PREGNANCY

Indigestion & Heartburn Back pain  Pelvic pain Whooping cough 

 Self help advice for common problems

Your body has a great deal to do during pregnancy. Sometimes the changes taking place will cause irritation or discomfort, and on occasio

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ns they may seem quite alarming. There is rarely any need for alarm but you should mention anything that is worrying you to your maternity team.

Our Pregnancy section offers effective advice and guidance for pregnancy-specific conditions such as heart burn, backache and pelvic pain.

Indigestion and Heartburn in Pregnancy

Indigestion - also known as dyspepsia;in pregnancy is partly caused by hormonal changes, and in later pregnancy by the growing womb pressing on your stomach.

As many as eight out of 10 women experience indigestion at some point during their pregnancy. The symptoms of indigestion can include feeling full, feeling sick or nauseous, and burping. The symptoms usually come on after eating food.

Heartburn is a strong, burning pain in the chest caused by stomach acid passing from your stomach into your oesophagus (the tube that leads from your mouth to your stomach).

You can help ease the discomfort of indigestion and heartburn by making changes to your diet and lifestyle, and there are treatments that are safe to take in pregnancy. Talk to your midwife, GP or pharmacist.

Read more on symptoms, causes and self help tips..

Symptoms of indigestion in pregnancy

Symptoms of indigestion and heartburn in pregnancy are the same as for anyone else with the condition. The main symptom is pain or a feeling of discomfort in your chest or stomach. This usually happens soon after eating or drinking, but there can sometimes be a delay between eating a meal and developing indigestion.

You may experience indigestion at any point during your pregnancy, although your symptoms may be more frequent and severe during later pregnancy, from 27 weeks onwards. As well as pain, indigestion may cause:

  • heartburn, a burning sensation caused by acid passing from the stomach into the oesophagus

  • feeling uncomfortable or heavy

  • belching (burping)

  • regurgitation (food coming back up from the stomach)

  • bloating

  • nausea (feeling sick)

  • vomiting (being sick)

Causes of indigestion in pregnancy

The symptoms of indigestion (dyspepsia), including heartburn, are caused by stomach acid coming into contact with the sensitive protective lining (mucosa) of your digestive system.

The stomach acid breaks down the mucosa, which causes irritation and leads to the symptoms of indigestion. When you're pregnant, you are more likely to have indigestion due to:

  • hormonal changes that your body is going through
  • your growing womb (uterus) pressing on your stomach
  • the relaxing of the lower oesophageal sphincter (ring of muscle) that acts like a gate between your stomach and your oesophagus, allowing stomach acid to leak back up

You may be more likely to get indigestion in pregnancy if:

  • you had indigestion before you were pregnant
  • you have been pregnant before
  • you are in the latter stages of pregnancy

Your GP or midwife will usually be able to diagnose indigestion or heartburn from your symptoms and by asking you some questions. For example, they might ask:

  • how the symptoms are affecting your day-to-day life
  • what your usual eating habits are
  • if you have tried any treatments already
  • if you experienced indigestion or any other stomach conditions before you were pregnant

Your GP or midwife may also examine your chest and stomach. They may press gently on different areas of your chest and stomach to see whether this is painful.

Treatments for indigestion and heartburn in pregnancy

In some cases, changes to your diet and lifestyle may be enough to control indigestion, particularly if the symptoms are mild.

If you have severe indigestion, or if changes to your diet and lifestyle don't work, your GP or midwife may suggest using medication to help ease your symptoms. Several indigestion medicines are safe to use during pregnancy. However, check with your GP, midwife or pharmacist before taking anything they have not recommended.

The types of medicines that may be prescribed for indigestion and heartburn during pregnancy are:

Antacids

Alginates

Choice and dosage of antacids & alginates

Iron supplements

Acid-suppressing medicines

Ranitidine

Omeprazole

Self-help tips for indigestion in pregnancy

You may not need medicine to control your symptoms. Your GP or midwife may suggest some of the following changes to your diet and lifestyle. In many cases, these changes can be enough to ease your symptoms.

Stop smoking to banish indigestion

Here are 8 steps to take to help you stop smoking right away.

Avoid alcohol to ease indigestion

Eat healthily to avoid indigestion

Change your eating habits

Avoid indigestion triggers

Prop your head up

Prescription medicines that may cause indigestion


Backache in Pregnancy

During pregnancy, the ligaments in your body naturally become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause backache.

During pregnancy, the ligaments in your body naturally become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause backache.

Read more on avoiding backache and self help tips..

Avoiding backache in pregnancy

There are several things you can do to help prevent backache from happening, and to help you cope with an aching back if it does occur.

The tips listed here can help you to protect your back – try to remember them every day:

  • avoid lifting heavy objects
  • bend your knees and keep your back straight when lifting or picking up something from the floor
  • move your feet when turning round to avoid twisting your spine
  • wear flat shoes as these allow your weight to be evenly distributed
  • work at a surface high enough to prevent you stooping
  • try to balance the weight between two bags when carrying shopping
  • sit with your back straight and well supported
  • make sure you get enough rest, particularly later in pregnancy

A firm mattress can also help to prevent and relieve backache. If your mattress is too soft, put a piece of hardboard under it to make it firmer. Massage can also help.

Exercises to ease backache in pregnancy

The gentle exercise below helps to strengthen stomach (abdominal) muscles and this can ease backache in pregnancy:

  • start in a box position (on all fours) with knees under hips, hands under shoulders, with fingers facing forwards and abdominals lifted to keep your back straight
  • pull in your stomach muscles and raise your back up towards the ceiling, curling your trunk and allowing your head to relax gently forward – don't let your elbows lock
  • hold for a few seconds then slowly return to the box position
  • take care not to hollow your back – it should always return to a straight, neutral position
  • do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully
  • only move your back as far as you can comfortably

The National Institute for Health and Clinical Excellence (NICE) advises that exercising in water, massage therapy, and group or individual back care classes might help to ease back pain in pregnancy.

Some local swimming pools provide aquanatal classes (gentle exercise classes in water, especially for pregnant women) with qualified instructors. Ask at your local leisure centre. Being in water will support your increasing weight.

When to get help for backache in pregnancy

If your backache is very painful, ask your doctor to refer you to an obstetric physiotherapist at your hospital. They can give you advice and may suggest some helpful exercises.

Get tips on preventing back pain at work and find out how you can deal with stress at work.

Find out about more common problems in pregnancy, including pelvic joint pain (sometimes called SPD).
Healthtalkonline has interviews with women talking about their experiences of pelvic pain in pregnancy and how they coped.

Find out why antenatal classes are important, what to do on labour day and more.


Pelvic pain in pregnancy

Some women develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PPGP) or symphysis pubis dysfunction (SPD).

PPGP is a collection of uncomfortable symptoms caused by a misalignment or stiffness of your pelvic joints at either the back or front of your pelvis. PPGP is not harmful to your baby, but it can cause severe pain around your pelvic area and make it difficult for you to get around.

Read more about symptoms and managing everyday activities with PPGP..

Symptoms of PPGP

PPGP is a collection of uncomfortable symptoms caused by a misalignment or stiffness of your pelvic joints at either the back or front of your pelvis. PPGP is not harmful to your baby, but it can cause severe pain around your pelvic area and make it difficult for you to get around. Different women have different symptoms, and it can be worse for some women than others. Symptoms can include:

  • pain over the pubic bone at the front in the centre
  • pain across one or both sides of your lower back
  • pain in the area between your vagina and anus (perineum)

Pain can also radiate to your thighs, and some women feel or hear a clicking or grinding in the pelvic area. The pain can be most noticeable when you are:

  • walking
  • going upstairs
  • standing on one leg (for example, when you’re getting dressed or going upstairs)
  • turning over in bed

It can also be difficult to move your legs apart – for example, when you get out of a car.

There is treatment to help, and techniques to manage the pain and discomfort. If you get the right advice and treatment early on, PPGP can usually be managed and the symptoms minimised. Occasionally, the symptoms even clear up completely. Most women with PPGP can have a normal vaginal birth.

Who gets pelvic pain in pregnancy?

It’s estimated that PPGP, or SPD as it's sometimes known, affects up to one in five pregnant women to some degree. It’s not known exactly why pelvic pain affects some women, but it’s thought to be linked to a number of issues, including previous damage to the pelvis, pelvic joints moving unevenly, and the weight or position of the baby.

Factors that may make a woman more likely to develop PPGP include:

  • a history of lower back or pelvic girdle pain
  • previous injury to the pelvis – for example, from a fall or accident
  • having PPGP in a previous pregnancy
  • a hard physical job

When to get help for pelvic pain in pregnancy

Getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort. Treatment by a physiotherapist usually involves gently pressing on or moving the affected joint, which helps it work normally again.

If you notice pain around your pelvic area, tell your midwife, GP or obstetrician. Ask a member of your maternity team for a referral to a manual physiotherapist who is experienced in treating pelvic joint problems. These problems tend not to get completely better until the baby is born, but treatment from an experienced practitioner can significantly improve the symptoms during pregnancy. You can contact the Pelvic Partnership for information and support.

Treatments for pelvic pain in pregnancy

Physiotherapy aims to relieve or ease pain, improve muscle function and improve your pelvic joint position and stability. This may include:

  • manual therapy to make sure the joints of your pelvis, hip and spine move normally
  • exercises to strengthen your pelvic floor, stomach, back and hip muscles
  • exercises in water
  • advice and suggestions, including positions for labour and birth, looking after your baby and positions for sex
  • pain relief, such as TENS
  • equipment, if necessary, such as crutches or pelvic support belts

Coping with pelvic pain in pregnancy

Your physiotherapist may recommend a pelvic support belt to help ease your pain, or crutches to help you get around. It can help to plan your day so that you avoid activities that cause you pain. For example, don’t go up or down stairs more often than you have to.

The Association for Chartered Physiotherapists in Women’s Health (ACPWH) also offers this advice:

  • Be as active as possible within your pain limits, and avoid activities that make the pain worse.
  • Rest when you can.
  • Get help with household chores from your partner, family and friends.
  • Wear flat, supportive shoes.
  • Sit down to get dressed – for example, don’t stand on one leg when putting on jeans.
  • Keep your knees together when getting in and out of the car – a plastic bag on the seat can help you swivel.
  • Sleep in a comfortable position – for example, on your side with a pillow between your legs.
  • Try different ways of turning over in bed – for example, turning over with your knees together and squeezing your buttocks.
  • Take the stairs one at a time, or go upstairs backwards or on your bottom.
  • If you’re using crutches, have a small backpack to carry things in.
  • If you want to have sex, consider different positions, such as kneeling on all fours.

ACPWH suggests that you avoid:

  • standing on one leg
  • bending and twisting to lift, or carrying a baby on one hip
  • crossing your legs
  • sitting on the floor, or sitting twisted
  • sitting or standing for long periods
  • lifting heavy weights, such as shopping bags, wet washing or a toddler
  • vacuuming
  • pushing heavy objects, such as a supermarket trolley
  • carrying anything in only one hand (try using a small backpack)

You can get more information on managing everyday activities with PPGP from the Pelvic Partnership.

Labour and birth with pelvic pain

Many women with pelvic pain in pregnancy can have a normal vaginal birth. Plan ahead and talk about your birth plan with your birth partner and midwife. Write in your birth plan that you have PPGP, so the people supporting you during labour and birth will be aware of your condition.

Think about birth positions that are the most comfortable for you, and write them in your birth plan. Being in water can take the weight off your joints and allow you to move more easily, so you might want to think about having a water birth. You can discuss this with your midwife.

Your 'pain-free range of movement'

If you have pain when you open your legs, find out your pain-free range of movement. To do this, lie on your back or sit on the edge of a chair and open your legs as far as you can without pain – your partner or midwife can measure the distance between your knees with a tape measure. This is your pain-free range.

To protect your joints, try not to open your legs wider than this during labour and birth. This is particularly important if you have an epidural for pain relief in labour, as this will take away any pain that warns you that you are separating your legs too far. If you have an epidural, make sure your midwife and birth partner are aware of your pain-free range of movement of your legs.

When pushing in the second stage of labour, you may find it beneficial to lie on one side. This prevents your legs from being separated too much. You can stay in this position for the birth of your baby, if you wish.

Sometimes, it might be necessary to open your legs wider than your pain-free range to deliver your baby safely, particularly if you have an assisted delivery (for example, with the vacuum or ventouse). Even in this case, it is possible to limit the separation of your legs. Make sure your midwife and doctor are aware that you have PPGP. If this happens, your physiotherapist should assess you after the birth. Take extra care until they have assessed and advised you.

HealthTalkOnline has interviews with women talking about their experiences of pelvic pain in pregnancy and how they coped.


Whooping cough

Whooping cough (pertussis) is a highly contagious bacterial infection of the lungs and airways. Whooping cough can be severe in young babies and, in some cases, they may need to be diagnosed and given immediate treatment in hospital.

In the UK, all pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant. Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

Read more about whooping cough and the importance of getting vaccinated whilst pregnant.

The condition usually begins with a persistent dry and irritating cough that progresses to intense bouts of coughing. The gasping for breath after one of these coughing bouts causes a distinctive "whooping" noise, which is how the condition gets its name.

Other symptoms include a runny nose, raised temperature and vomiting after coughing.

The coughing can last for around three months (another name for whooping cough is the "hundred day cough").

Read more about the symptoms of whooping cough.


When to see your GP

See your GP as soon as possible if you think you or your child may have whooping cough.

Your GP can usually diagnose the condition by asking about your symptoms and listening to the cough (the whooping cough is very distinctive).

Whooping cough can also be confirmed with:

  • blood test – to test for antibodies to Bordetella pertussis bacteria
  • a sample of mucus taken with a swab – to test for Bordetella pertussis bacteria

Whooping cough can be severe in young babies and, in some cases, they may need to be diagnosed and given immediate treatment in hospital.


What causes whooping cough?

Whooping cough is caused by a bacterium called Bordetella pertussis, which infects the lining of the airways, mainly the windpipe (trachea) and the two airways that branch off from it to the lungs (the bronchi).

If the bacteria make contact with your airways, this leads to:

  • a build-up of thick mucus – which causes the intense bouts of coughing as your body tries to expel it
  • swollen airways – which makes breathing more difficult and causing the "whoop" sound as you gasp for breath after coughing

People with whooping cough are infectious from six days after exposure to the bacteria to three weeks after the "whooping" cough begins.

The bacteria is passed from person to person by infected droplets in the air, spread by coughing and sneezing.

Treating whooping cough

If whooping cough is diagnosed during the first three weeks (21 days) of infection, a course of antibiotics may be prescribed. This is to prevent the infection being passed on to others.

It's important to take steps to avoid spreading the infection to others, particularly babies under six months of age.

Children with whooping cough should be kept away from school or nursery until either:

  • five days from the time they start taking antibiotics
  • they have had three weeks of intense coughing

The same advice applies to adults returning to work.

As a precaution, household members of someone with whooping cough may also be given antibiotics and a booster shot of the vaccine.

Antibiotics won't usually be prescribed if whooping cough is diagnosed in the later stages of infection (two to three weeks after the onset of symptoms). By this time, you will no longer be infectious. It's also very unlikely that antibiotics will improve your symptoms at this stage.

Your GP will be able to advise you about how to manage the infection at home using some simple self-care measures, such as resting and drinking plenty of fluids to avoid dehydration.

Read more about treating whooping cough.

Babies under a year old are likely to be admitted to hospital as they are most at risk of severe complications, such as serious breathing difficulties.

They will be treated in isolation to prevent the infection spreading and will be given antibiotics into a vein through a drip (intravenously).

Read more about the complications of whooping cough.

Whooping cough vaccination

In the UK, all pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant. Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

Read more about the whooping cough vaccine in pregnancy.

Children are vaccinated against whooping cough with the 5-in-1 vaccine at two, three and four months of age, and again with the 4-in-1 pre-school booster before starting school at the age of about three years and four months.

Read more about preventing whooping cough.

Although the number of cases of whooping cough has fallen dramatically since vaccination began, it is still possible for children to get the infection, so having the vaccination is vital.

The more people are vaccinated against whooping cough, the less chance of passing on the infection to a young baby, which could cause serious, and possibly fatal, complications.

The effectiveness of the whooping cough vaccination may fade over time, meaning it's possible to develop the condition during adulthood, even if you were vaccinated as a child.

Who is affected?

Due to the success of the NHS vaccination scheme, whooping cough is now uncommon in young children.

Most cases occur in adults whose immunity has faded. In these cases symptoms tend to be less serious, although the persistent cough can be frustrating and unpleasant.

Whooping cough is a cyclical disease with the number of cases thought to peak every three to four years. An outbreak of whooping cough in 2012 meant 9,711 cases were confirmed in England and Wales compared to 4,835 confirmed cases in 2013.

The overall increase in the number of cases of whooping cough is thought to be related to heightened awareness of the disease and more cases being reported.


Self help for more common problems

Includes constipation, cramp, feeling faint, feeling hot, incontinence, skin & hair changes and varicose veins.

Constipation in pregnancy

You may become constipated very early in pregnancy because of the hormonal changes in your body.

Avoiding constipation

There are a few things you can do to help prevent constipation. These include:

  • eat foods that are high in fibre, such as wholemeal breads, wholegrain cereals, fruit and vegetables, and pulses such as beans and lentils (find out more about healthy eating in pregnancy)
  • exercise regularly to keep your muscles toned (find out more about exercise in pregnancy)
  • drink plenty of water
  • avoid iron supplements as they can make you constipated – ask your doctor if you can manage without them or change to a different type

You can find out more about the symptoms of constipation and treatment of constipation, including the safe use of laxatives during pregnancy.

Cramp in pregnancy

Cramp is a sudden, sharp pain, usually in your calf muscles or feet. It is most common at night. Nobody really knows what causes it, but there are some ideas about causes of cramp and why it can happen in pregnancy.

Avoiding cramp

Regular, gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and may help to prevent cramp occurring. Try these foot exercises:

  • bend and stretch your foot vigorously up and down 30 times
  • rotate your foot eight times one way and eight times the other way
  • repeat with the other foot

How to ease cramp

It usually helps if you pull your toes hard up towards your ankle or rub the muscle hard. You can find out more about treatment of cramp, but remember always to consult your midwife, GP or pharmacist before taking painkillers in pregnancy. See Can I take paracetamol when I'm pregnant?

Feeling faint in pregnancy

Pregnant women often feel faint. This is because of the hormonal changes occurring in your body. Fainting happens if your brain is not getting enough blood and therefore not enough oxygen.

You are most likely to feel faint if you stand too quickly from a chair or out of a bath, but it can also happen when you are lying on your back. You can find out more about causes of fainting.

Avoiding feeling faint

Here are some tips to help you cope:

  • try to get up slowly after sitting or lying down
  • if you feel faint when standing still, find a seat quickly and the faintness should pass – if it doesn’t, lie down on your side
  • if you feel faint while lying on your back, turn on your side

It’s better not to lie flat on your back in later pregnancy or during labour. Find out more about the symptoms that might mean you're going to faint, such as a sudden, clammy sweat, ringing in your ears and fast, deep breathing. You can also find out about treating faintness, including what to do to help someone who is about to faint.

Feeling hot in pregnancy

During pregnancy you’re likely to feel warmer than normal. This is due to hormonal changes and an increase in blood supply to the skin. You’re also likely to sweat more. It helps if you:

  • wear loose clothing made of natural fibres, as these are more absorbent and breathe more than synthetic fibres
  • keep your room cool – you could use an electric fan to cool it down
  • wash frequently to help you feel fresh

Incontinence in pregnancy

Incontinence is a common problem both during and after pregnancy. Sometimes pregnant women are unable to prevent a sudden spurt of urine or a small leak when they cough, laugh or sneeze, or when they move suddenly, or just get up from a sitting position. This may be temporary, because the pelvic floor muscles (the muscles around the bladder) relax slightly to prepare for the baby's delivery. You can find out more about the causes of incontinence and preventing incontinence. You can help to prevent incontinence by doing pelvic floor exercises.

When to get help

In many cases incontinence is curable. If you have got a problem, talk to your midwife, doctor or health visitor. You could also call the confidential Bladder and Bowel Foundation helpline on 0845 345 0165, Monday to Friday, 9.30am to 1pm. The Bladder and Bowel Foundation provides a factsheet on how to do pelvic floor exercises (PDF, 663kb).

Urinating a lot in pregnancy

Needing to urinate (pass water, or pee) often may start in early pregnancy. Sometimes it continues throughout pregnancy. In later pregnancy it is the result of the baby’s head pressing on your bladder.

How to reduce the need to pass urine

If you find that you need to get up in the night to pass urine, try cutting out drinks in the late evening. But make sure you drink plenty of non-alcoholic, caffeine-free drinks during the day. Later in pregnancy, some women find it helps to rock backwards and forwards while they are on the toilet. This lessens the pressure of the womb on the bladder so that you can empty it properly.

When to get help

If you have any pain while passing water or you pass any blood in your urine, you may have a urine infection, which will need treatment. Drink plenty of water to dilute your urine and reduce pain. You should contact your GP within 24 hours of first noticing these symptoms. You can find out more about:

Don't take any medicines without asking your midwife, doctor or pharmacist whether they are safe in pregnancy.

Skin and hair changes in pregnancy

Hormonal changes taking place in pregnancy will make your nipples and the area around them go darker. Your skin colour may also darken a little, either in patches or all over.

Birthmarksmoles and freckles may also darken. Some women develop a dark line down the middle of their stomach. These changes will gradually fade after the baby is born, although your nipples may remain a little darker.

If you sunbathe while you are pregnant, you may find you burn more easily. Protect your skin with a high-factor sunscreen and don’t stay in the sun for a long time. Find out more about keeping skin safe in the sun.

Hair growth can also increase in pregnancy, and your hair may be greasier. After the baby is born, it may seem as if you are losing a lot of hair but you are simply losing the extra hair.

Varicose veins in pregnancy

Varicose veins are veins that have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in the vulva (vaginal opening). They usually get better after the birth.

If you have varicose veins you should:

  • try to avoid standing for long periods of time
  • try not to sit with your legs crossed
  • try not to put on too much weight as this increases the pressure
  • sit with your legs up as often as you can, to ease the discomfort
  • try support tights, which may also help to support your leg muscles – you can buy them at most pharmacies
  • try sleeping with your legs higher than the rest of your body – use pillows under your ankles or put books under the foot of your bed
  • do foot exercises and other antenatal exercises, such as walking and swimming, which will all help your circulation

Try these foot exercises:

  • bend and stretch your foot up and down 30 times
  • rotate your foot eight times one way and eight times the other
  • repeat with the other foot

Find out more about preventing varicose veins.

  • try to balance the weight between two bags when carrying shopping
  • sit with your back straight and well supported
  • make sure you get enough rest, particularly later in pregnancy

A firm mattress can also help to prevent and relieve backache. If your mattress is too soft, put a piece of hardboard under it to make it firmer. Massage can also help.