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
- History — how long, how often, other reasons for nausea and vomiting
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