Common discomforts of pregnancy

  

  • Hormone levels and physical changes may cause unpleasant symptoms
  • Reassure woman that discomforts are a normal part of pregnancy and usually resolve after birth — can be worse in multiple pregnancies. Often improve with simple measures
  • Medical/midwife consult if
    • Not sure if symptom caused by serious problem
    • Not sure about management of symptom
    • Problem not resolving despite simple lifestyle changes

Nausea and vomiting

  • Nausea with/out vomiting common in first trimester
  • Usually resolves by itself by 16–20 weeks of pregnancy and not usually associated with poor pregnancy outcome
  • Hyperemesis gravidarum (severe vomiting) can cause dehydration, ketonuria (ketones in urine) and unbalanced electrolytes (body salts) which may need hospital admission and IV fluid therapy

Ask

Check

  • Calculate REWS — AVPU, RR, O2 sats, pulse, BP, Temp
  • Weight, BGL 
  • Urine — U/A, note any ketones, send for MC&S
  • Head-to-toe exam — with attention to hydration — look at skin, mouth
  • Baby movements — after 18 weeks

Do not

  • Do not give iron tablets unless woman has anaemia or is at risk of anaemia

Do

  • Give diet advice
    • Encourage woman to talk with grandmothers about traditional foods to avoid or to help prevent nausea
    • Drink plenty of fluids (aim for 2 litres a day) — teas like lemongrass or ginger, drink water between meals
    • Eat small amounts of easily digested foods often (4–8 meals a day)
    • Avoid fatty, spicy or hot foods and foods with strong smell
    • Try to eat dry crackers or toast before getting up
    • Don’t lie down after eating
  • Review in 1 week to see if changes have helped. If not resolved — medical consult
    • May suggest — metoclopramide oral — 60+kg 10mg, 40–59kg 5mg 3 times a day (tds). First dose may need to be given IV/IM (same dose)

Reflux (heartburn)

  • May present as a burning feeling in chest or bitter taste in mouth
  • Is not associated with poor pregnancy outcomes
  • Treatment is to relieve symptoms 

Do

  • May need to try different strategies to address
  • Suggest
    • Small meals more often
    • Avoiding fatty or spicy foods or caffeinated drinks, eg coffee, cola, tea 
    • Sleeping on the left side, in a semi-upright position
    • Avoiding smoking
  • For persistent or severe symptoms
    • May try occasional use of antiacid
    • OR Try H2 antagonist (eg nizatidine) — medical consult

Constipation

  • Common, particularly during first trimester of pregnancy
  • Haemorrhoid symptoms common in second and third trimester
  • Can also be caused by iron tablets

Do

  • Suggest
    • Increase fibre in diet — fresh fruits and vegetables, wholegrain breads and cereals, baked beans
    • Eat more bush foods — bush sultana, tomato, orange, seed damper, yams
    • Drink more water — at least 2 litres a day
    • Walk for at least 30 minutes every day
  • Advise not to strain (push) when going to toilet
  • If increased fibre and water don’t relieve symptoms after 1 week — try laxative — do not use long term
    • Bulk forming laxatives (eg Metamucil) may cause fewer side effects than stimulant laxatives. Introduce slowly and drink lots of water
  • Standard haemorrhoid creams can be used if needed. Also try elevating legs and ice packs to anal area
  • If these things don't work — medical consult

Leg cramps

Lower leg cramps mainly happen at night after 28 weeks of pregnancy

Do

  • Suggest
    • Sitting up and pulling toes up toward shins to stretch muscles
    • Walking around when cramps come
    • Gently massaging legs — with rubbing medicine or heat
    • Drinking plenty of water

Other common problems that may occur

Include backache, pelvic girdle pain, varicose veins, carpal tunnel syndrome

  • Medical/midwife consult if concerned

Supporting resources