaller meals more try eating Wearing loose clothing may help. Itching can, however, be a sign of a more serious problem called obstetric • eating straighttakes the pressure sit up as this when you are cholestasis (see page 84). If itching becomes severe, or you develop off your stomach; jaundice (yellowing of the whites of the eyes and skin), see your doctor. • cause trouble, forfoods which avoid particular example fried Itching which is associated with a rash may also need treatment if it is severe. 79
  • 4. Problems NAUSEA AND MORNING SICKNESS • Remedies containing ginger may be helpful. Nausea is very common in the early weeks of pregnancy. Some women • Wear comfortable clothes.feel waistbands can make you Tight feel sick, some are sick. Some feel worse. sick in the mornings, some at other times, some all day long. If you are being sick all the time and The reasons are not fully cannot keep anything down, inform understood, but hormonal changes your doctor or midwife. Some in the first three months are probably pregnant women experience severe one cause. Nausea usually disappears nausea and vomiting. This condition around the 12th–14th week. Nausea is known as hyperemesis gravidarum. can be one of the most trying (See page 149 for the support group problems in early pregnancy. It Blooming Awful.) comes at a time when you may be feeling tired and emotional, and NOSE BLEEDS when many people around you may not realise you are pregnant and Nose bleeds are quite common in expect you to be your normal self. pregnancy because of hormonal changes. The nose bleeds are usually • morning, give yourself time to If you feel sick first thing in the short but can be quite heavy. To help the bleeding stop, press the sides of get up slowly. If possible, eat your nose together between your something like dry toast or a plain thumb and forefinger just below the biscuit before you get up. Your bony part of your nose for ten partner could bring you some minutes. Repeat for a further ten sweet tea. minutes if this is unsuccessful. As long as you don’t lose a lot of blood, • whenever yourest and sleeptired Get plenty of can. Feeling there is nothing to worry about. Blow your nose gently and try to can make the sickness worse. avoid explosive sneezes. You may also find that your nose gets more • thansmall amountsmeals, but don’t Eat several large often rather blocked up than usual. stop eating. PASSING WATER OFTEN • Drink plenty of fluids. Needing to pass water often is an early sign of pregnancy. Sometimes it • support. close to you for extra Ask those continues right through pregnancy. In later pregnancy it’s the result of the baby’s head pressing on the • can. Often the nausea getsasworse Distract yourself as much you bladder. If you find that you’re having to the more you think about it. get up in the night, you could try cutting out drinks in the late • make you feel worse.smells that Avoid the foods and It helps if evening but make sure you keep drinking plenty during the day. someone else can cook but, if Later in pregnancy, some women not, go for bland, non-greasy find it helps to rock backwards and foods, such as baked potatoes, forwards while they are on the toilet. pasta and milk puddings, which This lessens the pressure of the 80 are simple to prepare. womb on the bladder so that you
  • 5. Problems can empty it properly. Then you won’t need to pass water again quite • your regular exercise to improve take circulation; so soon. If you have any pain while passing water, or pass any blood, you may • slightly raised on booksthe bed sleep with the foot of or bricks; have a urine infection which will need treatment. Drink plenty of water to dilute your urine and • discomfort,pack to ease gently use an ice holding this reduce irritation. You should contact against the piles, or use a cloth your GP within 24 hours. wrung out in iced water; Sometimes pregnant women are unable to prevent a sudden spurt of urine or a small leak when they • gentlypiles stick out, push them if the back inside using a cough, sneeze or laugh, or when lubricating jelly; moving suddenly or just getting up from a sitting position. This may be temporary because the pelvic floor • pharmacist if theymidwife or a ask your doctor, can suggest If you sometimes can’t help wetting or soiling yourself, muscles relax slightly to prepare for suitable ointment; you can get help. the baby’s delivery. Incontinence is a very The growing baby will increase pressure on the bladder. If you find • where thegiving birth in a position consider pressure on your back common problem. It can affect anyone, sometimes this a problem, you can improve the passage is reduced – kneeling, for during and after pregnancy. situation by doing exercises to tone example. In many cases it is curable, up your pelvic floor muscles (see so if you’ve got a problem page 16). Ask a midwife or obstetric talk to your doctor, physiotherapist (see pages 62 and 63) SKIN AND HAIR CHANGES midwife or health visitor, for advice. or ring the confidential Hormonal changes taking place in Continence Foundation PILES pregnancy will make your nipples helpline on 0845 345 and the area around them go darker. 0165, Monday to Friday, Piles, also known as haemorrhoids, Your skin colour may also darken a 9.30am to 1pm. are swollen veins around the back little, either in patches or all over. www.continence- passage which may itch, ache or feel Birthmarks, moles and freckles may foundation.org.uk sore. You can usually feel the also darken. Some women develop a lumpiness of the piles around the dark line down the middle of their back passage. Piles may also bleed a stomachs. These changes will little and they can make going to the gradually fade after the baby has toilet uncomfortable or even painful. been born, although your nipples They occur in pregnancy because may remain a little darker. the veins relax under the influence If you sunbathe while you are of pregnancy hormones. Piles usually pregnant, you may find you tan go shortly after delivery. If you suffer more easily. Protect your skin with from piles you should: a good, high-factor sunscreen. Don’t stay in the sun for very long. • fibre, like wholemeal bread, fruit eat plenty of food that is high in Hair growth is also likely to increase in pregnancy. Your hair may and vegetables, and you should also be greasier. After the baby is drink plenty of water – this will born, it may seem as if you’re losing prevent constipation, which can a lot of hair. In fact, you’re simply make piles worse; losing the increase that occurred during pregnancy. • avoid standing for long periods; 81
  • 6. Problems It might be more comfortable to lie on one side with a pillow under your tummy and another between your knees. SLEEPLESSNESS to gather in the lowest parts of the body. You should: Late in pregnancy it can be very IF YOU AREN’T SLEEPING WELL difficult to get a good night’s sleep. You’re uncomfortable lying down, • periods; standing for long try to avoid or just when you’re beginning to get • you.not to let it bother it Try Don’t worry that comfortable, you have to get up to go to the toilet. Some women have • wear comfortable shoes; will harm your baby – it won’t. strange dreams or nightmares about the baby and about the birth. Talking • – tryyourrest for an muchaasday with put to feet up as hour you can about them can help you. Just because your feet higher than your heart; • comfortable to lie on It might be more you dream something, it doesn’t mean one side with a pillow it’s going to happen. The relaxation and breathing which are taught in • pageto17) –your foot exercises (see try do these will help. under your tummy and antenatal classes might be helpful. another between your knees. TEETH AND GUMS STRETCH MARKS • Relaxation techniques may help. Your antenatal These are pink or purplish lines Bleeding gums are caused by a build-up of plaque (bacteria) on the class (see pages 64–5) which usually occur on the tummy teeth. During pregnancy, hormonal may teach relaxation or sometimes on the upper thighs or changes in your body can cause the techniques, or you could breasts. Some women get them, plaque to make the gums more borrow a cassette from some don’t. It depends on your skin inflamed. They may become swollen your library. type. Some people’s skin is more and bleed more easily. To keep your elastic. You are more likely to get teeth and gums healthy, you should: • warm bath, somedrink, a A warm, milky stretch marks if your weight gain is gentle exercise or some restful more than average. It’s very doubtful whether oils or • yourspecial attention to cleaning pay teeth. Ask your dentist to music before bedtime may creams help to prevent stretch marks. show you a good brushing help. After your baby is born, the marks method to remove all the plaque; should gradually pale and become • canrest duringtothe day A help you feel less noticeable. • foods too often. Try drinks and avoid having sugary to keep them less tired. only to meal times; SWOLLEN ANKLES, FEET • Talk to your partner, a friend, doctor or AND FINGERS • is free whilethat dentalpregnant remember you are treatment midwife. Ankles, feet and fingers often swell a and for a year after your baby’s little in pregnancy because the body birth, so have a check-up now; holds more water than usual. Towards the end of the day, especially if the weather is hot or if you have been • any newwithreplacement fillings discuss or your dentist whether standing a lot, the extra water tends should be delayed until after your 82 baby is born.
  • 7. Problems VAGINAL DISCHARGE TI R E D N E S S Almost all women have more vaginal discharge in pregnancy. It should be • crossed;to sit with your legs try not In the early months of pregnancy you may feel tired clear and white and it should not or even desperately smell unpleasant. If the discharge is coloured or smells strange, or if you • weight as this increasesmuch try not to put on too the exhausted. The only answer is to try to rest as much as feel itchy or sore, you may have a pressure; possible. Make time to sit vaginal infection. Tell your doctor or with your feet up during the midwife. The most common infection is thrush, which your • youwith your legs updiscomfort; sit can to ease the as often as day and accept any offers of help from colleagues and doctor can treat easily. You can help family. Towards the end of prevent thrush by wearing loose cotton underwear. • alsosupport tights,the muscles of try help support which may pregnancy, you may feel tired because of the extra If vaginal discharge, of any colour, your legs – you can buy them at weight you are carrying. increases a lot in later pregnancy, most pharmacists; Make sure you get plenty tell your doctor or midwife. of rest. • thansleeping with your legs–higher try the rest of your body use VARICOSE VEINS pillows under your ankles or put bricks or books under the foot of Varicose veins are veins which have your bed; become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in • andfoot exercises (see page 17) do other antenatal exercises, the vulva (vaginal opening). such as walking, cycling and They usually get better after delivery. swimming, which will all help You should: your circulation. • periodsavoid standing for long try to of time; MORE S E R I O U S P RO B L E M S SLOW-GROWING BABIES Many of the tests in pregnancy check In the last weeks of pregnancy you the growth of your baby. If you have may also be asked to keep track of previously had a very small baby, or if your baby’s movements. If you you smoke heavily, the midwives and notice your baby’s movements doctors will already be monitoring becoming less frequent or slowing your pregnancy closely. Blood down, or if they stop, contact your pressure checks may also pick up midwife or doctor immediately. signs of trouble. If there is concern If tests show that your baby is not about your baby’s health, further tests growing well in the womb, early may be carried out and more delivery by induction of labour or frequent monitoring of your baby Caesarean section (see pages 101–2) may be recommended. may be recommended. 83
  • 8. Problems HIGH BLOOD PRESSURE AND Bleeding after about five months OTHER SYMPTOMS PRE-ECLAMPSIA may be a sign that the placenta is implanted in the lower part of the You should contact your GP During pregnancy your blood uterus (placenta praevia) or that it if you have a sudden ‘acute’ pressure will be checked at every has started to separate from the illness like diarrhoea, antenatal appointment. This is uterus (placental abruption). Both of vomiting, abdominal pain or because a rise in blood pressure can these can be dangerous for you and a high fever. be the first sign of a condition the baby, so contact your midwife or known as pre-eclampsia – often doctor immediately. called pregnancy-induced The cells on the surface of the hypertension (PIH) or pre-eclamptic cervix often change in pregnancy toxaemia (PET) – which can run and make it more likely to bleed, in families and affects 10% of particularly after intercourse. This is pregnancies. Your urine will also called a cervical erosion. Vaginal be checked for protein. If you do have pre-eclampsia, you infections can also cause a small will probably feel perfectly well. amount of vaginal bleeding. Some women experience such Some causes of vaginal bleeding symptoms as headaches, visual are more serious than others, so it’s disturbances, swelling and abdominal important to find the cause straight pain. Pre-eclampsia can still be away. The most common sort of bleeding in late pregnancy is the DEEP VEIN severe, however, without any small amount of blood mixed with THROMBOSIS (DVT) symptoms at all. Although most cases are mild and cause no trouble, mucus, known as a ‘show’. This is a DVT is a serious condition it can get worse and be serious for sign that the cervix is changing and where clots develop, often in both mother and baby. It can cause becoming ready for labour to start. It the deep veins of the legs. It fits in the mother (eclampsia) and may happen a few days before can be fatal if the clot travels affect the baby’s growth, and be contractions start or during labour from the legs to the lungs. life-threatening if left untreated. itself. You should always report this That is why routine antenatal to your doctor or midwife as soon as Flights over five hours where it occurs. you sit still for a long time checks are so important. may increase the risk. Pre-eclampsia usually happens SEVERE ITCHING AND towards the end of pregnancy, but OBSTETRIC CHOLESTASIS Pregnant women and women problems can occur earlier. Rarely, it who have recently had a baby can happen after the birth. The earlier Although itching is very common are amongst those more at in pregnancy it starts, the more severe in normal pregnancy, severe risk. If you intend to travel by it is likely to be. If it does get worse, generalised itching, without a rash, air, consult your GP or mid- the treatment ranges from rest at particularly in the last four months wife before the trip. Get advice home or in hospital to drugs to lower of pregnancy, may be the only sign on in-seat exercises to keep the high blood pressure, or, of an uncommon condition called your circulation active. After occasionally early delivery of the baby. obstetric cholestasis. This is a the 28th week of pregnancy, potentially dangerous liver disorder most airlines require a letter VAGINAL BLEEDING which seems to run in families, from your GP or midwife to Bleeding from the vagina at any time although it can occur without any say that you are fit to travel. in pregnancy can be a danger signal. In family history. It is important to early pregnancy, bleeding may be a contact your doctor if you have If you develop swollen troublesome itching because sign of an ectopic pregnancy or a mis- painful legs or have breathing obstetric cholestasis may lead to carriage (see pages 104–5), although difficulties after the trip, go to premature labour, stillbirth or serious many women who bleed at this time your doctor or your nearest health problems for the baby, and go on to have normal and successful Accident and Emergency to an increased risk of maternal pregnancies. If you have bleeding with department immediately. haemorrhage after the delivery. pain, contact your GP straight away. 84