SURVIVAL GUIDE AND FAQ
Morning Sickness
This is often the 1st sign of pregnancy and can be 'morning', 'night', or 'all day' sickness! It can be quite debilitating but generally improves by around 14 weeks' getation. It is thought to be caused by the hormone changes of early pregnancy and varies from woman to woman and pregnancy to pregnancy. The worst scenario is called hyperemesis gravidarum resulting in continual vomiting and dehydration. Some women will require admission to hospital for intravenous fluid. Fortunately this is rare.
Management includes eating little and often - dieticians call it 'grazing'. Carbohydrates such as bread, pasta and rice often help to relieve the nausea. Try to avoid spicy and acidic foods, as well as caffeine and soft drinks. It is important to keep your fluids up and if you are unable to drink, you should contact your doctor. Some natural anti-nausea remedies include ginger, Vitamin B6 and acupuncture. Metoclopramide (Maxolon) is a commonly used drug that is proven to be safe in pregnancy. Ondansetron (Zofran) is another safe drug to use. It is very effective but quite expensive. You will need a prescription from your doctor for these medications.
Fatigue
The fatigue that many women experience in early (and late) pregnancy can be the worst they will ever go through during their life. It can severely affect their day to day ability to function at home and work. Your body works significantly harder in the background during pregnancy to move blood into the placenta for the baby. It often seems that no amount of rest helps with this overwhelming tiredness.
It is important to eat well, take rests during the day if you can and try to have some early nights. Sometimes the fatigue is worsened by low iron levels or an underactive thyroid. These can both be checked by a simple blood test, and supplements recommended if needed.
Heartburn
This is a form of indigestion and very common during pregnancy. During pregnancy, hormone changes cause a slowing in the digestion of food in your stomach and relaxation of the valve between your stomach and oesophagus. Many women will experience a burning or pain in their chest, upper abdomen or throat. Later in pregnancy the baby will also often push on your stomach and force the contents of your stomach into the oesophagus. This can be very unpleasant and may keep you awake at night.
Simple treatments will often relieve the problem. Avoid big meals and try not to lie down soon after eating. Try propping yourself up in bed with an extra pillow. This allows gravity to keep the food in your stomach. Avoid spicy and fatty foods. Antacids can be very effective. There are many to choose from (e.g. Mylanta, Mucaine, Gastrogel, Quickeze, Rennie, Tums) and they are all safe. They can be easily obtained over the counter at a Pharmacy. If these simple measures are ineffective, you may try a medication called Ranitidine (Zantac). This can also be bought over the counter but it is best to check with your doctor first. Failing that, in the 3rd trimester, there are a few prescription medications that can be used under certain circumstances.
Backpain
During pregnancy, the body releases a hormone called Relaxin. This is a protein produced to soften the cervix and pelvic ligaments for labour. However, it also affects many of your other ligaments, joints and bones. Women also increase their weight and change their posture relatively quickly during pregnancy. It is not surprising that most women experience some back and pelvic pain. If you have a preexisting back issue, it is likely things will get worse.
Management should start with simple measure such as rest, massage and heat packs. Back strengthening exercises and core work such as Pilates are very helpful. I recommend a visit to a Women's Health Pysiotherapist for assessment and advice regarding posture and appropriate exercise. A list of my favourites are here.
Anti-inflammatory medications such as Neurofen and Naprogesic are NOT safe to use during pregnancy. Paracetamol is safe but not likely to be particularly effective. If you think medication is required, please talk to your Doctor or Physio first.
Constipation
This is almost universally a problem for pregnant women and can begin very early on. Once again the hormones of pregnancy are mostly to blame. They affect the bowel and cause it to slow down its function. Later in the pregnancy, the baby also pushes on the bowel and slows it even more. Often vitamins (especially iron) will exacerbate the situation.
It is recommended that you drink plenty of water to prevent dehydration. Make sure you have plenty of fibre in your diet including unrefined cereal grains, pulses and fruits. Natural fibre-based 'laxatives' (e.g. Metamucil, Fybogel) are safe and available at the Pharmacy. Avoid other laxative medications if possible as the body quickly becomes used to them and this can result in long term issues. On rare occasions, it is necessary to use these medications or suppositories/enemas but please discuss this with your Doctor before going ahead.
Haemorrhoids
These are often called 'piles' and are basically varicose veins in the rectum or anus. They can appear suddenly quite early in pregnancy or gradually develop over time. They often feel like little grapes. As the baby grows, it pushes on the big veins in the pelvis and causes back pressure on the veins in the rectum, causing them to swell up. Often the haemorroids cause no symptoms but commonly women experience discomfort, bleeding, itch or mucus discharge. Occasionally they can swell suddenly and become acutely painful. If this occurs, you should see your Doctor.
Constipation makes haemorrhoids worse so it is important to avoid this using the methods mentioned above. Try to avoid straining or coughing. Over the counter creams (e.g. Rectinol, Proctosedyl) are safe. Although these creams will not usually make the piles go away, they will often relieve the symptoms. Usually the haemorrhoids shrink or vanish after the pregnancy, but occasionally surgery will be required in the long term.
Thrush
This is a very common problem in pregnancy. It is caused by a yeast called Candida and can result in a thick white/yellow discharge, itch, soreness and redness around the vagina and vulva. Changes in the hormones and vaginal acidity during pregnancy can feed the growth of Candida. There are, however, other vaginal infections that can cause similar symptoms. As Candida is by far the most common infection, I would generally recommend you treat this first. If the symptoms persist, a vaginal swab is then suggested to rule out other causes so visit your Doctor.
Treatment is with antifungal vaginal pessaries or creams such as Canestan. This is safe in pregnancy and can be bought at any Pharmacy. It is important to make sure the pessary or cream goes INSIDE the vagina or it will be ineffective. It is acceptable to use the applicator but you can use your finger to insert the preparation if you prefer. 'Once only' oral preparations such as Diflucan should not be used during pregnancy.
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