First published Spring/Summer 2011
If you’ve ever run a marathon, received a promotion or aced a test, you know that the very satisfying rewards of these accomplishments require hard work, dedication and sometimes even physical pain. Pregnancy is no different! In order to reach the moment when you’re able to hold your perfect baby in your arms, undoubtedly you will have to put up with your share of aches, pains and frustrations. Fortunately, many of these discomforts can be managed with minor interventions.
What you may experience during pregnancy, how to cope and when you need to call your healthcare provider follow.
Many women experience headaches during pregnancy, which may be related to tension or dehydration, or they could be migraines. About a third of women with migraines experience worsening of their usual headaches during pregnancy, a third have similar headaches to pre-pregnancy, and a lucky third have less severe headaches.
What to try Make sure you stay hydrated. Acetaminophen is the safest medication (500 to 1,000 mg, or one to two extra-strength tablets), but you shouldn’t take more than 4,000 mg a day. You can also try deep breathing, light exercise, yoga, massage and acupuncture, but be sure your instructors/providers know you’re pregnant. Get enough sleep. Surprisingly, caffeine can be helpful in small doses (i.e., one 8-oz cup of coffee). Although avoiding caffeine is generally recommended in pregnancy, this is one situation where it can be therapeutic, if used infrequently, in moderation, and only with your healthcare provider’s ok. If you have a history of migraines, talk to your provider early on to develop a treatment plan in case your headaches don’t respond to conservative measures.
When to call If headaches persist despite the interventions above or you have any associated visual changes, excessive weight gain, severe stomach pain, weakness in your arms/legs/face, or any other concerns.
Pregnancy hormones can cause the lining of your nasal passages to swell and make more mucus, which can leave you constantly sniffling and blowing your nose, even when you don’t have a cold. Sometimes, minor nosebleeds may also occur.
What to try Saline nasal spray can work wonders for congestion. Use it liberally, like a nasal passage wash. Avoid the medicated version. Humidifiers can also be helpful, especially in winter.
When to call If you have difficulty breathing or have a nosebleed that doesn’t stop with gentle pressure.
Pregnancy causes the gums to swell and makes them more susceptible to trauma, especially when brushing your teeth.
What to try See your dentist regularly and maintain good oral hygiene, including brushing and flossing, to decrease the risk of developing a dental infection. As long as bleeding from gums is minimal and stops shortly after brushing, it is not a threat to your health.
When to call If you have significant bleeding from your gums or from other injuries that doesn’t stop with pressure.
When you’re pregnant, much of your blood flow is redirected to the placenta to help your baby grow. Your blood volume will increase to meet this demand. In addition, your blood pressure is lower due to pregnancy hormones. Sometimes you can experience lightheadedness or dizziness simply from dehydration, increased physical activity or going quickly from sitting/lying to standing. In addition, when you lie flat, the uterus can compress blood vessels and prevent blood from returning to your heart as quickly, which can also cause you to feel dizzy.
What to try Drink plenty of water or other fluids. If you exercise or do heavy physical chores, you should be able to carry on a conversation during activity. If you notice lightheadedness while lying down, try turning to your left side or putting a pillow underneath your left hip. Get up slowly from sitting/lying to allow your body time to readjust.
When to call If you feel lightheaded/dizzy most of the day despite trying the tips above, or if you lose consciousness.
As your belly gets larger and you become more uncomfortable — but even as early as the first trimester — you may notice more difficulty falling and staying asleep. Add to this the frequent need to urinate and changes of position by the third trimester, and you can find your sleep interrupted.
What to try Go to bed and wake up at the same time each day. Plan to spend ten hours in bed to get eight hours of real sleep. Find a comfortable pillow. Avoid caffeine and fluids after dinner. Used occasionally, 25 to 50 mg of diphenhydramine (Benadryl) can be helpful to induce sleep.
When to call If you are unable to sleep even following the above advice, your provider may prescribe a stronger medication for occasional use.
Morning sickness is one of the most common early-pregnancy complaints. Unfortunately, for many women, it’s not just “morning” sickness — it could be anytime-of-the-day sickness, and for a small percentage of unlucky women it lasts the whole pregnancy! The pregnancy hormones can cause an upset stomach and make eating and drinking difficult. The good news: For most women (80 percent), these symptoms begin to improve by the end of the first trimester. Also, although many women worry that their babies will not get enough nutrients to grow properly, this is almost never the case. Babies will take what they need, and, even if you feel miserable, they usually are quite content!
What to try Eat small, frequent, bland meals. Try easily digestible foods — which, many times, are white in color — white rice, white bread, potatoes, bananas and oatmeal. Some women find more protein-based diets sit better. Drink lots of fluids. Sports drinks often have electrolytes, which can help to restore fluid balance.
When to call If you can’t keep down any food or drink for over 36 to 48 hours. Your provider may prescribe anti-nausea medication and/or give you intravenous fluids.
Pregnancy hormones can relax involuntary muscles in your gastrointestinal tract, increasing the likelihood of some stomach acid traveling into your esophagus. Add to this an enlarging uterus and your baby pressing on your intestines and stomach, and you’ve got a recipe for heartburn!
What to try Avoid fatty foods, peppermints, caffeine and chocolate. If heartburn is worse when lying flat, put two to three pillows under your head while sleeping. You can also try over-the-counter antacids, which are safe in pregnancy, but tell your provider all medications you’re taking.
When to call If your heartburn causes frequent vomiting or you get no relief from the suggestions above.
The same pregnancy hormones that contribute to heartburn can also slow down movement through your intestines, causing constipation.
What to try Make sure you’re drinking plenty of water (if your urine is dark or medium yellow, drink more; if it’s light yellow or clear, you’re doing well). Have a few ounces of prune juice every morning. Eat more fiber, which is found in bran, whole grains, fruits and vegetables, and in supplements such as psyllium (Metamucil). Stool softeners such as docusate (Dulcolax) can be very helpful.
When to call If you haven’t had a bowel movement and are very uncomfortable, your provider may recommend a laxative, but you should not take it regularly without your provider knowing, as it can cause electrolyte imbalances and you can grow dependent upon it.
Pregnant women are more likely to have carpal tunnel syndrome, which is a group of symptoms related to pressure on a nerve running through the wrist. This may cause numbness, tingling and/or pain in the wrists and the hands.
What to try Avoid activities that require repetitive movements of the hand and wrist (such as typing). If you can’t avoid the activity, try using an ergonomic device such as a special pad that attaches to a keyboard and is designed to decrease pressure on the wrist. You can also try a splint or brace to keep the wrist in a neutral position, especially at night, which works to increase room in the carpal tunnel. Acetaminophen can help the discomfort as well.
When to call If you have severe pain or persistent numbness that doesn’t improve.
As your baby grows, your center of gravity shifts. In order to not topple over, you will unconsciously change your posture, which may put strain on your back. Many women have trouble sitting or standing in one position for a long time or have difficulty finding a comfortable sleep position.
What to try When you lie down, use a pillow between your legs and lie on your side with a pillow supporting your back. This may help straighten your spine and put less pressure on the muscles that support it. You can also try wearing a “pregnancy belt” or a band across your belly that helps provide support so less is required from your back. Stretching exercises, like pregnancy yoga, can also be helpful in maintaining flexibility and proper posture. When at your desk, put a small stool underneath and place one foot at a time upon it; this can reduce lower-back strain. Get up and walk once an hour to relieve back strain from sitting for prolonged periods.
When to call If you are unable to walk normally, have numbness or tingling in your legs, have severe pain not controlled with acetaminophen, or have any other symptoms that concern you.
PUBIC SYMPHYSIS SEPARATION
Many pregnant women experience pain low in the abdomen, which is often simply pressure from the baby’s head. Sometimes the pain is more severe — worst with walking and changing positions — and it may be very painful to touch the pubic bone. In these cases, it’s likely that the ligament between the pubic bones has relaxed and allowed the bones to separate more than normal in preparation for delivery. Called pubic symphysis separation or pubic symphysis diastasis, it usually resolves after the birth.
What to try Avoid positions that are uncomfortable, especially standing or walking for long periods of time. Avoid lifting heavy items, such as grocery bags. Try a pregnancy binder to help support the belly. Heat packs can provide some relief. Acetaminophen may be helpful in managing pain.
When to call If your pain is beyond the low pelvis, it could be a sign of a more serious problem. Be sure to tell your provider, who may prescribe a stronger medication.
FREQUENT URINATION/ INCONTINENCE
During pregnancy, it’s common to have to urinate small volumes frequently and to have some involuntary release of urine. The pregnancy hormones may also relax the muscles that help hold in urine. Additionally, as your baby gets bigger, your growing uterus puts a lot of pressure on the bladder, which can make it feel as though it’s always full.
What to try Caffeine (coffee/tea) and alcohol are natural diuretics that should be avoided in pregnancy. Also, not drinking anything after dinner will help decrease the number of nighttime bathroom trips.
When to call If you have pain when you urinate or notice your urine has a funny color or smell, which could be a sign of infection.
Constipation during pregnancy may lead to straining to have a bowel movement, which can cause painful hemorrhoids. They can bleed, and you may see spots of blood on bath tissue when wiping.
What to try Stool softeners and fiber (see Constipation). Witch hazel pads and mild steroid creams may help with discomfort.
When to call If you’re concerned about bleeding, or have severe pain.
Toward the end of pregnancy, many women notice swollen legs and feet.
What to try Elevate your feet whenever you can, to help blood flow out of the legs and back to the heart, which should decrease swelling. You can also try compression stockings (found at medical supply stores, or your provider may prescribe specially fitted ones). You may find looser-fitting shoes more comfortable, though it won’t solve the problem.
When to call If you have rapid, severe swelling of your legs that causes you to gain significant weight over a short period of time, or if one leg is more swollen than the other.
Leg cramps are common in pregnancy, but the cause is unknown.
What to try Keep hydrated. Avoid crossing your legs. Stretch your calves a few times a day. Wiggle your feet and ankles if you’re sitting for a long time. Walk and/or exercise regularly. If you get a cramp, stretch that muscle immediately.
When to call If the pain persists, or you notice any redness or swelling in your leg. These could be signs of a blood clot.
As you work through any discomfort, try to enlist support. Whether it’s your mom, a sister, or a pregnant friend who can commiserate over some decaf tea, sometimes knowing you’re not alone can serve you better than another dose of medicine. Your provider can always give you suggestions. And, always keep your eye on the prize — your baby, for whom this will all be worthwhile!
Lynsey Caldwell Owen, MD, is an ob/gyn at Malcolm Grow Medical Clinic on Andrews Air Force Base and at Southern Maryland Hospital Center.