Pregnancy ailments and changes in pregnancy

All kinds of ailments can arise during pregnancy that you did not have before, like nausea, frequent urination, fatigue, itchy skin, aversion to certain foods and smells, more discharge and back pain are mostly considered "normal". Your body will often use these ailments to "tell" you that it would be a good idea good to rest more frequently. Especially in the first few months of your pregnancy, a large amount of your energy will go into developing your baby, so adjust your lifestyle accordingly by sleeping and resting more. Eating small portions more often will help a bit against the nausea. The next few months of your pregnancy you will often feel more fit, have more energy and feel less affected by ailments. The last couple of months will be a bit harder again. Your belly will become much more full, your body will need more energy to get through the day and the ailments will often return in full force. It is said that in the last ten weeks of your pregnancy you actually age from around 40 to about  85 years old! You feel like your really have to slow down, you will sleep less deep, thus having to sleep during daytime, you often need to go to the bathroom, heartburn can become a problem and your concentration and memory don't work quite as well as you are used to.

It varies with each person how quickly and how much you will suffer from ailments. Some women can go on with their lives just like they would outside of pregnancy; others can do almost nothing anymore from day 1 of pregnancy. Most women are caught between these two extremes. It is important to recognize your boundaries and guard them well. The more you listen to your body and act on that, the better you will generally feel.

Listed below are things you can try yourself per ailment to improve them. As above, these tips will have a different effect on each individual. Therefore it is recommended to try out different tips to find out what works for you. If a specific ailment bothers you a lot and certainly if you feel that the ailment is not normal please contact us of bring this up during consultation hours.

Nausea - Fatigue - Mental Problems - Headaches - Frequent urinating / cystitis - Braxton Hicks contractions - Round ligament pain - Itching - Back pain - Pelvic pain - Discharge - Constipation and haemorrhoids - Sex - Pelvic floor - Movement of the baby - Acupuncture 

Nausea

Nausea is the most common ailment during pregnancy. Eighty percent of all pregnant women have to deal with it. In the first couple of months nausea is being caused by the changes in hormone levels. This kind of nausea varies from a sick feeling to the stomach to throwing up. This will mostly disappear after weeks twelve - sixteen of your pregnancy, but it also can remain during the whole pregnancy. It is important to keep eating during nausea. Most of the times your appetite will lessen, but eating less will increase the nausea. Avoid pungent food like spicy herbs and sour / acidic foods. It varies a lot per person what can and cannot be eaten without any problems. Dry foods like crackers and toasts often work very well. Dairy products can increase nausea, but sometimes can also lessen the nausea. Search for your own specific solutions that work to relieve your nausea. If your diet is not enough you could try some of the remedies that are known to work against nausea: vitamin B6, ginger or raspberry leaf tea, or even a sip of Coke can sometimes help. Try them out one at the time, and give it some time to see if it works. You can also go to a homeopath or an acupuncturist for help with nausea. If nothing helps or the nausea is so bad that you need to vomit regularly your GP can prescribe medication that are safe for use during pregnancy. If you need throw up so much that you feel you can't hold anything in then please contact us or your GP. There is a risk of dehydration which must be prevented or treated.

In the last months of your pregnancy it may occur that you become nauseous again. Often this will present itself as regurgitation of stomach acid. Your belly has become so much fuller than outside of pregnancy that your stomach gets less and less space. On top of that the muscle that closes the stomach is weaker because of the pregnancy hormones; so it is easier to get heartburn. With these ailments it is again important to watch what you eat. Make sure your stomach isn't too full or too empty. Eat small portions regularly. Here as above the problems vary per person. Generally dry products and dairy products (specifically custard or "vanille vla") work well against heartburn. Every food that contains pungent, acidic or carbonated ingredients will often increase the heartburn. Here too you can try home remedies. If this does not work sufficiently for you, you can buy antisecretory drugs at your pharmacy or drugstore. There are several different brands that mostly have the same working. Again, try to find what works for you specifically. Heartburn can also be a sign from your body signalling you to take more rest. Sometimes just taking more rest or breaks or reducing your tempo can work very well against heartburn. A lot of women have problems with heartburn specifically at night or in the morning. It could help to eat something just before going to sleep. It is also recommended to keep some food nearby to you when you go to sleep so that you can eat directly after waking up. You can also raise the headboard of your bed or use extra pillows.
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Fatigue

Fatigue is also a common complaint during pregnancy. Your body uses a lot of energy. If you keep doing what you were used to do, you will use much more energy than you normally would. It is logical that you will get fatigued from that alone. You will also sleep less deeply and fall asleep more difficult because of your pregnancy hormones. And if you need to urinate during the night a lot that again takes away sleep that you would normally get. In the last phase of your pregnancy it is also possible you can't sleep in the position you are used to; and every turn can then wake you (and it gets more and more difficult then to fall asleep again). It is important to compensate your lack of sleep during the night. This varies for each person, but the recommendation is to go to sleep earlier / wake up later or nap more if you feel very tired during the day. It is important to be as much rested as can be when you start your labour and your postpartum period, so listen well to your body. If you can't maintain a "normal" day-night-rhythm do not worry. Your baby won't have one either in the first weeks or months of his or her life.

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Mental problems

Because of all the changes during pregnancy you can be less mentally stable than usual. Partially this can be explained by your hormones changing, being fatigued and having other ailments. Another part of the explanation is that your pregnancy is a time in your life where everything is changing and can be seen in another light. That is fun and exciting on the one hand, on the other hand this can create fear and uncertainty. It is normal that you may react differently during the pregnancy than outside of it. You can be more labile, emotional and even feel gloomy during this period. This often goes back and forth and is something one can live with. It is wise to take plenty of rest and to take good care of yourself.

If you feel yourself getting more gloomy then please contact us and talk about the situation. We can discuss if additional support is wanted. Especially for women who have had mental problems or have had traumatic experiences before, additional support can be required in this area.
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Headaches

Headaches are often a sign from your body that you need more rest. Headaches may also indicate a lack of liquid. Drink more water to see if that helps. You can take paracetamol during the pregnancy according to package directions. Never take a painkiller with caffeine or codeine but always pure paracetamol. If you are beyond 22 weeks into your pregnancy and you have headaches accompanied by other symptoms like seeing stars, black spots in front of your eyes, nausea, high stomach aches or tingling of your arms that won't go away by taking more rest? Always contact us please! These complaints can indicate a blood pressure that is too high. It may be wise then to do an additional check-up.
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Frequent urinating / cystitis

It is normal to urinate more in your pregnancy than outside of it. Your bladder gets less space and must be emptied earlier. As long as you urinate normally this is not a problem. A cystitis (inflammation of the bladder) does occur frequently during pregnancy and often does not cause clear symptoms. To prevent cystitis it is wise to drink a lot of water and take in enough or even extra vitamin C. If you frequently have cystitis you can use cranberry juice or capsules which contain much vitamin C. These are available at drugstores and pharmacies without prescription. 

If you often really feel an urge to urinate but (almost) nothing comes out, that could point to a cystitis. This can be coupled with tightness or a stabbing pain in your lower abdomen. Please let your urine be checked by your GP. The best thing is to bring your GP some "clean" urine. With this we mean that you wash / shower first, urinate a bit on the toilet and then catch the rest in a clean jar. Consult your GP to check on which part of the day they would like to do the medical examination. If you have a cystitis this will be treated with antibiotics. This is important because a non-treated cystitis can lead, in extreme cases, to premature contractions even if your due date is far away. Moreover, an infection during the pregnancy can result quite easily to a pyelonephrites (inflammation of the kidneys). This can make you really sick and must be treated in the hospital. If your regularly have cystitis during the pregnancy it is wise for your GP to make a culture of your urine to check which bacteria is involved. Always keep us informed if you have a cystitis and possible culture results.
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Braxton Hicks contractions

Braxton Hicks contractions are contractions of the uterus. The uterus is a muscle. That muscle will be stretched greatly during the pregnancy. A normal reaction of that muscle is that ocassionaly it momentarily contracts. You can feel your uterus turn hard, henceforth the Dutch term "harde buik" (hard stomach). Braxton Hicks contractions can be felt from 18 weeks into the pregnancy and forward and are quite common and normal. Often they can give an unpleasant feeling or sensation, but they never hurt. Some women have Braxton Hicks contractions very frequently, while other women never feel them. Most women are in between those two extremes and feel them occasionally.

Your body can use Braxton Hicks contractions to indicate that you are being too busy. If that's the case you will get more and more Braxton Hicks contractions and often they will hurt a bit too. Usually they won't bother you much during the day but you will feel them in the evening when you are relaxing. You will feel a nagging pain in your lower abdomen, just like with a menstruation. This always is a sign to take very seriously. Have your urine checked to make sure that you don't have a cystitis. If that is not the cause, please rest until the pain has gone away and the Braxton Hicks contractions have diminished. Please contact us if you are in doubt.
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Round ligament pain

Round ligament pain is a sharp pain or jabbing feeling often felt in the lower belly or groin area on one or both sides. It is one of the most common complaints during pregnancy and is considered a normal part of pregnancy. Several thick ligaments surround and support your womb (uterus) as it grows during pregnancy. One of them is called the round ligament. The round ligament connects the front part of the womb to your groin, the area where your legs attach to your pelvis. The round ligament normally tightens and relaxes slowly.

As your baby and womb grow, the round ligament stretches. That makes it more likely to become strained. Some women have a lot of round ligament pain, while others never have those problems. On the whole round ligament pain occurs less with the first pregnancy than subsequent pregnancies. It can be annoying but it is harmless. It may help to adjust your tempo and walk or bike more slowly. Furthermore it can help to support your belly by wearing tighter pants or using a belly band. Your belly will "hang" less and your ligaments will be spared more. If you have a cold it is wise to hold your belly when you cough or sneeze to try not to tax the ligaments too much.
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Itching

Itching can bother you in several variants in the pregnancy, with and without spots on the skin. Most forms are annoying but not harmful. Showering and rubbing unscented ointments or oil helps to relieve the itching. If the itching really bothers you a lot you can get a more potent ointment from your GP, but he will not prescribe this lightly. If you have an increasing itch in the second half of your pregnancy that mostly occur on the inside of your palms and the bottom of your feet you need to inform us. It could be necessary to take a blood test to see how good your gall bladder is working at that time. This itch may indicate a problem that needs to be examined because it can have consequences for the baby. 
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Back pain

Back pain is a common ailment in pregnancy. Especially for women who have had troubles with their back before this often reappears during pregnancy. Your equilibrium changes because of the growing uterus. Your back will also be bend in a different angle than outside pregnancy and it will be taxed more. Please pay attention to your posture and how you lift / pick up things from early on in your pregnancy. The more you do this calmly and with more awareness the better you can use your back with less problems and pain. You can also consciously use your abdominal muscles while you are standing to support your back. You can do this by pulling in your bellybutton, which makes your pelvic tilt slightly. If you experience pain in your back that does not go away by resting or changing your tempo or if the pain is so intense that it hinders your movement and well being it may be wise to go to a physiotherapist. The physiotherapist can't often take away all of the pain but can give you information on what to do and on what not to do with regards to movement and exercises. We do recommend you to find a physiotherapist that has specialized in pregnancy. This can be a physiotherapist or a mensendieck therapist. Our assistant can help you with names and telephone numbers.
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Pelvic pain

Due to the changes in hormones your ligaments will be softer than outside of pregnancy. This results in the connections between the bone parts of the pelvic becoming weaker. During delivery this is beneficial because extra space will be created in the passage of the pelvic. However, during pregnancy this can cause problems. Pelvic pain is mostly felt in the pubic bone or in the sides of the lower back where the so called SI-joints are situated. Most women only feel this pain later on in pregnancy and mostly when they move. It is usually sufficient to take everything more slowly and calmly. Pelvic pain is mostly felt at night because of the pressure on the pelvic caused by laying down on bed a long time. It could help to put a pillow between the knees if you sleep on your side, or putting the pillow under your knees if you sleep on your back. If the pelvic pain increases despite taking everything slow, it is recommended to visit a specialized pelvic therapist. He or she can locate the problem precisely and give you a specific treatment to counter the problems. The pain does not completely go away most of the time after this, but the given regimen and exercises can help prevent the pain from getting worse. If the symptoms are serious it could be necessary to follow the given regimen and exercises during the first week(s) after the delivery. The pelvic pain and problems go away after the delivery. This could take a long while (months). In general, the more time and rest you take for your recovery the faster this recovery will take place.
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Discharge

It is common to have more discharge during pregnancy; this is usually transparent white and dries up yellow-like. This increase in discharge is caused by hormonal changes and a higher production of mucus in the external os of the cervix. This discharge is common and normal. If you want to use a pantyliner take care that it does not contain a plastic layer. Plastic generates more heat and gives a bigger chance of a yeast infection. During the pregnancy you will have a higher risk of getting symptoms from the Candida fungus everyone carries with him/her. If you get a lot of white, crumbly discharge and an increasing itching it could point to a yeast infection. Often this will disappear when untreated, but if it bothers you, you can buy medication in the farmacy or drugstore. Often the yeast infection will return a couple of weeks later. If you have a yeast infection in the last weeks of the pregnancy it is recommended to treat it. Otherwise, the baby can contract the fungus during the delivery. That does not necessarily have to cause problems, but it could give the baby thrush in the mouth. This thrush can than create problems with drinking.
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Constipation and haemorrhoids

A lot of women have troubles with bowel movement during pregnancy. Because of your changing hormone levels the intestines will not work as good as outside of pregnancy. It is important to watch what you eat. Lots of high-fibre food, plenty of water and an adequate amount of fruit and vegetables usually provide better bowel movement. Plums and kiwis are extra recommended. Drinking a glass of lukewarm water and eating a kiwi when getting up in the morning often does wonders. You can also drink plum juice or Roosvicee laxo. For good bowel movement it is recommended not to eat too much white bread and bananas.

Due to the weakening of the vascular walls (again brought on by the changes of hormones) and combined with gravity and the pressure of the pelvis, a lot of pregnant women suffer from haemorrhoids. A haemorrhoid is a bulge from a blood vessel. This can stay internally within the intestines, but can also come out through the anus. Haemorrhoids cause pain in both cases, especially when defecating. Haemorrhoids can also bleed while defecating. To prevent haemorrhoids or ensure they do not get worse if you do have one (or more) it is important to keep your stool as smooth as possible. It also recommended not to stand up, walk or sit all day because of the pressure on the pelvic floor. Lie down regularly if you can take a break, you will relieve this pressure for a moment. If you suffer from haemorrhoids you use a lidocaine ointment that will relieve the pain. You can also try Curanol, a homeopathic remedy that many women have good experience with. If haemorrhoids or constipation bother you a lot and these tips do not help enough, please inform us during consultations hours or contact your GP. He or she can prescribe medication in some cases.
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Sex

A woman's sex drive often changes during pregnancy. Some women do not experience this at all, but especially women who are very tired and/or experience nausea have less of a sex drive. Because of better blood flow all around the pelvic area lots of women want to have more sex than normal during the first few months of pregnancy. As the baby grows and the belly gets bigger it could prove more difficult to have sex; not only mechanically but also emotionally. A partner can look very differently at his or her pregnant woman. Men are also sometimes afraid to damage something while making love.

As long as sex does not hurt and feels good for both involved there is no objection to making love. The baby is properly shielded in the womb and does not suffer from lovemaking. After an orgasm a pregnant woman can get some Braxton-Hicks contractions. They can be a bit painful but will soon pass. There also can be a little bit of blood loss after sex. This can occur because the cervix area has much more blood flow and it is easy to damage a small blood vessel. It can be compared to a bloody nose and is nothing to worry about. If you often have blood loss after lovemaking we would recommend you to go to your GP. He or she can examine the cervix for infections or polyps. You can keep making love as far in the pregnancy as you wish. Sex could even start your delivery! Sperm contains prostaglandins that can induce labour and an orgasm could possibly kick start the contractions. It is important not to have sex after the water has broken; in that case you have a higher chance of getting an infection.

After giving birth it usually takes time for both parents to be ready for lovemaking again. Life is busy with the new baby, you often will feel tired and together your role will be more of parents than of love partners. In addition women usually are not as well lubricated because of hormone changes which can make having sex more difficult or even painful. As long as you are bleeding after giving birth it is not recommended having sex. The cervix is still partially open which gives a greater risk of infection. When the blood loss stops there is no medical reason not to have sex. During the pregnancy and after giving birth it is very important to give each other some room/space because of the changed situation in your lives. It can help to talk about your wishes and/or expectations and to take some time. A healthy dose of humour can help a lot to have fun together in bed. After giving birth it can be useful to use a lubricant the first couple of times you make love. And by that time it is wise to think about contraception again.
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The pelvic floor

The pelvic floor is a collection of muscles who together form the foundation that carries and supports all your abdominal organs. Furthermore it contains the sphincters of bladder and bowel. The pelvic floor has a rough time during the pregnancy. On the one hand all muscles weaken because of changing hormone levels, on the other hand the belly gets more full and bigger and the pelvic floor must carry an increasing load. Most pregnant women have trouble with weakening of muscles to a varying degree. This usually manifests itself in a heavy feeling in the pelvic floor or an occasional thrusting of cramping pain. In extremes cases the pelvic floor will function far less than usual and (partial) incontinence can occur. To help the pelvic floor pregnant women should lie down regularly relieve pressure from the muscles. Having short lie downs more often is better than having one long rest. Doing exercises for the pelvic floor is good but does not have much effect during pregnancy. It is more useful (and recommended) to do those exercises after giving birth. The functioning of the pelvic floor will mostly restore itself, but the original strength does not come back without exercise. Women often do not notice this until they have trouble with incontinence or prolapse later in life. And by then it is too late for exercise. You can exercise by yourself after giving birth or follow a special course for pelvic floor exercises postpartum. There is also the option of going to a pelvic floor physiotherapist for advice. More information on the pelvic floor during and after the pregnancy can be found here.
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Movement of the baby

From about the 19th week of the first pregnancy (with a subsequent child this is often earlier) you can start to feel the movements your baby makes in your belly. The first couple of weeks this will be irregular and variable. What you feel depends greatly on where your baby lies, where the placenta is situated and what you are doing yourself at that moment. From about 24 weeks onwards the baby will be so big and strong that we expect you to feel movements daily and frequently. It is difficult to state what a normal movement pattern is because it varies so much between every woman and every child. On average one can feel movements of the baby about 6 - 10 times a day. But one woman can feel movements practically throughout the day while another woman can count the times she feels movements on the fingers of one hand. These differences are not saying anything important about the health or personality of the baby. If you can establish what a normal movement pattern for your baby is after a while, it is important that this movement pattern stays the same. If you feel big changes please pay extra attention. You can also write down on a note how much you feel and what you feel. From about 34 weeks onward one often sees that the baby will make less movements. The baby gets less and less space and thus can make less big movements and stays more time in one position. Usually this does not mean that the baby moves less, but that the baby makes smaller, softer, more subtle movements. If you feel much less movement than what is usual for your baby and this continues after you have taken the time to feel and to make contact with your baby call us at our 06 number. Call us especially if you are worried about  (the lack of) movements of the baby.
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Acupuncture

Next to all these tips you can also benefit from acupuncture. There are acupuncturists who have specialized in treating pregnant women. They treat (among others) ailments like nausea, fatigue and headache. They can also help turning the baby when the baby is in breech position at the end of the pregnancy or help to start your delivery because you have, for example, reached almost 42 weeks of pregnancy. Two acupuncturists we have had good experiences with are Sabine Schmitz, telephone number: 06-51846508 and Manon Ritter, telephone number: 06-42723731.
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