Q: I'm feeling like a beached whale and I'm only 16 weeks, what can I do?
A: Weight gain in pregnancy is not only due to the baby, placenta, and amniotic fluid, but to a number of factors. Changes in your metabolism, the development of certain organs, such as the uterus and breasts, and an increase in your blood supply causing more fluid retention and swelling, all contribute to your weight. In addition, extra stores of fat are laid down since pregnancy requires more energy for the work involved in developing the fetus and coping with the demands of labor. Although most of this fat is stored in the first 30 weeks, weight gain is usually slower at the beginning of pregnancy and suddenly increases in the second half. The average weight gain is 27 lb (12.5 kg), 10 lb (4.5 kg) of which is gained in the first 20 weeks, and the remainder thereafter. If you feel you have put on more than this, my advice is to eat healthy, smaller, more regular meals and engage in gentle exercise.
Q: People keep telling me I'm too small, but the midwife says everything is fine. Can you explain?
A: Tell them to mind their own business! If your midwife says she is not worried, then I would feel reassured—some women just hide a pregnancy very well! Your midwife starts to measure your belly at around 12 weeks. By 26–28 weeks the major organs are more or less developed and your baby is concerned with growing and laying down fat supplies. After 20 weeks, your uterus grows approximately 1 centimeter per week until it reaches 36 centimeters. Your midwife or doctor will assess the growth at each visit. If the growth of the baby seems to lag behind or accelerate too quickly, serial ultrasound measurements may be necessary.
Q: I'm 17 weeks and my breasts have changed—they're painful and look different. Is that normal?
A: It's perfectly normal and very common to experience breast changes in pregnancy. These are caused by both an increased blood supply and a rise in pregnancy hormones, particularly in the first 12 weeks. Before your pregnancy was confirmed you may have felt tingling sensations (especially in the nipple area) as the blood supply increased. As early as 6–8 weeks, breasts can get larger and more tender and may begin to look different on the surface, with threadlike veins starting to appear. At around 8–12 weeks, the nipples darken and can become more erect, and as early as 16 weeks, colostrum, the first milk, may be expressed.
Q: Why am I getting more vaginal discharge since becoming pregnant?
A: In pregnancy, the layer of muscle in the vagina thickens and this, combined with an increase in the pregnancy hormone estrogen, causes the cells in the vagina to multiply in preparation for childbirth. As a side effect, the extra cells mean that there is an increase in vaginal discharge, known as leukorrhea.

If you feel sore or itchy and the discharge is anything other than creamy or white, or if it seems to have an offensive odor, see your midwife or doctor so that a test can be done to rule out infection. Some infections, such as yeast infection, cause an abnormal discharge. They are common in pregnancy, and are easily treated.

Q: Dark patches have appeared on my face. What could they be?
A: The dark patches on your face are called “chloasma” or “pregnancy mask” and these patches affect around half of pregnant women. Nearly all pregnant women notice some changes in skin coloring, with skin usually darkening from 12 weeks. This is due to an increase in the hormones that stimulate skin pigmentation, with darker-skinned women affected more. This darkening may be more apparent on certain areas, such as the nipples, perineum (skin between the vagina and anus), and navel, or areas that experience “friction rubbing,” such as the inner thighs and armpits. You can reduce or prevent dark patches on your face by minimizing your exposure to the sun and using high-SPF sunscreen.
Q: I'm a model and I'm worried I'll get stretch marks. Is there anything I can do to avoid them?
A: I appreciate your concern, especially as looking good affects your work. Stretch marks, also called striae gravidarum, are thought to be connected to the collagen and elastin content of your skin rather than to how much your abdomen expands. They occur as the collagen layer of the skin stretches over areas of fat deposits on the breasts, abdomen, and thighs. Unfortunately, there are no pills, creams, or magic lotions that can influence whether or not you will get stretch marks or, if you do, how badly you will get them, although getting regular exercise can help you to maintain an ideal weight during pregnancy and so minimize your chances of developing stretch marks.

Take comfort from the fact that although the marks may be red and vivid in pregnancy, in the months following the delivery they lose their color, usually becoming silvery white and less obvious.

Q: My belly is really itchy. Is it safe to use moisturizers on my skin in pregnancy?
A: As your abdomen grows it can become itchy as the skin stretches. You can use moisturizers on your body in pregnancy, and these may relieve the discomfort. Choose nonperfumed lotions, oils, or creams to avoid further irritation. Rubbing olive oil, vitamin E oil, or cocoa butter over the abdomen may also help. Eating a healthy diet with fruit and vegetables and drinking plenty of clear fluids to keep you well hydrated will also help the condition of your skin.
Q: I can't look in the mirror without feeling depressed about my size. Will things get better?
A: You are not alone in battling with your self-image in pregnancy. For many women, their changing body shape can create very negative feelings. Eating a healthy diet and getting some exercise helps to keep weight gain within expected levels, and exercise will help to lift your spirits and improve your sense of well-being. There is no set emotional response to pregnancy, but as well as coming to terms with a momentous life and body change, you are also under the influence of fluctuating hormones, all of which affect your moods and add to feelings of negativity.

Mild depression in pregnancy is often helped by reassurance and support from your partner, family, or friends. Talking over your fears and concerns with your partner, or with other pregnant women at prenatal classes, may help to relieve your anxieties—you will probably find that other pregnant women are experiencing the same feelings.

Prenatal depression is now recognized as having a negative effect on pregnancy and birth outcomes, so if you suspect that you may be depressed, consult your midwife or doctor. He or she may then refer you for counseling or prescribe medication. You may want to seek support through a community health department, church, or hospital plan. Hospitals and clinics often have classes for expectant mothers who feel they may be at risk for depression and postpartum depression.

Q: Why do people talk about the second trimester as the time when pregnant women “bloom”?
A: For many women, the second trimester is the most enjoyable part of pregnancy. As women find themselves released from the draining symptoms of early pregnancy, this can lead to an upsurge of energy, and many find it easier to eat, sleep, and work. Many women also notice that their skin is glowing and their hair is glossier than usual. It is also around this time when you first feel your baby move and, as your baby grows, you start to notice a definite belly and begin to look pregnant—changes that can help you feel more positive and excited.

However, not all women feel this way. A sizeable minority of women don't feel any better as the second trimester progresses, with nausea, fatigue, and other symptoms continuing unabated. Some may find it hard to come to terms with physical changes such as weight gain, or skin and hair changes. If this is the case, it's important to remind yourself that almost all of pregnancy's downsides clear up as soon as the baby is born. If you're feeling particularly down or low on energy, it may be a sign of other problems, such as anemia . Speak to your midwife or doctor for further advice.

Q: I'm worried that my husband doesn't find me attractive any more. Am I being paranoid?
A: Self-image can be a big problem with pregnant women and many worry that they are unattractive to their partners in the latter stages of pregnancy. This worry is usually unfounded and more to do with their own feelings about their increased size. Keeping anxieties bottled up can make them seem bigger than they actually are, so talk to your husband about your worries and explain how you are feeling. He may be completely unaware of what you are thinking.

Since your husband isn't carrying the baby, he cannot truly understand the physical demands of pregnancy. Informing him about the changes your body is going through can help him understand the process of pregnancy and be better equipped to provide support when you need it most. Some men actually find their partners more attractive during pregnancy, but you won't know this unless you talk to each other about your changing shape.

If you are worried about gaining too much weight in pregnancy, focus on eating a healthy, balanced diet and getting some light, daily exercise. A 30-minute walk or swim will help to keep you toned and supple, which will help your confidence as well as prepare you for childbirth.

Q: Can I wear high heels?
A: Although lots of pregnant women continue to wear the same footwear during pregnancy, it is advisable to avoid heels and opt for a flatter shoe, particularly as your pregnancy progresses.

Later in pregnancy, your posture and center of balance changes, since your increased weight is now mainly at the front of your body. In addition to this, increased levels of hormones secreted during pregnancy, such as relaxin, make the joints and muscles of the body more lax. So wearing high heels can increase the strain on the lower back and pelvic joints, giving rise to aches and pains in those areas. However, it's alright once in a while to wear high heels, for example at a party, but it might be wise to take flat shoes to change into for walking home.

Q: What should I do about my pierced belly button?
A: If you are pregnant and your navel is pierced, your doctor or midwife will probably recommend that you remove any metal jewelry from your navel for the duration of your pregnancy. Some women are happy with this advice, but a lot of women do not want to risk letting their piercing heal up, so they try to wear jewelery in their navel through their pregnancy.

You can use something called a “pregnancy retainer.” due to the popularity of body piercing, these have been manufactured to help pregnant women maintain their piercing as their body shape changes. They are made up of a soft, flexible substance called PTFE (polytetrafluoroethylene) in the shape of a “banana” bar that has two acrylic screw-on end balls. There is a wide range of sizes and styles for women to choose from. As a general rule, you should choose a retainer that is at least 4 mm longer than the size of the jewelry you are currently wearing, although, as you can imagine, every belly is different and will obviously change in size as your pregnancy progresses. The important factor is that your pregnancy retainer should not pinch into your skin at any time—if you feel your retainer is causing you discomfort, then buy a larger size.

Q: I don't have much to spend on maternity clothes, any ideas?
A: Lots of women are faced with this predicament when they become pregnant, but you don't need to spend a lot of money. Most women's clothes stores now stock selections of maternity wear at very reasonable prices. Invest in a couple of pairs of pants or skirts that you will be able to adapt as your pregnancy progresses and then mix and match colors and styles with a few tops. The tops don't have to be maternity wear—you could just buy ones a couple of sizes up from your normal size.

You could look in thrift stores too, or borrow maternity clothes from friends and family, since women wear maternity clothing for such a short period that it is often in good condition. Ebay is a good place to pick up a bargain, and garage sales often have plenty of items in excellent condition. Lastly, don't forget your partner's tops and jeans, which may be a perfect fit!

Q: I'm 20 weeks' pregnant and have noticed that I get short of breath very easily. Is this normal?
A: When you're pregnant, your lungs have to work much harder to meet your body's increased oxygen needs. To help you take in more air, your ribs flare out and your lung capacity increases dramatically. This can make you feel breathless, particularly from mid-pregnancy onward. In the last three months, most women find they get breathless even during mild exertion, which happens as the expanding uterus pushes up against the lungs. However, being breathless can also be a sign of anemia, which may need to be treated . Your breathing may start to get easier when your baby engages—moves down into your pelvis ready to be born.
Q: My midwife has told me I'm anemic. Can I improve my iron levels through my diet?
A: All pregnant women should be offered screening for anemia, which is done early in pregnancy (at the first appointment), again at 26–28 weeks, and again at 36 weeks. Generally, an iron-rich diet is advised in pregnancy and this may be enough to prevent or improve anemia. Eat plenty of lean red meat, beans, dried fruits, dark green vegetables, fortified cereals, and eggs. Try including a vitamin C-enriched food or drinks, since vitamin C helps the body absorb iron more efficiently. Vegetarians need to eat plenty of eggs, legumes, beans, and nuts to boost iron supplies. Iron supplements may be recommended depending on how low your iron levels have fallen.
Q: I have developed a dark vertical line down the middle of my belly. What is this?
A: A brown line down the center of your abdomen is known as the linea nigra. This occurs due to changes in skin pigmentation, which are extremely common in pregnancy, affecting 90 percent of all women in some way or another, and is often more noticeable if you are darker skinned. As well as the line on your belly, you may also notice a darkening of the skin around your nipples and a darkening of freckles, moles, or birthmarks. A few women may also experience brown patches on their face called chloasma or “pregnancy mask”. These changes are caused by the extra amounts of the hormone estrogen in pregnancy, which affects the melanin-producing cells of the skin—the cells that produce the pigment that darkens the skin. These color changes are normal and will usually fade once the baby is born.
Q: I'm 32 weeks and my pelvis is really aching now—what are the reasons for this?
A: Mild pelvic discomfort is a common symptom in pregnancy as your ligaments loosen, due to the increased levels of the hormones relaxin and progesterone in pregnancy. These changes in your pelvis prepare your body for the birth. This feeling is quite normal and happens to most pregnant women. If your pelvis continues to give you discomfort, you can try to adapt your day-to-day living to relieve the symptoms. Keep your legs together and swing them around when getting in and out of a car or bed. Think about your activities for the day and plan your movements ahead so as not to exacerbate any discomfort you have. Avoid wearing high-heeled shoes and take a rest whenever the discomfort becomes more noticeable.

If your pelvis is more than just uncomfortable, seek medical advice. More extreme discomfort that causes chronic pain is a sign that there's a dysfunction in the pelvic area, which may require treatment and support as pregnancy progresses. The most common form of pelvic dysfunction is symphysis pubis dysfunction (SPD), which is caused by separation at the pubic joint or the softening of the disc supporting the joint .

Q: I've never looked better—why is that?
A: Hormone levels in early pregnancy can make for a miserable time for many women as they battle against morning sickness, fatigue, and tender breasts. However, at around 12–16 weeks, when pregnancy hormones begin to settle down and these symptoms start to subside, many women feel that their skin and hair are in great condition and their energy levels are at a high. This is sometimes called “blooming” and you may be lucky and find that this continues throughout your pregnancy.

If you are feeling particularly well, you may feel tempted to do too much, but you should exercise some caution because there will still be times when your body needs additional rest and you need to store up energy in preparation for labor and birth.

Q: I'm 36 weeks and have noticed that I'm more comfortable and breathing more easily. Why is this?
A: It sounds like your baby has moved down into the pelvis. The baby's head is “engaged” when the widest part of the head has passed down into the pelvis. This means that when the doctor or midwife feels your abdomen, less than half of the head can be felt abdominally. Engagement is normally measured in one-centimeter increments from -4 (which means “floating” and not engaged) to zero (engaged). At a measurement of +4, you can actually see the baby's hair! The timing and significance of engagement depends on several factors. Women expecting their first baby tend to have firmer abdominal muscles, which gently ease the baby down into the pelvis during the last four weeks of pregnancy. This appears to be what your baby has done, and that is why you suddenly feel you can breathe a little easier as your lungs and rib cage are not so squashed. A second or third baby may not become engaged until labor starts, since the abdominal muscles tend to be more lax.
Q: What is perineal massage?
A: Perineal massage is the practice of massaging the perineum, the area of skin between the vagina and anus, to make it more flexible in preparation for childbirth. The intention is to prevent tearing of the perineum during birth, and the need for an episiotomy or an assisted (forceps or vacuum extraction) delivery, since the skin in this area may become more stretchy as a result of massage. Clinical trials indicate that perineal and vaginal massage can reduce the extent of tearing and so some consider it beneficial.

Use a lubricant such as KY jelly, cocoa butter, olive oil, vitamin E oil, or pure vegetable oil on your thumbs and massage around the perineum. Place your thumbs about 1–11/2 in (3–4 cm) inside your vagina and press downward and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling, or stinging sensation. With your thumbs, hold the pressure steady for about two minutes, or until the area becomes a little numb and you don't feel the tingling as much. As you keep pressing with your thumbs, slowly and gently massage back and forth over the lower half of your vagina, avoiding the urinary opening, and along your perineum, working the lubricant into the tissues for three to four minutes. This helps stretch the skin in much the same way that the baby's head will stretch it during birth. Do this massage once or twice a day, starting around the 34th week of pregnancy. After about a week, you should notice an increase in flexibility.

Q: I'm 35 weeks and feeling as tired as I did in the first trimester. Is that normal?
A: Fatigue can cause real problems for women in the first and last trimesters and is often worse for women who are overweight or who have a multiple pregnancy. In the early stages, you may feel tired and lethargic due to hormonal changes, while later in pregnancy, fatigue is caused by the extra demands on your body. Rest is the best cure, though this may be difficult if you're working or caring for children.

Boost your energy levels with regular, balanced meals. Late pregnancy is also the time to get your partner, family, and friends to help out with things like shopping, chores around the house, and cooking.

Extreme fatigue in the last trimester may indicate that your iron levels are low, so it may be worth getting your iron levels checked.

Q: I've gone from an A cup to a size D—my husband hopes this will last forever, but it won't will it?
A: Many women notice an increase in the size of their breasts in the second trimester and some maintain a bigger size after the birth, especially if they breast-feed. This is due to the effects of estrogen, which causes fat to be deposited in the breasts. As your breasts enlarge, the veins become noticeable under the skin, the nipples and area around the nipples (areolae) become darker and larger, and bumps may appear on the areolae. Some women get stretch marks on their breasts, but these fade in time. After the birth, your breasts may get even bigger when the milk comes in! They do reduce in size once you finish breast-feeding, although the majority of women report a permanent change of some degree.
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