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Changes in Pregnancy

Physical Changes and Ways to Cope

Pregnancy is an amazing time of change. Your changing hormones cause the physical changes you see and feel throughout your pregnancy.

Some of these hormones include:

can cause nausea. It is produced by the cells that become the placenta. It keeps a pregnancy going. Early pregnancy tests check for it.

keeps the placenta working well, the uterus relaxed and its lining healthy. It helps keep blood pressure in the normal range, and nutrients to be better absorbed from food. Progesterone stimulates the breasts to grow the milk producing glands.

makes the uterus grow and increases its blood supply. It increases the amount of mucous made in the vagina, stimulates the milk ducts in the breasts to grow, and signals the body to keep more fluid, store fat and sometimes change skin colour.

relaxes and softens ligaments, cartilage and cervix so they are more stretchable. It helps pelvic joints widen during birth.

causes the uterus to contract during and after labour and the milk to flow when breastfeeding. It is also known as the bonding hormone.

Growing a baby is hard work! Almost everyone feels uncomfortable at some point!

Some of the most common discomforts, their causes and ways to relieve them are listed in the following chart. Most of these changes go away after birth.

  • Mention the ones you are experiencing to your health care provider at your prenatal visits.
  • Note the list of warning signs for symptoms you should report right away.

Back Pain

  • Stress on your back results from the softening of the joints and ligaments of your spine and pelvis and the increased weight of
    your growing uterus
  • Muscles work harder as centre of gravity shifts
  • Increase in breast size pulls shoulders down

What can help?

  • Maintain good posture
  • Use a cushion for back support
  • Wear low heeled (not flat) shoes with good arch support and a comfortable bra
  • Use good body mechanics; bend your knees instead of bending over at the waist. Lift with your legs instead of your back
  • Avoid heavy lifting
  • Limit standing for long periods of time
  • Sleep on your side using a pillow between your legs, under your belly and behind your back
  • Stay active; add yoga and/or core and stretching exercises
  • Try pelvic rocking to relieve tension
  • Promote circulation and relaxation; take a warm
    bath, use a heating pad, get a massage
  • Consider a maternity support belt
  • See a physiotherapist or massage therapist

(feel tender and more full, tingling sensations, areola darkens, nipples enlarge and leak colostrum )

  • Estrogen, progesterone and prolactin hormones increase the blood supply to the breasts, develop milk ducts and cause the skin to change

What can help?

  • Wear a good-quality support bra or a sports bra without wires
  • Try wearing a bra at night
  • Wear breast pads if leaking colostrum; change pads when they are wet
  • High levels of progesterone
  • Pressure from your growing baby
  • Iron supplements

What can help?

  • Drink more water
  • Eat whole grain foods, fruits, vegetables and legumes to get more fibre
  • Try prune juice when taking prenatal vitamins with iron   
  • Exercise regularly; try walking 30 minutes daily
  • Pregnancy hormones trigger the uterus to start practicing for labour
  • Dehydration and increased activity of baby or mom, sexual intercourse or a full bladder may be triggers

What can help?

  • Change your position; if sitting, stand up (and vice versa)
  • Drink a glass of water, have a snack
  • Practice relaxation exercises such as slow deep breathing, visualization (imagine the contraction is an ocean wave or count as if going up and down a hill) or try mindfulness exercises
  • Enjoy a warm bath 
  • Progesterone causes blood vessels to relax thereby lowering blood pressure
  • Low iron and low blood sugar Stand up slowly

What can help?

  • Avoid standing for long periods of time
  • Exercise regularly
  • Don’t skip meals; enjoy small nutritious snacks and foods rich in iron
  • Sit down, place head between knees, add a cool cloth to neck or forehead
  • Progesterone can make you feel more sleepy
  • Metabolism increases so you use more energy
  • Lots on your mind

What can help?

  • Listen to your body, pace yourself
  • Rest during the day, take short naps and go to bed earlier
  • Ask for help with household chores, avoid taking on extra responsibilities
  • Go to bed and wake up at the same time
  • Avoid caffeinated tea, coffee and chocolate and a heavy meal before bedtime
  • Put screens/devices away well before bedtime, create a cool environment and wind down with a relaxing activity
  • Get comfy in bed, lie on your side and  experiment with lots of pillows
  • Sleep until you feel well rested
  • Deal with problems and concerns before bedtime or make a list for the next day
  • Exercise regularly; avoid within four hours of bedtime
  • Eat well, drink plenty of water, but not too close to bedtime

  • The round ligaments which hold the uterus in place stretch as the uterus  grows causing brief, sharp pain

What can help?

  • Avoid sudden movements such as stretching and reaching
  • Keep your stomach muscles (core) strong
  • Bend at the hips to avoid pulling on the ligament
  • Sit down and rest; bring your knees toward your chest or lie on your side using pillows under your belly and between your knees
  • Try a maternity belt or an abdominal support garment
  • Apply warmth with a heating pad or by taking a warm bath 

  • Progesterone makes it easier for bacteria to grow and for the gums to be more sensitive to plaque.  This increases the risk for gum disease

What can help?

  • Brush and floss teeth at least 2x/day using a soft toothbrush and fluoride toothpaste
  • Avoid soft, sweet, sticky snacks
  • After vomiting, rinse your mouth with water or a fluoride mouthwash
  • See your dental professional regularly

  • Extra fluid in the tissues puts pressure on nerves and blood vessels

What can help?

  • Avoid lying on hands and arms when asleep
  • Change or avoid activities that may be causing symptoms; take breaks from repetitive tasks
  • Do hand exercises and shoulder circles
  • Hormone changes, an increase in blood volume, stress/tension, fatigue, hunger, dehydration, an increase in breast size can all cause headaches

What can help?

  • Practice good posture
  • Try tension-reducing (shoulder circles) and relaxation exercises
  • Take a warm bath
  • Have your neck and back massaged
  • Take naps and rest throughout the day
  • Eat small meals often and drink lots of water
  • Lie down in a cool, dark room with a cool cloth on your head
  • Digestion slows
  • Valves that keeps food in the stomach relax due to progesterone
  • The amount of space in your abdomen decreases, and pressure on the stomach from the growing uterus pushes its acidic contents up

What can help?

  • Eat small frequent meals vs. 3 large ones
  • Avoid food that may trigger symptoms e.g., coffee, chocolate, citrus, fatty, fried and spicy foods
  • Drink fluids between meals
  • Try chewing sugarless gum
  • Wear loose clothing
  • Avoid lying down right after a meal
  • Sleep propped up or elevate head of bed 10-15 cm
  • Increased blood volume, pressure from the growing uterus and straining from constipation cause blood vessels in the rectal area to enlarge

What can help?

  • Prevent constipation and practice Kegel exercises
  • Don’t sit for long periods of time or strain when on the toilet, put feet up on a stool
  • Keep the area clean, try unscented wipes
  • Alternating cold and heat, apply ice wrapped in a cloth to the area, then soak in warm water 15-20 mins. several times a day
  • Lie on your side
  • Ask your health care provider about hemorrhoid creams or suppositories
  • Cause is not known but may be due to less calcium and more phosphorus in the blood

What can help?

  • Check that you’re getting enough calcium
  • Stretch your legs and exercise regularly
  • During a cramp, straighten your leg and point your toes towards your head or heel walk then apply heat (take a bath) or massage the area
  • Estrogen causes more mucous

What can help?

  • Add moisture by using a humidifier or vaporizer, salt water nose drops (1/4 tsp salt in 1 cup water) and applying warm moist towels to your face
  • Avoid smoke and antihistamines
  • Cause is not known but is thought to be due to pregnancy hormones, the size of the placenta and other factors Avoid strong odour triggers

What can help?

  • Eat small meals or snacks every one to two hours during the day
  • Try a few dry crackers 15 minutes before rising or a few salty potato chips before a meal
  • Sniff lemons and ginger or enjoy them in a hot water drink
  • Sip fluids frequently to prevent dehydration
  • Take a nap and rest more often
  • Try acupressure (Sea Bands: acupressure on P6 near wrist), pharmacy-grade ginger (250 mg four times a day) or mindfulness meditation
  • Switch iron containing vitamins for folic acid or vitamins low in iron for a short time
  • The growing uterus puts pressure on your bladder, kidneys produce more urine Drink less in the evening, but drink lots in the daytime

What can help?

  • Go to the bathroom every time you feel the urge to pee; empty your bladder well
  • Practice Kegel exercises
  • See a pelvic floor physiotherapist if you are leaking urine and not making it to the bathroom in time
  • Progesterone early on may cause you to breathe more deeply. Later on, the diaphragm is pushed up by the growing uterus so the lungs have less room to expand when you breathe in Listen to your body; adjust your level of activity and slow down or stop

What can help?

  • Breathe slowly and deeply through your mouth
  • Maintain good posture; lift your chest and shoulders back
  • Wear loose-fitting clothing
  • Be physically active
  • Prop your head up on pillows when you lay down so you are semi-sitting

(dry and itchy skin, darkening of the skin on face, line on your abdomen, and stretch marks)

  • Hormones cause the blood vessels in the skin to change, increase blood flow and change how elastic and pigmented the skin is

What can help?

  • For dry itchy skin use glycerin type soap, take an oatmeal bath and moisturize well
  • Avoid hot baths
  • Eat a healthy diet and drinks lots of fluids
  • Limit sun exposure; be sun safe by covering up and using sunscreen
  • Don’t be swayed by products that promise to prevent stretch marks. They don’t work!
  • Caused by hormone changes and increase in body weight
  • Amount of blood in body increases by 40% Elevate your legs often above the level of your heart and try not to cross them

What can help?

  • Get up and move every half hour
  • Avoid standing for long periods of time
  • Use a foot stool when sitting
  • Wear comfortable shoes and loose fitting clothing
  • Exercise to promote circulation. Try support stockings
  • Pressure and weight of the baby slows the flow of blood from the legs back to the heart
  • Blood pools and the veins swell where there are weak areas
  • Can be hereditary!

What can help?

  • Follow the tips for swollen ankles
  • Change your position often; alternate between sitting and standing/walking
  • When sitting do ankle and foot exercises
  • Sleep on your left side to promote circulation
  • Gain weight within the recommended guidelines
  • Prevent constipation

Emotional Changes

upset woman

Although pregnancy can be a happy and exciting time, it is also an emotional and worrying time for many. All the hormonal changes and adjustments can increase your stress level and affect how to you think, act and feel. Every person experiences pregnancy differently.

The unique pregnancy stresses that you and your partner might experience are:

  • physical discomforts and mood swings.
  • worrying about your health or the health of your baby.
  • fear of the unknown – childbirth.
  • adjusting to becoming a parent.
  • changing relationships with those you are close to.
  • financial concerns.

Take Care of Your Emotional Health

To cope with the normal “ups and downs” of pregnancy, you can:

  • listen to your body and take time to rest, relax and sleep as much as you can.
  • be kind and gentle with yourself – set realistic expectations!
  • prioritize tasks – do one thing at a time.
  • plan to do something you enjoy every day – you are not being selfish!
  • stay active and eat well.
  • try to avoid stressful situations.
  • talk to your baby and enjoy your growing bond.
  • create a good support network.
  • make time to go out – visit friends or spend time alone with your partner.
  • share your thoughts and feelings with your partner and/or someone you trust about all of the changes, the things you worry about and your feelings.
  • talk to your health care provider if you need extra support to help you cope.

Mood Changes and Anxiety in Pregnancy

Mental health concerns can happen to anyone, even during pregnancy. Depression and/or anxiety are common, affecting up to 1 in 5 women. They need to be taken seriously because they can affect your health and the health of your baby and also affect your relationship with your partner and others. The good news is depression and anxiety can be treated and managed.

There is no one single cause for mood and anxiety disorders. They may be triggered by pregnancy hormones that affect chemicals in the brain, a pregnancy complication, a personal or family history, stressful life events, or a lack of support.

What are the Symptoms?

Symptoms may be mild, moderate or severe and last for two weeks. They may include:

  • feeling weepy, sad, hopeless or overwhelmed.
  • trouble focusing or making decisions.
  • trouble sleeping or sleeping too much.
  • exhaustion and no energy
  • eating too much or too little.
  • feeling anxious or worried all the time.
  • losing interest or pleasure in activities you once enjoyed.
  • feeling irritated, restless, moody or even angry.
  • thoughts about harming yourself.

If you have these symptoms and feel you are struggling, find someone to talk to.

  • This is not your fault. You are experiencing an enormous life change. You are not weak and you are not a bad parent-to-be.
  • Help is available. Don’t suffer in silence. Take that first step and ask for help. If you are unsure where to start, a Public Health Nurse at Peterborough Public Health can help.
  • With help you will get better. Your health care provider will explore the pros and cons of the different self-help, support and treatment options that will get you feeling more like yourself and able to cope again. It may take time but you will recover.If you ever have thoughts of harming yourself go the hospital Emergency Department right away.

For tips on how partners can help, see ??. Sometimes they struggle too!

Warning Signs
Be sure to discuss any unusual changes or concerns with your health care provider.

Tell your health care provider right away if you have:

  • unusual or ongoing headaches.
  • nausea and vomiting that is ongoing.
  • changes in eyesight or spots before your eyes.
  • dizziness or feeling unwell.
  • vaginal bleeding or leaking of fluid.
  • any noticeable decrease in your baby’s normal movement.
  • lower back pain/pressure or change in
  • lower backache.
  • feeling that the baby is pushing down.
  • regular contractions.
  • severe abdominal pain.
  • sudden swelling of the face, hands.
  • calf pain in your leg.
  • unexplained rash.
  • fever and chills (i.e. temperature above
    38.3° C or 101° F).
  • burning sensation when urinating.
  • feeling overwhelmed, anxious, or sad.
  • if you are in a motor vehicle accident of any kind, have a fall or any injury to your stomach area.

Sex and Pregnancy

female partner kissing pregnant partner

Your sexual desire and comfort with having sex during pregnancy may stay the same, increase or decrease a lot. Many report a drop in the first trimester, a rebound in the second and a bigger drop in the third. But it’s different for everyone.

Why does sexual desire and activity change?
The changes that make you more or less interested in sex are:

  • morning sickness.
  • feeling tired.
  • being more sensitive in areas such as the breasts and belly.
  • increased blood flow to the pelvic area.
  • physical discomfort such as back pain.
  • feeling “big” and awkward or feeling beautiful and attractive.
  • more pelvic pressure.
  • leaking fluid (colostrum) from the breasts when they are stimulated.
  • uncomfortable contractions of the uterus with orgasm.
  • fears and myths about sex causing miscarriage, preterm labour, infection or harm to baby.

Is sex during pregnancy safe?
In general, sex is safe even up to the start of labour. However your health care provider may advise you to avoid sexual intercourse and/or orgasm if you have:

  • had a miscarriage before.
  • bleeding.
  •  history of premature labour.
  • a low lying placenta.
  • a lot of contractions in the last month of pregnancy.
  • ruptured membranes (your water has broken).
  • a sexually transmitted infection.

Tips on Having Sex

  • Talk, listen, and share your concerns with your partner. Check-in often. This helps avoid hurt feelings.
  • If tired in the evening, try the morning, afternoon or when you feel more rested.
  • If your breasts leak colostrum, consider wearing a comfortable bra.
  • Explore activities that bring you both pleasure. Intimacy also includes touching, kissing, massage, sex play without penetration, shallow penetration, and oral sex.
  • Try different positions using pillows to provide support where needed. Try side-lying or on your hands and knees with your partner behind you, or sitting on your partner’s lap.
  • If you need lubrication, choose a water-soluble gel (e.g. KY Jelly ) or a lubricated condom. Do not use Vaseline. Oral sex is safe in pregnancy if your partner:
    • doesn’t have a cold sore. The herpes virus could cause a serious infection.
    • avoids blowing air into your vagina. This could result in the dangerous
      condition of an air bubble blocking a blood vessel (embolism).

Don’t be alarmed if after love making you experience mild cramps, a little spotting or your uterus becoming hard for a few minutes. It is normal for the uterus to contract during an orgasm. This is more noticeable as the uterus gets bigger in pregnancy.

Oral Health

pregnant woman at dental visit

Taking care of your teeth and gums is an important part of having a healthy pregnancy. Hormone changes in your body can make your gums more sensitive, bleed more easily, and become swollen (gingivitis). If gingivitis is not treated, it may lead to more serious gum and bone disease (periodontitis). This disease can cause you to lose teeth. Periodontitis has also been linked to preterm labour and high blood pressure in pregnancy (pre-eclampsia).

How to Keep Your Mouth Healthy

  • Brush your teeth at least twice a day using fluoride toothpaste and a soft toothbrush. Clean carefully at the gum line where gum disease starts.
  • Floss daily to clean between your teeth and gums.
  • Let your dental office know you are pregnant. Have a check-up in your first trimester and continue with routine checks.
  • If an x-ray is needed in an emergency situation, ensure your abdomen is shielded with a lead apron to protect your baby from radiation.
  • If vomiting occurs, rinse your mouth out with water or a fluoride mouthwash; then wait 30 minutes before brushing your teeth. The stomach acid combined with brushing can damage the enamel of your teeth and cause decay.
  • Avoid sugary, soft and sticky snacks between meals.
  • Eat well following Canada’s Food Guide. Calcium and vitamins help maintain healthy teeth. See the list of good sources of calcium on the “Healthy Eating – Pregnancy” page
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