Pregnancy Discomforts

• Be mindful of your posture, especially if you have upper and lower back pain.
• When lifting from the ground, bend at the knees.
• When sleeping, try lying on either side with your upper leg bent and your lower leg straight. Place a pillow under the knee of the upper leg.
• Avoid standing for long periods of time. When standing, place one leg up on a stool, which will take some of the pressure off your lower back.
• Wear comfortable shoes with good arch support. You may notice that your feet grow during pregnancy.
• Exercises such as pregnancy yoga, walking, swimming and stretching may help. Avoid hot yoga.
• Ask for backrubs.
• Get a pregnancy massage.
• Use a heating pad or ice pack. Be careful not to place these directly on your skin to avoid burns.
• Avoid excess weight gain.
• Your breasts will enlarge throughout your pregnancy. You may need to wear a supportive bra.
• Consider wearing a maternity belt to support your pelvis and to help avoid upper back strain.
• If you’re uncomfortable in the last months of pregnancy, avoid leaning forward when doing work.
• Relax in a warm bathtub, but not a hot tub or Jacuzzi.
• Avoid getting overtired. Aim for plenty of sleep and rest periods.
• Consider making an appointment with a physical therapist or occupational therapist, as they can offer safe exercises and suggest ways to modify your movements so you’re more comfortable.
• Acupuncture is a safe option that may help back pain.

• It’s important to have regular dental checkups, cleanings and any necessary dental work during pregnancy.
• Softened gums, caused by hormonal changes in pregnancy, can lead to dental problems.
• Consider using a softer toothbrush.

• Normal changes include:
  Breasts become larger, firmer and more tender. 
  Breasts may become nodular (lump-like). It can be normal to feel breast tissue extending into the armpits.  
  You may feel tingling, throbbing, heaviness and fullness. 
  Nipples may change colors; areolas may darken. 
  Superficial veins may be more visible. 
  Stretch marks may appear. 
  Glands around the nipple may enlarge. 
  Colostrum (the “first milk”) may be present after week 16. 
  There may be brown patches around the areola of the nipple.
• Unusual changes to discuss with your provider include: 
  Orange peel appearance (stippling of the skin of breast).
  Nipple retraction inward.
  Nipples that are swollen, hard, red, hot, tender, cracked or have hard lumps.

In general, wear a well-fitting bra. Purchase a nursing bra for the last month of pregnancy. Avoid underwire bras during this time. If there is colostrum (“first milk”), wash the nipple area with water only.

Pregnancy increases your blood circulation, which means your nose and airway linings fill up with more blood. The following are safe options to help with nasal congestion:

• A cool mist humidifier
• A saline rinse or Neti pot
• Breathing strips
• Nasal sprays, but please first consult your doctor
• Peppermint oil lightly applied to your temples or sinuses

These treatments are not recommended for bloody noses. For a bloody nose, apply pressure by pinching your nose together for 5 minutes, and contact your doctor if there is no improvement.

When you're pregnant, your body produces extra progesterone. Progesterone relaxes your intestines, or bowel, so they don't have to work as hard to push waste out of your body. This can lead to constipation. To keep your digestive system running smoothly, try to:

• Eat fresh fruit instead of fruit juice whenever possible.
• Eat crisp, cooked vegetables instead of overcooked vegetables.
• Slowly increase the fiber in your diet. Consider adding chia seeds and fiber powder supplements (Psyllium husk). See the “Grains” section.
• Always drink 2.5 – 3 liters (10 – 12 cups) of fluids daily.
• Give yourself time to go to the bathroom before leaving your house. Try to stay on a regular schedule. See the "Hemorrhoids" section.
• Exercise regularly, unless your health care team has told you not to.
• Do not use oral mineral oil while pregnant. It reduces the amount of vitamins your baby will receive.
• For safe over-the-counter medications during pregnancy, see Medication use during pregnancy. Make sure all medications are first approved by your doctor.

Mild swelling of your hands and ankles is normal. It may worsen in hot weather or with long periods of sitting or lying on the same side while sleeping. Try these strategies to ease the swelling:

• When sitting, try not to cross your legs.
• If you must stand for long periods, try resting with your feet up for at least 20 minutes, 2 – 3 times a day.
• Drink 2.5 – 3 liters (10 – 12 cups) of fluids daily.
• Sit in a warm (not hot) bath with water up to your waist.
• Do not wear socks or pants with tight bands.
• Wear full-length support stockings (compression socks), especially when traveling by plane.
• Elevate your legs when sitting.
• Eat protein-rich foods.

Low blood pressure, low blood sugar and dehydration can make you feel dizzy. It’s normal to feel occasional faintness or dizziness due to all the changes taking place in your body when you are pregnant. These tips can help:

• Move slowly. When getting up to stand from a sitting or lying position, move slowly.
• Avoid hot baths or showers.
• Eat frequent small meals, 5 – 6 times a day or up to every 2 hours, as needed. Avoid becoming very hungry.
• Avoid prolonged exposure to heat.
• Avoid tight clothing.
• If possible, avoid standing for long periods of time; if you need to stand for long periods, move your feet as much as possible.
• Avoid lying flat on your back once you reach the last 3 months of pregnancy.
• Notify your doctor or nurse midwife if you have frequent faintness or dizziness.
• If you feel like you are about to faint, lie down to avoid injury.

Fatigue is normal, especially in the first and last few months of pregnancy. Here’s what you can do:

• Rest as much as possible.
• Limit household chores or social activities for a while, if possible.
• Eat a well-balanced diet.
• Exercise if at all possible. A short walk may help.
• Avoid excessive caffeine (no more than 200 milligrams per day).
• Anemia can also cause fatigue. If you are diagnosed with anemia, take iron as discussed with your doctor or nurse midwife. Dietary sources of iron are red meat, lentils and green leafy vegetables.
• Notify your care team if you have sudden or more severe fatigue.

Headaches are common in pregnancy. Sometimes certain foods can cause headaches. Pay attention to the timing of headaches and food you have eaten. Some examples of foods that may cause headaches are processed foods or foods containing MSG or aspartame.

Tension makes headaches worse. Practice relaxation techniques daily (such as meditation, deep breathing or muscle relaxation). The below tactics can help, too:

• Reduce stress as much as possible.
• Try applying an ice pack or heating pad to the back of your neck.
• Get a neck massage.
• Drink 2.5 – 3 liters (10 – 12 cups) of fluid daily.
• You can also try 1 cup of coffee. Do not eat or drink more than 200 milligrams of caffeine per day (no more than one cup of coffee).
• You may take Tylenol (acetaminophen) occasionally as needed. Please let your care team know if you are requiring it regularly.
• New headaches with visual changes or upper abdominal pain and blood pressures of 140/90 or higher should be checked by your care team for high blood pressure or other pregnancy problems.
• Please see Medication use during pregnancy.

• Avoid spicy foods.
• Avoid citrus, tomato sauces, mint and carbonated drinks.
• Chew your food well and eat slowly. Try not to eat on the run. Eat at a slow pace when possible.
• Avoid caffeine.
• Avoid reclining right after eating and avoid eating late in the evening.
• Raise your head on pillows when you sleep.
• Wear clothes that are loose fitting at the waist.
• When picking up objects, bend at the knees instead of at the waist.
• When heartburn happens, take sips of water. Relax and take a few deep breaths. Sit down, raise your hands over your head and bring them down again quickly. Repeat several times.
• See Medication use during pregnancy.
• Notify your health care team if your heartburn continues.

Increased pressure from your baby on your rectum and perineum, along with your body’s increased blood volume, can cause hemorrhoids. These painful, inflamed veins may feel like small, fluid-filled sacs. These strategies can help:

• Avoid constipation. See the "constipation" section.
• Keep the anal area clean.
• See the Medication use during pregnancy section.

• Eat small, frequent meals. Try to eat before you get hungry.
• Avoid strong food and other environmental odors as much as possible.
• Avoid triggers that make you nauseous.
• Avoid fatty or spicy foods.
• Eat a few crackers when you get out of bed in the morning.
• Whole grains and legumes might help by reducing the acidity in your stomach.
• Sit up after eating. Try to avoid lying down right after eating.
• Take sips of water throughout the day.
• Avoid drinking fluids right before or right after eating.
• When possible, allow 30 minutes before and after eating before engaging in activity.
• Drink sips of diluted sports drinks.
• Ginger (gum, candy, chews, tea) sometimes helps nausea.
• Try acupressure wrist bands.
• Multivitamins might make nausea worse. Do not take them on an empty stomach. Try taking them before bedtime. If this does not help, temporarily stop the vitamins (prenatal vitamins containing DHA), but do take a folic acid supplement of 0.4 milligrams (400 micrograms) daily.
• Get as much rest as possible.
• If you have a lot of saliva production, spit it out instead of swallowing it.
• Ask your health care team about vitamin B6 supplements and doxylamine supplements.
• Taking vitamin B6 supplements may decrease nausea during the first 3 months of pregnancy. Start with B6 (10-25 milligrams) every 6 –8 hours and do not take more than 200 milligrams daily.
• Notify your care team if you are vomiting so much that you cannot keep fluids down or lose 5% or more of your pre-pregnancy body weight.

It’s normal to have an increase in vaginal discharge during pregnancy. If you have vaginal itching or burning, it might be a yeast infection. Avoid wearing panty liners or mini pads as much as possible, as these trap moisture and increase the risk of yeast infections.

Contact your care team if you have any of the following changes: itching, burning or foul odor.

If you get the common cold or influenza (flu) while pregnant, here are some things you can do to help yourself feel better:

• Get lots of rest and avoid strenuous physical activity.
• Drink plenty of fluids (water or water with electrolytes, such as Pedialyte). Warm drinks with or without honey can soothe a sore throat and decrease mucous and congestion.
• For a sore throat, you can use lozenges, such as Cepacol, or zinc gluconate lozenges (like Cold-Eeze). You can buy these over the counter.
• You can use a saline nasal spray or Rhinocort nasal spray for a stuffy nose.
• If you're really suffering, Sudafed in small doses can be safe after 14 weeks of pregnancy. You can also try saline rinses or drips to dry out your nose. Nasal strips, steam, or vapor rub can help open up nasal passages.
• You can take Robitussin DM or Mucinex DM for coughing. For headache, you can take Tylenol up to 3000 milligrams per day, divided into doses of 1000 milligrams every 8 hours. 
• Tylenol (acetaminophen) may be taken as needed for fevers above 100.4 degrees Fahrenheit. 
• If you test positive for COVID-19, please refer to the U.S. Centers for Disease Control (CDC). If you feel you need to see your provider before your isolation period ends or if you have scheduled appointments that fall within that window, please contact your care team. 
• Obtain a home oxygen pulse oximeter. You can purchase these online or at a local drugstore.
• Stay home. Do not leave your home, except to get medical care, until your health care team says it’s OK. Do not go to work, school or public areas, and do not use public transportation or taxis.
• Watch for contractions, bleeding or leaking of fluid. If you are more than 24 weeks pregnant, please also make sure there is not a decrease in your baby's movement.
• As much as possible, stay in a different room from other people in your home. If possible, use a separate bathroom. If you must be in the same room as other people, wear a facemask to prevent spreading germs to others.
• Encourage all of your household and close contacts to get tested for COVID-19. Notify anyone you’ve been around in the 14 days before your positive test.
• Schedule an ultrasound between 28 – 32 weeks, or 3 – 4 weeks after your positive COVID-19 test.

If you think you may have COVID-19, please do a home test. The most common symptoms are chills, trouble breathing, severe fatigue, loss of smell or taste or any of the following that are not due to a chronic condition:

• Cough
• Sore throat
• Muscle aches
• Diarrhea
• Nasal congestion
• Runny nose
• Nausea or vomiting

Most people with COVID-19 do not have all of these symptoms. Most cold and flu-like symptoms are caused by viruses and will get better on their own without antibiotics.

If you have a fever above 101.4 degrees Fahrenheit, trouble breathing, oxygen levels less than or equal to 94% using a pulse oximeter, or concerns about your pregnancy, please call your care team.