Problems

Headaches

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 the few times in their lives when they don’t suffer from migraine headaches.

The bad news is, other types of headaches, particularly tension headaches, can become more common during pregnancy with the musculoskeletal strains, tensions, anxieties, and stresses associated with pregnancy.

You can always use acetaminophen at any time during pregnancy for headache. If you’re less than 20 weeks’ gestation, 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 headache.

Sometimes headaches have other causes, like sinus infections or allergies. If you suspect that your sinuses are the problem, try an over-the-counter antihistamine and if this doesn’t work, talk to your doctor.

Some women have caffeine withdrawal headaches, especially in the first trimester. These headaches are all too common if you have recently cut out all caffeine because you’re pregnant. 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 is also a treatment for some tension headaches as well. Taking your acetaminophen with a serving of caffeine may be just what the doctor ordered.

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 you can discuss the bleeding with your doctor or it resolves. Bleeding increases your risk of miscarriage, but, surprisingly, not by very much.

If you are having heavy bleeding and cramping, you need to be seen. Bleeding later in pregnancy may be a sign of labor or other problems. It can also be normal. A lot of women will spot later in pregnancy, especially if their cervix is starting to slowly make change. Always discuss heavy bleeding with your doctor immediately. This is almost never a reason to go the emergency department, but it is a reason to be seen in the office in the next day or two.

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.

The best way to tell the difference between real labor and false labor is to give yourself some time. Relax, drink some water, and see what happens over the next 2-3 hours. Real labor is progressive in every way, but you won’t be able to see this until some time has passed. If you’re having some regular contractions, the best thing to do is to see what happens over the next two to three hours. If you are really in labor, your contractions will become more frequent (maybe going from every six to seven minutes apart to every three to four minutes apart), last longer (going from, say, 30 seconds in length to 45 or 50 seconds in length), become more painful, regular, predictable, and persist. False labor, on the other hand, may start strong but will lose steam and wane over two to three hours.

Leaking fluid

Leaking fluid could be a sign that your water is broken, and you should always go to this hospital if you suspect this. Usually, when your 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.

Pregnant women also have more vaginal discharge than 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. The more babies you’ve had, the more likely you are to experience this discharge. If your discharge has a bad odor, 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.

Decreased fetal movement

If you are less than 20 weeks’ gestation or so, you are probably too early to feel any fetal movement. First time moms don’t typically report feeling movements (quickening) for the first time until 20 weeks or so; women who have had children before often feel the first movements two or three weeks sooner (around 17-20 weeks). 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 every day, but how much movement you feel 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 fetal movement and you are more than 24 weeks’ gestation, then lie down on your left side and concentrate on feeling for movements. You should feel at least six movements of some sort in the first hour; if you have felt some movements but not six, then continue counting for another hour. You should feel at least 10 movements during those two hours. Because of fetal sleep cycles, it’s not uncommon for it take two hours to feel the ten movements. Ideally, this is done during the baby’s active time. For many women, the baby’s active time is shortly after they have eaten dinner. So, maybe try eating a little something if you don’t reach the six kicks in an hour, and then extend to counting for the two hour mark. If you don’t reach 10 movements in two hours, then this is a reason to go to the hospital or office and be evaluated.

You might have read on the Internet that you should do “kick counts” every day. Most pregnant women do not need to do this as the practice may actually be harmful overall to the pregnancy. Only do daily kick counts if your doctor has told you to do it for a specific reason

Nausea and Vomiting

Nausea and vomiting during pregnancy is no one’s idea of a good time. Unfortunately, it affects about two-thirds of pregnant women. The good news is, nausea and vomiting are not associated with risks to the pregnancy; the bad news is, you are nauseated and throwing up.

What can you do?

  • Eat several small meals per day and avoid high-fat foods.
  • Eat more bland foods and avoid smells that are noxious.
  • Increase the protein and liquid content of your food.
  • Ginger ale, ginger teas, or ginger capsules can help (three 250 mg capsules a day and one before bed).
  • Taking a vitamin B6 supplement (25mg) 2-3 times per day alone or in combination with Unisom SleepTabs (doxylamine) at night may be beneficial.

Your doctor may need to prescribe an anti-nausea medicine for you if these remedies don’t resolve the issue. There are several drugs that are safe in pregnancy to choose from, including ondansetron (Zofran), metoclopramide (Reglan), promethazine, haloperidol, and a few others.

Make sure that your acid reflux and constipation are treated since both of those can contribute to nausea and vomiting as well.

In bad cases, you may need to be hospitalized for IV fluids and other treatments if you are unable to keep anything down and experiencing signs of severe dehydration/malnutrition.

Hopefully, you should feel better by the end of the first trimester. If you don’t, or if the above remedies are not working, your doctor may need to investigate other causes of your nausea and vomiting apart from pregnancy. Typically, you shouldn’t be concerned as long as you can maintain your body weight and stay hydrated during the first trimester. If you lose a few pounds from the nausea and vomiting, it isn’t too concerning; but, more significant losses should be investigated further.

Heartburn

You’ve probably heard 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 won’t make your pain any better.

Heartburn aka acid reflux aka GERD is a common problem during pregnancy and 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, avoiding trigger foods and using TUMS may be enough. For persistent symptoms, it is okay to use over-the-counter medications like TUMS, Gaviscon, Maalox, or Mylanta, as well as OTC or prescription antacid medications such as proton pump inhibitors (omeprazole, pantoprazole) and antihistamines (cimetidine).

Constipation

Constipation is incredibly common during pregnancy; in the 19th century, some people called pregnancy the Disease of Constipation. The good news is that all the remedies and treatments you might normally use for constipation are still safe during 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 has been a few days since your last bowel movement, you may need to stimulate a bowel movement from below. Try using a suppository (e.g., glycerin or Dulcolax), and if this doesn’t work you can repeat it in two hours.

If these over-the-counter remedies are not helpful, talk to your doctor.

Hemorrhoids

Nobody likes a hemorrhoid. Hemorrhoids don’t even like hemorrhoids. 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. Tucks 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 baths with added witch hazel may be your best friend in the postpartum period.

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, different severe pain that prevents you from being able to sit down. If you’re worried about this, ask your doctor immediately.

Pain

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 your ever increasing belly size, your hips rotate forward, the curvature of your back changes, and the muscle groups you use 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, the result is chronic muscle strain, sprain, and fatigue.

Things to try include using acetaminophen to treat the pain and if you are less than 20 weeks’ gestation, you can still use nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen or Naprosyn occasionally. A heating pad on the back, heat releasing patches, or a nice bath may also help a lot.

Exercise can help tremendously. Gymnasts and ballet dancers rarely complain of back pain during pregnancy because they have well-developed back musculature and core abdominal muscles. Exercises that help strengthen the back and 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 (belly band). These devices tend to change your center of gravity slightly and help redistribute the load. Typically, these are most helpful in the third trimester. Even if you did not need one in your first pregnancy, keep in mind that during your second or third pregnancy you carry the baby differently in your pelvis and it may be beneficial this time around.

Massage can be beneficial and some women may need help from a physical therapist. Your doctor can let you know if physical therapy or, in some cases, pelvic floor physical therapy, might be appropriate for your symptoms. In some cases, we may prescribe muscle relaxants but these tend to be sedating. Still, they can be useful at night.

It’s 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 or midwife. Various pains, particularly back pain, pelvic pain, and round ligament pain, are common in pregnancy.

Here is a list of things that can help relieve pains:

  • Stretch and do strengthening exercises like Pilates or Yoga
  • Wear a pregnancy support belt
  • Use Tylenol
  • Use warm compresses or pads
  • Wear low-heeled shoes with good arch support
  • Avoid lifting heavy items by yourself
  • Elevate one foot on a support if you must stand for a long period of time
  • Bend with your knees, not at the waist
  • Try to sleep on your side with one or two pillows between your knees
  • Place a board under your mattress to make your bed firmer

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: