Sometimes, the changes in your body during pregnancy can create discomfort or irritation. Indeed, at times, you may feel extremely uncomfortable and concerned for yourself and your baby. Always trust your own judgement and don’t be afraid to contact your midwife or doctor between appointments. This section provides some information on the most common minor and serious problems and concerns during pregnancy.
Problems and concerns in pregnancy
The Rotunda Hospital Dublin
MINOR PROBLEMS IN PREGNANCY
This is due to the ligaments softening and stretching during pregnancy, which can put a strain on the joints of the lower back and pelvis. As pregnancy progresses, you gain weight and your posture changes to cater for your growing baby. This puts strain on your back which may result in backache. Gentle stretching, massage or heat packs may help to relieve pain. Special yoga classes for pregnant women and acupuncture can help. If you are in severe pain, always contact your midwife or doctor, as you may need to see a physiotherapist for specialist treatment.
To prevent backache:
- avoid lifting heavy loads.
- always bend your knees and keep your back straight when lifting objects.
- wear flat or low-heeled shoes as these allow your weight to be more evenly distributed.
During pregnancy, you may find any physical exertion difficult and it may cause breathlessness. This is due to the growing baby pushing up your diaphragm, which makes it harder for you to take deep breaths. When this happens, stop what you are doing and breathe slowly in order to get the correct amount of oxygen. There is no risk to your baby.
High levels of the hormone progesterone occur in pregnancy and can slow down the intestinal process which can result in constipation. To prevent or relieve constipation you should drink lots of water, eat fresh fruit and vegetables every day and include high fibre foods in your diet. Avoid sugary and fatty foods and try to exercise regularly.
Suddenly feeling faint or dizzy can occur at any stage of pregnancy but it is more common in the early weeks and towards the end of pregnancy. This can happen when your blood sugar level falls, especially if you have morning sickness. Eat small meals at regular intervals and drink plenty of fluids during this stage of your pregnancy. Your blood pressure can fall if you are lying on your back for some time, or you suddenly get up from bed or a chair. To relieve dizziness, sit down with your head between your knees, or lie down on your side. Try to avoid hot areas, don’t stand for long periods of time and don’t stand up or change position quickly.
These are swollen veins around your anus (back passage) which can itch, feel painful or bleed. You may feel a ‘lump’ around your back passage. Piles can make passing a bowel motion difficult and painful. To relieve the swelling and reduce the pain, use a haemorrhoid cream from the pharmacy or apply a cold compress. Avoid constipation and standing for long periods of time.
These are common in pregnancy especially in the first few weeks. This is due to hormone changes and an increase in your blood supply. Drink plenty of water, rest as much as possible and take some gentle exercise to help alleviate the pain. If headaches are persistent, always inform your midwife or doctor, as it could be a sign of a more serious problem. (See the section on serious problems in pregnancy, later in this chapter.)
This is caused by the hormonal changes occurring in your body and by your growing womb pressing on your stomach. The valve at the top of the stomach relaxes during pregnancy allowing acid to rise. Try eating small amounts of food regularly and avoid fatty and spicy foods. There are a number of over-the-counter medications (simple antacids) available from your local pharmacy which can help to ease the symptoms of heartburn. Always read the instructions carefully and make sure you do not take more than the recommended dose. Your pharmacist will be able to offer advice on the product you buy.
This is a sudden sharp pain usually in the calf of the leg or the feet, which is more common at night time. To relieve cramp, flex (bend) your knee and/or ankle and pull your toes up towards your ankle. Massaging the affected area can also help relieve the pain. If pain in the calf of your leg persists or your leg becomes red or swollen, contact your midwife or doctor.
Nausea or morning sickness
This is very common in the early stages of pregnancy. Some women may feel sick or vomit early in the morning. For others, it may last all day or occur only in the evening time. It is caused by the change in hormone levels in early pregnancy and the symptoms usually go away by 12 – 14 weeks. Try eating a plain biscuit or dry toast and eat small amounts frequently. Drink plenty of fluids to avoid becoming dehydrated. For most women, morning sickness will pass. Some women though are unable to keep any food or fluids in their stomach and become ill, requiring medication and/or admission to hospital for treatment.
Some women suffer from nosebleeds during pregnancy which are due to the effects of the increased hormone levels. The bleeding usually stops by pressing the sides of the nose together with your thumb and forefinger. If the bleeding persists or is difficult to stop, please consult your midwife or doctor.
This is due to the increased blood supply to the skin and the stretching of the skin on the tummy. To relieve the itch, apply some calamine lotion from the pharmacy. Itch may also be due to dry skin and unscented moisturizers may provide relief. If you have severe or persistent itching, contact your midwife or doctor as it could be a sign of a more serious problem. (See the section on serious problems in pregnancy, later in this chapter.)
These occur around your tummy, breasts and the top of your legs. As the skin stretches during pregnancy, some of the fibres in the skin will tear resulting in red spidery ‘stretch marks’. This can occur at any stage of the pregnancy and depends on your skin type. Some women will benefit from applying oils or creams to the area but for others, stretch marks will just happen as part of pregnancy. The marks will gradually become less noticeable after the pregnancy.
Swollen ankles and hands
This usually occurs towards the end of pregnancy as the body holds more fluid and the circulation is restricted due to the pressure of your growing baby. It is more common in hot weather and in the evening time, especially if you have been standing a lot. To prevent this occurring, avoid long periods of standing, sit down when possible and avoid wearing high-heeled shoes. Foot exercises can also help to ease the discomfort. Swollen ankles and hands can also be a sign of pre-eclampsia. (See the section on serious problems in pregnancy, later in this chapter.)
Teeth and gum problems
Bleeding gums can be a problem for some women caused by the build up of plaque on their teeth. Due to the hormonal changes in pregnancy, the plaque makes the gums inflamed and they become swollen and bleed. Using a mouthwash will reduce the build up of plaque and you might want to use a softer toothbrush. Avoid sugary drinks and food. Visit your dentist for further advice.
Thrush is a yeast infection in the vagina caused by a fungus called candida. It results in a thick vaginal discharge and itchiness of the surrounding area. It is common in pregnancy as high oestrogen levels lower the acidity of the vagina. To relieve the symptoms, use an antifungal cream or pessary available from the pharmacy and wear cotton underwear. Eating natural yoghurt may help to prevent thrush and also to relieve itching, if applied to the affected area.
This occurs when small amounts of urine leak when you sneeze, laugh or cough. The softening of the ligaments and your growing baby putting pressure on your bladder causes it. If this becomes a problem for you, contact your midwife or doctor who will refer you to the physiotherapist for pelvic floor exercises to help tone up the muscles. At parent education classes, exercises to prevent this happening are discussed. The physiotherapists have made five videos on learning about pelvic floor muscles, doing your pelvic floor muscle exercises, leaking urine and doing exercises after you have your baby. The videos can be accessed at this link.
These occur during pregnancy as rising hormone levels relax the walls of the blood vessels and the veins become swollen and painful. They are more common in the legs but can occur in the vulva (around the vaginal opening). The weight of the growing baby also puts pressure on the veins. Try not to stand for long periods of time and do not cross your legs. Compression stockings will help relieve the discomfort of varicose veins.
SERIOUS PROBLEMS IN PREGNANCY
Abdominal or tummy pain can be associated with the growing womb; however, severe or lasting pain in early pregnancy can be a sign of an ectopic pregnancy (pregnancy outside the womb), which requires urgent medical attention. Later in pregnancy, abdominal pain may be a sign of labour. It can also be a sign of a urinary tract (kidney) infection or high blood pressure. If you have abdominal pain, which is severe or lasts for a few hours always contact your midwife or doctor.
Vaginal bleeding can occur at any stage of the pregnancy and it is not normal. As many as one in four women will have some degree of vaginal bleeding during the first three months, ranging from brown straining to bright red spotting or passing blood clots. In the majority of cases, the bleeding will settle down and the pregnancy will continue to full term with a healthy outcome. But, if you experience any vaginal bleeding and/or abdominal pain, you should contact your midwife or doctor.
In early pregnancy, bleeding can be a sign of a threatened miscarriage or an ectopic pregnancy. You should contact the emergency and assessment unit or the early pregnancy assessment unit. An ultrasound scan will be performed to find the cause of the bleeding.
In later pregnancy, bleeding can be a sign that the placenta (afterbirth) is attached to the lower part of your womb or part of the placenta has become detached from the wall of your womb. There may also be light bleeding due to changes in the cervix. If at any time during your pregnancy you have vaginal bleeding, you should contact your midwife or doctor.
Pain and swelling in the calf of a leg can be a sign of deep venous thrombosis (blood clot), which is a very serious condition and requires urgent medical attention. Women who intend going on a long flight during pregnancy should wear compression socks/tights, as they are more prone to a blood clot. It is also important to drink plenty of fluids and to exercise the legs while travelling. A blood clot may also cause chest pain and breathlessness, therefore it is important to seek medical attention if you develop any of these symptoms.
High blood pressure can occur at any stage during pregnancy. If protein in the urine is also present, it is known as pre-eclampsia. It is most likely to occur in the last three months of pregnancy. You are checked for symptoms of high blood pressure at each antenatal visit. Many women with a mild form of pre-eclampsia may feel quite well. Sometimes a woman may complain of headache, blurred vision and/or abdominal pain. If pre-eclampsia is diagnosed, you may be monitored in the day assessment unit as an outpatient or admitted to hospital. The early birth of your baby may be necessary
While most pregnancies end successfully with the birth of a healthy baby, unfortunately sometimes things go wrong and the baby dies. There are specially trained staff in the hospital to help and support you and your family through this difficult time. These include the bereavement midwife, specialist midwives, medical social worker and chaplain. If you wish to speak with any member of the support team, please phone the hospital 01 817 1700.
Reduced fetal movements
You should feel your baby moving at least 10 times in a 12-hour period, every day during the last three months of your pregnancy. If you notice the movements becoming less frequent or you are not aware of any movements for a number of hours, you should contact the hospital immediately. You will be asked to attend the emergency and assessment unit where the midwife will monitor your baby’s heartbeat – this is called a cardiotocograph (CTG). You may be asked to keep a record of your baby’s movements after your hospital visit.
Itchy skin can be common during pregnancy. However, for some women it can be a sign of pregnancy cholestasis, which can be a serious condition that affects the liver. If you develop a troublesome body rash, always contact your midwife or doctor for advice.
Trauma to the abdomen
If you fall or receive any injury to your tummy, you should come to the hospital to check that everything is ok with you and your baby. To reduce the risk of injury to your baby if you are involved in a road traffic accident, make sure you wear your seat belt correctly. (See staying healthy during pregnancy.) Depending on your blood group, you may require an injection called Anti-D to protect against antibodies developing in your blood.
EMERGENCY AND ASSESSMENT UNIT
The emergency and assessment unit provides a 24-hour service for the examination and assessment of women who come in with signs of labour, complications of pregnancy, complications in the postnatal period or acute gynaecological emergencies. It is located on the ground floor, opposite the main reception area.
You may contact the emergency and assessment unit at any time by phoning 1800 522 687 for advice or to speak to a midwife.
The staff at the main reception desk will check some information with you and inform a midwife in the unit that you have arrived. The midwife will aim to see you within 10 minutes of your arrival. She will talk to you about your symptoms or concerns. She will review your healthcare record and will carry out an examination and assessment to find out how urgently you need to be reviewed. This is called a ‘triage’ consultation. The urgency of your review will be categorised as emergency (red), urgent (orange) or non urgent (green). The midwife will decide if you need to be seen by a doctor and will tell you how long you are likely to be waiting.
You will be seen as quickly as possible and in order of medical need. If you feel your symptoms are changing while you are waiting please tell the midwife.
GENERAL PRENATAL WARD
You may need to be admitted to the general prenatal ward following review in outpatients or in the emergency and assessment unit if a problem is detected that requires close observation and monitoring of you and your baby. Your doctor and the midwives will discuss any treatment and test results with you