As the pregnancy advances, many women feel heavy and tired. The baby takes up more space, often creating several discomforts. Towards the end, it is normal to feel fed up with being pregnant, just wanting your baby to arrive soon!
Backache and sciatica
Hormones soften and relax the ligaments connecting the pelvis to the lower back, at the sacroiliac joints, making the bones prone to moving out of align- ment causing pain. The sciatic nerve may also be pinched, causing shooting pains down the buttock and back of one leg (sciatica). As your belly swells, the centre of gravity shifts, favouring incorrect posture, which doesn’t help. Incorrect lifting, sitting, and moving techniques can twist and strain back muscles unnecessarily. After 36 weeks, babies in a posterior position can also cause lower backache. Upper back pain may be felt with desk work, sewing, or holding and feeding a new baby after the birth.
What some women find helpful:
- Maintain good posture – Tuck your bottom under and keep your ?body straight, to reduce the curve in your lower back. Keep your?neck, back and hips in alignment when sitting for long periods. Avoid slumping. Sit well back on the chair with your thighs fully supported and place a pillow in the small of your back. If you can’t rest your feet comfortably flat on the floor, use a footrest or phone books, so your knees are at the same level as your hips (or slightly higher). Sleep with pillows between your legs and behind your back.
- Use proper lifting techniques – Squat or bend your knees with your feet apart and one foot slightly forward. Don’t bend from your waist and hips. Face the object you intend to lift (never twist or turn to pick something up), avoid jerky, sudden movements and hold heavy objects close to your body.If possible, let someone else lift. When picking up a toddler, kneel on one knee and use your free hand to push off from the other knee as you lift.
- Work at a comfortable height – If standing, this should be hip to waist level. Kneel to perform tasks at a lower level. When standing for long periods, put one foot up on a footrest to relieve the curve in your lower back, swap feet occasionally. If cleaning, put the vacuum or mop in one hand while putting the opposite leg forward to work, with the forward knee slightly bent.
- Do pelvic tilt exercises – Lean your back against a wall, feet slightly apart, with the weight on your heels and knees slightly bent. Breathe in, and on the out breath, tighten your belly muscles and buttocks, flattening the hollow of your lower back against the wall and tilt your pelvis forward and upwards. Hold this for a few seconds. This can also be done lying on your back with your knees bent and feet flat on the floor.
- Try shoulder rotation exercises – Place your fingertips of both hands on your shoulders and rotate your elbows in a backward circular motion a few times.
- Use natural therapies – Consider chiropractic, osteopathy, Alexander or Bowen techniques; swimming, yoga, massage, shiatsu, acupuncture, a TENS machine, herbal liniments or tinctures (St John’s wort and skullcap); and homeopathic remedies (Hypericum perfoliatum or Arnica). If you have strained your back, use hot or cold packs on the affected area or have a warm bath. Some women add a few drops of lavender oil to the bath to help with muscle spasm.
Medical treatments: Consult a doctor if your back pain is severe. You may need bed rest until the muscles recover. Avoid painkillers and sedatives unless prescribed by your caregiver. You may be referred to a physiotherapist for exercises and perhaps a pelvic girdle to stabilise the joints (like an elastic corset worn around the hips). ?
Breathlessness usually comes and goes, even while sitting and having a nor- mal conversation. During pregnancy, the lungs take deeper breaths, inhaling up to 40% more air to supply extra oxygen for your baby. During middle to late pregnancy, pressure from the baby on the diaphragm can make it difficult for the lungs to expand. Breathlessness sometimes occurs with pal- pitations (feeling your heart is pounding inside your chest). ?NOTE: Breathlessness that does not go away, or associated with pain in the chest?or upper back or sweating and feeling faint, is of concern, requiring urgent medical attention. Contact your caregiver or hospital.?What some women find helpful: Be patient and don’t panic. Breathless- ness usually improves after a short period. Sitting upright or sleeping on a couple of pillows may help you catch your breath.
Carpal tunnel syndrome
Carpal tunnel causes a feeling of pins and needles, numbness, stiffness and/ or pain in the hands, due to fluid accumulating in the wrists, putting pres- sure on the median nerve. Slumping your shoulders can also put pressure on the ulnar and median nerves, causing carpal tunnel. Grasping objects can be difficult, especially in the mornings, but it usually improves throughout the day. Discomfort may make it difficult to sleep at night but it generally improves a few weeks after the birth.
What some women find helpful:
- Massaging the wrists with creams or oils (aromatherapists may suggest adding a drop of juniper or chamomile oil). You (or another person)?can massage each side of the wrist using the thumb(s). Start from the middle of the wrist, use a firm but comfortable stroking motion, moving down and straight out the sides, across the base of the wrists.
- Using acupuncture, acupressure or shiatsu massage. The point (L14) is located on the fleshy inside pad of the hand, at the base of the thumb. Apply pressure firmly, holding in position for six to eight seconds. Do this two to four times in the morning and repeat as needed throughout the day (see page 528).
- Physiotherapy splints can be fitted to wear at night, often with your hands elevated on pillows. This may help if it is early in the pregnancy and/or your work is being affected. ?Medical treatments: Ultrasound is sometimes used on the wrists to stimu- late tissues around the affected nerve. This treatment is not proven and results vary.
Constipation can happen with increased progesterone slowing the move- ment of the gut, dietary changes and dehydration with morning sickness, as well as direct pressure on the intestines from the growing baby.?What some women find helpful:
- Drink at least eight glasses of water a day and one to two glasses of fruit juice (prune juice is great) and/or fresh vegetable juice. Hot or very cold drinks can stimulate the bowel. Try warm water with a squeeze of lemon first thing in the morning.
- Increase fibre in your diet – cereals, bran, fruit and vegetables, especially dried fruits (prunes, apricots, dates, figs and sultanas). A bit of liquorice may also help.
- Take your time when going to the toilet, relax your pelvic floor muscles and breathe deeply. Try not to put off passing motions. Place your feet on a low footstool for support.
- Gentle, daily exercise such as walking, swimming or yoga.
- Change iron supplements to a different brand (check with your ?caregiver).
- Herbalists may suggest psyllium, flax seeds, liquorice root or sprinkling ?slippery elm powder onto your cereal or adding a pinch of cayenne to food.
- Aromatherapists may suggest a mixture of chamomile, rose and ?patchouli oils added to a carrier oil for a gentle abdominal rub in a clockwise direction, above the level of the uterus and the lower back (but not before 12 weeks of pregnancy.)
- Homeopathic remedies may include Nux vomica or Sepia.?Medical treatments: Your caregiver may suggest fibre bulking laxatives with plenty of water, or a glycerol suppository inserted into the anus and held for 10 to 20 minutes, to soften bowel motions and make them easier to pass.
- Mineral oils (liquid paraffin), which can be absorbed into the body and ?interfere with the absorption of vitamins A, D, E and K.
- Oral preparations and suppositories containing stimulants that cause cramping, excess fluid loss and possibly premature labour (castor oil, ?senna, cascara, bisacodyl, phenolphthalin, danthron or sodium sulphate).
- Salts of magnesium, potassium and sodium, which can be absorbed into ?the system and interfere with the kidney functioning of the baby.
Haemorrhoids (piles) are essentially varicose veins of the anus due to increased progesterone, making the blood vessels relax. Also, pressure from the baby and uterus on the rectal area makes the blood pool, swelling the veins. Haemorrhoids appear as one (or several) small lumps around the opening of the rectum and are usually painful, itchy and may bleed, espe- cially after a bowel motion. They don’t affect the labour and birth, but may be sore for a week or so afterwards, but should eventually go away. For a few women, they decrease in size but remain. ?
What some women find helpful:
- Avoid constipation. Use the strategies outlined above for this.
- Avoid hot spicy foods (cayenne, black pepper, hot sauces and curries). ?These can increase congestion in the haemorrhoids and cause them to ?bleed.
- Try to do at least three sessions of pelvic floor exercises each day. Avoid squatting for prolonged periods, and rest to take the pressure off the area. Perhaps elevate the foot of the bed, or put a small pillow under your bottom when resting. If the haemorrhoid is large, you can replace it back into your bottom with your finger (wearing a glove if you like), to make you feel more comfortable.
- Herbalists may suggest drinking nettle leaf tea, taking bioflavonoids and vitamin C, or applying witch hazel ointment or pouring liquid witch hazel onto a small gauze pad and applying this to the haemorrhoid. Diluted lemon juice, or apple cider vinegar, are alternatives. (These may sting if the haemorrhoids are bleeding.) Ointments with St John’s wort flower or calendula may help.
- Aromatherapists may suggest cypress, frankincense and geranium oils in a bowl of warm water to sit in, or as a wet compress, or mixing it with K-Y gel and applying this to the area.
- Homoeopaths may prescribe Pulsatilla, Sepia or Nux vomica.?Medical treatments: You can use the treatments advised to avoid consti- pation (above). There are also creams you can buy over the counter from chemists (such as rectinol or anusol). If they are not effective, your doctor may prescribe a stronger cream.
Indigestion or reflux causes burning or discomfort in the chest and throat, usually after eating. Up to 66% of pregnant women experience heartburn, due to increased progesterone relaxing the sphincter muscle at the top of the stomach, allowing food and stomach acids to regurgitate back into the gullet (oesophagus). The muscle sphincter at the bottom of the stomach also relaxes, allowing irritating bile from the bowel to reflux back into the stomach, making heartburn worse. Other contributing factors are nervous tension, stress, smoking, alcohol and caffeine.
What some women find helpful:
- Have small, frequent meals. Eat slowly and chew thoroughly. Try eating at least two hours before bed. Avoid spicy, fatty and rich foods. Yoghurt or chewing slowly on raw almonds may help. Some women avoid bread and foods containing yeast.
- Drink plenty of fluids. Carbonated drinks may be better. Having fluids between meals, instead of with them, may make a difference. Try a glass of milk before going to bed (add honey if you wish).
- Good posture. Your stomach empties towards the right, so sleeping on your right side when first going to bed can help. Some women need to sleep relatively upright on a couple of pillows. Avoid stooping to pick things up. Stay upright and bend the legs.
- Try the flying exercise. Sit cross-legged, arms straight at your sides, raise and lower them quickly, bringing the back of your hands together over your head. Repeat this several times after eating.
- Use relaxation strategies to help with stress.
- Herbal remedies. Slippery elm powder mixed with warm milk, ?cinnamon and honey or marshmallow root; meadowsweet, fennel, aniseed and peppermint teas; a combination of fennel, anise, cumin?and dill seeds chewed before and after meals; a mixture of yoghurt, kefir, warm milk and cinnamon or fresh papaya, papaya tablets or leaves; herbal antacids or peppermint water (available at chemists).
- Acupuncture and acupressure. A point is located in the centre of the breastbone, between the breasts and in line with the base of your cleavage (or nipple line for men). Apply firm pressure for approximately 30 to 45 seconds.
- Aromatherapy. Try burning spearmint oil or putting a couple of drops on a tissue to inhale intermittently (avoid before 12 weeks).
- Homeopathic remedies. These may include Mercurius solubilis or Natrum muriaticum. ?
Medical treatments: Your caregiver may recommend antacids. Use as little as possible, or as directed. Generally, aluminium, magnesium and calcium types are safest, taken as liquid or tablets. Those based entirely on alumin- ium salts can cause constipation and interfere with iron absorption. Some doctors prescribe acid-suppressing medications (cimetidine, omeprazole or ranitidine). There is little research to support their safety during pregnancy, but at this stage they are presumed to be safe.2 ?AVOID: Sodium bicarbonate, magnesium carbonate or fizzy antacids, which can cause an imbalance in your blood chemistry. Milk of magnesia can cause diarrhoea and may be absorbed into your system, causing kidney problems in the baby. Avoid preparations containing aspirin (unless prescribed by your caregiver).
Nearly 50% of pregnant women experience painful spasms in the feet, calves or thighs, usually at night, often jolting her (and her startled partner) awake, adding to sleep problems. Many causes have been suggested, generally relat- ing to low calcium, magnesium, potassium and/or salt in the body, because these minerals play vital roles in the functioning of muscles. At this stage, it is thought that magnesium supplements are most likely to help and there is some evidence that adequate salt in the diet may be useful. This may be why leg cramps tend to be worse during the hotter months (when you sweat more).
What some women find helpful:
- Use salt to taste. Electrolyte sports drinks or mineral waters may be effective.
- Gentle walking, swimming or yoga can help with blood circulation.
- Avoid pointing your toes. This can trigger a cramp. If stretching in bed, ?point your toes up towards your body.
- To relieve a cramp, bend your foot back firmly towards your body. ?You may need your partner to do this if you can’t reach. Massage the affected area, aromatherapists may suggest lavender or chamomile oils or you may use arnica cream.
- Try a warm bath (or foot bath) before bed and keeping the legs warm.
- Magnesium phosphate tablets or ‘cell salts’ (from health stores).
- A full body massage to help blood circulation.
- Homeopathic treatments, such as Magnesia phosphorica.
- Herbalists may recommend raspberry leaf tea or tablets.
Medical treatments: Don’t take quinine. There is no clear evidence that it helps, and if taken during pregnancy it can affect the hearing of your baby. Some people drink tonic water, the amount of quinine in this is very low and not thought to be toxic enough to have physical effects on an unborn baby.
Palpitations are a feeling that your heart is racing, or beating strongly and rapidly, in your chest. It is pretty common during pregnancy and may be trig- gered by stress, anxiety, nervousness, fear, shock or physical exertion and some medications. However, they can also be felt for no apparent reason, often accompanied by breathlessness and usually subsiding after a few minutes.
NOTE: Occasionally palpitations can indicate a heart condition. Your caregiver may suggest wearing a halter monitor at home for 24 hours (a machine that monitors and records your heart beat continuously). If you are feeling unwell, or the palpitations are very frequent, or associated with chest pain, feeling sweaty, faint or nauseated, seek medical attention. ?What some women find helpful:
- Generally resting quietly and taking a few deep breaths is enough.
- Dealing with stress and using relaxation tech- niques can be helpful. Some homeopaths may recommend Lillium tigrinum. See your homeopath for an assessment. ?
Fluid retention (oedema) affects 65% of healthy pregnant women with a normal blood pressure. It is more common after 20 weeks of pregnancy and usually occurs in the legs, feet and hands, generally more noticeable at the end of the day or when you're on your feet for long periods. Rings on the fingers can become tight and you may need to take them off until after the birth.?What some women find helpful:
- Slow down and put your feet up at the end of the day for at least 20 minutes. Rest them on another chair if doing desk work or studying. Wear comfortable flat shoes. Full support stockings may help if you are on your feet all day.
- Try some gentle, regular exercise such as swimming or yoga.
- Cut back on foods with a high salt content (eg. olives, parmesan, ham, ?bacon, sundried tomatoes, crisps, corn chips, soy sauce).
- Drink at least eight glasses of water a day. Drinking less makes the ?swelling worse.
- Swimming or having a bath increases urine production, giving short- ?term relief.
- Acupuncture or Shiatsu massage can help.
- Cell salts with magnesium and phosphorous (from health stores).
- Chiropractic or osteopathy, especially if one leg is more swollen than ?the other, possibly because your back and pelvis are out of alignment.
- A massage, concentrating on the legs from the feet upwards with a gel, ?oil or lotion. When massaging the hands, firmly press from the nails to the bases of the fingers. Aromatherapists may suggest adding geranium to massage oils, or a few drops of lemon, neroli, orange or pettigrain to a warm bath. Check with your practitioner.
- Herbalists may recommend dandelion, nettle, or yarrow teas, as well as eating whole grapes, celery, apples and apple juice.
- Homeopaths may prescribe Natrum muriaticum, Apis mellifica or Phosphorus.
Symphysis pubis pain
The symphysis joint at the front of the pelvis comprises of a small oval disc of car- tilage, about three to four centimetres long, held together by ligaments. This feels like a hard bump under the pubic hair, in the middle. Increased progesterone and relaxin hormones soften and relax the symphysis, sometimes causing pain as the pelvis moves. The sensation is felt low, as a twinge, ache, clicking sensation, or sharp debilitating pain, sometimes shooting into the vagina. The position of the baby can sometimes aggravate it, especially if their head is engaged. ?AVOID:
- Twisting your body or standing on one leg. Stand with equal weight on both feet.
- Sitting with crossed legs, or on the floor with legs crossed. Sit symmetrically on a chair.
- Lifting and carrying heavy objects or your toddler (if possible).
- Vacuuming the carpet or mopping the floor.
- Squatting; and if swimming, avoid breaststroke.
- Lying on your back for sex. Use alternative positions, such as ?side-lying.
What some women find helpful:
- Doing regular pelvic floor exercises.
- Putting a pillow between the knees when turning in bed.
- Adapting your walking stride length to your pain. Walk with very small ?steps if you have a lot of pain.
- Taking one step at a time on stairs, and doing this sideways.
- When getting in and out of a car, sitting down backwards on the seat ?and turning around to the front of the car with your knees and ankles together. Do the reverse when getting out. Do not kick open the car door with one foot.
- Using a heat pack, acupuncture, Shiatsu, massage or yoga. A chiropractor or osteopath may be able to do a manipulation. Your herbalist or homeopath may recommend a remedy. ?
Medical treatments: Your caregiver may refer you to a physiotherapist for exercises and/or a pelvic girdle (an elastic corset worn around the hips) to stabilise your joints. If it is extremely debilitating you may need a walking frame for a while. Avoid painkillers and sedatives unless prescribed by your caregiver.
Varicose veins are caused by blood pooling in the legs, making the veins swell into purple/blue bulges. Increased progesterone weakens the valves and walls of the veins, making them less efficient at pumping blood back to the body. Pressure from the growing baby can make them worse. Vari- cose veins can cause aching, sore legs, especially if bumped or knocked. However, they should improve (or disappear) a few months after the birth. It is possible to have varicose veins surgically removed, but most caregivers advise waiting until after you have had all your children, in case they come back with a subsequent pregnancy. ?What some women find helpful:
- Regular, gentle exercise such as swimming, walking or yoga to strengthen muscles surrounding the veins.
- Full-length support stockings if you are on your feet most of the day. Put them on first thing in the morning before getting up. Avoid tight socks and half-leg stockings.
- Moving your feet at frequent intervals, rather than standing in one spot for prolonged periods. Avoid crossing your ankles or legs when sitting. If at a desk, put your feet up on another chair, or flat on a couple of phone books.
- Lie down with your feet elevated for at least 20 minutes at the end of the day. Aloe vera gently rubbed into throbbing areas may help.
- Rest as much as possible. Perhaps elevate the foot of the bed to help circulation.
- Naturopaths may suggest bioflavonoids, garlic and vitamin C to strengthen connective tissue around the veins.
- Herbalists may suggest witch hazel ointment or pouring witch hazel or diluted lemon juice, or vinegar, onto a small gauze pad and applying it to the area overnight with a loose bandage, or just cold, wet compresses for temporary relief. Remedies may include nettle, yarrow, St John’s wort or shepherd’s purse, to help with the blood flow. Homeopathic remedies include Pulsatilla or Sepia.
- Aromatherapists may suggest a few drops of lemon and/or geranium oil in a bath or diluted and soaked into a gauze pad as a direct compress to the area. Consult your practitioner. ?Medical treatments: Some caregivers suggest purchasing medical com- pression stockings (TED stockings). However, these are thick and some women find them too uncomfortable in summer.
The veins in the outer lips (labia) of the genitals can swell, similar to varicose veins that develop in the legs. Vulval varicosities can feel uncomfortable and make the vulva ache and feel sore. They don’t cause any problems for a vaginal birth and should disappear a few days after the baby is born. ?What some women find helpful: Pelvic floor exercises are beneficial, to help the blood to circulation and strengthen the supporting tissues around the veins. Try wearing underwear that feels supportive on the vulva, but does not cut into the groin too much. Avoid squatting for prolonged periods and rest as much as possible. Some women elevate their bottom on a small pillow when resting. Avoid straining when going to the toilet. Strategies for constipation and haemorrhoids can help. Natural thera- pies are similar to those for varicose veins of the legs (discussed above).
Rib and chest wall pains
The growing baby pushes up under your ribs, moving them slightly outwards (called rib flaring). This may strain the intercostal muscles between the ribs, causing discomfort or pain. Sitting upright and giving your baby a gentle push down with your hand can help.
Splitting, tearing belly pains.
Tenderness, tearing or splitting sensations down the centre of your belly can be caused by the two large abdominal muscles stretching and slightly separating to accommodate your baby’s growth. This is normal, but not every woman feels this natural separation. Massaging the area, using a heat pack and supporting the belly with a pillow while sleeping may help.
Tender, sore navel
If you have an ‘inny’ belly button and it pops out, this makes the previously protected skin rub on clothing, feeling raw and tender. Massaging creams, oils or pawpaw ointment can be soothing. Wearing underwear that covers your belly will help protect it. If you have a belly ring, you may want to take it out (see page 164). Check your belly in the mirror to make sure you haven’t scraped it or burnt it while ironing. Easily done!
Bruised sensations or sore spots.
Tender or bruised spots on your belly can happen when the baby continually presses on one part of the uterus, making the abdominal muscle over it feel sore. Gently pushing your baby off the tender area with your hand can provide temporary relief. Pelvic rocking on your hands and knees may move your baby off the bruised spot. Homeopaths may suggest Arnica.
Aching thighs and vagina
The weight of your baby (and their head engaging) slows blood flow to the genitals, causing aching in the thighs and vagina. Varicose veins in the legs or vulva can intensify these sensations. Do regular pelvic floor exercises and try to stay off your feet much as possible. Lie down and put your legs up for 10 to 20 minutes each day if at all possible.
Internal vaginal pains
Short, sharp, internal vaginal pains can take you by surprise. They may be experienced as the baby moves and shifts on the softened and more flex- ible cervix in the final weeks. These sensations are usually sporadic and unpredictable, settling down quickly. There is not much you can do, except breathe and count to ten. This is not how labour feels.
NOTE: If you are concerned about any aches and pains, contact your hospital or caregiver.
This is an edited extract of the ebook Birth: conceiving, nurturing and giving birth to your baby by Catherine Price and Sandra Robinson. It is available for purchase from iTunes or Amazon
Read more about your pregnancy here
Last revised: Tuesday, 10 September 2013
This article contains general information only and is not intended to replace advice from a qualified health professional.