Looking after your physical health and your emotional wellbeing during and after pregnancy is important. Feeling and being at your best sets you and your baby up to have the best possible experience of labour, birth and parenthood!
Common pregnancy complaints
Nausea and/or vomiting is very common, particularly in the first 12-16 weeks of pregnancy. Often known as ‘morning sickness’, this can be misleading, as it can occur at any time of day. It can help to have a snack before getting out of bed and eating small, regular meals throughout the day. There are plenty of other things you can try. Sometimes nausea and vomiting can be severe and debilitating, this is known as hyperemesis gravidarum, and may require treatment with antisickness medications and/or admission to hospital for treatment. It is advised not to brush your teeth immediately after vomiting, but rather to use a mouthwash containing fluoride (0.05%) no more than oncea day. If vomiting is occurring regularly in the day, rinsing immediately with water is advised. This will help prevent tooth wear caused by acidic products from the stomach entering the mouth.
Urinary tract infections are more common in pregnancy. You should look out for the signs and symptoms, and contact your GP or midwife urgently if you think you could have an infection. Symptoms include painon passing urine, passing small amounts of urine more often than usual, or urine that is cloudy and strange smelling.
Incontinence can affect women during and immediately after pregnancy and it is associated with pelvic floor dysfunction. Many factors can contribute to this, including the effect of hormones on the pelvic floor and pressure from the growing baby, which causes stretching of the pelvic floor muscles. This can affect how well they can work to support our bladder ad bowel function. Some women may leak a small amount of urine when coughing, laughing, sneezing or moving suddenly. If you experience these symptoms, you can seek specialist support from pelvic health physiotherapy via www.physioselfrefer.co.uk.
It is recommended that all women strengthen their pelvic floor during pregnancy and continue with this following birth. You may find the 'squeezy' app helpful for this. Further information can be found at Pelvic Health During Pregnancy - Suffolk and North East Essex Maternity and Neonatal Services including how to access on-line or face to face antenatal pelvic health education sessions.
Feeling faint is common and often caused by standing up too quickly or lying flat on your back. Always stand up gently and when lying down try to stay on your side, particularly after 28 weeks gestation.
Headaches may increase due to hormonal changes. Drink plenty of water, rest and take paracetamol if required. Contact your midwife/doctor if you experience a sudden severe headache (with/without problems with vision).
Indigestion/heartburn is caused by hormonal changes, and the womb pressing on your stomach as your baby grows. There are plenty of home remedies you can try. Milk and/or antacids can help ease symptoms.
This often occurs as the body holds morewater whilst pregnant. Avoid standing for long periods, rotate your ankles regularly and elevate your feet when seated if possible. Sudden and severe swelling isn’t normal and you should call your maternity unit if you notice this.
Constipation can occur from quite early on in pregnancy. Drink plentyof water and ensure you’re getting lots of fruit, vegetables and fibre in your diet.
This can affect one in five women during pregnancy. It can cause mild discomfort for some, and be very debilitating for others. Try to keep your knees together and avoid putting excess strain on oneside of the body during daily activities. Examples include getting dressed whilst sitting down, taking stairs one step at a time and using a backpack instead of a handbag. Ask your midwife about seeing a specialist physiotherapist if you’re experiencing problems with pelvic pain.
More information can be found here:
Infections, viruses and vaccinations
Chicken pox
CChicken pox is caused by the varicella zoster virus. Chicken pox is highly infectious and can be dangerous to your baby. If you had chicken pox as a child, it is likely that you are immune; you do not need to worry. If you are unsure whether you have had chicken pox before, you may be offered a blood test to confirm your immunity. If you think you may have come into contact with someone with chicken pox and you know that you are not immune, please phone your GP or midwife for advice. Do not attend the maternity unit for advice unless advised to by your midwife/doctor. More details about chicken pox here.
Sexually transmitted infections (STIs)
STIs such as chlamydia, herpes and gonorrhoea are becoming increasingly common and when left untreated in pregnancy can be dangerous to your baby. If you are concerned that you or your partner may have been exposed to STIs please attend your local sexual health service clinic for full sexual health screening. More information about STIs here.
Parvovirus B19 (slapped cheek syndrome)
Parvovirus is very infectious and usually affects children. The main symptom is a red blotchy rash on the face. It can also be accompanied by mild fever, headache and sore throat. If you contract parvovirus in pregnancy it can be harmful to your baby. Please speak to your GP or Midwife if you think you may have been in contact with parvovirus. More information about parvovirus here.
Toxoplasmosis
Toxoplasmosis is an infection caught by direct contact with cat faeces (poo), contaminated soil or contaminated meat. Most people don’t realise they have it, but it can cause flu like symptoms and it can harm your unborn baby. Pregnant women are advised to wear gloves when gardening or handling cat litter and to thoroughly wash fruit and vegetables to remove all traces of soil. We don’t test for toxoplasmosis routinely as it is very rare. More details about toxoplasmosis here.
Group B Streptococcus (GBS)
GBS is a transient bacterial infection, commonly found in the gut, occasionally spreading to the vaginal and rectal tract. GBS causes no symptoms and is harmless to adults. It can however be harmful to babies of infected mothers if they are born vaginally. GBS can be detected via urine tests or by taking swabs of vaginal and rectal mucosa. GBS is notroutinely tested for in pregnancy, however if it is detected or if you have been infected with GBS in the past, it will be recommended that you have intravenous antibiotics in labour, to protect your baby from infection.
More details about GBS here:
Flu vaccine
The flu vaccine is available in winter every year and is safe at every stage of pregnancy. The flu vaccine is recommended because catching flu when pregnant can cause serious complications for both you and your baby.
Whooping cough (pertussis) vaccine
The whooping cough vaccine is recommended for all pregnant women and can be given from 20-32 weeks. Whooping cough can cause pneumonia and brain damage in young babies but having a booster vaccine will help protect your baby.
Travel vaccinations
If you are travelling to countries that require specific vaccinations please speak to your practice nurse. Some vaccines that use live bacteria or viruses are not recommended during pregnancy because of concerns they could harm the baby in the womb. Inactivated vaccines are safe in pregnancy.
Physical health in pregnancy
There are some ways you can help yourself to stay healthy during pregnancy.
Resources:
Pre-existing conditions and pregnancy
It is important to tell your GP, obstetrician and/or midwife about any pre-existing physical or mental health conditions. This also includes any previous surgery (including cosmetic procedures) or any childhood conditions or health problems which you have now recovered from. This information helps the team assess if anything further is needed to keep you and your baby healthy during the pregnancy.
If you are under specialist care for your medical condition, it is important that you speak to them and discuss any impact your condition may have on your pregnancy. Ask them for a summary and for this to be written inyour antenatal notes. Notes don’t automatically move between hospitals and/or departments, so don’t presume that your midwife or doctor knows what your previous carers have said or recommended.
Please do not stop, or change, any medicationswithout medical advice.
Conditions we need to know about early (before 12 weeks) include:
- High blood pressure
You may need to start a small dose of medication as a preventative against a condition called pre-eclampsia. - Epilepsy
Certain medications may need to be stopped and changed to an alternative before you become pregnant, or as soon as possible if you’re already pregnant, due to the risks they pose to your baby. Some other medications need to be increased. - Diabetes
Your blood sugar levels will need to be closely monitored as your medication requirements are likely to change.
For more information visit:
Tips on improving mental wellbeing
At your booking appointment, the midwife will ask you questions about your mental and physical health so that they can find out whether you need any extra support. Every woman is asked these questions. Even if you don’t have a specific mental health issue, it’s a good idea to talk to the midwife if you’re feeling anxious or feel like you are isolated and/or do not have support.
Your midwife will ask you:
- how you are feeling
- whether you have or have ever had mental health difficulties
- whether you have ever been treated by a specialist mental health service
- whether a close relative has ever had severe mental illness during pregnancy or after birth.
- It’s important to be honest with the midwife about how you feel.
They won’t judge you, and they can help you get support or treatment if you need it. If the midwife thinks you need more support after talking to you, they will refer you to the most appropriate service for your needs such as talking therapies, a specialist midwife, specialist perinatal services or your GP.
It is not uncommon for mental health problems to start during pregnancy, so if you have any of the symptoms below at any point, speak to your midwife or doctor as soon as possible. If you are unwell they can arrange treatment to help.
- feeling low or anxious most of the time for more than two weeks
- losing interest in things you normally like
- having panic attacks
- feeling worthless or guilty
- losing your appetite
- having unpleasant thoughts that keep coming back and you can’t control them
- finding yourself repeating an action (like washing, checking, counting) to feel better
- finding your thoughts race and you become extremely energetic and happy
- feeling you are so afraid of giving birth that you don’t want to go through with it
- continual thoughts that you are an unfit mother or that you’re not attached to the baby
- thoughts about self harm or suicide
You should also tell your midwife or doctor if you have (or have had) an eating disorder, as you may benefit from additional support to deal with your body’s changes through pregnancy and beyond.
It may seem like everyone else is happy and coping, but it doesn’t mean they are. Lots of women feel low in pregnancy, but many women who feel down may try and hide it. Here are some tips to improve your emotional wellbeing:
Exercise and eat well
Swimming, walking, running, dancing, yoga - whatever works for you - keep doing it through pregnancy. Exercise gives you a chance to focus on something different, and is great for you and your baby’s health. A surge of endorphins, or stress-relieving stretches, can help you feel good and sleep better. Good nutrition will keep you healthy and help your baby grow and develop.
Take time out for yourself every day
Do something you enjoy that’s just for you: take a warm bath, chill out to some music, close your eyes, massage your bump – whatever makes you eel peaceful. Doing this will also help your baby’s brain to develop.
Meditation, breathing techniques or hypnobirthing
Many women find meditation and breathing techniques not only help them to relax in pregnancy, but can also help to manage pain in labour. Ask your midwife what classes are available at your maternity unit.
Talk to someone you trust
Getting things off your chest and talking your worries through with an understanding and trustworthy friend, family member or colleague at work can make all the difference. Talk about how you’re feeling.
Ask for practical help from family or friends
If you’re struggling to cope physically or emotionally with your pregnancy - get some help. Whether it’s help with housework, or shopping, or if you have other children, some childcare, try not to exhaust yourself and rest when you need to. If you do not have close supportive relationship, talk to your midwife about how you feel.
Develop a wellbeing plan
You can download and work on a two page personal plan, which helps you to think about your emotional wellbeing during pregnancy and after birth. Download your wellbeing plan here.
Consider talking therapies
Sometimes it’s easier to talk to someone that doesn’t know you. It can be a space to voice all your worries and try to make sense, or control some of the negative thoughts you might be having. Talking therapy services can provide support to those experiencing symptoms of anxiety or depression. Priority is given to pregnant women and new parents. You can either self-refer over the phone or online, or ask your midwife or GP to do it for you. The service is free and aims to be flexible around your needs.
Here are some talking therapies services:
If these tips don’t help you, and you feel low or worried for more than two weeks, it may be something more serious. The good news is that you can get help to feel better. Talk to your midwife or doctor about your options and where you might get support.
Uncommon complications in pregnancy
Gestational diabetes is high blood sugar that develops during pregnancy and usually disappears after the birth. It occurs when the body cannot produce enough insulin (a hormone responsible for controlling bloodsugar levels) to meet the increased demands of pregnancy. Symptom saren’t common, but many women are screened for this condition duringpregnancy, particularly if they have certain ‘risk factors’. Ask your midwife if you are at risk of developing gestational diabetes and if you need tobe tested.
Pre-eclampsia is a rare but serious condition of pregnancy, usually occurring after 20 weeks. It is defined as raised blood pressure and protein in the urine. Pre-eclampsia is usually detected through regularantenatal checks, but can sometimes develop quickly Symptoms include:
- severe headaches
- sudden increase in swelling - particularly in the face, hands,feet or ankles
- problems with your vision
- pain just below your ribs
- feeling very unwell or tired.
If you have any symptoms of pre-eclampsiaor intrahepatic cholestasis of pregnancy call your maternity triage/assessment unit straight away.
Intrahepatic cholestasis of pregnancy is a liver disorder that can develop in pregnancy (usually after 30 weeks gestation), affecting up to one in every 140 pregnant women. Symptoms include:
- severe itching, normally on the hands and feet (commonly)
- dark urine, pale stools (rarely)
- yellowing of the skin and whites of the eyes (rarely)
If you have any symptoms of pre-eclampsiaor intrahepatic cholestasis of pregnancy call your maternity triage/assessment unit straight away.
Placenta praevia can be picked up on an ultrasound scan as a ‘low lyingplacenta’ in mid pregnancy. This is when the placenta is covering all or part of the entrance to the womb. If you are found to have a low lying placenta you will be re-scanned between 32-36 weeks. The majority of low lying placentas will move to the upper part of the womb by 36 weeks, however 10% of low lying placentas remain low. This can cause bleeding in pregnancy that is sudden and severe.
A caesarean birth may be recommended in cases of severe placenta praevia, and the likelihood of needing for a blood transfusion can be higher. The placenta can also sometimes implant abnormally into the wall of the womb. This is a rare condition known as placenta accreta.
The risk of having placenta accreta is higher if there is a previous scar on the womb, such as from a previous caesarean section, as the placenta can invade into the previous scar. This is a very serious condition that can be challenging to manage and a hysterectomy (operation to remove the womb) is sometimes needed at the time of delivery.
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Vitamins and supplements during pregnancy
Vitamins and supplements help to keep you and your baby healthy during your pregnancy.
It is recommended that all women take folic acid and vitamin D supplements during pregnancy. You can buy these over the counter or alternatively ask your GP for a prescription. Folic acid can be stoppedwhen you are 12 weeks pregnant, whereas vitamin D can be taken throughout pregnancy and whilst breastfeeding.
Other vitamins are unlikely to be needed if you have a healthy and balanced diet. Some women find that their iron levels drop in pregnancy – you will be offered blood tests to see if you need any iron supplements.
If you receive certain benefits you may be entitled to free vitamins from Healthy Start.
Find out more about vitamins and supplements in pregnancy on NHS Choices.