Pregnancy symptoms and management

Heartburn & Constipation

• During pregnancy the movements that push swallowed food from your oesophagus into your stomach and then along your bowel are slower. Your stomach also takes longer to empty. This slowdown gives nutrients more time to be absorbed into your bloodstream and to reach your baby. Unfortunately it may also lead to heartburn (reflux of food and stomach acid up the food pipe into your throat) and constipation. Heart burn is usually worse in the last 12 weeks of pregnancy because hormones relax smooth muscle which can lead to regurgitation of stomach contents creating burning in the lower part of the oesophagus. As the baby and uterus grow, they press on the stomach and displace it pushing the acid contents out into the oesophagus creating heartburn

Some suggestions to prevent heartburn include:

• Eating small, frequent meals and avoid fried foods, carbonated drinks, citrus fruits, tomatoes or juices and greasy or spicy foods.
• Avoid coffee as it can irritate the stomach making hearburn worse.
• Drink fluids slowly between meals to avoid overfilling the stomach.
• Wear loose clothing around the stomach
• Milk and yoghurt may help.
• Avoid big meals prior to bedtime
• Try peppermint or chamomile tea
• You may wish to fall asleep with a few pillows to make you more upright
• Sit upright in chairs, Sit on the floor and try to stretch the abdomen by joining hands and raising arms above the head as high as possible, then lower them and repeat 
• Antacids such as Mylanta, Gaviscon, Rennies, and Tumms can help.
• If symptoms are severe you can start taking ranitidine tablets (Zantac). This medication is safe in pregnancy and is available over the counter at any pharmacy or supermarket, but is often cheaper with a prescription.

To prevent or relieve constipation,

• Include plenty of fibre in your diet (try All-Bran breakfast cereal, Oats, Nuts, kiwi fruit and pears)
• Drink lots of fluids.
• If you require further assistance – Laxatives such as Metamucil and Nulax are safe to take in pregnancy
• Regular physical activity also may help

Tiredness & Difficulty Sleeping

Most pregnant women feel tired in the first trimester of pregnancy then experience difficulty sleeping in late pregnancy. In late pregnancy, sleep is easily disturbed by visits to the toilet, heartburn, kicks from the baby or a feeling of discomfort when lying down. Some women may experience disturbing dreams in the last couple of months, which can be due to anxiety about approaching childbirth and parenthood.

The following suggestions may be helpful:

• Make sure you are getting enough iron and protein in your diet.
• Gentle exercise, such as walking in the late afternoon or evening, can promote sleep.
• Avoid caffeine-containing stimulants such as tea, coffee or cola before bed time.
• Try sleeping on one side with a pillow under your tummy and another pillow between your knees.
• Rest during the day. Relax by soaking in the bath, listening to music, enjoying a massage or meditating before bedtime.
• Avoid overheating and keep your bedroom cool
• Magnesium tablets may help

Dizziness

Normal circulatory changes in early pregnancy may leave you feeling a little dizzy. Stress, fatigue and hunger also may play a role. To prevent

mild, occasional dizziness, avoid prolonged standing and rise slowly after lying or sitting down. If you start to feel dizzy when driving, pull over. If you’re standing when dizziness hits, sit or lie down. Stay well hydrated and dress in layers to avoid overheating.

Tender Breasts

Increased hormone production may make your breasts unusually sensitive. Your breasts will feel fuller and heavier, and you will probably go up a cup size or two. Wearing a more supportive bra or a sports bra may help.

Increased Urination

You may need to urinate more often as your enlarging uterus presses on your bladder. The same pressure may cause you to leak urine when sneezing, coughing or laughing. To help prevent urinary tract infections, urinate whenever you feel the urge. If you’re losing sleep due to middle-of-the-night bathroom trips, drink less in the evening – especially fluids containing caffeine, which can make you urinate more. If you’re worried about leaking urine, panty liners may offer a sense of security.

Haemorrhoids

(Piles) These are swollen veins around the rectum and anus (back passage) that may itch, ache or feel sore. Haemorrhoids may bleed a little and make going to the toilet uncomfortable. They can be triggered by constipation, as well as pressure from the baby’s head.

The following suggestions may be helpful:

• Avoid constipation and straining on the toilet by including plenty of fibre in the diet by eating fruit and vegetables, wholemeal breads and breakfast cereals such as All-Bran.
• Avoid standing for long periods.
• Rectinol ointment, available from pharmacies, can be applied to haemorrhoids that are causing discomfort.

Muscle Cramps

Muscle cramps in the feet, legs or thighs are common during pregnancy, especially at night. The cause of cramps is unclear but the following may help:

• Stretching and massaging the affected muscle.
• Magnesium supplements, which can be bought from pharmacies or health-food stores.

Backache

Most women experience backache at some stage during their pregnancy. The causes include altered posture as the baby grows and hormonal changes, which lead to the loosening of ligaments and greater water retention in the tissues.

The following suggestions may be helpful:

• Be aware of your posture when standing or lifting, and use chairs with good back support when sitting.
• Avoid heavy lifting and prolonged standing.
• Rest with your legs elevated.
• See a physiotherapist for further assistance.

Skin Changes

Pregnancy hormones can change the tone and colour of your skin. The extra blood circulating around your body can cause your skin to “glow”. In some women, the pregnancy hormones may cause red patches and increased acne, and areas of your skin may become dry and scaly. You may also notice deeper pigmentation across your face.

Areas of skin that may get darker during pregnancy include underneath eyes, nipples, the genitalia, the inner sides of thighs and armpits. Some women develop a dark line running down the centre of their stomach. Sunlight intensifies areas of skin that are already pigmented and many women find that they tan more easily during pregnancy. Even after birth the deeper pigmented skin will remain darker for some time, but will gradually fade and disappear.

Chloasma – a special form of pigmentation also referred to as the “mask of pregnancy” appears as brown patches on the bridge of the nose, cheeks and neck. Some dark-skinned women develop patches of paler skin on the face and neck. These patches will begin to fade after the baby is born. Make-up can be used to cover up these patches.

Itching

As your baby grows, the skin over your abdomen gets tighter and may cause mild itching. You can use a cream on the abdomen containing ingredients such as Vitamin E, Cocoa butter, Shea butter or Olive oil to assist with stretching of the area. Itching is common in pregnancy. Contact us if the itching is persistent or severe or spreading to other parts of the body such as the limbs, as this can be a sign of a more serious problem that requires medication or further tests.

Pelvic pain/hip/pelvic girdle pain

Pelvic girdle and hip pain are very common during pregnancy affecting ~20% of pregnant women. It is contributed by the increased weight and pressure on this area and the hormones in pregnancy including relaxin which work on relaxing the ligaments in the pelvis.

There are several bones and joints that make up your pelvic girdle – the bony arched structure in your hip area that supports your legs – including the symphysis pubis joint, hip joint, coccyx, sacrum and sacroiliac joint. Pain can occur when there is a mechanical problem within these joints

The hormone relaxin, along with other hormones, affects the ligaments in the pelvic girdle, allowing for an increased range of motion in the pelvic joints. The position of the baby can be a factor.

Being in an unbalanced position can make the pain more noticeable such as when:

• Standing on one leg (such as when getting dressed)
• Walking
• Going upstairs
• Turning over in bed
• Moving your legs apart such as when getting out of a car.

Treatment may involve physical therapy – to help the joints in the pelvic girdle move normally, Exercises – to strengthen your stomach, back, hip and pelvic floor muscles to help realign the joints, Pain relief – medication, acupuncture or TENS, Equipment – pelvic support belts or crutches if necessary.

Other tips: Avoid activities that make pain worse, but be as active as you can within your pain threshold, Wear supportive, flat shoes, Get dressed and undressed in a sitting position – don’t stand on one leg to put on trousers, When getting in and out of a car, keep your knees together – you can sit on a plastic bag to help you swivel in the seat, Sleep in a comfortable position – a pillow between your legs can make sleeping on your side more comfortableGo up or down the stairs one at a time – go upstairs leading with your less painful leg, but downstairs leading with the most painful one

You may wish to see a physiotherapist to assist with managing this common problem.