Pregnancy health – your questions answered

It’s only natural to be concerned about your health when you’re pregnant. Our midwife eases your worries as she answers your questions and queries…

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Linea nigra is common during pregnancy

Q. Last year my baby was found to have the infection group B strep and had to go to a special care ward. I’m planning another baby soon, should I be tested for it?

A. As your last baby was affected by group B streptococcus (GBS), you’ll need IV antibiotics as soon as labour starts, or your waters break, to reduce the chance of her developing the infection, as labour and delivery is when the risk of the infection being passed on is highest.

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As soon as labour starts, go to the labour ward so the antibiotics can be given, and then further doses repeated, depending on how long your labour lasts. Around a quarter of pregnant women carry GBS in their vagina and, as we do not routinely test for it in this country, are unaware they are carriers.

There are no symptoms and it’s often detected when you’re swabbed for something else such as abnormal discharge. However, there are some situations in which it’s more likely your baby may develop GBS. For more, visit www.rcog.org.uk and search ‘GBS’.

Q. I’m 30 weeks pregnant and my midwife said I could have placental insufficiency as my bump is measuring smaller than normal. What does this mean?

A. When the placenta isn’t providing your baby with the oxygen and nutrition he needs to grow, this is called placental insufficiency. If your bump is significantly smaller than expected your midwife will inform a consultant who may scan your baby to help assess her size. The doctor (or sonographer) can also look at the blood flow through the umbilical cord to make sure that your baby is getting everything he needs.

In a small number of cases placental insufficiency leads to an abnormally low weight in the baby, a condition called intrauterine growth restriction, which increases the chances of complications during pregnancy and birth. But try not to worry – it could just be that you’re carrying a small baby. What’s important is that your baby is still moving and growing, and you will be the best judge of that, but it’s important to take any concerns over the size of your baby seriously.

Q. My midwife asked if I had any family history of pre-eclampsia. What is this?

A. Pre-eclampsia is caused by a defect in the placenta that reduces blood flow to your baby. It can happen any time from 20 weeks and if left untreated could mean your baby is deprived of essential nutrients and oxygen. 

Some factors that could increase the risk of developing pre-eclampsia include being a first-time mum, high blood pressure, kidney disease, diabetes, being overweight, if you’ve had it before or are expecting more than one baby. It’s also thought to run in families.

The condition can cause a rise in blood pressure and protein to leak into the urine, which could indicate the kidney’s are working overtime, but your midwife will be checking these at every appointment. In some cases pre-eclampsia can mean a premature delivery and serious illness in the mum, so regular check-ups are essential.

Q. My friend had a group A strep infection after giving birth. What is this?

A. Not to be confused with group B strep – a separate infection – group A strep is a bacterium that’s commonly found in the throat or on the skin. It can cause a range of infections, from mild sore throats to life-threatening diseases. Although the infection can develop during pregnancy or labour, it’s more common following the birth and can quickly become life-threatening if it gets into a wound, or the womb, and spreads into the blood stream.

Symptoms include feeling generally unwell, sore throat, raised temperature, rash, fast pulse, fast breathing, abnormal vaginal discharge, vomiting and/or diarrhoea, abdominal pain, leg pain and achy joints. If you have any of these symptoms after the birth, tell your midwife or doctor as soon as you notice them. In most cases you’ll be reassured everything is OK and may be given antibiotics, but it’s important to get checked out.

Q. I’m 7 months pregnant and experiencing a lot of pain in my pubic area, particularly towards the end of the day. Should I mention it to my midwife?

A. Yes, get her to check you over and make sure that you don’t have a urine infection. It sounds more like PGP (pelvic girdle pain) though, which is common in pregnancy. Hormones cause the ligaments in the pelvis to stretch, which is helpful for giving birth, but can be uncomfortable. It would be helpful for you to be referred to a physiotherapist, or osteopath, who’ll suggest exercises for temporarily taking the strain off your pelvis, as well as show you positions for limiting movement in this area. They may also suggest wearing a properly fitted support belt around your pelvis.

When it comes to the birth, good positions include being on all fours, kneeling, standing or lying on your side. For severe cases it’s advised that you measure the comfortable distance that you can open your knees so that if, during labour you need an epidural, you know how wide you can open them safely.

Q: I’m six months pregnant, and my skin looks awful, with brown patches on my face and belly. What’s going on?

A: Around 90% of women find pigmentation increases in their skin during pregnancy. For some, their freckles become more obvious, while others develop chloasma, or ‘pregnancy mask’. This is a brownish stain, usually across the nose and cheeks, which fades after the birth. It’s harmless, but if you’re worried, use sunscreen and avoid too much sun exposure.

Lots of women develop linea negra too, a brown line that stretches from the pubic area to the belly button. This also fades after the birth, but never disappears. Other areas that often darken include the nipples, vulva and perineum. These changes are thought to be related to increased levels of progesterone, oestrogen and adrenal hormones.

Q: I normally sleep on my back, but I’ve heard this isn’t safe during pregnancy. Why is this?

A: It isn’t a good idea to lie flat on your back during the later stages of pregnancy, as the weight of your bump presses down on some major veins that carry blood back to your heart. This can cause you to feel dizzy and faint and, in theory, could interfere with the flow of blood and nutrients to your baby.

But don’t lie awake worrying about what position you should be in or be alarmed if you wake up on your back – you’ll naturally change position before it causes you or the baby any problems.

The best position is lying on your left side with a pillow under your bump and another pillow between your knees. It can be difficult to get comfy in any position, so it’s normal to toss and turn as you try to find what’s best for you.

Q: I’m 20 weeks pregnant and have a white discharge and itching inside my vagina. Could it be thrush?

A: Thrush is a yeast infection that’s very common in pregnancy. It thrives in warm, moist conditions and causes itching, soreness and thick, white discharge that often smells like yeast.

It certainly sounds like you’ve got thrush, but you should see your midwife or GP who can take a swab and send it to a lab to confirm. They can sort out a prescription for a vaginal pessary and cream to clear it up. Some women find that dabbing live natural yoghurt on the area can help clear the infection and soothe itching.

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To stop thrush coming back, you should avoid strongly perfumed bubble baths and tight clothing. It’s a good idea for your partner to be treated too, as he can keep reinfecting you.

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