Nausea and Vomiting

Nausea and vomiting are among the first signs of pregnancy. These are called “morning sickness” because they usually occur in the morning. Fifty to seventy percent of all pregnant women experience nausea or vomiting, and in most cases, it goes away by the fourteenth week of pregnancy. The nausea and vomiting are usually related to the changing levels of hormones in your body. Here are some suggestions for preventing or relieving nausea and vomiting:

1. Even though you may not feel hungry, it is important to eat. Small and frequent meals throughout the day are recommended. DO NOT go for long periods of time without food because nausea becomes more bothersome when the stomach is empty. Be sure to have a bedtime snack. If you awaken during the night, have a snack before you go back to sleep.
2. If you awaken in the morning with nausea, eat a few crackers before you even get out of bed. Then get up slowly.
3. Carbohydrate-containing foods such as whole grain breads or crackers, rice cakes, unbuttered popcorn, cereal, and baked potatoes are well tolerated. Carry crackers with you.
4. Drink beverages between meals and sip them instead of drinking them quickly.
5. Avoid fried, spicy, or greasy foods. If the taste or odor of a particular food causes nausea, avoid that food.
6. Avoid caffeine and cigarette smoke.
7. IF VOMITING CONTINUES FOR OVER 24 HOURS AND YOU ARE UNABLE TO RETAIN ANY FOOD OR FLUIDS, CALL THE OFFICE. It is important that you do not become dehydrated.

Fatigue

Feeling more tired than usual is very common. It is thought to be caused by the increased production of hormones. You may need to more rest periods or naps during the day. Most women feel more energetic during the middle months of pregnancy.

Faintness and Dizziness

This is a symptom of early pregnancy, especially when standing quickly. It is caused by reduced blood flow to the brain due to new circulatory patterns. Low blood sugar can also cause this problem, which is another reason to eat frequent, small meals.

Frequent Urination

Pressure on the bladder from the enlarging uterus may cause you to need to urinate more frequently. As the pregnancy advances, the uterus rises in the abdomen and the pressure on the bladder is relieved; however, in the last month of pregnancy, the urge to urinate frequently may return as the baby moves downward. Decreasing your fluid intake will not alleviate this problem and may lead to dehydration.  Any pain or burning during urination may indicate a bladder infection. If this occurs, call the doctor.

Headaches

Many women experience headaches in early pregnancy. They are thought to be due to an increased hormone level or changes in the blood volume. Low blood sugar or emotional tension may also contribute to headaches. Try eating a small snack, lying down, or taking a nap. TYLENOL or EXTRA STRENGTH TYLENOL every six hours is permissible prior to 32 weeks; after that, notify your doctor. DO NOT TAKE ASPIRIN or IBUPROFEN. If headaches are not relieved with Tylenol, please call the office.

Increased Vaginal Secretions

This symptom may be the result of increased blood and glucose to the vagina. No treatment is necessary except daily cleansing. It is not recommended that you douche.  You may want to wear a panty liner if the secretions are particularly heavy. If you notice any itching, irritation, or odor, you may have a vaginal infection and these symptoms should be reported to your doctor.

Nasal Stuffiness and Nose Bleeds

These changes are due to drying of the nasal passages and delicacy of the blood vessels caused by hormonal changes. If nosebleeds occur, tilt your head back, and squeeze the nostril shut or apply ice to the bridge of the nose for 3-4 minutes. This should stop the bleeding.

Varicose Veins

Veins that are dilated, knotted and sometimes painful are called varicose veins. They usually affect the superficial veins of the legs.  When a woman is pregnant, there are several factors that may increase the chances of developing varicose veins. The first is increased blood volume. All the veins in the body increase in size to help accommodate the extra blood. Additionally, the hormones of pregnancy may add to the enlargement of veins. The growing uterus also contributes to increasing venous pressure. As it grows, it presses on pelvic veins that are returning blood to the heart.

To lessen discomfort of varicose veins:

1. Wear support hose, but remember, you must put them on first thing in the morning. Keep them at the foot of your bed.
2. Elevate the foot of your bed.
3. Elevate your legs whenever possible. Try to have your feet higher than your heart. Do not prop your feet above your head, as against a wall.
4. Do ankle circles.

Constipation

Pregnant women are prone to constipation due to uterine pressure on the rectum and the relaxant effect of progesterone on the bowel. Constipation is a common side effect of iron therapy.

To prevent or relieve constipation, increase your fluid intake to eight or more glasses daily.  This is the most important thing you can do to prevent or relieve constipation.  It is also important to increase the fiber in your diet. Whole grain breads and cereals and fresh fruits and vegetables should be a part of your daily diet. It may be necessary to add bulk to your diet through medications such as Metamucil or Citrocil. Stool softeners such as Colace or Senekot can be used daily if constipation is persistent after increasing fiber.

Hemorrhoids

Hemorrhoids are varicose veins of the rectum. They are swollen and often painful or itchy. They may cause minor bleeding. Preventing constipation may prevent hemorrhoids, however, if hemorrhoids do develop, try the following remedies:

1. Warm sitz baths–sitting in a warm bath for 15 minutes two to three times a day.
2. Cleansing, using soothing pads such as Tucks.
3. Ointments and suppositories may relieve itching and pain.

Indigestion

Heartburn is common in the last half of pregnancy. As the baby grows, stomach acid can splash upwards into your esophagus resulting in a burning sensation. Try to eat small frequent meals. Keep away from spicy, fried, or greasy foods. Do not lie down immediately after eating. Tums or any low sodium antacid may give some relief.

Legs and Muscle Cramps

A “Charlie Horse” may be caused by uterine pressure on the nerves or too little calcium and/or potassium. Exercise regularly, and walking is best. Avoid exercises which may cause you to point your toes. Keep covers loose at the foot of the bed. Moist heat to the cramped muscles may be beneficial. Be sure you are getting enough calcium in your diet. You need four servings of dairy products daily. You may try adding a banana and milk before bed.

Swelling

Most women experience some swelling or edema of the ankles, especially at the end of the day or after sitting or standing for long periods of time.A certain amount of fluid retention is necessary for a healthy pregnancy. These suggestions will help you reduce swelling:

1. Drink 8 glasses of liquid daily. Increasing your fluid intake will improve the efficiency of your kidneys.
2. Avoid foods high in sodium such as carbonated beverages, canned or processed foods, pickles, lunchmeats, salted nuts, and chips.
3. Wear loose and comfortable clothing. Avoid clothing with tight waistbands. Do not wear knee hose or knee socks with tight bands.
4. When standing, move your legs frequently. When sitting, elevate your feet on a stool or box.
5. Lay on your side for forty-five minutes a day when you come home from work or during the afternoon. Lay on your side at night when you go to bed.  This takes the weight of the uterus off the large veins, improves circulation, and decreases fluid retention.
6. Support hose can help with swelling and help prevent varicose veins. Remember to wear them first thing in the morning.

Backaches

As the uterus weight increases, your pelvis tilts forward, throwing your back into an exaggerated curve. This curve is usually the cause of back discomfort in pregnant women. The most beneficial exercise for preventing or relieving a backache is the pelvic rock which is listed in the prenatal exercises. Other hints for protecting your back are:

1. Roll to one side before sitting up
2. Sleep on a firm surface (use boards under a softer mattress or purchase an extra firm mattress). If you sleep on your side, keep your knees bent, pillow between your knees. If you sleep on your stomach, keep a pillow under your stomach.
3. When you are sitting, make sure your knees are level, not lower than your hips. Make sure your back is supported. Take frequent breaks to stretch muscles.
4. When standing, try to always use the pelvic rock. This means your stomach muscles will be contracted, not relaxed. This can be done throughout pregnancy.
5. Do not wear high heels. They throw your weight forward and increase the weight on your lower back.
6. When lifting, always bend your knees to use your leg muscles. Keep the weight close to your body.
7. Always put the side rail down before lifting a child in or out of a crib.
8. If you are carrying a child on your hip or shoulder, do a pelvic rock. Do not jut one hip out.
9. To lift a child out of a playpen, collapse one half of the playpen first. Do not lift over the raised side.
10. When you are giving a child a bath, remember to bend your knees, staying down on your knees or on a low stool during the bath.
11. Let toddlers do as much for themselves as they can. Do not carry them more than necessary while you are pregnant! Get down on the floor or sit in a chair for close cuddling with them. Never lift a child above your head when standing.

When doing chores consider the following:

1. When vacuuming, use your arm and leg muscles. Do pelvic rocks. Do not use long strokes and change hands.
2. When dusting, bend your knees or get on your hands and knees for chair rungs, low bookshelves, etc.
3. DO NOT MOVE FURNITURE!
4. If you are ironing, sit on a high stool or stand with one foot on a low stool.
5. If you are washing dishes, preparing food, or doing other standing tasks, keep a low stool handy and rest one foot on it. Remember to change feet and to do pelvic rocks.
6. Whenever you are lifting an object, be sure to bend your knees. It is better to crawl around the floor on your hands and knees.  Keep grocery sacks or plastic laundry baskets in every room for easier pick up. Again, DO NOT BEND AT THE WAIST.

To lessen a low backache:

1. Do a pelvic tilt in the hooklying position (lying with knees bent, feet flat on the floor) on a firm surface.
2. Do a pelvic tilt on your hands and knees. The small of your back should be flattened but not sagging. Contract your stomach muscles and your buttocks and press up with your lower back. Hold for 5 seconds, then relax so that your back returns to neutral only.
3. Lie on your side on a firm surface with your knees bent. Try a pillow between your legs or under your top leg.
4. Rock in a rocking chair. Use a small pillow at the small of your back.
5. Use moist heat (a warm shower, a long warm, NOT HOT, tub or bath).
6. Have someone give you a massage to the painful area. Make sure you are lying on a firm surface in a comfortable position.

Round Ligament Pain

A sharp pain or stabbing sensation in the groin is usually caused by the round ligament stretching as the uterus increases in size. The pain is sometimes made worse by stretching, walking, or climbing stairs. To relieve the pain, bend at the waist toward the pain, or lie on your side bringing your knees up toward your abdomen. Avoid rapid changes in position. A heating pad may be helpful.

Gingivitis

Inflammation in the tissues of the gums occurs in over 50% of pregnant women. It is caused by the change in hormone levels. This is called pregnancy gingivitis and may cause swollen bright red or bluish red gums that bleed easily when stimulated by a toothbrush or dental floss. Pregnancy gingivitis can be eliminated by proper oral hygiene. You should have your teeth cleaned at your dentist’s office as well as daily brushing and flossing. Complete cleansing of the teeth will remove plaque and a plaque-free mouth does not prevent pregnancy gingivitis.

Skin Changes

Stretch marks are pink or purplish streaks that commonly appear on the lower abdomen, breasts, thighs, or buttocks. They are caused by a breakdown of the lower layer of the skin. Many women try to prevent stretch marks by massaging their skin with creams and lotions. This helps reduce dryness and itching, but this does not prevent stretch marks. The red or pink color fades to silver white and they become thinner after delivery.

During pregnancy, there is an increase in skin pigmentation. In many women the midline of the abdomen turns dark brown forming a dark brown line. Tan or dark brown patches may appear over the forehead, nose, and cheeks, especially in women with dark hair and eyes. A sunscreen during times of sun exposure will reduce this further darkening of the skin. These changes generally reverse after delivery. Tanning beds are not recommended during pregnancy, but there is no evidence that it is harmful to the fetus.

Dry skin is common during pregnancy. You may need to use a moisturizer. Some women develop blackheads and pimples. This is due to the increased activity of the oil glands. It may be helpful to follow your cleansing routine with a mild astringent. Sometimes tiny red spots or “spider veins” will appear on the trunk, back or face. None of these changes are medical problems.

Breathing Problems

As the fetus grows, the uterus takes up more room. Your lungs do not have as much room to expand, so you may be short of breath.

A few weeks before you give birth, the baby’s head will move down in the uterus, or “drop,” and press against the cervix. This usually happens between 36-38 weeks of pregnancy in women who have not had a baby before, but it may happen later. In women who have already had a baby, it may not happen until the start of labor. When the fetus drops, it will be easier to breathe.

If you are short of breath, here are some things to try:

1. Sit up straight
2. Sleep propped up
3. Ask your doctor or childbirth educator about breathing exercises.

Inability to Sleep

After the first few months, you may find it hard to sleep. This often happens in the last weeks of pregnancy. Your abdomen is large, and it is hard to get comfortable. To get the rest you need:

1. Take a warm bath at bedtime.
2. Try the tips to relax that you learned in childbirth classes.
3. Lie on your side with a pillow under your abdomen and another between your legs.
4. Rest for short breaks during the day.