Pregnancy Care

During pregnancy, breasts enlarge and can be quite tender. However, breast tenderness is most pronounced during the first three months. Wearing a good support bra helps with alleviating some of the tenderness.

Constipation is caused by several factors, such as a growing uterus which temporarily displaces your digestive organs, and hormonal influences that slow your digestive system. You may also become constipated from irregular eating habits, changes in environment, stress, and by added calcium and iron in your diet. Too little exercise and not enough fiber and liquids may also contribute to the problem. Please note that constipation refers only to bowel movements that are hard in consistency or are painful. Infrequent bowel movements are not unusual.

Prevention/remedies

• Increase the amount of fiber in your diet to help soften stool and promote natural bowel activity. Eat foods high in fiber such as fruits (fresh and dried), raw vegetables, whole grain products and nuts. Choose breakfast cereals that have at least 5 grams of fiber per serving.
• Drink lots of fluids, especially water.
• Eat small, frequent meals; thoroughly chew your food.
• Exercise, even walking will help relieve constipation.
• Eat prunes or figs, or drink prune juice. These fruits contain a natural laxative. Avoid over-the-counter laxatives.

Note: Iron tablets can aggravate constipation; however, the prescription for iron can be adjusted. Also, stool softeners that are safe to take during pregnancy can be prescribed. Inform your healthcare provider if the problem is not resolved with the above suggestions.

Dizziness or lightheadedness can be caused by low blood sugar or low blood pressure, too little iron in your blood (anemia), or a sudden change of position.

Prevention/remedies

• Avoid standing for long periods of time.
• Drink plenty of fluids.
• Eat well and frequently – include foods high in iron.
• Move slowly when standing from a sitting or lying position.
• Take frequent rest periods.
• Women prone to low blood sugar should carry snacks with protein and carbs at all times.

Fatigue is common during the first trimester. It is important to get as much sleep and rest as possible. Even taking short naps helps. Your energy level will pick up after the first 3 months. However, fatigue and insomnia tend to recur in the last months of pregnancy. A warm bath, massage or hot drink before bed will help you to relax, and ready you for sleep.

Frequent urination is another symptom of pregnancy that is most pronounced during the first trimester, as well as the end of pregnancy. Do not restrict fluid intake in an effort to decrease the frequency of urination. As long as you do not experience burning or pain while urinating, frequent urination is normal and will go away postpartum.

The increased blood volume and hormonal changes of pregnancy may cause headaches*. Nasal congestion, fatigue, eyestrain, anxiety or tension may also increase the frequency of headaches. Try to determine what triggers your headaches so that, when possible, they can be avoided.

Prevention/remedies

• Apply a cool, wet washcloth or ice pack to your forehead and the back of your neck (a warm cloth works better for some).
• Breathe in fresh air.
• Drink plenty of liquids (8-10 glasses a day).
• Eat something healthy every 2-3 hours.
• Find a quiet, dimly lit place to relax.
• Get plenty of sleep each night and, when possible, rest during the day.
• Massage your neck, shoulders, face and scalp, or ask your partner or a friend to give you a massage.
• Take a warm shower or relaxing bath.

*If you are having headaches that are severe, frequent, long-lasting, or accompanied by blurred vision, spots, lights flashing, or swelling, and you are in the third trimester, it is important to contact your healthcare provider.

During pregnancy the stomach may make more acid. As your baby grows, he or she begins to press against your stomach and can force acid upward causing heartburn.

Prevention/remedies

• Avoid citrus fruit, tomatoes, red peppers, chocolate and spicy foods.
• Avoid drinking with your meals; however, drinking small sips of water is fine. Drink liquids an hour before and after meals.
• Avoid highly seasoned, rich and fatty foods.
• Do not lie down flat after eating. If you must lie down, elevate your head and shoulders with pillows.
• Eat smaller but more frequent meals.
• Eliminate caffeine and cigarettes.

Hemorrhoids are varicose veins in the rectal area caused by the increased blood volume and additional weight of pregnancy. They may itch or burn during bowel movements and may bleed slightly.

Prevention/remedies

• Apply an ice pack to hemorrhoids for relief of discomfort.
• Avoid sitting on the toilet for long periods of time or straining while having a bowel movement. Put your feet up on a stool to reduce straining.
• Take a 15-20 minute warm sitz bath 3 or 4 times a day.
• To help avoid hemorrhoids, prevent constipation by maintaining a diet that is high in fluids and fiber.
• Witch hazel, Tucks, Anusol or Preparation H can be applied to the hemorrhoid area for symptomatic relief.

Muscle cramps* are common during pregnancy, but the cause is difficult to determine. Possible causes include a calcium imbalance or decreased circulation in your legs.

Prevention/remedies

• Elevate legs as often as possible.
• Ensure diet contains enough calcium and magnesium.
• Exercise to increase circulation in legs.
• Keep legs warm.
• Loosen bedding from the foot of bed.
• Stretch your calf muscles before going to bed.
• Take a bath before going to bed.
• While in bed, stretch with your heels pointed (not your toes). This will also help relieve a cramp.

*Contact your obstetrician if your lower left or right extremities are swollen, warm, red or painful.

One-half of all pregnant women experience both nausea and vomiting during the first months of pregnancy. Nausea and vomiting during pregnancy tend to be the worst 8 to 10 weeks after your last menstrual period. It usually goes away by 12 to 16 weeks after your last period. Although this is called “morning sickness,” it can occur anytime of the day.

Mild to moderate nausea and vomiting may make you feel terrible, but it will not hurt you or your baby. Severe vomiting during pregnancy that prevents you from keeping any food down is called hyperemesis gravidarum. It is rare, but can cause health problems.

Call your healthcare provider if you:

• Are not able to keep any liquids or foods down for 24 hours.
• Are vomiting several times a day or after every meal.
• Have abdominal pain, difficulty urinating, or have a fever.

Nausea or vomiting during pregnancy is treated in 4 steps:

Lifestyle and diet changes

Change your diet. Simple changes, such as those listed below, may lessen nausea and help to avoid vomiting. Nausea during pregnancy is worse if you are dehydrated (not enough fluid in your body) or if the levels of sugar in your blood are low from not eating often enough. The following suggestions help control nausea.

• Avoid foods that are greasy, fried, spicy or very hot.
• Avoid foods that have strong odors.
• Dairy products may make nausea and vomiting worse; however, yogurt has been known to help.
• Do not lie down right after a meal.
• Drink carbonated beverages between meals; wait 30 minutes after eating before drinking liquids.
• Drink plenty of fluids.
• Eat foods that are high in carbohydrates, such as potatoes, noodles or toast.
• Eat plain crackers or dry toast in the morning before getting out of bed or any time you feel nauseous.
• Eat small meals every 2 to 3 hours, instead of 3 large meals.
• Prenatal vitamins may make nausea worse. If you stop taking a prenatal multivitamin, you should take 2 tablets of folic acid daily (0.8mg, which is 800 micrograms per day) during the first trimester. Folic acid tablets will not worsen nausea.
• Suck on a slice of lemon or lime.

Nonmedication treatment

You may take ginger or use acupressure bands. Both have been shown to decrease nausea.

Ginger has been used for treating nausea since ancient times. Ginger root tea, ginger gum, ginger snaps, ginger syrup added to water and ginger ale are all safe and can decrease the severity of your nausea. You can also buy ginger capsules at a drug store. The daily dose of ginger that has been tested is 1 gram (250 mg capsules powdered ginger taken 4 times per day). Ginger capsules come in several doses; therefore before taking the capsule form, ask your healthcare provider about correct dosage.

Sea-bands, often used for motion sickness, are wristbands with a pressure point stud sewn inside. These bands are safe and are found to be helpful for some.

Start by taking vitamin B6; you can take 25 mg 3 times a day for 1 week. If your nausea continues, try a Unisom (doxylamine) 25 mg tablet once a day with vitamin B6. It is best to take a full tablet at night.

Medication

If nausea and vomiting make it difficult to complete normal activities, medications can be prescribed. This may include medications such as Phenergan or Diclegis.

Check with your healthcare provider before taking any additional vitamins or medicines.

During pregnancy, the pelvic joints relax in order to increase the size and flexibility of the pelvis in preparation for birth. This may cause pressure on the sciatic nerve, and may be felt as pain in the pelvic area, down the thigh and into the leg. The onset of pain may be sudden and may be felt in one or both sides of your lower abdomen or groin. You may also feel a spasm in your vagina or rectum. It is good to know that the pain may end as quickly as it began.

As the uterus grows, the ligaments that hold your uterus in place stretch; sudden movement or position change may cause the ligaments to spasm. This is known as "round ligament pain."

Prevention/remedies

• Always use proper body mechanics when lifting, bending, or stretching during pregnancy and after delivery.
• Drink the fresh juice of a lemon in a cup of warm water to help decrease fluid retention.
• Experiment with different positions to find 1 most comfortable for you.
• Limit your salt intake.
• Sleeping on your side with one leg forward, supported on a pillow, and the other leg back, as if running.
• Use a heating pad or hot water bottle.
• Wear a maternity support belt to help alleviate pressure.

Your growing uterus puts pressure on your internal organs and diaphragm, leaving less room for your lungs to expand, which causes shortness of breath*. In the latter months of pregnancy you may find it difficult to breathe when climbing stairs. Also, finding a comfortable position without difficulty breathing while lying down can be challenging.

Prevention/remedies

• Hold your arms above your head; this raises your rib cage and temporarily gives you more breathing space.
• Practice slow breathing. This enables use of the lungs greatest capacity.
• Sleep with your head elevated.
• Take a slow pace when climbing stairs. In the last few weeks of pregnancy, lightening occurs (baby drops into the pelvis). When this happens, the pressure is off the diaphragm, your lungs will have more room, and breathing becomes easier.

*Contact your obstetrician if shortness of breath does not resolve or if present with other symptoms.

About 90% of women experience stretch marks. Stretch marks occur when the skin is stretched beyond its normal elasticity. They appear most frequently on the abdomen, but some women also develop them on their thighs, upper arms, and breasts. Unfortunately, there is no proven remedy to prevent stretch marks; however, the stretch marks that do remain will fade to a light silvery color.

You can help your skin to look its best by:

• Ensuring that your diet contains sufficient protein will help your skin stay healthy.
• Keep your body hydrated by drinking plenty of water.
• Keeping your skin soft and moisturized will not prevent stretch marks, but it may help minimize itching. Try a gentle massage with a moisturizing lotion or cocoa butter.

During pregnancy, swelling of the feet, legs, and hands can cause your skin to feel tight, however, this is normal. This is especially true in the latter stages of pregnancy and during hot weather. Increased salt intake may also contribute to transient swelling. Your body naturally holds water; additionally, during pregnancy your blood volume increases approximately 40%. Therefore, swelling or puffiness is not unusual, but it can be uncomfortable.

Prevention/remedies

• Avoid sitting with your legs crossed.
• Avoid standing for long periods of time.
• Avoid wearing tight clothing.
• Decrease salt intake.
• Drink adequate amounts of fluids.
• Elevate legs and feet as often as possible to improve circulation.
• Exercise regularly by walking or swimming.
• Lie on bed or floor and raise your legs up on the wall (keep knees bent).
• Soak your feet in cold, or ice, water for increased comfort.
• Use a footstool when sitting and perform ankle circles whenever possible.
• Wear comfortable flat shoes.
• Wear support hose/compression stockings when planning to stand or walk for long periods of time. Your legs are least swollen in the morning; therefore, it is recommended you put stockings on before getting out of bed. Some health insurance policies may pay for your stockings if you have a prescription; check with your insurance provider.

In the early months of pregnancy, some women have difficulty falling asleep or staying asleep. This may be your body’s adjustment to pregnancy. In the latter months of pregnancy, you may find your normal sleeping position uncomfortable. In addition, your baby’s kicking and your increased bladder pressure may cause you to wake frequently during the night.

Prevention/remedies

• Avoid eating a big meal within two hours of going to bed.
• Avoid products that contain caffeine.
• Develop a regular sleep schedule/routine. It is fine to take short naps or to rest during the day.
• Exercise daily.
• Experiment to find the most comfortable sleeping positions. Lie on your side and place several pillows between your knees.
• Reduce any noise or lighting.
• Take a warm, relaxing bath before bed.
• Try childbirth preparation exercises or other relaxation techniques.

If you are having difficulty sleeping and believe that it is due to increased anxiety or depression, talk to your healthcare provider.

One of the first changes you may experience when you become pregnant is in your vaginal discharge. It is important to be aware of the normal changes during pregnancy and to inform your healthcare provider about any changes that may appear abnormal.

What is normal vaginal discharge?

Normal vaginal discharge during pregnancy (called leukorrhea) is thin, white, milky and mild smelling. Leukorrhea is normal and nothing to worry about.

What is abnormal vaginal discharge?

If your vaginal discharge is green or yellowish, strong smelling, and/or accompanied by redness or itching, you may have a vaginal infection. Two of the most common vaginal infections during pregnancy are yeast infections and bacterial vaginosis. Your healthcare provider can easily treat vaginal infections. Another cause of abnormal discharge could also be a sexually transmitted infection. You should notify your healthcare provider any time there is a change in normal pregnancy discharge. NEVER try to diagnose and/or treat yourself.

During pregnancy DO NOT:

• Use tampons (they can introduce new germs into the vagina).
• Douche (this can interrupt the normal balance and lead to a vaginal infection).
• Assume that it is a vaginal infection and treat it yourself.

During pregnancy DO:

• Use panty liners if it makes you more comfortable.
• Wear 100% cotton underwear.
• Notify your healthcare provider at your appointment of any changes.