Heading: Antenatal care
Nurse: First of all, welcome to our seminar on antenatal care. In this session, I will discuss with you the antenatal care, including common minor ailments during pregnancy and their management. I will also talk about antenatal exercise, emotional problems and sex life during pregnancy. We hope that you will learn more from this seminar!
Heading: Common minor ailments during pregnancy
Nurse: Minor ailments are common during pregnancy and they are usually mild and transient. During early gestation, you may often feel nauseated and sometimes vomit. Your flavour of food may somewhat change. This is because hormonal changes will make pregnant women become more sensitive to the smell of the foods. This occurs in more than 50% of pregnant women. Nausea and vomiting may start between the 4th to 6th week of pregnancy. It is usually mild and gradually resolves from the 12th week after. In rare cases, such symptoms may persist during the entire pregnancy.
Heading: Vomiting & nausea
Pregnant woman: I always feel nausea. So I don’t want to eat in the morning. What should I do?
Nurse: You may have 1 to 2 pieces of salty crackers or one piece of bread before getting up. Eat small frequent meals of light, non-flavoured food. Avoid eating fried, deep fried or oily foods because they likely cause indigestion.
Pregnant woman: What should I do if I have a severe vomiting? Should I take any medications?
Nurse: If you have severe vomiting, please visit a doctor. Don’t take any medications without doctor’s prescription because some drugs may affect foetal development and growth.
Heading: Indigestion, Heartburn
Pregnant woman: Sometimes I have heartburn that makes me feel like my chest is on fire. Is this due to indigestion?
Nurse: This is caused by hormonal changes during pregnancy. Or it may be due to relaxing of lower oesophageal sphincter because of hormonal changes. In this case, gastric juice will leak back into the oesophagus and causes heartburn.
If you have this problem, eat small frequent meals, chew slowly and thoroughly. Please also avoid spicy and oily foods.
Pregnant woman: After getting pregnant, I notice that my bowel habit becomes worse, sometimes passing hard stool. What can I do?
Nurse: Constipation is generally caused by imbalanced diets and lacking of exercise or physical activities. During pregnancy, hormonal changes cause relaxation of the intestinal muscles. This slows down the bowel movement. In addition to absorption of extra amount of water by the bowel, this eventually leads to constipation.If you have constipation, you may try the following: First of all, drink sufficient amount of fluids. Have 8 to 12 glasses of drinks every day. Warm or hot drinks are preferable. Eat a balanced diet and include food with plenty of fibre, and avoid eating too much fat and protein. Have moderate exercise or physical activities. The most important is never take non-prescription laxatives.
Heading: Haemorrhoids (piles)
Pregnant woman: Besides constipation, it seems that I also have haemorrhoids because I am bleeding while I am opening my bowel. I am very worried.
Nurse: Haemorrhoids are common problems during pregnancy and so please don’t worry. Haemorrhoids are enlarged and swollen veins in or around lower rectum and anus. It is due to increased intra-abdominal pressure leading to poor blood circulation in the anal veins. It usually occurs during the late gestation and will resolve gradually after delivery. Constipation and prolong standing will worsen the problem. Passing hard stools may also cause bleeding of the haemorrhoids.
Pregnant woman: What should I do?
Nurse: The best solution is to keep the bowel open. But mind you, you should seek medical advice promptly if you have severe haemorrhoids or heavy bleeding!
Heading: Mild Abdominal Pain
Pregnant woman: I have mild abdominal pain recently. I’m wondering if these are so-called labour pains?
Nurse: Pregnant women can sometimes have abdominal pain due to a number of reasons. For example, mild uterine contractions can cause mild and transient abdominal pain. Besides, constipation may also cause abdominal pain! During pregnancy, the uterine ligaments are also being stretched and this causes mild abdominal pain. Hard kicks from the foetus also cause mild abdominal pain. This can be managed easily. All you need is to have adequate rest and keep your bowel open. If the abdominal pain increases in frequency, from transient to regular labour pains, or increase in severity, this may be a sign of labour contraction. If this happens, consult a doctor or go to the hospital immediately.
Heading: Urinary frequency
Pregnant woman: I heard a pregnant woman complaining about urinary frequency during the antenatal visit, is it a problem?
Nurse: In early gestation, the uterus is still located inside the pelvic cavity. When the uterus expands, it presses on the anterior portion of the bladder and this causes urinary frequency. In mid-gestation when the uterus extends to the abdominal cavity, urinary frequency will decrease. During the last few weeks in the late gestation, the foetus engages into the pelvic cavity in preparation for labour. This again exerts pressure on the anterior portion of the bladder. As a result, urinary frequency occurs again.
Pregnant woman: I see. So, does drinking less fluid helps reduce urinary frequency?
Nurse: Don’t do that. Drinking less fluid can lead to a higher risk of urinary tract infection or cystitis. If you have a sharp pain or burning sensation during urination, consult the doctor for any infection!
Pregnant woman: Sometimes I feel dizzy when rising from my seat in the office. I also feel dizzy even when I am sitting in a car. Though it is mild, I wonder why this happens?
Nurse: It is because the blood volume in your body will increase in early gestation. The elasticity of the blood vessels and blood flow to various organs also change. Blood flow in the placenta also adds extra burden to your body. Besides, hormonal changes and the needs of your foetus cause an unstable blood sugar level. If you don’t have regular meals, your blood sugar levels may drop and you will feel dizzy.
You may feel dizzy if you’re in a poor-ventilated area or when the surrounding environment is hot. You may also feel dizzy when you have been standing for too long, or change your posture suddenly such as quickly rising from a chair or changing from a lying to a sitting position. It happens because your body is unable to transport oxygen to the brain immediately.
Pregnant woman: I see! What should I do if I feel really dizzy?
Nurse: When you feel dizzy, sit down or lie down immediately for a rest or go to a well-ventilated place. Having regular meals does help and so it is best to have small frequent meals. When you are hungry, have one or two crackers, have a drink and take a short break. Never change your posture quickly or suddenly.
Heading: Feel dizzy when lying down
Pregnant woman: Sometimes I feel dizzy even when I’m lying down!
Nurse: During late gestation, the uterus will press on the vena cava. Such compression may hinder blood flow from lower limbs to the heart. With less blood pumping from the heart, your blood pressure drops and results in dizziness. When this happens, lie on your side or rise slowly. You will feel better in one or two minutes.
Heading: Heart Palpitation and Shortness of breath
Pregnant woman: Sometimes, I feel heart palpitations and have shortness of breath.
Nurse: Heart palpitation is a very common symptom in pregnancy. You feel palpitations because your heart has to work harder so as to transport oxygen and nutrients to the foetus. When the uterus gradually grows in size, it will also press against the lungs and affects your breathing. Therefore, you will have shortness of breath. This is more prominent when you are climbing upstairs. For this reason, pregnant women should rest more.
Heading: Breast pain and engorgement
Pregnant woman: I have breast pain and engorgement which only used to occur before my menstrual period! Why?
Nurse: Breast pain and engorgement occur because the mammary glands multiply and expand and there are also extra fat due to hormonal changes during pregnancy. Besides pain and engorgement, sometimes there will be a small amount of milk secretion. You’ll need to wear a good support bra. Bathe as usual and clear up the secretions of the nipple with water.
Heading: Skin problems
Pregnant woman: I feel itchy especially around the abdomen. Sometimes, I also have rashes. What should I do?
Nurse: Pregnant women’s skin will become more sensitive and therefore you may feel itchy when irritated, especially around the abdomen and areas with stretch marks. The problem gets worse in cold and dry weather. Never use soap or liquid soap that may causes irritation. Apply a moisturiser to the affected areas can help relieve the problem.
Heading: Striae (Stretch marks)
Pregnant woman: I have heard about the formation of stretch marks during pregnancy? What are stretch marks?
Nurse: Stretch marks are formed when capillary blood vessels become visible after the tearing of the dermis as the skin becomes thinner during pregnancy. Stretch marks usually present in the lower abdomen, breasts, buttocks and outer aspect of the thighs. The number of stretch marks varies depending on individuals.
At present, there is no evidence that ‘striae cream’ can prevent the formation of stretch marks. However, applying olive oil to the abdomen and thighs help moisturises the skin. Stretch marks fade away gradually as silvery white, fine stripes after delivery.
Heading: Increase vaginal secretions
Pregnant woman: I notice I have increasing amount of vaginal secretions. Why?
Nurse: Hormonal changes during pregnancy lead to an increase in vaginal secretions. However, it may also be due to Vaginal Candidiasis or other types of vaginal infections.
To prevent vaginal infections, wear cotton panties and line it with airy sanitary pads to keep the genitals clean and dry. Showers are preferable. If you notice your vaginal secretions become yellow, cheese-like, smelly, or you feel itchy around the vulva, seek medical advice promptly.
Heading: Low back pain
Pregnant woman: I am worried that I will have low back pain during later part of my pregnancy.
Nurse: Hormonal changes during pregnancy make the ligaments around the joints more relaxed, especially for those at the back and the pelvis. Burdens to the spine and the pelvis increase as the foetus gains weight. As your centre of gravity moves forward, improper walking or sitting postures will cause low back pain. You should maintain proper walking and sitting postures as shown in these two photos (Photos illustrate a woman in standing and sitting positions keeping her spine straight).
Pregnant woman: What can I do to alleviate low back pain?
Nurse: Wear comfortable flat shoes and avoid high heels. Maintain proper posture. Always keep your spine straight. Avoid stooping because it exerts a great burden on the spine. Choose a mattress that is firm enough to support your body weight and to maintain the proper curvature of the spine. More antenatal exercise before delivery helps stretching the joints and strengthening the muscles. If you have severe low back pain, seek medical advice promptly!
Heading: Leg cramps
Pregnant woman: I always have leg cramps while sleeping. Is this common during pregnancy?
Nurse: Leg cramps are caused by muscle tension. It usually occurs while pregnant women are at rest. Doing moderate exercise, avoiding fatigue and doing leg exercise may help alleviate the problem. You can learn how to do leg exercise from the following video.
Heading: Leg exercise
Background: A physiotherapist explains how to do leg exercise, which is demonstrated by a woman.
Physiotherapist: Lets’ start with the toes and ankles. First of all, point your toes and ankles upwards, then downwards, inwards and outwards. Rotate your ankles to draw a big circle. That’s right! These movements mainly help enhance blood circulation of the feet and decrease swelling. Remember, do 2 minutes each session, twice a day.
Nurse: When you have a leg cramp, stand or sit down with stretch your leg muscles. Point your toes towards your head. You may also slowly massage your legs.
Heading: Varicose veins
Pregnant woman: I notice I have increased number of blue veins on my legs, some of them seem a bit enlarged. Are those varicose veins?
Nurse: Yes! During pregnancy, it is common that the veins in the legs and the vulva become enlarged. This is due to an increased blood volume in the body. Women who have multiple pregnancies in short intervals are more prone to having varicose veins.
Avoid walking or standing for long periods during pregnancy. To help alleviate the burden on the veins, elevate your feet while you are sitting down and wear compression stockings. The problem generally resolves after delivery.
Heading: Leg oedema
Pregnant woman: I was told that pregnant women should buy shoes one size larger because oedema usually occurs in the late gestation. Is it true?
Nurse: About 80% of pregnant women may have leg oedema in the late gestation. This is because the rising oestrogen level causes water retention in the body. Prolong standing or sitting will also lead to leg oedema.
Pregnant woman: What should I do?
Nurse: For mild oedema, take more rest. Elevate your legs with pillows while you are sitting down or sleeping. Wear comfortable shoes that are slightly larger than the ones you wore before you are pregnant. Avoid eating salty foods and avoid prolong standing. Make sure you do antenatal exercise.
Pregnant woman: What medications help reduce leg oedema?
Nurse: Do not take non-prescription diuretics. This will lower your blood pressure and decrease blood flow to the foetus, which means less supply of oxygen and nutrients to the foetus. For severe oedema, seek medical advice or go to the Accident & Emergency Department promptly.
Heading: Antenatal exercise
Pregnant woman: You just mentioned about antenatal exercise. What types of antenatal exercise should we do? What are the benefits?
Nurse: Having a walk or swimming are some good examples of antenatal exercise that you can do. Moderate exercise helps improve physical and psychological health, stretching the joint, strengthening the muscle, and enhancing your lung and respiratory functions as well as your heart functions. Exercise also shortens the delivery process and decrease constipation.
You can join antenatal exercise classes organised by the Department of Physiotherapy at hospitals from Hospital Authority. Antenatal exercise can minimise low back pain, leg oedema, varicose veins, muscle cramps and urinary incontinence. It is best to start doing antenatal exercise when you are at 16th to 20th week of pregnancy. If you are interested, you can approach the Department of Obstetrics & Gynaecology of a hospital from Hospital Authority or the Maternal and Child Health Centre (MCHC) for a referral letter.
Heading: Emotional problems during pregnancy
Pregnant woman: I notice that I become more bad-tempered recently. Why?
Nurse: I understand your feelings. In fact, there are usually great emotional changes during pregnancy. Nausea and vomiting in early gestation can lead to mood changes. In mid-gestation, pregnant women become more emotionally stable and more relaxed as they have adapted physically. In late gestation, several factors make pregnant women more prone to unstable mood. For example, the expected date of delivery is approaching; pregnant women experience more physical discomfort such as enlarged abdomen, low back pain and impaired mobility. That’s why support from the partner during pregnancy is very important.
Pregnant woman: How can we overcome emotional disturbances?
Nurse: You and your partner should face the difficulties and problems encountered in pregnancy together. Talk frankly and be considerate. We encourage expectant fathers come with their partners for the antenatal health talks. A harmonious sex life is also important. If you feel depressed and have persistent insomnia, seek help from the health care professionals promptly!
Heading: Sex life during pregnancy
Pregnant woman: I am now in the 4th month or so of pregnancy. I stopped having sex with my husband since I was confirmed pregnant. Should we have sex only after delivery? I am worried that my husband may grow tired of me.
Nurse: Pregnant women can still have sex. Sex life between a couple can carry on into the 12th to 36th week of pregnancy. However, if there are signs of miscarriage in early gestation or if placenta praevia has occurred during the mid- and late gestations, you should both abstain from sex. Sexual intercourse is not the only form of sex. You both can attain sexual satisfaction and physical pleasure by other means such as cuddling, caressing and kissing.
Pregnant woman: But with my abdomen getting bigger day after day, won’t there be difficulties in lovemaking?
Nurse: You may adopt different postures at different stages of pregnancy. In early gestation, apart from the ‘normal position’, the ‘stretching position’ may be used to avoid pressing on the woman’s belly. In mid-gestation, intense actions which press hard on a woman’s belly should be avoided. You may choose ‘kneeling back position’ and ‘face-to-face sit-up position’.
Pregnant woman: Can we have sex when my belly further enlarges?
Nurse: It is common that pregnant women will have low back pain and feel increased abdominal pressure during late gestation. At this stage, husband should show more concern and adopt the ‘back side-by-side position’. Sexual satisfaction can also be attained through mutual caressing. Sexual intercourse after 36 weeks of pregnancy is undesirable because this may cause premature rupture of the membrane and delivery may take place at any time. Avoid vigorously stimulating the nipples as this causes uterine contractions which triggers premature labour contractions and result in pre-term labour.
Nurse: Finally, we hope that proper antenatal care will help relieve all your worries and allow you to welcome your newborn baby joyfully. If you have any further enquiries about your antenatal care, you are welcome to seek advice from the MCHC or other health care professionals.
Pregnant woman: Thank you. We know what to do now!
Heading: Other information
Nurse: Family Health Service of Department of Health, 24 hour health information hotline 2112 9900, website: www.fhs.gov.hk