Our GP tackles your pregnancy health dilemmas – from aches and pains to depression
A: It’s possible, but highly unlikely at this stage of pregnancy. The baby is putting a huge amount of pressure on your pelvic floor, as well as increasing the pressure inside your tummy, so it is more likely that you will leak urine. You may have leucorrhoea – a normal vaginal discharge that occurs during pregnancy. Sometimes this discharge is white and creamy, or it can be clear and slimy. To reduce the chance of getting thrush infections connected with this excess discharge, wear cotton knickers that let you breathe, and change regularly. See your health carer to rule out other problems.
A: Lower backache, I’m afraid, is a bit of an occupational hazard of pregnancy. For one thing, your centre of gravity changes with your shape, putting more strain on your lumbar and sacral spine (the part of your spine from the top of the pelvis downwards). For another, your ligaments become much more lax, so that your pelvis can stretch enough to let the baby’s head through. But there are things that you can do to help. Lumbar supports for chairs, and sometimes a support belt that you wear around your lower tummy, can be effective. So too is physiotherapy – have a chat with your GP about a referral. The physiotherapist will also be able to advise about back supports.
If the pain in your lower region is at the front, it could be due to several causes. One is round ligament pain – caused by stretching of the ligaments in your lower tummy and usually felt as a sharp pain in your groin. Another is symphysis pubis pain, which comes from the join at the front of your pubic bone and can cause pain in the pubic area, groin and inner thigh. Again, physiotherapy can help.
A: Bell’s palsy is a weakness that affects the muscles of your face, usually on one side. It’s caused by inflammation of the nerve that supplies these muscles. We’re not sure exactly what causes this inflammation, but it’s probably a viral infection. Although you’re not more likely to get Bell’s palsy during pregnancy than at any other time in your life, it’s not less likely either. Bell’s palsy usually occurs in young adulthood and about 1 in 70 young people get it at some point. We sometimes treat Bell’s palsy with steroids to try and reduce inflammation, but we’re not sure if they make much difference. Fortunately, 4 out of 5 people recover completely without treatment within a couple of months. In the meantime, if you’re having problems closing your eyelid completely, have a chat with your GP. She may recommend eye drops to lubricate your eye, or an eye pad to protect it.
A: Postnatal depression (PND) affects around 1 in 10 women in the year after they have a baby. If differs from ‘baby blues’, which affect at least half of mums – they cause sudden weepiness about a week after birth, but they tend to pass quite quickly. If you’ve had PND once, you are slightly more likely to suffer again, but there is plenty you can do to avoid it. The most important thing is to make sure you have lots of support after the birth – help from family and a good social network can stop you feeling isolated and overwhelmed. Talk to your partner and make sure that they know what the early symptoms are: they include not enjoying life, feeling tearful, lack of concentration, not sleeping and feeling everything is your fault.
I’m sorry your GP hasn’t been supportive – it’s worth seeing another GP, or talking to your health visitor, before you have your baby. Getting help early is the key.
A: Pain over the symphysis pubis, or symphysis pubis dysfunction (SPD) is a long name for pain in the pubes! Your pelvis is joined at the middle at the front by fibrous tissue and ligaments. This area is called the symphysis pubis. Obviously, your baby’s head will need to come out through your pelvis if you have a vaginal delivery, and it’s a pretty close fit. The hormones floating around your body in pregnancy are designed to help loosen your ligaments and make it easier for your baby’s head to get through.
Unfortunately, in some women that loosening process allows the joint to move when you do, causing pain that can be severe. The pain often feels as if it’s inside, and it’s worse if you lift one leg or separate your legs – which sadly includes climbing stairs, turning over in bed and a host of other movements we take for granted.
The pain almost always goes within a few weeks of giving birth. In the meantime, swimming and water aerobics, investing in a body pillow or just supporting your legs with pillows in bed, physiotherapy and sometimes a support belt (ask your midwife or GP) can all help.
A: Congratulations on your pregnancy – polycystic ovary syndrome can certainly make getting pregnant more difficult. That said, there’s a difference between having polycystic ovaries, which affects 20% of women, and polycystic ovary syndrome, which affects only half that number. If you have polycystic ovaries, your ovaries have lots of small cysts in them. If you have polycystic ovary syndrome, you have the cysts as well as hormone changes and / or excess hair, acne and excess weight.
Polycystic ovaries probably won’t make a lot of difference to your pregnancy. But polycystic ovary syndrome could mean a greater risk of gestational diabetes, high blood pressure, premature delivery and miscarriage. Fortunately, you’ll have your blood pressure and urine checked (for diabetes) every time you have an antenatal check up. You may also have a blood test for diabetes mid pregnancy. You can minimise your risks by attending all your check ups and avoiding putting on too much weight. You should also tell your healthcare professional about your polycystic ovaries every time you have a consultation, so they can be on the lookout for the complications mentioned above.
A: Congratulations! You’re quite right to say that you need to think about tests in view of your age – but fortunately there are far more options around these days, especially for testing to see if your baby is affected by Down’s syndrome or another chromosomal abnormality. This the is the main risk for babies of older mums.
If you’re over 37, you can opt to have an amniocentesis, in which a needle is put through the wall of your tummy under ultrasound control. A small amount of the amniotic fluid, in which your baby floats, can then be drawn off and examined. This will tell you for certain whether your baby is affected by Down’s syndrome or another chromosomal abnormality – but it does carry a risk of miscarriage of between 1 in 100 to 1 in 200.
Alternatively, you can have a blood test or an ultrasound scan called a nuchal thickness scan. These will tell you how high your risk of having an affected baby is, but won’t tell you for certain. However, these don’t the same risk as an amniocentesis. If your risk does turn out to be high, you’ll be offered amniocentesis to give you a definite answer.
A: If you were 23 weeks, I’d have said that round ligament pain was the most likely cause – the round ligament attaches the top of your womb to your groin and it can cause nasty sharp pains in your lower stomach and groin as it stretches. However, this pain tends to get better after about 24 weeks. Later in pregnancy, it’s very common to get pain from your symphysis pubis – the join between the two halves of your pelvis directly above your vagina. This happens because your ligaments are stretching up to let the baby’s head through. However, this pain doesn’t usually travel down your leg. The pain you describe is more likely to be related to a trapped nerve. Ask your GP about referral to a physiotherapist – preferably with an interest in problems of pregnancy.
A: There’s more fluid in your bloodstream in pregnancy – that’s one of the reasons your blood gets ‘diluted’ and you get checked out regularly for anaemia. Palpitations in pregnancy are pretty common. Usually though, as long as you’re otherwise healthy, your heartbeat is fast but regular, and you don’t have any pain, dizziness or shortness of breath, they turn out to be harmless. If you have anaemia or other medical problems, like an overactive thyroid gland, you may be more prone to palpitations. However, I’m concerned to hear that you describe the palpitations as painful. I would recommend that you see your doctor if you get palpitations for the first time in pregnancy – but because yours are painful, you need to get seen as soon as possible.
A: Doctors aren’t quite sure how acupuncture works – various theories have been suggested, including the idea that acupuncture needles stimulate nerves, which in turn send messages to the brain.
If you are going to use an acupuncturist, make sure they are fully qualified and that they always use disposable needles. Ask your midwife, GP or obstetrician if they can recommend anyone. Where the acupuncturist will insert the acupuncture needles will depend on the problem. There’s some anxiety that stimulating certain points especially in the lower tummy and lower pack, can make your uterus contract – so proceed with caution.
Acupuncture has been used to relieve a wide variety of conditions, including morning sickness and backache. As for breech delivery (when a baby is feet down) a US study found that as aspect of acupuncture called moxibustion increased the number of head-first births in women whose babies were breech at about 32 weeks. This type of acupuncture involves burning sticks of herbs called moxa near an acupuncture point in the little toe. It was found to be most effective at 32 to 36 weeks and should only be used in healthy pregnancies. However, if you’re 26 weeks pregnant, you won’t know for several weeks if your baby is likely to stay in the breech position. If you do want to proceed, wait until about 32 weeks and then talk to your midwife or doctor.
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