Most aches and pains in pregnancy are normal

You're pregnant: your back aches, you feel tired and dizzy and, to top it all, your ankles look like balloons. Is there no end to the indignities a woman has to suffer when carrying her little bundle?

It might help to know that there are some good reasons for these discomforts and some simple ways to deal with them. You are carrying extra weight and pumping extra blood around your body. You are also tapping into your own body resources, such as iron and calcium, to grow your baby. In addition, the levels of several hormones gradually increase during your pregnancy to help the pregnancy and birth. Two hormones in particular, progesterone and relaxin, make the muscles, ligaments and vessels more elastic so they can stretch to accommodate your baby. Your pelvic joints become more flexible, allowing them to open and let the baby to pass through at birth. The discomforts you might experience are the side effects of all these changes.

Because the risks of most medications in pregnancy are not known, they are generally not recommended as the first line of treatment for mild discomforts. It's good to know then, that there are some effective, non-medical options available. As a general rule, regular gentle exercise, such as yoga, walking and swimming, and good nutrition can do a lot to prevent or alleviate many of these problems.

This article looks at the changes that affect your muscles, joints and circulation:

• back pain
• breathlessness
• dizziness and fainting
• fatigue
• pelvic pain
• varicose veins
• water retention (oedema).

Also, read about Digestive System Discomforts in Pregnancy, and Skin changes in pregnancy.

Back pain

Many women experience back pain, particularly later in pregnancy as the baby bump pushes your weight forwards. It is tempting to arch your back in response but this puts it under strain. Your joints are softened and more flexible than usual due to those pregnancy hormones. They move more easily and can pinch nerves, causing pain. 

• Support your spine by standing up straight. Roll your shoulders back and tuck your pelvis forward and under you.
• Yoga and other gentle forms of exercise strengthen your back and help you practise good posture.
• When sleeping, try lying on your side, with pillows behind your back and under your top leg.
• A belly belt can help support the weight of your bump and distribute it across your back.
• Massage not only eases aching muscles but can also be a good practice for your birth supporters!
• It may help to visit a physiotherapist or osteopath. Make sure you let your practitioner know that you are pregnant.

Shortness of breath

Shortness of breath in the last trimester is caused by the baby growing up under your diaphragm; the band of muscle that runs across your chest under your lungs and helps you to breath. Shortness of breath earlier in your pregnancy suggests you are anaemic (low in blood iron).

In the last few weeks before you give birth, you may experience ‘lightening’ as your baby moves downwards into the pelvis (engages). At this stage, you will notice you can breathe more easily once again.

• If you are short of breath in the first or second trimester talk to your lead maternity carer (LMC) or your GP, who may advise iron supplements.
• Regular, gentle exercise will increase your lung capacity and ease breathlessness.
• Yoga helps to broaden your rib cage and lift your posture to give your baby maximum room.
• Talk to your LMC about what you can do to get and keep baby in the optimal position, so that he or she can move down and ease the pressure.

Dizziness and fainting

Increased progesterone levels in pregnancy reduce blood pressure. If you stand for any length of time you may feel dizzy or even faint. You may also experience these symptoms if, from around 20 weeks onwards, you lie on your back for any length of time. This is because the extra weight you are carrying in your abdomen presses on the major blood vessels that run down behind your uterus. This compression reduces your blood pressure and can also restrict the flow of blood and oxygen to your baby. 

• Avoid standing for long periods of time.
• Avoid lying on your back.
• Sit down, or lie on your side if you feel dizzy.

Fatigue

Fatigue is common in pregnancy, particularly in the first and third trimesters. If you find the fatigue is particularly bad, you might have anaemia (low in blood iron). This can be checked with a blood test ordered by your LMC. It could also be that you are not getting enough exercise. Exercise increases your energy levels as well as helping you get a good night’s sleep.

• Eat little and often, selecting highly nutritious, low GI foods (low in sugar).
• Ask your LMC whether iron supplements may be necessary.
• Rest regularly.
• Take regular, gentle exercise, such as swimming, walking or yoga.

Muscle cramp

Cramp is thought to be caused by sodium and calcium deficiencies as your body gives up its reserves to make your baby’s bones. Often, pregnant women get cramp in their calves, usually at night.

• Eat a diet rich in calcium, magnesium and vitamins B and D or take these as supplements. 
• Reduce your intake of caffeine (coffee, tea and chocolate), which can slightly lower calcium absorption.
• Exercise your calves and ankles regularly and especially just before bed.

Pelvic pain

Some women experience pain in their pelvis during pregnancy – particularly at the front around a joint called the symphisis pubis. This is caused by softening of the ligaments that hold the pelvis together, allowing the bones to move and pinch nerves.  In a very small number of women, the pain of the condition – known as symphisis pubis dysfunction (SPD) - is severe. Once the baby is born the joint usually returns to normal and the pain quickly resolves.

• Avoid movements that aggravate your pain.
• Try not to adopt positions that open the legs wide.
• Talk to your LMC or a physiotherapist, who may be able to recommend a belt to support your pelvis.
• An osteopath may be able to help realign the pelvis.
• Acupuncture has been found to alleviate the pain of SPD in some women.

Varicose veins

Varicose veins are caused by the poorer blood return that happens with lower blood pressure and relaxing of the veins. Varicose veins usually occur in the lower limbs – especially the calves. Varicose veins in the anus are called haemorrhoids.

• Avoid crossing your legs.
• Elevate your legs as often as possible.
• Take regular gentle exercise.
• Use support stockings if you are particularly concerned.
• Avoid standing for long periods of time.
• Do gentle leg exercises, such as ankle circling and calf stretches.

Watch the everybody Human Atlas Movie on varicose veins

Water retention (oedema)

As your pregnancy progresses, you may find your hands, feet, wrists or ankles get puffier. Again, this is due to less efficient blood circulation caused by pregnancy hormones.

Water retention on its own is not a concern. Your LMC will keep an eye on any swelling you have, while at the same time checking your blood pressure and urine. If water retention is accompanied by high blood pressure and protein in the urine, it indicates a condition called pre-eclampsia that requires medical attention.

• Take regular, gentle exercise to improve your circulation.
• Elevate the affected limbs.
• Drink plenty of clear fluids.
  

Join the everybody Communities forums to discuss the ups and downs of pregnancy with other New Zealand mums-to-be.

Original material provided by Jo Lawrence-King, Childbirth Educator, edited by everybody and reviewed in March 2009 by Dr Tom Whimbrow, FRANZCOG.