Some Minor Discomforts During Pregnancy

Most women experience some discomforts during pregnancy. These discomforts are generally self-limited and annoying and may be somewhat alleviated by simple remedies. Nausea, commonly called morning sickness, can occur at any time of day. It is made worse by skipping meals, eating too large a meal, or by excess fatigue. Some women actually vomit, while others may have only a vague feeling of discomfort. Eating small meals, dry toast, crackers, or a snack every two to three hours can minimize nausea. Eat slowly. Frequent urination usually occurs early in pregnancy when the uterus is expanding and may push against the bladder. It will improve in mid-pregnancy, but recurs in late pregnancy. Limiting fluids in the evening may decrease the number of times you need to get up during the night. Burning or pain with urination may indicate a bladder infection. Please call your healthcare provider if you have these symptoms. Breast tenderness is common and may last the entire pregnancy. A bra with good support helps. Some women will have a clear to milky discharge from their nipples and may need to use soft dress shields or nursing pads to protect their clothing. Abdominal cramping similar to menstrual cramps is common in early pregnancy, as is a bloated sensation. Later there may be a lower pelvic/groin discomfort on one side or the other caused by stretching of the round ligaments and muscles supporting an enlarging uterus. A heating pad and rest can help. Fatigue is a usual complaint during early and late pregnancy. Increased rest may be necessary. Paradoxically, mild exercise often helps to combat the fatigue. Take the prenatal multi-vitamins and iron if prescribed. Heartburn is a burning acidic feeling in the mid to lower chest experienced at various times during pregnancy due to slower digestion and regurgitation. Sitting upright, elevating the head of the bed and over-the-head stretching exercises provide relief. Mild antacids used in small quantities also bring relief. Examples include Tums, Maalox, Mylanta, Rolaids. Leg cramps tend to occur in mid-pregnancy due to poor circulation. These often occur at night and awaken you from sleep. A simple exercise of flexing your toes vigorously towards your knees will relieve them. Maternity support hose can help achy legs but not if they are too tight and reduce circulation further. Balance rest and mild exercise during the day. If a specific area of tenderness or redness develops, you should call your healthcare provider. Constipation. Exercise and drinking enough fluids (six to eight glasses of water a day), eating bran, and dried fruits and vegetables will reduce constipation. Metamucil, a fiber product, or Colace, a gentle stool softener, may be suggested.

Headaches are quite common in all stages of pregnancy. Rest and stress reduction or a non-aspirin preparation like acetaminophen (Tylenol) will help. If headaches are prolonged or accompanied by blurred vision, please call your healthcare provider. Do not take aspirin or ibuprofen (Advil/Nuprin) without your doctors advice. Nasal congestion can be bothersome to some and may make you think of an on-coming cold. Usually it is due to increased blood supply in the nasal membranes and does not make one feel ill. Nosebleeds may occur. If they persist despite ice, compression and tilting the head back, please call your healthcare provider. Dry itchy skin, pigment changes and stretch marks occur and an emollient cream (Eucerin, Vaseline Intensive Care, etc.) may help relieve the dryness and reduce the itchiness. Some women develop brownish discoloration on their face, skin, or a brown line appears in the middle of their abdomen. These are related to hormone changes and will fade after delivery in most cases. Whether you will develop stretch marks on your breasts and abdomen will be determined by your skin type, heredity, and total weight gain during pregnancy. No creams will prevent them. Vaginal discharge increases for most women. It is usually a white creamy discharge. Maintain good hygiene. Douching is not recommended during pregnancy. If persistent itching or irritation continues, you should be checked for vaginitis. Swollen feet, ankles, and hands. Resting on your left side and elevating your feet several times a day will help reduce swelling in late pregnancy. Remove rings if they become too snug. Hands tend to be most swollen in the morning. Adequate fluid intake will actually help fluid excess be reabsorbed. Some women develop numbness and tingling in their fingers; if this happens, please call your healthcare provider. Shortness of breath often occurs in the last few months. Your blood is more dilute, less oxygen-rich and your additional bulk and weight contribute to the exhaustion. The sensation is heightened by the pressure of the uterus against the diaphragm, making it harder to take a deep breath. You may find that you need more time to do your usual activities. You should rest more frequently and may need to stop some overly strenuous activities. Control your rate of weight gain. Exercise classes and aerobics for pregnant women are available. If shortness of breath is extreme or comes on suddenly and is persistent, please call your healthcare provider. Pressure under the rib cage is another discomfort that can occur as the baby presses against the organs of the upper abdomen. This pressure feels like a sore spot or bruised area, especially under one rib. Sitting in a straight-backed chair with a pillow behind the lower back helps relieve the pressure and facilitates breathing. A warm bath or a heating pad will also help. Lightening or dropping is not a discomfort but a sensation of a change in the babys position. Your abdomen appears lower and you are experiencing more vaginal pressure and frequent urination instead of the heartburn, shortness of breath, or rib discomfort of before. It usually means that the baby has engaged into the pelvis, which is normal prior to delivery. Hemorrhoids are dilated veins that protrude from the rectum and can be most annoying. You can experience itching or burning around the anus or have a spot of blood on the toilet tissue after moving your bowels. Regular bowel habits, soft stools, and Kegel exercises may reduce hemorrhoids. Vaseline

petroleum jelly or Tucks pads may decrease the itching and burning. Ask about prescription medications available if symptoms are not controlled. Backaches late in pregnancy can be caused by poor posture and the weight of the growing baby distorting your normal balance and pulling on your back muscles to correct the shift. Good posture, low-heeled shoes, rest, back massage, and heat will help. Hip pain and pelvic bone pain can occur late in pregnancy. The hormones of pregnancy loosen the ligaments supporting these areas in expectation of delivery. This loosening allows the pelvis to accommodate the passage of the babys head and body in labor. But it may create distress with prolonged standing or walking in the hips or pelvic bone area. Rest and heat can be of great help. Braxton-Hicks contractions, or false labor, are uncomfortable, intermittent, irregular uterine contractions that occur periodically towards the end of pregnancy. False labor will fade with rest or a warm bath. If the contractions become regular every five minutes lasting sixty seconds each at term, call your healthcare provider. If you are not near term and the contractions persist, call your healthcare provider. Other Influences: Flu and colds occur in pregnancy. Extra rest, plenty of fluids and acetaminophen (Tylenol) for fever or discomfort are best. A vaporizer will help moisturize the air and ease a sore throat or nasal congestion. Early in pregnancy, it is best to avoid unnecessary medications. After the third month, you may use NeoSynephrine nose drops for 3 - 4 days only, Sudafed decongestant tablets, or Robitussin in moderation for relief of cough. If you have a fever higher than 101degrees, or if your symptoms persist, call your healthcare provider. Other common illnesses, such as sore throat and rashes, can be treated by your primary medical physician or clinic. If you or the physician have any questions concerning medications or treatment at your stage of pregnancy, please call your healthcare provider. Alcoholic beverages in excess are not recommended. Smoking is strongly discouraged, as it is known to decrease the amount of oxygen received by the fetus, impairing growth and development. Passive exposure to tobacco use by other household members has the same effect on the fetus. After delivery, the newborn is more susceptible to respiratory infections. Ask about information and programs that can help you to stop smoking. Caffeine is contained in coffee, tea, chocolate, colas, and soft drinks. It is a drug and should be limited to one or two servings a day. Cat litter boxes should be changed by someone else. The disease toxoplasmosis can be transmitted by cat feces and undercooked meats. Avoid both. If you garden, wear gloves and wash your hands well after working the soil. Paint fumes are usually not toxic if the area is well-ventilated.

Travel poses no specific risks during pregnancy, but there are minor precautions to observe. Consider access to obstetrical care. Travel will not cause premature labor, but there is a possibility that you may deliver in different surroundings with an unfamiliar obstetrician. Keep active and use leg exercises during long flights and car trips. Most airlines have restrictions in the last month of pregnancy. Check first. Dental work. Do not neglect dental care, daily flossing, or routine dental visits. If your dentist feels that X-rays are necessary, delay until after the third month and properly shield your abdomen. Local anesthetics (Xylocaine, Novocaine, etc) are permitted. Sexual activity can continue throughout pregnancy unless you are at risk (early pregnancy bleeding, spotting, history of a low placenta previa, ruptured membranes or premature deliveries). Exercise and activity. Mild to moderate exercise is helpful to maintain your health and combat fatigue of early and late pregnancy. Brisk walking, jogging, swimming, dancing, or racket sports are all fine, as long as you do them for fun and do not push yourself to exhaustion. Avoid saunas and hot tubs. Avoid sports that might involve serious falls. This is not the best time to take up a vigorous new sport or exercise program. Exercise classes specifically designed for pregnant and post-partum women are beneficial if you were not previously active. It will enhance your feelings of well-being, combat fatigue, benefit your labor, and post-partum period. On the job. Many women are concerned about how long to continue working. You can continue your job for as long as you are comfortable, unless otherwise instructed by your doctor. Diet. Proper nutrition is very important during pregnancy. The quality of your diet needs special attention. A normal, healthy weight gain is about 25-35 pounds. This includes not only the weight of the baby, but also the weight of the uterus, amniotic fluid, placenta, increased blood volume and breast growth. An underweight woman may gain more during her pregnancy and someone who is overweight may gain less due to improvement in eating habits. If you gain more than three pounds per month, you are probably eating more than you need. There should be minimal weight gain during the first three months, with about 75% of total gain occurring between 20 to 36 week's gestation. Many people will encourage you to eat enough for two, but a pregnant woman need only add about 300 calories each day to her regular diet. The goal is not to eat more, but to select foods more carefully. Avoid excess fats, sweets, and alcohol. Eat fresh fruit and vegetables as well as whole grains. Caffeine intake in coffee, tea, chocolate, and colas should be reduced. Diet drinks or foods containing aspartame (NutraSweet) or saccharin should be limited or avoided because the long term effects on your baby are unknown. The best guide to adequate nutrition is a balanced diet and weight gain. The following diet is balanced. Actual food choices may vary widely according to tastes and desired weight gain. Three to four servings of dairy products - milk, cheese, yogurt, or other calcium-rich foods Six ounces of protein - meat, poultry, fish, eggs, cheese, beans, nuts, yeast Two or more servings of fruit or juice rich in Vitamin C Two or more servings of vegetables Four servings of whole grain products - breads, cereals, rice

A prenatal vitamin supplement will provide extra iron and folate required during pregnancy. It may darken the color of your stools or cause constipation. Prenatal vitamins are not a substitute for a nutritious diet.

Medications For your convenience, we have listed a number of medications, which with reasonable, necessary, and sparing use, are permitted in pregnancy. Pain relievers: Acetaminophen (Tylenol, Datril) will help headache and minor discomforts. Please avoid using aspirin. Cold & Flu: Antibiotics: Actifed, Sudafed, or Co-Tylenol for congestion. Robitussin for cough suppression. Penicillin and ampicillin are permitted any time during your pregnancy if you were not previously allergic. Sulfa drugs are allowed up until the third trimester. Erythromycin is an alternative if you are allergic to penicillin. Avoid tetracyclines.

Stool Softeners: Antacids:

Metamucil, Colace, Senokot, or Milk of Magnesia Mylanta, Maalox, Gelusil, Riopan, etc.

Anti-diarrheas: Kaopectate, Pepto-Bismol, or Immodium Most women are aware of the danger of unnecessary drug use in pregnancy. If you are currently taking medications for clear indications, please let your healthcare provider know. Recommended Reading There are many good books available in bookstores and libraries. The following are popular and wellwritten: 1. The Complete Book of Pregnancy and Childbirth, by Sheila Kitzinger 2. What to Expect when Youre Expecting, by Eisenberg, Murkoff, and Hathaway
Health in Pregnancy Class 9/97