Common pregnancy discomforts

Pregnancy is a life changing experience. But it also causes a lot of discomforts to the mother. In this article, we provide pointers to a number of smaller articles that cover these discomforts.

• Nausea
• Backaches and other aches and pains
• Breast changes
• Dizziness
• Haemorrhoids
• Constipation
• Heartburn or acidity
• Stretch marks
• Other skin changes
• Sleeping problems
• Leg cramps
• Nasal problems
• Shortness of breath
• Swelling
• Varicose veins
• Feeling warmer than usual
• Thin white vaginal discharge during pregnancy
• Checklist - When to call the doctor

Nausea ("morning sickness")

Nausea or/and vomiting can be one of the first signs of pregnancy and usually begins around the 6th week of pregnancy and for most women it seems to stop around the 12th week of pregnancy.  It is a first trimester discomfort.  The term “morning sickness” is misleading and nausea can occur at any time of the day or the night.

The nausea is because of the increased pregnancy hormones in your body. Many doctors think that nausea is a good sign because it means that the baby is growing well. 

Morning sickness is not harmful to you or your baby. 

If you have excessive vomiting and do not get treated, it can cause lack of nutrients and dehydration in you.  This complication is called Hyperemesis gravidarum (HG) and can prevent your baby from getting adequate nutrients for its growth.  If you have severe persistent vomiting, call your doctor.

• Eat small meals often vs. few large meals
• Do not skip meals or stay on an empty stomach
• Drink fluids 1/2 hour before or after a meal, but not with meals
• Drink small amounts of fluids during the day to avoid dehydration
• Avoid lying down immediately after eating
• Eat salty crackers (some examples: Monaco biscuits, NutraChoice cream crackers by Brittania) or ginger biscuits the first thing in the morning
• Keep a stock of crackers and healthy snacks handy at work, in the car, in your handbag, near your bedside table so that you can easily grab these
• Avoid foods and smells that increase nausea
• Avoid strong fumes and strong smells. Open the windows or turn on fans if the smell bothers you. Have someone else cook for you. Turn on the exhaust fan in the kitchen while food is being cooked.
• Get plenty of rest
• Avoid very warm places (feeling hot can worsen nausea)
• Get plenty of fresh air. Avoid stuffy places
• Use a lot of ginger and lemon in drinks or food. For example, drink fresh "nimbu pani" or lemonade
• Exercise / Go for walks

Backaches and other aches and pains

During pregnancy, most women suffer from backaches and other aches and pains in their bodies.

Causes:

• Your increased weight puts a lot of strain on your back causing backaches.
• Because of hormonal changes your joints get looser--in a way preparing for childbirth. They are not as strong and this causes frequent aches and pains.
• As the baby grows and the uterus expands, women might get pain in the pelvic area (nerves can get pinched etc.).

• Avoid standing in one position for too long. Keep move about to continue circulation
• Get adequate rest and sleep. Make sure you take short naps to help your back
• If the pain is unbearable and coming in the way of your being healthy, check with your doctor which medicines might be safe to take.
• Ask your doctor for some back support bandage.
• Do continue with exercise (as long the pain is mild) to strengthen your muscles. This will help in preventing/reducing backaches and other aches.

Breast changes

Starting with the early weeks of pregnancy, your breasts will start changing because of hormonal changes. Your breasts are starting to prepare for breastfeeding right from the start.

They will become full, swollen and heavy and feel tender and uncomfortable. As the due date approaches, your breasts will get even bigger in preparation for breastfeeding.

In the third trimester, some pregnant women begin to leak colostrum from their breasts. Colostrum is the first milk that your breasts produce for the baby. It is a thick, yellowish fluid containing antibodies that protect newborns from infection. If leaking becomes embarrassing, put some cotton pads inside your bra.

Tips to stay comfortable:

• Wear a comfortable supportive bra. Many women wear a sports bra for added support. (later, you can use this same bra while nursing as well since it is easy to move it up to nurse the baby) 
• Wash your nipples with water instead of soap. Soap can dry and irritate nipples. If you have cracked nipples, apply some Vaseline or pure lanolin.

Dizziness

Many pregnant women complain of dizziness and lightheadedness throughout their pregnancies.  In fact, most Indian movies have the heroines fainting and everyone sees this as the first visible sign of pregnancy. In reality, fainting in healthy pregnant women is rare (and warrants a call to the doctor) but many pregnant women “feel faint” and dizzy.

There are many reasons for these symptoms.

During the first trimester especially, there is not much blood yet to fill your expanding blood vessels and lesser blood reaches the brain and this causes temporary dizziness.

In the second and third trimesters, the expanding uterus can put pressure on the blood vessels and make you feel dizzy.

Later, you might feel dizzy while lying on your back because your expanding uterus might press on a vein carrying blood from the lower part of your body to your heart.

Changing metabolism in the body causes low blood sugar making up feel dizzy. So you need to keep snacking frequently.

Helpful tips:

• Do not sit or stand suddenly. Do so gradually. The blood gets shifted away from your brain as you change positions suddenly during pregnancy.
• When you're feeling dizzy, lie down on your left side (this increases blood flow)
• Avoid lying on your back for a long time
• Avoid sitting or standing in one position for a long time. Keep moving to increase circulation.
• Eat healthy snacks or small meals frequently.
• Drink a lot of water and stay hydrated
• Avoid stuffy places. Keep your room well ventilated.
• Avoid strong fumes
• Keep your feat elevated

Call your doctor as soon as possible if you faint or have persistent dizziness.

Haemorrhoids

• In pregnancy, haemorrhoids are caused by the increase in the blood supply in the veins (they start bulging with excess blood supply) and the body.
• The expanding uterus puts pressure on the veins as well.
• The straining because of constipation can both cause and worsen haemorrhoids.
• Many women get haemorrhoids only after childbirth because of the straining involved in labour. The straining during labour can further exacerbate hemorrhoids in women who had them in pregnancy as well.

• Drink lots of fluids.
• Eat plenty of fiber-rich foods like whole grains, raw or cooked leafy green vegetables, and fruits.
• Stay regular. Take steps to avoid constipation.
• Try not to strain for bowel movements.
• Talk with your doctor before taking any laxative.
• Talk to your doctor about ice packs or topical medicines that you can apply to soothe haemorrhoids.

Constipation

Many pregnant women complain of constipation. High levels of hormones in your pregnant body slow down digestion and relax muscles in the bowels leaving many women constipated.

In the last two trimesters, the pressure of the expanding uterus on the bowels exacerbates constipation.

Tips to stay regular:

• Eat fiber-rich foods like fruits and vegetables and lots of lentils or daals daily
• Drink eight to ten glasses of water everyday.
• Avoid caffeinated drinks (coffee, tea, colas, and some other sodas), since caffeine makes your body lose fluid needed for regular bowel movements.
• Get moving. Mild exercise like walking may also ease constipation.

Heartburn or acidity

Heartburn is a burning sensation in at the top of the stomach and bothers most women during pregnancy. Contrary to the term, heartburn or the burning sensation, occurs not in the heart but above the stomach in the bottom of the food pipe (it connects the mouth to the stomach).

Causes:

• Pregnancy hormones slow the digestive muscles. So food goes more slowly down the digestive tract. Also, a valve that separates the stomach and the food pipe gets sluggish and when you eat a big meal, the acid from digesting the food enters and irritates the bottom of the food pipe and causes heartburn. 
• Later in the pregnancy, an expanding uterus puts pressure on the food pipe and causes heartburn and bloating.

• Eat small frequent meals instead of few big ones
• Eat slowly instead of gulping your food
• Avoid fried and excessively spicy foods
• Check with your doctor for some antacid medicine
• Sip some cold milk (this will soothe your digestive tract

Stretch Marks

Most women get stretch marks in different degrees during pregnancy. Depending on the color of your skin, these could be pink, red or dark brown thin lines on your stomach.

These start occurring in the second trimester because the skin stretches to accommodate the growing weight.

Stretch marks occur mostly on the abdomen. But you can also get them on your thighs, buttocks and the breasts.  After pregnancy, the weight is reduced, but the stretch marks remain, although they do fade. They do not pain but may cause dryness and an itchy sensation.

The problem is that they don’t look good and they itch. Massaging, with a good lotion is supposed to help with itching but is supposed to not really help in preventing the stretch marks.

So, what can you do about stretch marks?

• You can eat a well-balanced nutritious diet that will help the skin elastic--help in stretching the skin during pregnancy and returning to its original self, after pregnancy with minimal damage.
• Stay hydrated and drink lots of water. This will also help in boosting the skin’s elasticity.
• Many Indian women say, that the traditional post-childbirth massage, helps in reducing stretch marks.  There is no scientific evidence as such to prove this, but in the meantime, a massage might be a good idea anyway for relaxation and healing after the ordeal of childbirth.

Other Skin Changes

Many skin changes occur in pregnancy because of pregnancy hormones.

Here are some other skin changes (other than stretch marks) that most women notice during pregnancy:

• The nipples become darker starting from the first few weeks of pregnancy.  It is said, that thes will help your baby in locating your breasts for breastfeeding. Your body is preparing for breastfeeding and the baby right from start.
• A dark line (called the linea nigra) comes up on the abdomen in the center from the belly button to the pubic hairline.
• Melasma or brown spots caused by pigmentation on the skin. These are more common in dark-skinned Indian women.
• Most of these skin changes are caused by pregnancy hormones and will fade or disappear after delivery.  So, do not worry about skin changes.

Sleeping problems

Pregnancy is a time when most women find it difficult to catch up with much needed sleep because of many discomforts.

During pregnancy and especially in the first trimester, you feel very tired and need more sleep than usual.  Make sure you get adequate sleep. After all your body is supporting another human being. You might also struggle with nausea and frequent trips to the bathroom.

In your second trimester, the “honeymoon” phase of your pregnancy, you feel energetic and most women do not have problems sleeping. Make the most of it.

It gets very difficult to sleep in the third trimester. Here are some problems:

• Because of your large abdomen, you might find it difficult to find a comfortable position. Many women find sleeping with their legs crossed and a pillow between legs more comfortable.
• Leg cramps might be frequent at night. Make sure you are taking enough calcium.
• The baby’s movements might keep you up at night. The fact that the baby is moving is a good sign and there is nothing that you can do about this.
• Heartburn can keep many women up at night.
• And on top of all this, you will need to go to the bathroom very often. Your growing baby will put pressure on your urinary bladder and make you feel like going to the bathroom frequently. There is not much you can do about this also.

It seems like, that nature is preparing you for all the sleepless nights after the baby comes.  But you need to sleep well and ensure that you are well rested before childbirth.  What you need to learn is to make the most of the sleep you can get despite disturbances. You will need to sleep and wake up and do whatever it is you need to (go to the bathroom, feed the baby after childbirth…) and then go right back to sleep.  It comes naturally after some time. But there are some steps that you can take to get your sleep.

Here are some tips that can help you sleep better:

• Avoid eating a large meal before your sleep. You might get indigestion or heartburn.
• Women find it uncomfortable to sleep with a large abdomen. Many women find that sleeping on your side, with your legs crossed and a pillow between the legs very comfortable. Many doctors say that the ideal side to sleep on is the left side. This increases the blood supply to the baby.
• Do not have any coffee or caffeine rich foods (chocolates etc.) before bed. These will keep you awake. This is all the more reason for you to limit your caffeine intake.
• Yoga, pranayam (yogic breathing exercises) and meditation can help a lot. Do not start any new yoga exercises. But if you have been doing yoga earlier, you could continue after checking with your doctor.  Meditation is safe, a great way to relax and helps you to sleep better.
• During the day, get fresh air and get some exercise. Walking outside is a great exercise during pregnancy.
• Staying organized during the daytime (Keeping up to date with tests and doctor appointments, preparing for the baby) will reduce your anxiety. This way you can reduce your chances of sleepless nights full of anxiety.
• Staying active and keeping your mind occupied will also help you sleep well.
• Take short naps during the day. But do not overdo it because then you might not sleep well during the night.
• Some light reading and a warm bath before sleeping can do wonders for your sleep

Leg cramps

During your pregnancy, and mainly in your second and third trimesters, you might have painful spasms called cramps in your legs or feet. These occur mainly at night.

Leg cramps may be caused by the additional weight gain of pregnancy, fluid accumulation and changes in your circulation. The growing uterus may also put pressure on your nerves and blood vessels causing cramps.

Some say that leg cramps could be caused by a calcium deficiency. This is due to a change in the way your body processes calcium during pregnancy. There is no conclusive medical research on this, but meanwhile it is best to ensure that you are taking adequate calcium—it can only help in your pregnancy. Talk to your doctor about the latest on this.

Tips to prevent / ease leg cramps:

• Drink lots of water and fluids to keep circulation going (remember tea and coffee do not count).
• Get regular mild exercise, like walking.
• Gently stretch your leg muscles. If you have a sudden leg cramp, straighten your legs and flex your ankle and toes gently up towards your face. Doing this a few times before sleeping, can help prevent these at night.
• Ask your doctor for other simple stretching exercises to ease cramps.
• Keep your legs warm at night.
• When you get leg cramps, massage your legs and use some heat—for example apply a hot water bottle or a wet warm towel.
• Many find take a warm bath before going to bed very helpful.
• Eat calcium rich foods like milk, curds etc.
• Ask your doctor if you need calcium or other supplements.

Nasal problems

Nosebleeds and nasal stuffiness are common during pregnancy. They are caused by the increased amount of blood in your body and pregnancy hormones irritating the lining of your nose.

Stop nosebleeds by squeezing your nose between your thumb and finger for a few minutes.  If you are bleeding from the nose for a long time or have frequent nosebleeds, talk to your doctor.

Drinking extra water and keeping your room humid during dry weather may help relieve nasal stuffiness. You can keep your room humid by getting a cool mist humidifier or keeping a wide utensil full of water in your room.

Shortness of Breath

As the baby grows, your expanding uterus will put pressure on all of your lungs and you will feel short of breath. This is normal. It is in the third trimester when the baby really grows that you will experience the maximum shortness of breath.

Tips to ease breathing

• Do things slowly and avoid rushing
• Take deep breaths frequently
• Get lots of fresh air
• Do mild exercise like walking
• Maintain good posture (walk erect instead of bending. This will expand your lungs and maximize oxygen flow in your lungs).
• Do not sleep on your back. Instead sleep on your side to breathe better. Many women keep a pillow between their legs to sleep on their sides.

Swelling

Most women develop mild swelling in the face, hands, or ankles at some point in their pregnancies. As the due date approaches, swelling often becomes more noticeable. If you have rapid, significant weight gain or your hands or feet suddenly get very swollen, call your doctor as soon as possible. It could be a sign of high blood pressure called preeclampsia.

Tips for reducing swelling:

• Drink 8 to 10 eight-ounce glasses of fluids (water is best) daily.
• Avoid caffeine
• Try to avoid very salty food (pickles etc. as well)
• Rest when you can with your feet elevated.

Varicose Veins

During pregnancy there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. Plus, pressure on the large veins behind the uterus causes the blood to slow in its return to the heart. For these reasons, varicose veins in the legs and anus (hemorrhoids) are more common in pregnancy.

Varicose veins look like swollen veins rising above the surface of the skin. They can be twisted or bulging, and are dark purple or blue in color. They are found most often on the backs of the calves or on the inside of the leg.

Try these tips to reduce the chances of varicose veins:

• Avoid tight socks
• Sit with your legs and feet raised when possible

Feeling warmer than usual

During pregnancy, your BBT (basal body temperature) is higher than before because of hormonal changes (the increase in progesterone) and this causes you to feel warm. This is normal. Here are some tips to feel better:

• Wear cool and airy clothes
• Drink lots of water
• Avoid warm and stuffy places
• In winters, maintain a balance in temperature to avoid catching a cold

Thin white vaginal discharge during pregnancy

The hormonal changes in pregnancy can cause a thin white vaginal discharge. This is usually mild in smell. This is normal. It usually starts around your second trimester and lasts till the end of the pregnancy. Some tips to deal with this and avoid further problems:

• Wear a thin sanitary napkin (do not use tampons while pregnant)
• Keep yourself clean and wash often
• Avoid synthetic underwear. Stick to cottons underwear.

If the discharge turns yellowish or greenish or foul smelling and you start getting red and itchy, call your doctor, it could be a urinary infection.

Checklist - when to call the doctor

There are so many strange things happening to your body during pregnancy. Some are normal pregnancy discomforts (nausea during the first trimester, swelling, etc.) and sometimes there can be complications.  If you see any of the following signs, it might be risky to you and your baby. 

So, call your doctor as soon as you can if you:

• are bleeding from the vagina
• leaking fluid (could be amniotic fluid) from the vagina
• suspect your baby is moving less than normally after 28 weeks of pregnancy (if you count less than 10 movements in 2 hours or less)
• have sudden or severe swelling in the face, hands, or fingers
• get severe or long-lasting headaches
• have discomfort, pain or cramping in the lower abdomen
• have a fever or chills
• are vomiting excessively or have persistent nausea
• feel discomfort, pain or burning with urination
• have problems seeing or blurred vision
• feel dizzy
• sense a change in your baby's movement
• yellowish, greening or foul smelling vaginal discharge

Remember, its better to be safe than sorry. So, when in doubt call your doctor.

References

1. Abramowitz L, Sobhani I, Benifla JL, Vuagnat A, Daraï E, Mignon M, “Anal fissure and thrombosed external hemorrhoids before and after delivery”, Dis Colon Rectum. 2002 May;45(5):650-5.2002