You are likely to feel various types of pain in your abdomen in the course of pregnancy. Very rarely are these associated with something bad. Rather, they are the result of a fast growing organ (your uterus) in a relatively small space. Early in pregnancy, before you have an u/s, we worry about pain the abdomen because there is always a risk of ectopic. So if you have abdominal pain and have not had an u/s yet, you need to give us a call. Once we know you don’t have an ectopic, which we know once you have had an u/s showing a heart beat in the uterus, we are less concerned. It is difficult to define or tell you why every pain happens. But overall, if the pain goes away on its own and is not constant and severe, it is likely related to normal growth. If the pain is severe and not going away on its own within 1-2 hours, you should give your provider a call.
Back pain in pregnancy is common. It is very difficult for the upright human body to tolerate the sudden weight onto the front of your body. That said, there are lots of things to try that can help. First and foremost, make sure that you are doing regular exercise unless we have discussed a specific contraindication. Even a brisk daily walk will help with general aches and pains and energy. Another option is yoga. Many patients do very well with yoga in pregnancy to help with aches and pains as well as health. If your pain is in your lower back, you may also consider an abdominal support. You can find this at most baby stores or Amazon. If your pain is in your upper back, between your shoulder blades, you need a more supportive bra. After all of that, you still may have some pain. We advise heat and tylenol as you need it. If your pain is bad enough that it is interfering with getting your daily activities done, talk to your provider about other options like physical therapy.
Your body goes through many changes during pregnancy and your breasts are not exempt. You will notice many changes in your breasts. Many people complain of increased pain and tenderness. You may also notice changes to your nipples. Changes in size and color that are normal. Some people complain of burning in the nipples. Some people notice small “whiteheads” increasing in number on the nipple. Most people will notice some leaking prior to delivery, though this doesn’t happen to all. There is no time frame when leaking may occur, it can happen anytime in the pregnancy. Don’t worry that you are losing colostrum (the extra nutrient stuff that comes out after delivery), this doesn’t really form until after delivery. All of this is normal. We generally advise making sure of basic stuff like a well fitted bra.
Headaches in pregnancy are very common. For some they seem to occur because of hormonal changes, so of course these are hard to treat or avoid. But generally, many headaches can be avoided by healthy habits or at least treated once they start. The first thing to remember is that outside of hormones, headaches are usually due to not enough water, not enough food or not enough sleep. So try to solve those problems the best you can. Next, when you do get a headache, hit it early and fast with a serving of caffeine and a dose of Tylenol. If you are having severe frequent headaches, your provider might have you see your primary care provider to evaluate for other reasons for headache.
During pregnancy two things happen that make heartburn almost inevitable. First, hormones of pregnancy cause the sphincter between your stomach and your esophagus to loosen, allowing acid to splash up. Second, later in pregnancy your uterus expands pushing up on your stomach which again cayuses acid to splash up. Luckily, you live in an era where we have some nice fixes for this. We usually recommend that you start treatment with Tums or Mylanta. If this is not doing the job, you can move on to Pepcid or Zantac (their generic equivalents are fine) and you can take those up to twice per day. If that is not working, then let your provider know. We can move on to prescription drugs.
On occasion, you may feel as if somebody quickly stabbed a knife into your vagina. This complaint is probably one of the primary reasons your provider started thinking about this website. Despite the fact that we hear it from most pregnant women, it is not described in books or literature. It is not a sign of pre-term labor, or the baby coming out. Rather, it is a common complaint with no associated bad findings. We think it probably happens due to nerve pressure from the expanding baby and uterus. You’ll figure this out on your own, but you just kind of have to let it pass.
There are mainly 3 kinds of leg complaints during pregnancy. The first is simple pain, usually self resolved which can occur randomly anywhere in the leg. Sometimes this is numb rather than pain. This is most likely related to nerves traveling through the pelvis and being compressed by the enlarging uterus. There is nothing really to do about this but it is not anything to worry about. The second complaint we hear about is leg cramps. These can be pretty impressive, mostly at night. We recommend increasing your calcium and increasing hydration. It is also not a bad idea to stretch before going to bed. The third complaint is swelling. This is also probably the most common and annoying. Lower leg and ankle swelling occurs frequently in pregnancy. Mostly this happens towards the end but it can happen at anytime. The good news is it is not a sign of anything bad. The bad news is there are few fixes. But we do have a couple of hints. First, do try to increase hydration, the more you have things moving through your kidneys the better. Second, when at rest put your feet up. This doesn’t mean you have to rest, just take advantage when you do. Third, if you have access to water, hang out in at least 6-10 feet of water (maybe with a kick board). The water pressure can work in your favor to push some of that water back into your circulation.
The only concerning possibility for leg pain and swelling is the possibility of a blood clot. Usually this is suggested by one sided swelling (mostly calf) along with distinct calf or leg tenderness and pain. If you note this please give your provider a call. We’ll need to send you for some imaging to make sure you don’t have a blood clot.
Unfortunately nausea and vomiting is VERY common (though not necessary) in pregnancy. For most people it will only last for the first trimester. For some "lucky" individuals it lasts longer. Either way, this is not a symptom we truly understand and to be quite honest it is not a symptom we can alleviate completely. But we can offer some words of advice to try to live your life. Here are some pointers:
0-eat small frequent meals; sometimes keeping something in your stomach can help with the nausea
-eat something immediately in the morning (and we mean at your bed side table) the moment you get up, like crackers
-ginger really does help, whether in the form of tea, ginger ale or candies
-sea bands, those cloth bands with the plastic disk you can buy in the pharmacy, the pressure point on the wrist works
-hard candies, especially peppermint or lemon
v-itamin B6, 50mg up to three times per day
-adding to the B6 you can add doxylamine (sold as a type of Unisom) 10mg up to 4 times per day (this will make you sleepy but sometimes that is better than nausea)
Sometimes despite all of the above you will still have nausea and or vomiting. If this is limited to nausea and occasional vomiting your provider may encourage you to hold strong and know that this is likely to eventually go away.
If you are not functioning or vomiting constantly please call your provider, we can consider prescription medications.
This is your second or third (or more) and you seeing some signs and symptoms that you didn’t experience with your first or maybe they are just earlier and/or worse. Remember, your previous pregnancy(s) changed your body, so this body is not the body that was pregnant last time. We expect you to feel pressure sooner (this is never a sign of early labor). We expect you to notice contractions sooner. These are normal but of course you should still watch for regular painful contractions. You may also feel more tired. Our theory on that is it is much harder to take care of a child or children and be pregnant at the same time rather than that first pregnancy when you were just pregnant and did not have another child. Be patient with yourself, get the best rest you can. Abdominal support belts are often very helpful in next pregnancies.
Like abdominal pain, you can’t grow a human being in the relatively small space of your abdomen and pelvis without some discomfort. You are likely to feel some low pelvic/groin pains and stretches throughout your pregnancy. Most people are very fearful of these especially in early pregnancy because of the fear of miscarriage. When the pain is fairly constant and no bleeding is involved it is more likely to be related to what we call round ligament pain. It is called this because the ligaments that hold your uterusin place and are attached to the walls of your pelvis are called the round ligaments. They have to stretch along with the uterus as it grows and that is just not always comfortable. You may also notice some episodes where if you move quickly you you experience a sharp pain. We can assure you that you did not rip something. It is when more stretch is put on something that is already stretched. You’ll need to give it a moment until it passes. You will also feel pressure in your pelvis, especially towards the end. This is not a sign of impending labor or delivery. It is simply a sign that you have a large organ sitting on and inside of our pelvis. When some of these things get really uncomfortable, try getting on hands and knees. Cows and dogs don’t have this problem.
Your chest wall and ribs do not like to expand. But as you get larger, your belly will likely encroach on the ribs causing anywhere from soreness to outright pain. Many times position changes or sitting more upright in bed can help. Sometimes you may have to wrap the ribs to provide them support. This can be done with anything from ace wraps to belly supports to weight lifting belts. You can also use heat or cold depending on what feels right.
Hormones have a huge effect on your skin. You may see darkening of some areas of your skin. You may see increased hair growth on your body. Most women get a darkening of the skin line running from the belly button down to the lower abdomen. This is called the linea nigra and is a normal skin change of pregnancy. You can not treat or avoid these skin changes, so don’t try. The other common finding are stretch marks on the abdomen. This is a largely genetic trait so you can’t do anything to avoid getting them. Please don’t spend a lot of money on expensive creams that claim they will prevent or treat stretch marks, none of them work. The old fashioned remedies of coconut oil or vitamin E are for comfort of the stretching belly but again won’t prevent stretch marks. You may also notice changes in your moles or freckles. This is a very common change but we don’t like to assume anything with the skin so if you notice significant darkening, enlarging or changing of moles or pigments, please have it checked out by a dermatologist.
You will note changes in your vaginal discharge throughout pregnancy. For the most part we hear complaints about too much or increased discharge. The good news here is that increased discharge is not a sign of anything bad. In fact, it is common to get significantly increased discharge towards the end of pregnancy. This is likely due to the changes occurring as the cervix softens and gets ready for labor and dilation. There is no dangerous level of discharge, unless you think you have been exposed to chlamydia or gonorrhea, in which case please tell us. Otherwise, many of our patients get diaper rash before their babies because of wearing pads or liners.
Bleeding during pregnancy is very common. The important question is how much and when. A small amount of self-limited spotting at any point in the pregnancy is common enough not to be concerned about. During the first trimester, we often see a small amount of bleeding. While the embryo is implanting, it needs to burrow into the lining of the uterus and hook into the mother’s blood supply. There can often be some bleeding in this process But not everyone does. If your bleeding is more like heavy period bleeding along with cramping then you need to give your provider a call. As well, if you notice any kind of bleeding along with abdominal pain and you have not yet had an ultrasound, you need to give your provider a call. In this case we are worried about an ectopic pregnancy (where it implants outside of the uterus). This can be life threatening and needs to be diagnosed as soon as possible. So if you have significant abdominal pain (with or without bleeding) and have not had an u/s yet, please either call your provider or go to the ER.
In the second trimester, again, a small amount of spotting can be normal. Especially after intercourse. If this remains a small amount and stops, you can observe. If the bleeding comes along with contractions, you should give your provider a call.
At the end of the pregnancy, anytime after 34 weeks, some bleeding very normal as the cervix starts to soften and change. If this is a small amount you can watch. If it is a large amount you should give your provider a call.
If you have been diagnosed with a low lying placenta or placenta previa you should give your provider a call if you experience any bleeding beyond spotting.