Headaches. The best treatment for headaches depends on the type of headache. If you are having recurrent headaches, we can assess your headaches and direct you to the most appropriate treatment. For simple headaches, try Tylenol first. Also caffeine works very well for most types of headaches. Laying down and relaxing with a warm or cold compress on your head may also help. If you suspect that your sinuses are causing your headache, then an antihistamine like Allegra, Zyrtec, or Claritin may help, but avoid those drugs with the “-D” component.
Bleeding. Some amount of bleeding during the first trimester is very common, affecting about one-third of pregnant women. Avoid sex if you are bleeding until we can discuss the bleeding or it resolves. Bleeding increases your risk of miscarriage, but, surprisingly, not by very much. If you are having heavy bleeding and cramping, you may need to be seen. Bleeding later in pregnancy may be a sign of labor or other problems. It can also be normal. Always discuss heavy bleeding with us immediately.
Contractions. Contractions can be very uncomfortable and worrisome but they are also very common and normal. Distinguishing between real labor contractions and so-called Braxton-Hicks (B-H) contractions can be confusing sometimes, but here are general guidelines. Real labor contractions are almost always very frequent, every 2-4 minutes apart; whereas B-H contractions are less frequent (7-20 minutes apart). Real labor contractions are very predictable and regular, B-H contractions less so and irregular. Real labor contractions are painful and get more painful over time; B-H contractions may be painful at times but the intensity decreases over time.
The best way to tell the difference between real labor and false labor is to given yourself some time and observe what is happening. Relax, drink some water, and see what happens over 2-3 hours. If, over that time, your contractions are occurring more frequently and just a few minutes apart, are lasting longer, hurting more, and very regular, then you may need to call us or go to the hospital. False labor tends to decrease in intensity over time and may go away altogether with rest in a few hours. Always call us if you are unsure, particularly if you are preterm.
Leaking fluid. Leaking fluid could be a sign that your bag is broken, and you should always go to this hospital if you suspect this. Usually, when your bag of water is broken, the leakage will be continuous and will saturate through your underwear. When pregnant, women are more likely to occasionally urinate on themselves and this can sometimes be surprising and mistaken for leaking amniotic fluid. Also, discharging a small amount of fluid over time could be a sign of vaginal infection that may need to be treated.
Decreased fetal movement. You shouldn’t expect your baby to move at all until around 20 weeks. Some women feel movement sooner than this, usually women who have been pregnant before. When you first start to feel movements, they may be inconsistent and you might go days without feeling movement. You shouldn’t necessarily expect to feel daily movements until about 23-24 weeks. When the baby’s movements have become regular and well-established, you can expect to feel at least 6 movements in one hour during the babies active time if you are paying attention to them. For many women, this active time is shortly after they have eaten dinner. If you don’t feel 6 movements in one hour but you are feeling some movements, then 10 movements over 2 hours is also acceptable. However, anything less than this is a reason to go to the hospital or office and be evaluated.
Nausea and Vomiting. Nausea and vomiting of pregnancy (NVP) affects two-thirds of pregnant women. Eating smaller, bland meals may help, especially early in pregnancy. Make sure that acid reflux or heartburn is treated as this can contribute to the problem. Surprisingly, the most effective treatments for NVP are over the counter. You should start with taking Vitamin B6, 25 mg, two or three times per day. If you are still having problems, then add Unisom SleepTabs at night, and perhaps half of a tablet in the morning. This combination relieves half of the symptoms of NVP. Ginger (three 250mg capsules a day and one before bed) sometimes helps women, too. If you are having trouble after this, talk to us. We may prescribe other anti-nausea medicines. The good news is that it usually gets better, with most women only having symptoms for about 35 days in the first trimester. Most mild cases of nausea and vomiting do not harm your health or your baby’s health. Nausea and vomiting is considered severe if you cannot keep any food or fluids down and begin to lose weight, requiring more intensive medical care than just anti-nausea medicines. If nausea and vomiting persists or even begins after the first trimester, it may be due to another cause which would need to be ruled out by your physician.
Heartburn. Avoid eating spicy, acid-producing foods and eat smaller, more frequent meals. Don’t eat right before bed. Sleep with your head slightly elevated if you are having trouble. Acid relievers like Tums, Gaviscon, Maalox, and Mylanta are all safe. So too are antihistamines like Cimetidine and proton-pump inhibitors like Omeprazole. You may need to take these medicines daily.
Constipation. Pregnancy is notorious for causing constipation. Increasing fluid and fiber intake can help tremendously. Beyond this, using Miralax daily or other drugs like Colace can help too.
Hemorrhoids. Treating constipation is the first step to helping hemorrhoids, which typically worsen during pregnancy and get better afterwards. Preparation H and Anusol are safe to use, as well as Tuck’s Pads or Witch Hazel.
Pain. Various pains, particularly back and pelvic pain, are common in pregnancy. Stretching and strengthening exercises can help, such as Pilates or Yoga for pregnancy. Wearing a pregnancy support belt can help as well. Taking Tylenol is safe and using warm compresses or pads may help too. You should wear low-heeled shoes with a good arch support. Avoid lifting heavy items by yourself. Elevate one food on a support if you must stand for long periods of time. Don’t bend at the waist, but with your knees. Try to sleep on your side with one or two pillows between your knees. Place a board under your mattress to make your bed more firm.
Of course, a massage would be wonderful and is safe during pregnancy, and some Chiropractors will take pregnant patients. We sometimes may prescribe muscle relaxants or physical therapy.
Seasonal Allergies. Allegra, Zyrtec, or Claritin are safe, but avoid those drugs with the “-D” component. Most other over allergies remedies are safe as well.
Here are some common questions about pregnancy problems:
What can I do for constipation?
Constipation is incredibly common during pregnancy; in the 19th century, some people called pregnancy the Disease of Constipation. The good news is on of the remedies and treatments that you might normally use for constipation are still safe in pregnancy. You should start by increasing your water and fiber intake. Many women will add daily use of MiraLAX or a generic equivalent to their diet. This is a gentle agent that is non-stimulating and safe to use during pregnancy. If it's been a few days (for a week) since you went, you may need to stimulate a bowel movement from below. Try using a Dulcolax suppository, and if this doesn't work you can repeat it in two hours or so.
If these over-the-counter remedies are not helpful, talk to your doctor.
You've probably heard the the folktale that a lot of heartburn means that your baby will have a lot of hair; this probably isn't true, but dreams of a well-coiffed baby undoubtedly doesn't make your pain any better.
Heartburn or indigestion or acid reflux is a common problem during pregnancy and likely gets worse throughout the third trimester for most women as the uterus grows and puts more pressure on the stomach. If you have occasional symptoms, then avoiding triggering foods and using some Tums may be enough; but for persistent symptoms, it is okay to use over-the-counter or prescription antacid medications, including both proton pump inhibitors and antihistamines. Click here for a list of medicines that are safe to use during pregnancy
Why am I itching?
Most itching in pregnancy is related to dry skin. A good lotion can go a long way to reducing or eliminating itching related to this problem. In some cases, itching confined to one area may be related to a reaction to something, for what is called a contact dermatitis. If you suspect this is the case, try to avoid whatever you came into contact with a consider using an antihistamine or over the counter steroid cream until you are better.
In rare cases, itching all over the body that is not associated with a rash can be due to intrahepatic cholestasis of pregnancy or ICP. ICP is an important diagnosis to not miss and your doctor may need to check some labs to make sure you don't have this. If you do, she will prescribe medicine to improve the situation and she will likely deliver you a couple of weeks earlier than normal.
Why don’t I feel the baby moving?
The answer to this question depends on how far along you are. If you are less than 20 weeks or so, you probably are just too early to feel any fetal movement. First time moms don't typically report feeling movements for the first time (quickening) until 20 weeks or so; women who have had children before often feel the first movements two or three weeks sooner. Even after these gestational ages, it is still common to go a few days without feeling fetal movement until about 24 weeks or so.
After 24 weeks, you should expect to feel some movement everyday but how much movement varies from pregnancy to pregnancy. You or your partner may not be able to feel the baby with a hand on the outside of your belly simply because you have an anterior placenta or the baby is turned and kicking in the other direction.
If you are concerned that you have not felt enough feeling movement, and you are after 24 weeks, then lie down on your left side and concentrate on feeling for movements. You should feel six movements of some sort in the first hour; if you have felt some movements but not six, then go another hour. You should feel a total of 10 movements or more in a two hour period and sometimes it takes a while because babies have periods of time when they are asleep. If it's been two hours and you have not felt 10 movements then you may need to go to the doctor or the hospital for evaluation.
You might have read on the Internet that you should do "Kick counts" every day. Most pregnant women do not need to do this in the practice may actually be harmful overall to the pregnancy. Only do daily kick counts if your doctor has told you to for a specific reason.
How can I prevent stretch marks?
The short answer is no.
Though there are a lot of products marketed to pregnant women who are willing to spend a lot of money to prevent stretch marks, none of them have good scientific data that they work. Some products site their own small studies, but don't waste your money on that kind of evidence. If your belly is dry and it feels good to use a nice lotion or other skin care product, go for it! But don't pretend that it will prevent any stretch marks.
Why are my legs and hands so swollen?
Ah, the joys of pregnancy! If constipation, hemorrhoids, and heartburn weren't enough to make you feel glorious, just wait until your legs start swelling.
Most swelling or edema in pregnancy is normal. Swelling is common; about 60% of women will have significant lower extremity swelling and a large number of these women will also have swelling in their hands that make rings too tight and wrists hurt. Much of the conventional wisdom about swelling during pregnancy is related to a concern for the development of preeclampsia, but swelling is so common, that in most cases this is not really a concern at all. Your doctor checks your blood pressure at your regular visits to make sure that you're not developing preeclampsia.
Most swelling in the legs is related to the uterus blocking the return of blood that is collected by gravity in the legs. As the uterus gets bigger, it blocks the veins that drain the legs back up to the heart. Since there are no pumps in the legs, then the blood tends to pool and this leads to swelling. You may be able to make this temporarily better by elevating your legs, particularly while laying on your side. But for most women who are up and working throughout the day, there is little opportunity for this. Wearing a pair of support hose may help tremendously.
If your hands are swelling, you may have symptoms of carpal tunnel syndrome which is very common during pregnancy. Wearing an over-the-counter wrist splint at night on one or both hands will lead to significant improvement of these painful symptoms.
One common myth about swelling is that a woman should drink more water when she is swelling to make the swelling better. This is simply untrue. If you're having significant swelling in your legs, you may also find that you are lightheaded or having woozy episodes because you're water content has left your blood vessels and gone into your soft tissues; in this case, drinking more water may help you not feel as woozy, but it will not affect how badly you are swollen.
My back is killing me. What can I do?
Back pain in pregnancy is almost universal. The bigger the belly, the more curved the spine, and the worse the back pain. As your center of gravity moves forward with ever increasing belly size, you're hips rotate forward, the curvature of your back changes, and the muscle groups that you use In your back to maintain your posture change. Because you are not used to using these muscle groups to stay upright, and because all of your muscles are doing more work than normal carrying around the extra weight, then the result is chronic muscle strain, sprain, and fatigue.
What's a girl to do?
- For starters, you can use acetaminophen to treat the pain and, if you are less than 22 weeks pregnant, you can still use nonsteroidal anti-inflammatories like ibuprofen or naprosyn. A heating pad on the back, or heat releasing patches, or a nice bath may also help a lot.
- Exercise can help tremendously. Gymnasts and ballet dancers rarely complained of back pain during pregnancy because they have well-developed back musculature and core abdominal muscles. Exercises that help strengthen the back in core abdominal muscles can provide relief and prevent worsening problems as the pregnancy goes on. This includes things like Pilates or Yoga.
- Many women benefit from wearing a back brace or pregnancy support belt. These devices tend to change your center of gravity slightly and help redistribute the load. Typically, these are most helpful in the third trimester and even though you may not have needed one in your first pregnancy, because you likely carry the baby differently in your second or third pregnancy, you might find one helpful in those subsequent pregnancies.
- A good massage is nice and some women will appreciate chiropractic therapy during pregnancy as well. In some cases, your doctor might order physical therapy.
- It is unusual for back pain during pregnancy to require any testing or other treatments. However, if you have a history of chronic back pain or orthopedic abnormalities, be sure to tell your doctor.
Why can’t I breath?
Literally 97% of pregnant women complain of shortness of breath at some time during their pregnancies. Most of the time, this is related to some of the pulmonary physiologic changes of pregnancy that give women the sensation that they are not breathing and deeply or moving as much air with each inspiration; but their actual oxygen status remains unchanged. It is normal to feel as if you are not breathing is deeply or if your rate of respirations increase with less vigorous activity while pregnant.
Rarely, difficulty breathing is a sign of a more serious problem. If you're having trouble catching your breath even while resting or if you have symptoms of low oxygen levels, like changes in the color of your skin or confusion, then you may need to seek medical care immediately. Women who have underlying asthma may also have shortness of breath related to uncontrolled asthma during pregnancy and this would be a reason to seek immediate medical attention. Also, if you noticed that you can't sleep without propping your head up with several pillows, you may need to talk to your doctor.
Otherwise, if you're shortness of breath is just with exertion and becomes improved with rest, this is likely normal.
What can I do for my headache?
Pregnancy is good and bad for headaches.
The good news is, migraine headaches are uncommon during pregnancy. Most chronic migraineurs thoroughly enjoy pregnancy because it is one of a few times in their lives when they don't suffer from migraine headaches.
The bad news is, other types of headaches, particularly tension type headaches, can become more common during pregnancy with the musculoskeletal strains and intentions of pregnancy and the anxieties and stresses associated with pregnancy.
You can always use acetaminophen at anytime during pregnancy for headache. If you're less than 20 weeks, you can still use Ibuprofen or Naprosyn. Other medications like Excedrin Migraine can also be used on a limited basis.
A good massage, a relaxing bath, or just a good night's rest may be the cure for a tension type headache.
Sometimes headaches have other causes, like sinus infections or allergies. If you suspect that your sinuses are the problem try and over-the-counter antihistamine and if this doesn't work talk to your doctor.
Some women in the first trimester have caffeine withdrawal headaches. If you have recently cut out all caffeine because you're pregnant these types of headaches are all too common. Remember that you can have up to 350 mg of caffeine per day. You may need to add a little bit of caffeine back in order to prevent headaches. Caffeine also is a treatment for some tension type headaches as well. Taking your acetaminophen with a serving of caffeine maybe just what the doctor ordered.
What can I for my acne?
Unfortunately, acne tends to get worse during pregnancy. Blame your hormones and you're beautiful, oily glow of pregnancy. Still, there are a few things that you can do. It is safe to wash your face with benzoyl peroxide during pregnancy. Benzoyl peroxide is the common ingredient of most over-the-counter acne remedies. Check the label.
If you wash your face at night and then go and lay down on your pillow from last night, you may find that you have re-contaminated your face with last nights oils and bacteria. One evidence-based trick is to place a fresh clean towelette over your pillow each night that you removed in the morning. This towelette can collect the new night skin oils and bacteria and not allow them to saturate into your pillow in pillowcase. Just change it each night.
Many other acne treatments are not safe during pregnancy. Ask your doctor before trying any other remedies.
Why does sex hurt?
Sex is safe during pregnancy and often a lot of fun. Most couples enjoy the pregnant woman's body's changes during pregnancy but sometimes women can find sex painful and problematic.
Some women find it difficult to become relaxed during pregnancy because they're worried that sex maybe harmful to the pregnancy; this is an unnecessary fear – sex is not associated with any negative outcomes during pregnancy.
Most of the time discomfort and pain during sex is just related to your changing anatomy and body shape. Familiar positions may become uncomfortable because your belly is in the way and more penetrating positions may become less desirable because your uterus has started to take space away from the upper part of your vagina. Usually, a little creativity can be both fun and problem-solving. Rear-entry positions, with the help of the few pillows or a wedge cushion, can solve several problems at once. The woman on top, as long as it's not too penetrating, can also be pleasurable for both and it can allow you to determine the angle of injury and the depth of penetration to a degree. Finally, if you lay on your side and draw your top leg upwards, this can allow your partner to straddle your bottom leg and enter at a 90° angle from the normal. This side saddle approach allows for complete control over the angle of entry and allows you to control the depth of penetration with your top leg; he is very unlikely to complain.
Why is my heart beat so fast?
Due to some of the physiological changes of pregnancy, is common for women's resting heart rate to be about 10 to 15 bpm faster while pregnant. Pregnant women are also more likely to have bigger increases in their heart rate with exertion since they or doing more work while pregnant. This increased work starts even in the first trimester, as pregnant women have a blood volume of expansion of over 40%; but it doesn't stop there, as pregnant women also do more actual work, moving around another 35 pounds or more.
Is the uterus gets larger, the heart is actually pushed upwards and rotated to the left; this changing position of the heart allows women to become more aware of their heart beating and sometimes this is alarming because we don't normally perceive that our heart is beating in our chest. Couple this with the fact that the heart may be beating faster than normal, then this can be quite anxiety provoking. But as long as your heart rate isn't too fast it rest and you don't notice that it is irregular, don't worry too much. If you feel like that you're heart rhythm is irregular for your heart rate is staying persistently very fast, talk to your doctor.
I have gestational diabetes. Now what?
If you failed your glucose screen and your glucose tolerance test, then you now have gestational diabetes.
Hopefully, you'll get a chance to talk to a dietitian. In the meantime, cut out all of the simple sugary items from your diet: colas, cookies, cakes, candies, and other sources of sugary carbs. Pay attention to portion size. If you're not already, and-in for or five 20 minutes walks or other cardiovascular exercise sessions per week.
You'll need to check your blood sugar several times per day, at least initially. You should check your blood sugar first thing in the morning, a fasting blood glucose, and then check it two hours after each large meal – breakfast, lunch, and dinner. You're fasting blood sugars should be below 95 and your blood sugars after meals should be below 120. If your blood sugars are running higher than this, you may need to take medicine to help lower your blood sugars.
Is also helpful in the beginning at least to track what you are eating. This can help your dietitian and your doctor decide if their are some things you should do differently in your diet. It can also help you understand why your blood sugar might spike – for example, after delicious pizza.
Is my discharge normal?
Probably. Pregnant women have more of a vaginal discharge then nonpregnant women. It is common for pregnant women to wear a panty liner while pregnant because of this discharge. Most of this discharge is physiologic and represents cervical mucus. If your discharge has a bad odor or itches or is green in color, tell your doctor to make sure it's not an infection. Otherwise, expect to have some discharge throughout pregnancy.
These hemorrhoids are a pain in my ***! Help!
Nobody likes a hemorrhoid. Unfortunately, they are common during pregnancy and become more common in the third trimester. All of the normal over-the-counter remedies for hemorrhoids are perfectly fine to use while pregnant, including Preparation H and Anusol HC. Tuck's Pads, which are pads infused with Witch Hazel, are also effective. Many women will use the pads in combination with one of the creams.
Most hemorrhoids get significantly better after delivery, though they may get worse with pushing. Sitz bath's with added Witch Hazel, may be your best friend in the postpartum.
Rarely, hemorrhoids become thrombosed and need to be dealt with surgically as an emergency. You should suspect that a hemorrhoid has become thrombosed if you have new and different severe pain, preventing you from even sitting down. If you're worried about this, ask your doctor immediately.
Is it normal that my boobs are leaking already?
Yes. Especially if you've already had children, you might notice that your milk comes in early or that you have occasional leakage even in the first trimester. Even if you haven't had a baby yet, it's not uncommon at all for you to leak some milk. If this is a persistent problem (and an embarrassing one), you might need to change up your bra or wear nipple shields so that your nipples are less stimulated.
I need help breastfeeding.