7 Conditions and problems in 75 Avoid lifting heavy objects. Avoid Bend your knees and keep straight when your back something lifting or picking up from the floor. How to avoid backache • • Common minor problems Backache As your baby grows, the may hollow in your lower back become more pronounced, and this can also cause During pregnancy, backache. your ligaments become softer to prepare you for and stretch can put a strain on This labour. the joints of your lower back can cause and pelvis, which backache. need a second scan to check need a second scan to check that all is well. Conditions and in pregnancy problems Most women feel well in Most women feel early pregnancy but can uncomfortable. Somefeel women describe a pain low down in the abdomen similar does to a period pain. This not necessarily mean that something is wrong, but if the pain is more than discomfort or if there is any , your or GPmidwife should refer you for a scan in the early pregnancy assessment unit. scan will show whether This the pregnancy is growing in the . Sometimes you Problems in early in early Problems pregnancy

This chapter describes some of the minor and more serious health problems and and serious health problems and more describes some of the minor This chapter should get help. with them and when you deal to on how advice gives Your body goes through a lot of changes of lot a body goes through Your Sometimes these during pregnancy. or discomfort you cause changes can about may be worried and you irritation, is usually There you. what is happening to should about, but you worry nothing to your to you mention anything that concerns or concerns have If you or doctor. midwife write appointments in between questions me” to in the “what matters them down hand-held record maternity section of your or midwife with your (MHHR) and discuss may be seriously think that something appointment. If you next at your doctor or doctor midwife with your judgement and get in touch own your trust wrong, away. straight 7 Feeling faint You may often feel faint when you are pregnant. This is because of hormonal changes taking place in your body and happens if your brain is not getting enough and therefore enough oxygen. If your oxygen level gets too low, you may actually faint. You are most • Move your feet when turning How to avoid constipation likely to feel faint if you stand round to avoid twisting your still for too long or get up too spine. • Eat foods that are high in fibre, like wholemeal breads, quickly from a chair or out of • Wear flat shoes that allow wholegrain cereals, fruit and a hot bath. It can also happen your weight to be evenly vegetables, and pulses such when you are lying on your back. distributed. as beans and lentils. How to avoid feeling faint • Work at a surface that is • Exercise regularly to keep high enough so that you your muscles toned. • Try to get up slowly after don’t stoop. sitting or lying down. • Drink plenty of water. • Try to balance the weight • If you feel faint when between two bags when • Avoid iron supplements. Ask standing still, find a seat carrying shopping. your doctor whether you can quickly and the feeling manage without them or should pass. If it doesn’t, lie • Sit with your back straight change to a different type. down on your side. and well supported. Cramp • If you feel faint while lying on • Make sure you get enough your back, turn on your side. Cramp is a sudden, sharp pain, rest - particularly later in It is advisable not to lie flat on usually in your calf muscles or pregnancy. your back at any time in later feet. It is most common at night, pregnancy or during labour. When to get help but nobody really knows what If your backache is very painful, causes it. • Ask your doctor or midwife ask your doctor to refer you to a to check your haemoglobin maternity physiotherapist at your How to avoid cramp (Hb) level as you may need hospital. They will be able to Regular, gentle exercise in iron supplements. give you some advice and may pregnancy, particularly ankle suggest some helpful exercises. and leg movements, will improve Feeling hot your circulation and may help to During pregnancy you are likely prevent cramp occurring. Constipation to feel warmer than normal. This You may become constipated is due to hormonal changes very early in pregnancy because and to an increase in the blood of the hormonal changes taking supply to your skin. You are also place in your body. likely to sweat more.

76 7 Conditions and problems in pregnancy 77 Try eating smaller meals Try more often. Sit up straight when you are eating, as this takes the pressure off your stomach. affect the foods which Avoid you, like fried or highly spiced food, but make sure you are still eating well (see pages 31 for information on healthy eating). stomach. Heartburn is more than Heartburn is more than stomach. It is a strong, just indigestion. caused burning pain in the chest passing from acid by stomach the tube into your stomach is This leading to your stomach. because the valve between your tube relaxes and this stomach during pregnancy. How to avoid indigestion • • •

and after pregnancy. 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 may be temporary, position. This because the pelvic floor muscles relax slightly to prepare for the baby’s delivery. Some severe women have more incontinence and find that they cannot help wetting themselves. to get help When In many cases incontinence is curable, so if you have a problem doctor or talk to your midwife, health visitor. www.bladderandbowelfoundation.org Indigestion and heartburn Indigestion is partly caused and by hormonal changes in later pregnancy by your growing uterus pressing on your You can also get help and support You from the confidential Bladder helpline and Bowel Foundation on 0845 345 0165 (9.30am to or visit 1.00pm Mon to Fri) Try and get more regular rest Try and relaxation. in the Paracetamol recommended dose is for generally considered safe pregnant women but there are some painkillers that you should avoid. Speak to your pharmacist, nurse, midwife, health visitor or GP about paracetamol you how much can take and for how long. Wear loose clothing made loose clothing Wear fibres, as these of natural and are more absorbent synthetic ‘breathe’ more than fibres. your room cool. You Keep fan to could use an electric cool it down. you frequently to help Wash fresh. to feel Incontinence is a common you during problem. It can affect Incontinence When to get help When is severe or is If the headache associated with swelling, blurred vision or heartburn type pain contact your doctor or midwife immediately. • • How to ease headaches Some find they pregnant women get a lot of headaches. Headaches • • • How to avoid feeling hot How to How to avoid heartburn

• Heartburn is often brought on by lying flat. Sleep well propped up with plenty of pillows.

• Avoid eating and drinking for a few hours before you go to bed.

• Your GP may prescribe an many as 1 in 4 women being have enough iron reserves for antacid if the problem is anaemic before pregnancy a health pregnancy. There is no persistent. and 1 in 3 after delivering their benefit in taking more than one baby. You might not be aware iron tablet a day as your body How to ease heartburn that you are anaemic but if you can only absorb a certain amount experience tiredness, paleness, each day and it will make side • Drink a glass of milk. Have or dizziness effects more likely. The best one by your bed in case you these could all be warning improvement in your blood count wake with heartburn in the signs. Women with anaemia in is seen if you take one tablet night. pregnancy have been shown to daily consistently. Taking your have a higher risk of low birth tablets on an empty stomach with • Note that you should not weight babies and of needing a vitamin C rich foods (such as take antacid tablets before blood transfusion. There will be fruit and vegetables) will ensure checking with your midwife, huge demands on you after birth your body can absorb as much doctor or pharmacist that and being anaemic will make iron as possible. Tea, coffee, dairy they are safe for you to take the caring for you and your baby products and antacids can all during pregnancy. much more difficult. reduce the amount of iron you absorb so avoid these for about Leaking nipples You will be offered a blood two hours before taking your Leaking nipples are normal and test to check for anaemia at iron tablets. Some people find usually nothing to worry about. your booking appointment. For that iron tablets can make them The leaking milk is colostrum, most women the cause is a constipated but this is a common which is the first milk your lack of iron. Good sources of problem in pregnancy and can breasts make to feed your baby. easily absorbed iron include be avoided by drinking plenty of red meat, chicken and fish. If When to get help you are vegetarian ensure you See your midwife or doctor if the are getting enough iron from milk becomes bloodstained, or other foods such as tofu, beans, if you notice unusual lumps on lentils, peas and dried fruits. your breasts. Your doctor may also give you a prescription for iron tablets. If Anaemia they do it is important that you Anaemia (a low blood count) in begin taking them once a day to pregnancy is common with as ensure that you and your baby

78 7 Conditions and problems in pregnancy 79 Sit with your head forward. Sit with your head the sides of your Press nose together between your just thumb and forefinger, below the bony part, for 10 minutes and try not to swallow the blood. Repeat for a further 10 minutes if this is unsuccessful. If the bleeding continues, seek medical advice. If you find that you have to get up in the night try cutting out drinks in the late evening, but make sure you keep drinking plenty during the day. some Later in pregnancy, women find it helps to rock usually last long but can be quite be can but long last usually as you don’t lose As long heavy. there is nothing a lot of blood, may also about.to worry You gets more find that your nose up than usual. blocked bleeds How to stop nose • • • • often urine Passing Needing to pass urine often may start in early pregnancy. Sometimes it continues right In later through pregnancy. pregnancy it’s the result of the baby’s head pressing on the bladder. How to reduce the need to pass urine • • Drink plenty of fluids. Drink plenty for close to you Ask those and support. help extra as as much Distract yourself nausea you can. Often the more you gets worse the think about it. foods and smells that Avoid worse. It helps make you feel can cook. if someone else Eat bland, non-greasy foods, as baked potatoes, such pasta and milk puddings, to prepare. are simple which comfortable clothes. Wear can make waistbands Tight worse. you feel • • • • • to get help When all the time If you are being sick and cannot keep anything down, Some or doctor. tell your midwife pregnant women experience severe nausea and vomiting. condition is known as This hyperemesis gravidarum and needs specialist treatment. Nose bleeds Nose bleeds are quite common in pregnancy because of don’t They hormonal changes. Get plenty of rest and sleep whenever you can. Feeling tired can make the sickness worse. Eat small amounts of food often rather than several large meals, but don’t stop eating. If you feel sick first thing in sick If you feel the morning, give yourself If time to get up slowly. possible, eat something like dry toast or a plain biscuit before you get up. • • • How to avoid nausea and morning sickness This can be one of the most can be one This trying problems in early It comes at a time pregnancy. tired when you may be feeling and emotional, and when many people around you may not realise that you are pregnant. Hormonal changes in the first Hormonal changes three months are probably one cause. Nausea usually disappears around the 12th to 14th week. Nausea is very common in the Nausea is very common Some early weeks of pregnancy. and some are sick, women feel It can happen at any time sick. all day long. of day – or even Nausea and morning sickness Nausea and morning fluids and including lots of fibre in including lots fluids and to know It is important your diet. contain does not that Pregnacare anaemia. iron to fix your enough 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. Then you may not need to pass water again quite so soon.

When to get help If you have any pain while Pelvic joint pain When to get help passing water or you pass Getting diagnosed as early as any blood, you may have a If during or after your pregnancy possible can help to minimise urine infection, which will need you have pain in your pelvic the pain and avoid long-term treatment. Drink plenty of water joints when walking, climbing discomfort. Treatment usually to dilute your urine and reduce stairs or turning in bed, you involves gently pressing on or pain. You should contact your could have pelvic girdle pain moving the affected joint so that GP within 24 hours. (PGP) or symphysis pubis dysfunction (SPD). This is a it works normally again. The growing baby will increase slight misalignment or stiffness Ask a member of your maternity pressure on your bladder. If you of your pelvic joints, at either team for a referral to a manual find this a problem, you can the back or front. It affects up to physiotherapist, osteopath or improve the situation by doing one in four pregnant women to chiropractor who is experienced exercises to tone up your pelvic a lesser or greater extent. Some in treating pelvic joint problems. floor muscles (see page 45). women have minor discomfort, others may have much greater They tend not to get better Ask a midwife or maternity immobility. completely without treatment physiotherapist for advice. from an experienced practitioner.

Visit the Pelvic Partnership for support and information at www.pelvicpartnership.org.uk

Piles Piles, also known as haemorrhoids, are swollen veins around your anus (back passage) which may itch, ache or feel sore. You can usually feel the lumpiness of the piles around your anus. Piles may also bleed a little and they

80 81 7 Conditions and problems in pregnancy difficult to get a good night’s difficult to get uncomfortable sleep. It can be just when you get lying down or, comfortable, you find that you have to get up to go to the toilet. Some women have strange dreams or nightmares about the baby and about Talking the birth. aboutyou. them can help It might be more comfortable to lie on one side with a pillow under your tummy and another between your knees. marks Stretch are pink or purplish lines These usually occur on your which abdomen or sometimes on your upper thighs or breasts. Some women get them, some don’t. It depends on your skin type. Some people’s skin is more are more likely to elastic. You marks if your weight get stretch Hair growth is also likely to hair Your increase in pregnancy. the After may also be greasier. baby is born, it may seem as if In you are losing a lot of hair. fact, you are simply losing the hair that you grew during extra pregnancy. Sleep Late in pregnancy it can be very If you sunbathe while you are pregnant, you may find that you your Protect tan more easily. skin with a good, high-factor sunscreen. Don’t stay in the sun for very long. Hormonal changes taking place Hormonal changes make your in pregnancy will nipples and the area around skin colour Your them go darker. may also darken a little, either in Birthmarks, or all over. patches may also moles and freckles darken. Some women develop a dark line from their belly buttons down to the top of their will changes These pubic hair. gradually fade after the baby has been born, nipples although your may remain a little darker. Skin and hair changes changes Skin and hair Push any piles that stick out any piles that stick Push inside using a gently back lubricating jelly. Ask your midwife, doctor Ask your midwife, or pharmacist if they can suggest a suitable ointment. Avoid standing Avoid for long periods. regular Take to exercise improve your circulation. find it helpful to may You use a cloth wrung out in ice water. Eat plenty of food that Eat plenty of food like is high in fibre, wholemeal bread, fruit and vegetables, and drink plenty will prevent This of water. can constipation, which make piles worse. • • • • • • How to ease piles can make going to the toilet going to the toilet can make or even painful. uncomfortable in pregnancy occur They certain hormones because relax. Piles make your veins weeks usually resolve within after birth. When your baby is born your gums should return to normal.

How to keep teeth and gums healthy

• Clean your teeth and gums carefully. Ask your dentist to show you a good brushing method to remove all the gain is more than average. It is reduce ask your doctor or plaque. very doubtful whether oils or midwife to check your blood • Avoid having sugary drinks creams help to prevent stretch pressure. and foods too often. Try to marks. After your baby is born, eat them at mealtimes only. the marks should gradually pale Teeth and gums and become less noticeable. • Go to the dentist for a Always tell your dentist that you check-up. HSC dental are pregnant as this may affect Swollen ankles, feet and treatment is free while you your treatment. Bleeding gums fingers are pregnant and for a year are caused by a build-up of after your baby’s birth. Ankles, feet and fingers often plaque (bacteria) on your teeth. swell a little in pregnancy During pregnancy, hormonal • Ask your dentist if any because your body is holding changes in your body can cause new or replacement fillings more water than usual. Towards plaque to make your gums more should be delayed until after the end of the day, especially if inflamed. They may become your baby is born. the weather is hot or if you have swollen and bleed more easily. been standing a lot, the extra water tends to gather in the lowest parts of your body.

Suggestions for swollen ankles, feet and fingers

• 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 higher than your heart.

• Do foot exercises (see page 46).

• If the swelling does not

82 7 Conditions and problems in pregnancy 83 Try sleeping with your legs Try higher than the rest of your body – use pillows under your ankles or put books under the foot of your bed. (see page Do foot exercises 46) and other antenatal as walking such exercises will and swimming, which help your circulation. • • Try to avoid standing for long Try periods of time. not to sit with your legs Try crossed. not to put on too much Try weight, as this increases the pressure. Sit with your legs up as often as you can to ease the discomfort. support tights, which Try may also help to support the muscles of your legs. veins in the legs are most the legs are most veins in can You affected. commonly the varicose veins in also get They opening). vulva (vaginal after delivery. usually get better if your doctor or midwife Tell veins or if a you have varicose ever had a close relative has disorder as clot or blood clotting as you will need assessments pregnancy progresses. If you have varicose veins: • • • • • Varicose veins Varicose veins which veins are Varicose have become swollen. The Tell your midwife or doctor your midwife Tell of any if vaginal discharge, increases a lot in later colour, pregnancy. Tell your midwife or doctor if the your midwife Tell is coloured, smells discharge or sore. itchy strange, or if you feel When to get help When Almost all women have more in pregnancy. vaginal discharge It should be clear and white and should not smell unpleasant. coloured or is If the discharge itchy smells strange, or if you feel or sore, you may have a vaginal most common The infection. your which is thrush, infection You doctor can treat easily. can help to prevent thrush by wearing loose cotton underwear. Vaginal discharge Vaginal Towards the end of pregnancy the end of pregnancy Towards because tired you may feel you are weight of the extra carrying. Make sure that you get plenty of rest. In the early months of In the early tired you may feel pregnancy desperately exhausted. or even only answer is to try to rest The as possible. Make time as much up during to sit with your feet of any offers the day and accept and family. help from colleagues Tiredness More serious problems High blood pressure and pre-eclampsia During pregnancy your blood pressure will be checked at every antenatal appointment. This is because a rise in blood pressure can be the first sign of a condition known as pre-eclampsia – also called pregnancy-induced hypertension (PIH) or pre-eclamptic toxaemia (PET). It can run in families and affects 10% of . Your urine is checked for protein • bad pain just below the ribs; can cause fits in the mother at every visit, as this is a sign of (called eclampsia) and affects • vomiting; pre-eclampsia. the baby’s growth. It is life- • sudden swelling of the face, threatening if left untreated. The symptoms hands or feet. That is why routine antenatal Some of the symptoms of pre- checks are so important. eclampsia are: However, you can have severe pre-eclampsia without any Pre-eclampsia usually happens • bad headaches; symptoms at all. towards the end of pregnancy, but it may happen earlier. It • problems with vision, such can also happen after the birth. as blurred vision or lights This can be a serious condition It is likely to be more severe if flashing before the eyes; for both mother and baby. It it starts earlier in pregnancy. Treatment may start with rest at home, but some women need admission to hospital and medicines that lower high blood pressure. Pre-eclampsia can be a reason to deliver the baby early – this may be either by induction of labour or by caesarean section.

When to get help If you get any of the symptoms described here, or have any reason to think that you have pre- eclampsia, contact your midwife, doctor or the hospital immediately.

84 7 Conditions and problems in pregnancy 85 the itching becomes severe becomes the itching – particularly if it affects your hands and feet; you develop jaundice (yellowing of the whites of the eyes and skin); and a severe you get itching rash. rash, most commonly in the rash, most commonly of pregnancy. last four months can lead Obstetric cholestasis to premature birth, stillbirth or serious health problems for your It can also increase the baby. risk of maternal haemorrhage after the delivery. to get help When see your doctor if: should You • • • Wearing loose clothing may Wearing help. also want to avoid may You synthetic materials. of the abdomen is stretched and is stretched of the abdomen itchiness. this may also cause How to avoid itching • • and obstetric Severe itching cholestasis be a sign can Severe itching of a condition called obstetric is a potentially This cholestasis. dangerous liver disorder that seems to run in families, although it can occur even if there is no family history. main symptom is severe The without a generalised itching Mild itching is common in Mild itching pregnancy because of the increased blood supply to the skin. In late pregnancy the skin Itching If the placenta is still low in the uterus, there is a higher chance that you could bleed during your pregnancy or at the time can be bleeding of birth. This very heavy and put you and may be your baby at risk. You advised to come into hospital at the end of your pregnancy so that emergency treatment if can be given very quickly you do bleed. If the placenta is near or covering the , the baby cannot get past it to be born vaginally and a caesarean section will be necessary. For 9 out of 10 women the 9 out of 10 women the For placenta has moved into the upper part of the uterus by this time. The position of your placenta The 18 to 21- is recorded at your scan. If it is week ultrasound you will be significantly low ultrasound scan an extra offered later in your pregnancy (usually at around 34 weeks) to recheck its position. (or a low-lying praevia (or a low-lying Placenta is when the placenta placenta) part of in the lower is attached to or covering the uterus, near the cervix. Placenta praevia Placenta Small babies your baby’s movements. Do increase as he or she moves. Many of the tests in pregnancy not rely on any home kits you You will usually be able to go check that your baby is growing. may have for listening to your home once you are reassured. If you have previously had a very baby’s heartbeat. small baby, or if you smoke, the An ultrasound scan to check midwives and doctors will already You must contact your local on the growth of your baby, as be monitoring your pregnancy maternity unit immediately. You well as the amount of amniotic closely. Blood pressure checks must not wait until the next day fluid around your baby, may be may also pick up signs that there to seek help. arranged if: are complications. If there is You will be asked about your 1. your uterus measures concern about your baby’s health, smaller than expected; further tests might be carried out baby’s movements. You will and your baby will be monitored have a full antenatal check-up, 2. your pregnancy has risk more frequently. including checking your baby’s factors associated with heartbeat. stillbirth; What should I do if I feel my baby’s movements are Your baby’s heart rate will be 3. the heart-rate monitoring is reduced or changed? monitored, usually for at least normal but you still feel that 20 minutes. This should give you your baby’s movements are Always seek professional help reassurance about your baby’s less than usual. immediately. Never go to wellbeing. You should be able sleep ignoring a change in to see your baby’s heart rate The scan is normally performed

86 7 Conditions and problems in pregnancy 87 develop, often in the deep veins develop, often in be fatal if the of the legs. It can the legs to the clot travels from risk may increase lungs. The flight if you are on a long-haul (over five hours), where you sit still for a long time. have an assessment will You carried out at booking to see if you have increased risk of developing clots and if so treatment can be given. to get help When If you develop swollen and painful legs or have breathing difficulties, go to your GP or your nearest emergency department immediately. More information More College of Obstetricians see the Royal more information For Thrombosis guideline and Gynaecologists’ and Embolism during at Reducing the Risk and the Puerperium, Pregnancy pha.site/thrombosis-pregnancy (see page 179), although many although (see page 179), at this time women who bleed and go on to have normal successful pregnancies. Bleeding in late pregnancy sort of most common The bleeding in late pregnancy is the small amount of blood mixed with mucus that is known is a sign that This as a ‘show’. and the cervix is changing becoming ready for labour to days start. It may happen a few before contractions start or during labour itself. Deep vein thrombosis Deep vein thrombosis is a serious condition where clots bleeding In early pregnancy, may be a sign of an ectopic pregnancy or a Bleeding after sex cells on the surface of The in the cervix often change pregnancy and make it more likely to bleed – particularly after is called a cervical This sex. can infections erosion. Vaginal also cause a small amount of vaginal bleeding. Bleeding from the at any time in pregnancy can be a dangerous sign. Some causes of vaginal bleeding are more serious than others, so it’s important to find the cause straight away. Vaginal bleeding Vaginal Seek medical help contact your GP should You if you have a sudden ‘acute’ illness like diarrhoea, vomiting, or abdominal pain, high fever severe itch. These investigations usually usually investigations These that all is provide reassurance are any concerns well but if there your doctor and about your baby, will discuss this with midwife scans may be you. Follow-up circumstances, arranged. In some that it would you may be advised for your baby to be bornbe safer as soon as possible. within 24 hours of being hours of being within 24 requested. What are blood clots? Pregnancy increases the risk of having a blood clot during and for about six weeks after pregnancy.

There are two kinds:

1. Deep-vein thrombosis (DVT) is a blood clot that forms in a deep vein, most commonly in the leg or pelvis.

Symptoms (if any): be torn, causing vaginal bleeding. The baby can lose • Swelling (most likely to be in Vasa praevia is a rare a life-threatening amount the muscles of your legs) condition (occurring in about 1 in 3,000 to 1 in of blood and die. It is very • Red, purple, blue or white 6,000 births). It occurs when difficult to diagnose but it discolouration the blood vessels of the may occasionally be spotted umbilical cord run through before birth by an ultrasound • Pain or discomfort the membranes covering the scan. Vasa praevia should cervix. Normally the blood be suspected if there is 2. Pulmonary embolism (PE) occurs vessels would be protected bleeding and the baby’s heart when part or all of the blood clot within the umbilical cord. rate changes suddenly after breaks free and passes through When the membranes rupture of the membranes. your blood vessels and reaches rupture and the waters It is linked with placenta your lungs. break, these vessels may praevia (see page 85).

Symptoms:

• Coughing (with blood-stained spit)

• Chest pain

• Breathlessness or collapse

Health professionals use the term venous thromboembolism (VTE) to cover both types of blood clots.

If you develop any of these symptoms during or after your pregnancy, please get medical advice immediately.

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