What’s normal in pregnancy

Practical Parenting's midwife, Anne Richley, takes you step-by-step through:

*What you can expect;
*What you can do about it;
*When you need to seek help.

Nausea: the facts

• About 70% of pregnant women suffer from nausea and vomiting.
• It usually gets better around the 14th week.
• It can continue or reappear later but won’t harm your baby.

What can I do about it?
Keep your blood sugar levels up with regular light, healthy snacks during the day, ending with one just before bedtime
Try an acupressure wristband if the nausea doesn’t resolve.

When do I need help?
If you continue to vomit several times a day and are feeling unwell. Your midwife may suggest some anti-emetic tablets that reduce vomiting.
If you can’t even keep fluids down and are getting dehydrated. You may have to be put on an intravenous drip in hospital.
Severe sickness, known as hyperemesis gravidarum, has to be treated – but it only affects 2% of mums.

Itching (pruritus gravidarum): the facts

• About 17% of expectant mums suffer from itching in pregnancy.
• It can be bad enough to keep you awake at night.
• It often gets worse with heat.
• It affects your growing abdomen the most.

What can I do about it?
Soothe the affected area with calamine lotion.
Take a cool bath.
Moisturise your skin with wheat germ oil or baby oil.

When do I need help?
If the itching is really bothering you and it goes on after the 28th week of pregnancy. This can be a sign of obstetric cholestasis, which can lead to premature or even stillbirth. Your midwife can do blood tests to check your liver function

Bleeding: the facts

• A little breakthrough bleeding in early pregnancy is common and usually harmless.
• If you’re rhesus negative and over 12 weeks pregnant, you probably need an injection of Anti D to prevent the production of antibodies, as they could affect your baby. See nice.org.uk.

What can I do about it?
Some women are advised to take bed rest though there’s no evidence it helps. But if you’re worried about miscarrying, resting may make you feel better.
Sometimes bleeding comes from around the cervix after intercourse, but the cause is unknown, the consequences rarely serious and there’s no routine treatment.

When do I need help?
If you have heavy or painful bleeding you need to contact the labour ward immediately.
Less serious bleeding can be dealt with by your midwife. She can listen to the baby’s heartbeat or arrange a scan to reassure you.

Swelling (oedema): the facts

• It affects around half of pregnant women.
• It’s caused by the increased volume of blood and retention of excess fluid, exacerbated by sluggish circulation.
• It’s rarely a cause for concern.

What can I do about it?
Put your feet up when you get the chance.
Wear support tights.
Drink plenty of water.
Take gentle exercise, such as swimming.

When do I need help?
If the swelling is accompanied by a rise in blood pressure.
If there’s excess protein in your urine (checked at antenatal appointments), which can be a sign of pre-eclampsia – this can affect the baby’s growth.

Baby’s movements: the facts

• Most mums begin to feel their baby move around 16-22 weeks.
• Women vary a lot in when this happens.
• The early movements may feel like flutterings or mild wind.
• After 28 weeks, it’s normal to feel at least 10 movements a day.

What can I do about it?
If you have concerns, tell your midwife. She can reassure you by listening to the baby’s heartbeat with a Doppler (monitor) or pinnard (ear trumpet).

When do I need help?
A dip in the baby’s activity can be a sign of distress. So if after about 28 weeks you’re not feeling 10 movements a day, tell your midwife and she can monitor the baby’s heartbeat. She’ll usually find everything’s all right.

Fatigue: the facts

• This affects almost every pregnant mum.
• It’s worst in the first 12 weeks, when your metabolism is high and the baby developing fast.
• It can be so profound that you feel as if you’ve been drugged!

What can I do about it?
Don’t go too long without food.
Try to keep your blood sugar level up: avoid sugary food and drinks, which provide instant energy followed by a crash.
Take gentle exercise to raise energy levels and improve circulation.
Try to rest.

When do I need help?
If the exhaustion doesn’t improve and is accompanied by breathlessness, palpitations or dizziness. Your midwife will probably do a blood test for anaemia and might give you an iron supplement.

Aches and pain: the facts

• These are inevitable as your body is undergoing huge changes.
• The change in your centre of gravity often causes backache.
• Your expanding uterus can lead to abdominal pain.
• Your abdomen and bladder can feel uncomfortable as your baby angles for space inside.

What can I do about it?
Be aware of your posture: stand and sit up straight to give your internal organs room.
Do exercise such as yoga, swimming and walking, which are great for posture.

When do I need help?
If you get pain in the pubic area. This may be caused by separation of the cartilage, called symphysis pubic dysfunction (SPD), so see your GP.
If back pain is bad a physiotherapist can suggest exercises and may also give you a support belt.
If you have a severe persistent abdominal pain or signs of premature labour, contact the labour ward immediately.

For advice on all your pregnancy worries, check out Practical Parenting magazine each month.