Common Discomforts In Pregnancy

Description: Abdominal pain in pregnancy is typically caused by the stretching of the round ligaments, which are the large ligaments that help hold the uterus in place. Spasms in these ligaments can cause sharp, knife-like pain in the abdomen or side and can last a few seconds to a couple of minutes.

Things to try:

• Avoid sudden movements when going from sitting to standing

• Wear a pregnancy support band

• Apply warmth to the area in the form of a heating pad or a hot water bottle

When to call your midwife: If the pain is severe, unrelenting, rhythmic, happens in the first trimester, radiates outward, or you notice a bump/lump on your belly.

Back Pain

Description: Upper and/or lower back pain is reported by almost 70% of pregnant individuals during their pregnancy. Low back pain tends to be associated more later on in pregnancy, as the weight of the uterus pulls them forward. Individuals with weak abdominal muscles or who have had more than one pregnancy are more likely to experience low back pain.

Things to try:

• Massage therapy

• Chiropractic care with a Webster Certified chiropractor

• Use appropriate body mechanics when lifting or bending

• Yoga

• Swimming

• Hot/cold therapy (heating pads & ice packs)

• Pelvic rock/tilt exercises

When to call your midwife: If the pain is severe, unrelenting, radiates down the legs or buttocks, you experience a loss of bladder or bowel control, you notice any numbness or loss of sensation in the lower limbs, or if the pain gets worse over time.

Description: The increase in the hormones estrogen, progesterone, and prolactin spur the breast changes that happen during pregnancy in preparation for lactation after delivery. These changes can be dramatic, and often chest/breast tenderness is one of the first early signs of pregnancy. Tingling, heaviness, tenderness, and increased nipple sensitivity are all possible changes that may occur during pregnancy.

Things to try:

• Go in for a fitting with a Certified Bra Fitting Specialist - a properly fitted bra can make a huge difference in managing chest/breast tenderness

• Your bra size is likely to change at least once if not several times during pregnancy - see above

• Limit or avoid caffeine (Demma & Trister Grace, 2015).

When to call your midwife: If pain/tenderness is only on one side or in a localized spot, if pain is severe, if you notice any dimpling or puckering of the chest/breast tissue, or if you notice any redness or warmth on the chest/breast.

Description: You may have noticed that your gums bleed a little after brushing your teeth now. This is due to the rise in the hormones estrogen and progesterone, which can cause inflammation and extra blood flow to the soft tissues in the mouth. This may also be a warning sign of gingivitis, an inflammatory infection of the gums that pregnant people can be more susceptible to thanks to the increase in estrogen levels.

Things to try:

• Switch to a soft bristled toothbrush

• Remember to brush your teeth and floss frequently

• See your dentist regularly throughout pregnancy

When to call your midwife: If the bleeding is severe or if you have been currently diagnosed with or have a history of gingivitis or gum disease.

Constipation

Description: Constipation is a very common early pregnancy symptom. The increase in progesterone to help maintain the pregnancy prior to the formation of the placenta also slows down the smooth muscle action of the lower digestive tract, which means that more water is absorbed in the large intestines and the waste products harden and may become troublesome to pass. Some people who are sensitive to it may also experience constipation from the increased iron supplementation in their prenatal vitamins.

Things to try:

• Are you drinking enough fluids throughout your day? Pregnancy places increased demands on your daily fluid intake. You want to try and drink at least 100oz a day. (Nichols, 2018).

• Add in foods that are high in fiber to your diet. Avocados, lentils, chia seeds, and raspberries are great foods that are high in fiber and can help with constipation.

• Switch to a prenatal vitamin or folate supplement that does not contain iron.

• Try a bulk laxative, like Aloe pills.

When to call your midwife: If you develop a fever, severe abdominal pain, and/or experience weight loss along with your constipation it is time to reach out to your provider to rule out other possible causes or complications.

Description: Dizziness impacts about 28% of pregnant persons and is typically experienced in the second and third trimesters. About 5% of pregnant persons may also experience an episode or two of fainting.

Things to try:

• Take your time getting out of bed or when lying down, as standing up quickly after sitting or lying on your back can cause a feeling of light-headedness, dizziness, or fainting

• Don't stay on your feet for extended periods of time

• Drink an adequate amount of water every day, especially in warm weather and/or during physical exertion

• Eat small meals throughout the day to help maintain blood sugars

When to call your midwife: If you experience fainting spells in the first trimester, if you experience any shortness or breath or chest pains when feeling dizzy or faint, if symptoms are accompanied by a severe headache or nausea and/or vomiting.

Description: Experiencing pain during sex can be one of the more distressing symptoms of pregnancy. This pain may be sharp and intense or you may only experience some mild discomfort. The pain may be better or worse depending on position or with the use of lubes, or it may stay the same regardless of these factors.

Things to try:

• Try different positions as angle and depth of vaginal penetration may lessen or worsen the pain. Side-lying or pregnant person in the dominant position may be more tolerated by those experiencing dyspareunia.

• Have an open discussion with your sexual partner/s about what you are experiencing along with exploring possible alternatives and techniques for physical intimacy

• Pelvic floor therapy

• For survivors of sexual abuse or trauma, counseling or therapy may be of great benefit to help relieve symptoms

When to call your midwife: If the pain is severe, you experience the pain very early on in pregnancy, you have any foul-smelling vaginal discharge or other signs of a vaginal infection, you experience any vaginal bleeding or spotting.

Swelling (Edema)

Description: Edema is a fairly common occurrence in pregnancy, especially in the third trimester. This type of swelling typically happens in the feet and/or around the ankles as well as in the hands and fingers in. Rarely you may notice a little swelling in your face as well.

Things to try:

• Elevate the legs occasionally throughout the day

• Use support or compression socks

• Regular low-impact exercise

• Try to keep from standing or sitting for prolonged periods of time

• Warm epsom salt foot baths

When to call your midwife: If the swelling becomes severe; you notice sudden onset of swelling in hands and face; you have a headache that won't go away, dizziness, and/or sharp pain in your right upper abdomen in addition to the swelling; your blood pressure becomes elevated; and/or if you have swelling that is worse on one side of the body compared to the other.

Description: Fatigue is one of the most common symptoms of pregnancy, with approximately 95% of pregnant persons experiencing it (Demma & Trister Grace, 2015). It is most commonly reported in the first trimester, however it can happen at any time during pregnancy.

Things to try:

• Take naps/rest whenever you can

• Try some yoga or meditation if you are having trouble sleeping at night

• Increase your protein and healthy fat intake - you should be aiming for around 75-80g of protein a day until you reach your third trimester, where you should increase to 100g daily until after delivery (Nichols, 2018).

When to call your midwife: If fatigue is severe or is accompanied with hair loss, shortness of breath, weakness, and/or heart palpations.

Description: Most headaches in pregnancy can be attributed to benign causes such as tension, clogged sinuses, dehydration, allergies, and/or low blood sugars. Whatever the cause, a headache can be a very unwelcome pregnancy symptom. Luckily most of these causes are easy to treat.

Things to try:

• Ensure that you are drinking enough water throughout the day

• Avoid caffeine, nitrates (found in bacon and other cured meats), and artificial sweeteners

• Massage

• Tylenol (acetaminophen) - 325-650mg every 4 to 6 hours as needed for short term use. Do not exceed 3000mg daily. (Jordan, 2019).

When to call your midwife: If your headache is severe or doesn't go away with treatment, if you have a history of or suspect high blood pressure.

Heartburn

Description: Heartburn happens when stomach contents move back up the esophagus and cause a burning sensation that can feel like it is creeping up the back of the throat. Heartburn symptoms can be mild to severe and is reported by approximately 75% of persons who are in their third trimester, although it can happen at any point during pregnancy.

Things to try:

• Elevate head when in bed or lying down

• Eat small meals throughout the day verses three large meals

• Wait at least an hour after eating to lie down after

• Avoid greasy and/or spicy foods

When to call your midwife: If the heartburn is severe or debilitating or if symptoms do not improve with dietary and lifestyle modifications.

Description: These present as swollen blood vessels in the rectum that can cause itching, pain, and bleeding during bowel movements.

Things to try:

• Increase dietary fiber

• Pelvic floor therapy/Kegel exercises

• Avoid prolonged sitting on the toilet or straining during bowel movements

• Over the counter topical pain relief (Preparation H, Tucks, etc).

When to call your midwife: If bleeding or pain become severe or you develop an ulceration or signs of an infection.

Description: Sleep disruptions during pregnancy are common. Insomnia can make it hard or impossible to fall asleep initially even when an individual is feeling extreme fatigue, or you may fall asleep easily but upon waking in the night find it difficult to fall back asleep.

Things to try:

• Get into a regular bedtime pattern/routine that you follow every night

• Limit or avoid screen time for at least an hour before going to bed

• Acupuncture and/or acupressure

• Meditation and/or relaxation techniques

• Avoid caffeine intake

When to call your midwife: If symptoms are so severe you develop signs of sleep deprivation, if sleep hygiene modifications do not improve symptoms, and/or if you start developing feelings of depression.

Itchy Skin

Description: Itchy skin, especially around the belly, can be a result of the stretching that has to occur to accommodate your growing uterus and baby during pregnancy.

Things to try:

• Avoid harsh, scented, or perfumed soaps or skin care products

• Use unscented, dye-free laundry detergents and avoid the use of fabric softeners or dryer sheets

• Applying unscented skin lotions with vitamin E can help relieve the itching sensation

When to call your midwife: If itching becomes severe, if a rash/raised bumps or welts develop on your abdomen, if you develop a deep itch in your hands or feet that seems to worsen at night, or if itching becomes persistent.

Description: Calf and foot cramping in pregnancy is common and typically worsens at night. The exact cause of this is unknown, however there are some ways to help relieve the symptoms.

Things to try:

• Ensure that you are drinking enough water throughout the day

• Try doing a few calf and lower leg stretches before going to bed

• Avoid sitting for long periods of time

• Soaking the legs in warm water and epsom salts before bed may help reduce cramping overnight

When to call your midwife: If the symptoms become severe, if you notice any bruising or varicose veins in your legs, or if you develop swelling in the leg/s.

Description: Nausea is reported by up to 80% of pregnant people and is so common it is considered one of the presumptive signs of pregnancy (Demma & Trister Grace, 2015). The nausea can be accompanied by vomiting and is typically worst in the first trimester and begins to ease a bit by the 14th to 16th week of pregnancy.

Things to try:

• Eat small meals frequently throughout the day

• Try sipping some peppermint or ginger tea

• Avoid greasy, acidic, or spicy foods

• Rest as much as possible

When to call your midwife: If the nausea or vomiting becomes so severe that you experience weight loss, can't keep fluids or solids down, and/or are unable to function at work or home.

Excessive Saliva (Ptyalism)

Description: One of the less common pregnancy symptoms excessive salivation, also known as ptyalism, usually accompanies the more common experiences of nausea and vomiting in pregnancy. Symptoms can be mild to severe, with some individuals experiencing disruption in sleep patterns or social restraints due to the severity.

Things to try:

• Use mouthwash to help with any bitter or off-putting taste

• Try hard sour candies to help with swallowing

• Carry a small cup to spit into as needed

• Lay on your side when sleeping with a towel or soft cloth under your face

When to call your midwife: If salivation becomes excessive to the point of experiencing dehydration symptoms or if experiencing emotional or psychological distress due to severity of symptoms,

Description: Sciatica occurs when pressure is applied to the sciatic nerve, causing pain or a burning sensation in the pelvis, buttock, and down the back of the leg/s. This can happen in pregnancy due to the increased weigh of the uterus and growing baby pressing on the nerves.

Things to try:

• Side-lying to relieve pressure off the affected side/limb

• Heat/cold therapy (heating pad/ice pack)

• Pelvic rock/tilt exercises

• Massage

• Chiropractic care

When to call your midwife: If symptoms worsen or become severe, if you notice any numbness in the leg or saddle area, if you have weakness in the leg, or if you experience a sudden loss of bladder or bowel control.

Description: Shortness of breath is a common experience in pregnancy that can start as early as the first trimester. While the exact cause is unknown, however it is likely due to the increased oxygen and blood demands associated with pregnancy.

Things to try:

• If you notice your breathing is getting too fast or you are feeling winded, take a couple of long, deep breaths and try and stay conscious of and regulate your rate of breathing

• Stand up and stretch your arms up above your head while inhaling deeply occasionally throughout your day

• Remind yourself that this is a normal sign associated with pregnancy if you feel that anxiety or worry is making the issues worse

When to call your midwife: If you develop a fever, have a very rapid breathing rate, feel weight or heaviness on the chest, feel like you may be having an asthma attack, develop a thick or rattly cough, begin wheezing, feel like you have the flu or have symptoms of a respiratory infection.

Stretch Marks (Striae)

Description: Stretch marks commonly appear on the belly and on the breasts during the latter half of pregnancy as the skin stretches and grows. While the cause is unknown, genetics seems to play a role in the likelihood of the occurrence and severity of stretch marks during pregnancy.

Things to try:

• Skin creams and lotions with vitamin E may help with the itching and discomfort that can accompany stretch marks

• Avoid heavily scented soaps or lotions to limit skin irritations

Description: Many pregnant persons experience an tingling or pins and needles sensation in their hands or fingers during pregnancy due to changes in spinal alignment and posture. Edema can also cause tingling in the hands along with carpal tunnel syndrome.

Things to try:

• Maintain good posture

• Use of proper body mechanics

• Sleeping in splints/braces (for carpal tunnel symptom relief)

When to call your midwife: If pain becomes severe or will not go away or if symptoms seem to worsen at night.

Description: It is normal to experience some form of urinary incontinence during pregnancy or immediately postpartum. Up to 75% of pregnant persons develop urinary incontinence at some point during their pregnancy.

Things to try:

• Pelvic floor therapy

• Do 75-100 Kegel exercises per day

• Use the restroom frequently throughout the day

When to call your midwife: If you are completely unable to hold your bladder, you develop numbness in your saddle area, and/or the severity/frequency has begun to impact your quality of life.

Urinary Frequency & Urgency

Description: Urinary frequency is one of the hallmark signs of pregnancy. This classic pregnancy symptom is a result of pressure on the bladder from the weight and size of the uterus and growing baby along with other physiologic changes that happen during pregnancy.

Things to try:

• Try not to wait too long to use the restroom after feeling the urge to urinate

• Reduce fluid intake in the hour or so before going to bed to reduce the number of times you need to void during the night

• Use the restroom at regular intervals throughout the day

• Void your bladder before sex

When to call your midwife: If you experience any signs of a urinary tract infection such as burning, foul smelling urine, dark or cloudy urine, blood in the urine, or feeling mild/moderate menstrual-like cramping before 37 weeks gestation.

Description: Experiencing an increase in vaginal discharge in pregnancy can be very normal, especially in the final weeks leading up to delivery. This type of discharge, also known as leukkohrea, are typically clear or may be white in color, can range from watery to the consistency of eggwhites, and usually is odorless though sometimes a mild, though not unpleasant, odor can occur.

Things to try:

• Use panty liners

• Avoid douching or use of vaginal cleaning products (soaps, rinses, wipes, deodorants, etc.)

When to call your midwife: If discharge develops a foul or fishy smell, if discharge has small curd-like white chunks, if accompanied by vaginal irritation/pain/itching, if discharge develops a green/yellow/brown color, if you notice any vaginal bleeding or spotting, or if discharge feels like it is leaking/trickling/running steadily from the vagina or you experience gushes of fluid.

Description: These abnormally large, swollen veins typically appear on the lower legs however in pregnancy they can also develop on the vulva.

Things to try:

• Use compression socks and avoid knee-high socks and stockings

• Avoid crossing legs when sitting down

• Keep legs elevated when sitting or lying down

• Avoid standing for long periods of time

• For vulvar varicosities: use of a pregnancy support band and support undergarments can help provide symptom relief

*NOTE: There is no treatment for varicose veins beyond symptom relief. Once they develop they do not go away.

When to call your midwife: If the varicose veins are severe, causing you a lot of pain or discomfort, or interfering in normal daily activities.

Resources

Check out this wonderful YouTube video by Monash Health, Morning Sickness and Other Discomforts of Pregnancy. It outlines some common issues like morning sickness, heartburn, and back ache and provides some great tips to help cope with the symptoms.

Pelvic floor therapy can be beneficial in pregnancy to help with urinary stress incontinence (both during the course of pregnancy and for your future pelvic floor health) and other pelvic floor concerns that can arise during pregnancy or postpartum. Erin Glace PT, MSPT, PRPC with Mommy Care PT offers online, in-person, and group classes for pelvic floor health and care in the Hampton Roads area of Southeastern VA. Check out their website at MommyCarePT.com or give them a call at 757-553-6701.

Another must-see video to learn about the incredible changes our bodies go through in pregnancy along with some of the classic symptoms and their causes is TED-Ed's The Surprising Effect of Pregnancy.