Q: Why does pregnancy make you feel so sick?
A: Although no one is really clear about the cause of nausea in pregnancy, it is thought to be due partly to the hormone human chorionic gonadotrophin (hCG), released early in pregnancy. For most women, symptoms are mild and begin to ease at 12 weeks. For some, the sickness may last throughout the day and continue beyond this time. A small percentage of women experience severe nausea and vomiting, known as hyperemesis gravidarum.

There are practical measures you can take to relieve nausea and vomiting (see Coping with morning sickness).

Q: I'm two months' pregnant and feel incredibly tired all the time. Is this normal?
A: Yes, fatigue is a common complaint in pregnancy with most women feeling a sudden loss of energy in the early stages as their body gets used to the changes caused by pregnancy. This often lasts throughout the first trimester, but after about week 13 you should start to feel a bit more energized. When you're not resting, try to stay active and engage in some regular form of exercise.

Another cause of fatigue is anemia, a common condition in pregnancy that needs to be monitored. Although it's more likely that your fatigue is due to the pregnancy itself, when you see your doctor or midwife you will be offered a blood test to check your iron level, and if this is found to be low you will be offered supplements. To avoid anemia, eat iron-rich foods, such as dark green leafy vegetables, red meat, whole-grain cereals, legumes, and prune juice. Vitamin C helps your body to absorb more iron from your diet, so try drinking fresh orange juice with meals, and limit your tea and coffee intake since caffeine inhibits iron absorption.

Q: I often feel faint—what could be causing this?
A: Feeling faint or having a dizzy spell is quite common in pregnancy since pregnancy hormones cause your blood vessels to relax and dilate. Although this improves the blood flow to the baby, it also has the effect of slowing down the flow of blood around your body, which can lead to low blood pressure, known as hypotension. Although this is unlikely to be a risk in itself, it can cause feelings of faintness, most commonly when you stand up too fast from a sitting or lying position.

Other causes of faintness include lying on your back (since this can put pressure on several large blood vessels involved in returning blood back to your heart, which can cause low blood pressure and in turn make you feel dizzy and faint); a lack of food or drink; getting overheated; and fast breathing (hyperventilating).

Sometimes, feeling faint can be more serious. If the feeling does not pass by eating, drinking water, cooling down, or taking things slowly as you stand up, it may need further investigation and you should seek the advice of your midwife or doctor since this could be due to anemia (see the question on pregnancy and tiredness) and you may need treatment in the form of iron supplements.

Q: Is pelvic pain in early pregnancy normal?
A: Pelvic pain is associated with the soft area between the two pubic bones supporting your pelvis, the “symphysis.” this can swell or separate causing considerable pain, termed symphysis pubis dysfunction, or SPD. This is thought to be caused by pregnancy hormones and is quite common in late pregnancy, but can occur earlier. Many women feel most pain when walking or climbing stairs. Wear comfortable shoes; use pillows to support the hips and legs in bed; keep your legs together when getting out of bed; and get lots of rest. Acetaminophin may help relieve the pain. You may be referred to a physical therapist and advised to wear a support belt. In severe cases, crutches may be needed. Most cases resolve after the birth.
Q: I'm embarrassed because I think I've got hemorrhoids. I don't want to go to the doctor—what can I do?
A: Hemorrhoids are swollen veins at or near the anus that can be very uncomfortable, especially during pregnancy. Hemorrhoids are a common feature in pregnancy, with many women experiencing them at some stage, so your doctor will not be at all surprised. You could also speak to your midwife about the problem if this is easier. Your doctor or midwife will be able to recommend a treatment, such as a cream or a cooling maternity gel pad.

Since hemorrhoids often develop as a result of straining due to constipation, increasing your fiber and fluid intake may help you to have regular bowel movements, which in turn may help to relieve the problem. Eat fresh fruit and vegetables and drink lots of water. If you are very constipated, you could ask your doctor or midwife to prescribe suppositories or a stool softener. You may feel embarrassed, but it is best to approach someone rather than to suffer alone.

Q: I've been getting regular headaches since becoming pregnant—should I be worried?
A: Headaches in the early stages of pregnancy are quite normal and are thought to be related to the effects of pregnancy hormones. Headaches can also be caused by other factors such as dehydration, low blood sugar, a stuffy environment, fatigue, and lack of sleep. Try increasing your intake of water, trying to drink at least eight glasses of water a day, and have small regular meals to maintain your blood sugar. If you feel a headache coming on, drink two glasses of water and rest for 30 minutes. Taking a lose dose of acetaminophen (325–650mg) is considered safe, but it is best to avoid this if possible.

If you are suffering with headaches at around 28 weeks or more, you should inform your doctor or midwife of these, especially if your headaches are accompanied by blurred vision, an inability to focus, or flashing lights. These may be a sign of pregnancy-induced hypertension (high blood pressure), which could indicate preeclampsia. Try not to worry, since even though many women complain of headaches and some will have high blood pressure in pregnancy, few go on to develop preeclampsia. It is thought that the incidence is somewhere between two and five percent of all pregnancies.

Q: My gums have started bleeding since I've been pregnant—why is this happening?
A: It is very common for gums to bleed in pregnancy. The pregnancy hormone progesterone causes areas of tissue that connect muscles and ligaments to soften and become stretchier so that your body can make room for the growing baby. However, this can affect tissue in other parts of the body, such as in the gums, making them softer and more prone to bleed.

Also, some women crave sweet foods in pregnancy, an excess of which can affect the gums, causing them to become tender, swollen, and more likely to bleed, and increasing the chances of developing gingivitis, a gum infection. Pregnant woman are encouraged to see a dentist early in pregnancy for a checkup.

It is important to brush your teeth at least twice a day and floss regularly when pregnant to minimize the risk of an infection. Unlikely as it may sound, it has been suggested that there may be a link between premature birth and gum disease.

Q: Whenever I sneeze, I leak—is that going to last for ever?
A: Many women suffer from stress incontinence during pregnancy, which means a leakage of urine when you cough or sneeze. The leaks are caused by the relaxation of muscles in the pelvic floor—a group of muscles and ligaments that support the pelvic organs—due to pregnancy hormones. Also, as the growing baby puts more pressure on the bladder, stress incontinence becomes more likely.

It is recommended that you do Kegel exercises to reduce the likelihood of leakage. These can be started at any stage of pregnancy, but the earlier you begin the better; once you get the technique right they are simple. Since these are such discreet exercises, it is easy to practice without anyone else realizing what you are doing.

Stress incontinence should improve following the birth, although it can take up to six weeks. There is some suggestion that the problem can persist longer depending on the type of birth you have, with a natural vaginal birth more likely to cause ongoing problems than a cesarean delivery.

Q: I've been getting nosebleeds for the first time in my life. Why is this?
A: It's not unusual for nosebleeds to occur in pregnancy due to the increased blood supply in the body, and the dilation of blood vessels. Nosebleeds are not serious, but if the bleeding is severe, you can ask your doctor for a spray to help the blood to clot. If your nosebleeds are frequent, ask your doctor or midwife to investigate it further.

When you have a nosebleed, sit for a few minutes with your head upright and apply pressure to the nostrils. To avoid further nosebleeds, make sure you blow your nose gently, drink plenty of fluids to avoid dehydration, use vaseline on dry nostrils, avoid smoky environments, and open your mouth when you sneeze to relieve nasal pressure.

Q: I'm 30 weeks' pregnant and have a persistent backache—is there anything that can help?
A: The weight of your baby and the fact that joints and ligaments soften in pregnancy can cause backaches. Sometimes sciatica occurs, a sharp pain that travels down the back and leg when the sciatic nerve is trapped in a joint in the lower back.

For lower backaches, warm baths and a warm compress can help, and gentle massage done by an experienced practitioner. Regular exercise, such as yoga, pilates, or water aerobics classes , strengthens back muscles, but check with your doctor before embarking on a new exercise regime. Watch your posture, making sure that you sit upright—you could try using a birthing ball—and wear flat shoes.

If you have sciatica, ask your doctor or midwife to refer you to a physical therapist to assess your condition and teach you exercises to help relieve the pain and minimize a reoccurrence. Some women find a maternity girdle or support belt to be useful.

Q: Little moles are appearing on my skin. Why is this happening?
A: Skin changes occur frequently in pregnancy due to the effect of pregnancy hormones. However, some changes, such as new moles and freckles appearing, although not usually serious, should be discussed with your midwife or doctor, particularly if new or existing moles seem to change shape, are red or tender, or start to bleed.

In general, skin either becomes quite oily in pregnancy, due to an increase in the production of the skin's natural oil, sebum or, if skin is prone to dryness, it may become even drier and more sensitive. Many women experience a darkening of the skin, while others notice a pattern on their face that looks like a patchy suntan, called chloasma. If your skin is sensitive, avoid scented creams and oils, and perfume. Regular cleansing of the skin and avoiding oil-based products may also help.

Q: My mom had varicose veins—am I likely to get them in pregnancy?
A: Around a third of women suffer from varicose veins in pregnancy to some degree . These occur because increased levels of the hormone progesterone cause the walls of the veins to become more relaxed; there is also increased pressure within the veins as a result of the enlarged uterus pressing on major veins in the pelvis. A family history of varicose veins does increase the possibility of them occurring, but there are several things that you can do to reduce the risk or severity of varicose veins.

If varicose veins do appear during pregnancy, they usually improve within three months of giving birth, although unfortunately in subsequent pregnancies they are likely to recur.

Q: My feet are swollen and tight; can I do anything about it?
A: Swollen feet and ankles, known as edema, are due to excessive fluid seeping into the tissues because of the increased volume of blood. By late pregnancy, as blood volume continues to rise, this is a common problem. The swelling is usually worse later in the day and when the weather is warmer. There are steps you can to take to help reduce the swelling, such as elevating your legs when sitting, rotating your feet, and lying on the floor with your feet up the wall. Wearing support hose also improves circulation in the legs. Make sure that you drink plenty of fluids, particularly water, since this improves the kidney function and reduces water retention. Gentle exercise, such as swimming or walking, also increases the efficiency of the circulatory system. There is evidence that reflexology from a registered practitioner may help.

If you also have swelling in your hands or face, it is worth having a blood pressure check to rule out preeclampsia. Most women find that the swelling gradually disappears after they give birth.

Q: My fingers are tingling and my midwife said it might be carpal tunnel syndrome—what is this?
A: Carpal tunnel syndrome occurs when swollen tissues in the wrist compress the nerves and cause pins and needles and numbness. Other symptoms include difficulty grasping with fingers and thumb and a general weakness in the hands. This is common in pregnancy due to the increased volume of blood, which can cause fluid retention.

There are ways to reduce the symptoms, such as circling and stretching exercises to improve circulation and increase wrist mobility. Wearing wrist splints and elevating your hands on a pillow at night can also help. A referral to a physical therapist can be made if the condition is severe.

Q: I'm 35 weeks and get terrible leg cramps. What can I do?
A: Leg cramps, where the leg muscles go into a painful spasm, is common in pregnancy, particularly at night, which may be due to the pressure of the uterus on pelvic nerves. This usually resolves itself once you are out of bed and using the muscles. However, if the pain doesn't recede and there is any reddening or swelling in one leg, you should seek medical advice immediately to eliminate the possibility of a clot.

To reduce the incidence of cramps or their severity, drink lots of water to prevent dehydration and try leg stretches and ankle exercises, circling your heel first and then wiggling your toes, before going to bed. Gentle exercise, such as walking or swimming, can also help and getting your partner, friend, or relative to massage your legs, particularly the calf muscle, can improve circulation. Some research suggests that taking magnesium supplements reduces the incidence of cramps, but further studies are needed.

Q: I'm itching to the point where I'm bleeding. What can I do?
A: Most itching in pregnancy, especially on your belly, is due to stretching of the skin, hormonal changes, and heat. However, if you have significant itching, see your midwife or doctor to determine whether you have a condition called obstetric cholestasis, a serious but rare condition that affects the liver and occurs in about one percent of pregnancies —a blood test can rule out this condition.

Using a nonperfumed moisturizing lotion or emollient cream daily after washing may help, and avoid bathing in very hot water. Try not to scratch, since broken skin is vulnerable to infection; wearing cotton gloves at night may stop you from scratching in your sleep. After 28 weeks, five drops of essential lavender oil in a bath helps soothe the skin. Hydro-cortisone creams or tablets may be prescribed if the itching is severe and other measures aren't working.

Q: My breasts keep “leaking.” Should this be happening now?
A: In pregnancy, your body prepares for breast-feeding and some women find that they leak colostrum, the first watery, yellowish milk, as early as 16 weeks. Some leak large amounts, some small amounts, and some not at all. The amount you leak has no bearing on the amount of milk produced after the birth or your ability to breast-feed. If you are self-conscious, wear breast pads to protect clothing. You may leak more when sexually aroused because oxytocin, one of the hormones responsible for the “letdown” reflex in the breasts, is released at this time.
Q: I've got terrible indigestion—why is this?
A: Progesterone, the hormone that relaxes smooth muscle (muscle that controls unconscious actions) in pregnancy, has the unfortunate side effect of relaxing all smooth muscle in the body, including the entire digestive tract. This slows digestion and the ring of muscles called a sphincter at each end of the stomach become less effective, which can cause heartburn and indigestion as acidic juices from the stomach leak back into the esophagus. In addition, your growing baby will be compressing your stomach so that you have a smaller space to digest food.

To relieve indigestion, eat little and often, eat slowly, don't eat late at night, and cut down on fatty or spicy foods. Rather than lie flat, prop yourself up with pillows. Talk to your midwife, doctor, or pharmacist about remedies that are safe to use in pregnancy.

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