During pregnancy there are major changes in the body, some which are the result of the hormones associated with pregnancy, and others that happen later, due to the size and pressure effects from the pregnant uterus, in the last trimester. At various stages in the pregnancy, women may experience different symptoms or feelings, some of which may be serious, others that are irritating and uncomfortable, but which don’t affect the health of the baby itself. Let’s look at some of those.
Bleeding during Pregnancy
It is not unusual for light bleeding to occur at various stages in the pregnancy. In the first few weeks, this may be associated with implantation bleeding. The bleeding will be light, short lived and not painful. However, it is difficult to be completely reassuring in this situation, and I would normally have women come in and be checked by a scan to confirm that the baby is healthy, and the fetal heart is present. Some pregnancies may continue happily, even in the presence of moderate to heavy bleeding, but these will need extra monitoring over the term. I always advise women that if they have any concern, even with light bleeding, they should call up and get checked out. Often the bleeding is fairly minor, from the edge of the placenta, and settles without any specific treatment. Occasionally, there is some bleeding from the tip of the cervix, where the lining becomes quite soft and friable, and bleeds easily after sport, exercise or intercourse.
Pain during Pregnancy
Pain is a symptom that every woman should take note of. However, there are some conditions in pregnancy where pain occurs, that don’t signify a problem for the baby. Braxton Hicks contractions can sometimes be felt from the middle trimester. They are felt as a tightening or hardening of the uterus, which lasts for a few seconds to half a minute or so. Provided they are short lived, don’t go on for more than a few minutes, and disappear when you rest, there should be no cause for concern. Again, it is sometimes difficult to sort out the difference between early labour pains in the third trimester and frequent Braxton Hicks contractions. If there is any doubt, call your doctor or the Maternity ward and speak to a midwife, who will advise as to how to proceed.
Ligament Pain is a common concern as pregnancy progresses. The pregnancy hormones can cause your tendons and ligaments to loosen and relax, ultimately making things a little easier for the baby’s head to pass through the pelvis. However, in the earlier part of the pregnancy, low back pain may be an issue. Other pains in the joints in the pelvis are common. Women may require support from a physiotherapist or a chiropractor and I frequently recommend that they continue to do so in a pregnancy. Sometimes, the changes that occur in the lower back may compress the sciatic nerve, causing pain in the buttock, the back of the thigh, or the outer part of the lower limb. Physiotherapy, exercises, manipulation, acupuncture, hot packs and tablets for pain control are all measures which may be used.
There is one other ligament which sometimes causes pain, called the round ligament. There are actually two, one on each side of the uterus. These are anchored at the back of the groin. As the uterus grows, these ligaments stretch and sometimes tear a little. Round ligament pain is often noticed on one side or other of the lower abdomen, made worse by movement or activity, even such benign actions as getting in and out of bed. They are usually not associated with any tightening of the uterus, and are alleviated with rest.
Nearly every woman has some degree of noticeable swelling during pregnancy, particularly in the last trimester. Women often complain of swollen ankles, or the rings on their fingers become tight and have to be removed before they get completely stuck. Swelling on its own is a common feature of pregnancy, and is not associated with any risks to the mother or baby. The one thing that we do look out for is any elevation of the blood pressure. Swelling, particularly if it’s worsening quickly, in association with raised blood pressure, is a much more significant problem. For some women, surgical stockings or support tights may help relieve the discomfort of swelling of the lower limbs.
Nausea during pregnancy is often called ‘morning sickness’. This can be a bit of a misnomer, as it is usually all day sickness. Nausea is usually a feature of the first trimester of the pregnancy, and for an unfortunate few, can be severe and last all the way through the pregnancy. I hope you’re not one of those! This nausea is related to the high (and increasing) levels of hormones in the early pregnancy and usually resolves itself around 10 to 12 weeks. If the nausea is associated with prolonged vomiting, women may need to go into hospital from time to time, for intravenous fluid therapy and other drug treatment. For women with milder symptoms, simple measures such as having small frequent meals and snacks through the day, Vitamin B6 and ginger tablets or other medications for nausea can be useful.
Heartburn may be a very distressing problem for women, particularly later in their pregnancy. Again, it is related to the effects of the pregnancy hormones, making the muscle sphincters in the stomach and bowel a little more relaxed than usual. If you do have heartburn, you don’t need to ‘suffer it bravely’ through your pregnancy. There are some simple measures which can help. Sleeping with an extra pillow or two can be helpful. Sometimes a small snack with yoghurt or milk will do the trick and settle things down. Antacids, such as Mylanta, Quick-Eze, or Rennies are very commonly used in pregnancy (fairly liberally!). For women where antacids are not sufficient, we can offer Ranitidine, which is a tablet taken up to two or three times a day, which will reduce the amount of stomach acid produced. Antacids may be used in combination with Ranitidine to deal with any breakthrough heartburn.
Varicose Veins occur in pregnancy when the veins become dilated and the valves and the veins work less efficiently because of the relaxing effects of the pregnancy hormones. These veins can be unsightly and uncomfortable. There is no easy cure for varicose veins in pregnancy, and surgery is never advised during pregnancy. Very commonly, there will be significant improvement in the varicose veins once the baby is born, and surgery is usually not required. Keeping the legs elevated and using compression stockings are useful measures.
Constipation is a common problem. There is often a change in bowel habits in pregnancy, often with some bloating and constipation. Women with irritable bowel syndrome may notice some worsening of the symptoms. Common remedies are to ensure an adequate fluid intake each day, increasing your natural dietary fibre and eating more fruit. If those simple dietary measures are unsuccessful, then try Metamucil, Normacol or Nulax.
As I said, there are many changes which can occur in pregnancy, most often of no significance. If you have any concern about anything unusual or different, it is best to contact your doctor or midwife. There are no silly questions in pregnancy. We would much prefer women to phone up about problems great and small, than to keep things to themselves, just in case there may be a serious problem lurking there. A minute or two on the phone for discussion and reassurance may save hours or days of apprehension or worry. If you have any concerns, talk to your GP, obstetrician or midwife.