Chapter Eight - MINOR DISCOMFORTS DURING PREGNANCY

Many women experience some discomfort or minor complaints during pregnancy. Although these discomforts are not dangerous, they can be troublesome. It is important for women to learn what is normal and what is dangerous. For problems that are not life-threatening, it is helpful to explain to women what they can do to ease the discomfort on their own, and to listen to them with sympathy and kindness. This helps create trust and understanding between the health worker and the woman, and makes the job of caring for her easier.

MORNING SICKNESS

About one-third to one-half of pregnant women feel nausea (discomfort in the stomach) during the early weeks of pregnancy. Although it is called morning sickness, women may also feel unwell in the early evening or at other times of day. It generally goes away by about the third month of pregnancy. If it usually happens in the morning, it may help the woman to eat a piece of dry biscuit, yam, or banana before getting out of bed. If she feels nausea at other times during the day, it may help to eat smaller meals more frequently, rather than two or three big meals a day. If the nausea and vomiting are severe or persist after the third month, or if they interfere seriously with eating, the woman should go to a health facility.

HEARTBURN

Heartburn, in spite of the name, has nothing to do with the heart. It is a burning sensation in the throat and chest caused by indigestion. It tends to occur towards the end of pregnancy when the enlarged womb pushes up the stomach. This causes small amounts of stomach acid to pass upwards. Women should try to eat several small meals every day, not eat spicy or oily foods, and avoid lying down immediately after eating.

Box 8.1: Common Discomforts and When to Expect Them FIRST TRIMESTER · Morning sickness or nausea and vomiting · Tiredness or dizziness · Tenderness in the breasts · Frequent urination SECOND TRIMESTER · Tiredness · Backache · Changes in the colour of the skin · Increased fluid from the vagina · Increased saliva in the mouth · Heartburn THIRD TRIMESTER · Tiredness · Backache · Pressure in the pelvis · Increased fluid from the vagina · Contractions in the womb that are irregular and do not cause any pain · Muscle cramps, especially in the legs · Frequent urination · Heartburn and gas · Constipation · Increased varicose veins · Colostrum (yellowish liquid) from the breasts · Stretch marks on the skin of the abdomen · Shortness of breath · Swelling in the ankles and feet

CONSTIPATION (NO BOWEL MOVEMENT)

Constipation during pregnancy is quite common. It occurs because the contractions of the bowel which move digested food through the body are slowed by the hormones of pregnancy. Eating lots of vegetables and fruits, drinking a lot of water, and exercising regularly can help keep the bowels working normally. Enemas should be avoided unless recommended by a doctor, nurse, or midwife.

VARICOSE (SWOLLEN) VEINS

Varicose veins are caused by the blood collecting in the veins, particularly in the veins of the legs. They may appear for the first time during pregnancy, or become worse. This is because the body produces more blood during pregnancy, and because the weight of the baby makes the blood collect in the legs. Women can make themselves more comfortable by propping up their feet when sitting, and by making sure they do not stand for long periods of time. Regular exercise also improves the circulation of blood in the legs. Varicose veins improve after delivery, but will not disappear altogether.

HAEMORRHOIDS (PILES)

Haemorrhoids are varicose veins around the anal opening. They may cause pain and bleeding during bowel movements and are made worse by constipation (hard stool). Haemorrhoids may be relieved by avoiding long periods of sitting, and by eating foods that promote easy bowel movements (fresh fruits and vegetables in particular). The pain can be relieved by warm baths or suppositories.

VAGINAL DISCHARGE

The normal fluids in the vagina tend to increase during pregnancy. This is nothing to worry about unless the discharge becomes greenish, yellowish, or bubbly, and is accompanied by itching or an unpleasant odour. Changes like these are usually signs of an infection. If a woman develops these problems, a laboratory test may be necessary to identify the cause and determine the best treatment. If the facilities are not available to do laboratory tests, there are guidelines available that specify which antibiotics to give when signs of a vaginal infection are present (see Chapter 18).

BACKACHE

As the baby grows heavier and a woman's balance changes, her lower back is put under increasing strain. Keeping the back straight when standing and sitting may help relieve or prevent backache. There are also exercises that may help to relieve the strain (see Figures 8.1-8.3).

Ways to Relieve Backache and Avoid Straining the Back

Figure 8.1: Shoulder Circles

1. Sit with arms hanging to the side.
2. Lift shoulders up towards ears.
3. Move shoulders back.
4. Relax shoulders and return to the starting position.

Figure 8.2: How to Lift Something

1. Place one foot forward and bend down on the other knee.

2. Bring the child or object close. Rise slowly with front foot flat on the floor and use back foot to push up and for balance.

Figure 8.3A: How to Reach Things on the Ground

Do not bend over at the waist to reach things on the ground.

Figure 8.3B: How to Reach Things on the Ground

Instead, squat down by bending knees and keeping back straight.

LEG CRAMPS

Cramps in the muscles of the legs, especially the calf, frequently occur towards the end of pregnancy. To relieve the cramp, women can try gradually stretching the leg out straight with the toes pointed back towards the body (see Figure 8.4). Rubbing does not usually help as much as stretching out the muscle.

SWELLING IN ANKLES AND FEET

It is normal to have some swelling in the ankles and feet during pregnancy. Swelling in the wrists or hands is less common. Swelling occurs because the body is keeping more fluid in the tissues than normal. Women should be advised to avoid tight cuffs, bracelets, shoes, or rings. If the swelling increases too much these may be difficult and painful to remove. If the swelling increases suddenly or causes very rapid weight gain, women should go to a health facility to have their blood pressure and urine checked for pre-eclampsia, which is a life-threatening complication (see Chapter 9).

SHORTNESS OF BREATH AND TIREDNESS

It is not unusual for women to get tired easily, especially during the first three months or so of pregnancy. The body is adjusting to many new changes. Towards the end of pregnancy, the womb takes up so much room that breathing may become difficult. This does not necessarily mean there is anything wrong. The shortness of breath goes away as soon as the baby is born. If, however, a woman becomes very short of breath, has chest pains, has a very high pulse rate, or remains tired even after resting, she may be suffering from heart disease, anaemia, or some other problem. She should go to a health facility for an examination.

ABDOMINAL DISCOMFORT

As pregnancy continues, women may experience occasional cramps or discomfort in the lower part of the abdomen. This is often due to stretching of the abdomen or the baby moving about too much. It may be relieved by sitting or lying down. Drinking plenty of fluids can also help prevent this problem. Toward the end of pregnancy women may notice irregular contractions of the womb. These are quite normal. But if a woman is still a month or more before her due date and the contractions become increasingly strong and regular and do not go away after resting, she should be advised to go to a health facility.

URINARY DISCOMFORT

During the first and last months of pregnancy, as the uterus and baby are pressing on the bladder, a woman may feel the need to urinate more often than normal. Drinking a lot of water and urinating often may help prevent infections. Signs of infection may include a painful burning sensation when urinating and a constant need to urinate with little or no urine actually passing. If a woman has these signs she should go to a health facility immediately for medicine, since urinary infections can become worse very quickly.

Figure 8.4: How to Stretch Out a Cramp in the Calf of the Leg

Stretch the leg out straight and point the toes back toward the body.

Summary: Minor Discomforts During Pregnancy There are a number of minor problems that a woman can have during pregnancy. Most of them can be taken care of within the home; none of them are life-threatening. The most common complications, and what to do about them, are: MORNING SICKNESS: Eat smaller meals more frequently, instead of several big meals. HEARTBURN: Avoid spicy foods and eat frequent, small meals. Do not lie down immediately after eating. CONSTIPATION: Drink water, eat vegetables and fruits. VARICOSE VEINS: Prop up feet when sitting; avoid standing for long periods of time. HAEMORRHOIDS: Avoid sitting for long periods; eat fruits and vegetables. VAGINAL DISCHARGE: If it is green or yellow and has an unpleasant odour, seek treatment at a clinic. BACKACHE: Keep back straight when sitting and standing; do exercises. LEG CRAMPS: Stretch the muscle out slowly by straightening the leg and pointing the toe back. SWELLING IN ANKLES AND FEET: Avoid tight clothing, shoes, and jewelry. If the swelling is sudden, go to a clinic. SHORTNESS OF BREATH: if prolonged, go to a health facility. ABDOMINAL PAIN: Drink fluids to prevent the pain. Sit or lie down when the pain strikes. If it is prolonged, go to a clinic. URINARY DISCOMFORT: Drink lots of water and urinate often. If there is pain, go to a health facility.