By Kate Sidley
Gynaecologist Dr Bronwyn Moore gives us the low down on what’s normal and what’s not during pregnancy, and when you should call your doctor.
Constant lower back pain
Lower back pain is common in pregnancy – around 65% of women suffer from it. As your uterus grows, it stretches and weakens the muscles in your abdomen. Hormones soften your ligaments. These changes can result in changes to your posture and put strain on your lower back and pelvis.
Call your doctor if:
- The pain is severe or getting worse.
- You experience loss of feeling in your legs, buttocks, or genital area.
- You have fever, nausea, or blood in your urine. Back pain can be caused by kidney infection.
- You think you’re in labour. Lower back pain towards the end of the second term, or during the third trimester, may be a sign of preterm labour.
- Back pain associated with labour is spasmodic, not constant. Contact your doctor immediately.
Swollen hands and feet
Mild swelling up to the mid calf is normal. It tends to be worse later in the day, and better on rising, and usually worsens in the last trimester. High temperatures in summer also make it worse. However, swelling is a sign of pre-eclampsia, a serious condition that can put you and your baby at risk.
Call your doctor if:
- The swelling is excessive or sudden, or if you notice swelling on your face. Have your blood pressure and urine checked as soon as possible.
- One leg is significantly more swollen than the other, or if you also have tenderness in the thigh or calf, as this could indicate a blood clot.
Mild cramps and blood-spotting at six weeks
Cramping and mild spotting in the first eight weeks of pregnancy often occur when the fertilised egg implants in the uterine wall. Throughout pregnancy, it’s not unusual to experience a small amount of bleeding after sex or exercise. This is localised bleeding, due to friction on the cervix.
When is it an emergency?
Any bleeding after the first trimester should be discussed with your doctor, particularly if the amount of blood is significant or increasing. If you start to bleed in the last trimester, head straight for the hospital. It could be an abruption, where the placenta tears from the uterine wall.
Don’t worry if you’re exhausted, it’s your body working hard and changing constantly. There are more hormones buzzing about, particularly progesterone, which causes sleepiness.
By the end of the first trimester, your body will have adjusted and you should have more energy. Late in your pregnancy, you may become exhausted again as your growing baby puts demands on your body. You may also struggle to get comfortable and find yourself waking in the night.
Speak to your doctor if:
- Your tiredness doesn’t improve after trimester one
- Your tiredness seems particularly severe
- You are dizzy, weak, or fainting.
Fatigue can be symptomatic of other conditions, such as anaemia or a thyroid problem. So do mention it at your regular antenatal visit.
- Mild to moderate morning sickness, with nausea and/or vomiting, is reported by around 70% of pregnant women. You might feel anywhere from blah to downright ghastly, but it’s normal.
- Hypermesis gravidarum is a more serious condition, in which severe and ongoing vomiting – sometimes four or more times a day – results in weight loss and dehydration. It’s more common in multiple pregnancies and is associated with molar pregnancies (a placental abnormality). A sonar will exclude these.
- Take this condition seriously to avoid dehydration, malnutrition, and to ensure that your baby is not adversely affected. Often, a brief stay in hospital is required.
- “The patient may be given a drip with fluids, as well as anti-nausea medication. We do have medications that are effective and safe in pregnancy,” says Moore. Your doctor will note your symptoms and monitor your weight gain at regular antenatal check-ups.
See your doctor if:
- You’re unable to keep down any liquids for a period of more than 8-10 hrs
- You’re also experiencing fever, diarrhoea, abdominal pain, headaches, fainting, or dizziness.
- Changes in hormones, your cervix, and the vaginal walls will account for this increase in leucorrhea – a milky, thin, and odourless discharge.
- As labour approaches, your discharge may contain thick mucus and some blood. This is the cervical plug coming away from the neck of the cervix and it’s called the ‘show’. This often is one of the first signs of labour.
- Thrush is common in pregnancy and usually is associated with itching and increased discharge. Topical treatments can be used, but the oral medication is not prescribed in pregnancy.
Speak to your doctor if:
- The discharge is yellow, green, or brown
- It smells
- You feel sore or itchy.
Contact your doctor or midwife immediately if you’re less than 37 weeks pregnant and you experience a sudden increase in discharge, or if it becomes mucus-like or tinged with blood. This could be a sign of preterm labour. Similarly, a thin, watery discharge may be leaking amniotic fluid. If you are unsure, contact your doctor.
Gas, constipation, and ligament pain can cause occasional discomfort in the tummy area during pregnancy. However, abdominal pain could be potentially something serious. In the early days, things to consider might be an ectopic pregnancy or miscarriage. In the late second and early third trimester, it can be an indicator of preterm labour.
Consult your doctor urgently if you experience:
- Severe or persistent pain
- Pain along with bleeding, fever, chills, faintness, vomiting, nausea, or discomfort when urinating.
My baby hasn’t moved much
- From 25 weeks you should feel regular movement a few times a day. If you notice your baby has gone quiet, encourage him to move by eating or drinking something, or taking a warm bath. If he still doesn’t move, have it checked out.
- Closer to term, lack of movement is a serious indication that something might be wrong. Contact your doctor or go to the labour ward for an assessment immediately.
- A decrease in movements can indicate a lack of nutrients or oxygen, and your doctor will want to assess the situation.
When to go to the hospital:
- If you experience vaginal bleeding
- Fluid draining from the vagina
- Regular painful uterine contractions
- If you’re concerned about your baby’s movement.