Minor Ailments in Middle Pregnancy and Their Management

During pregnancy, the rapidly rising hormones, like oestrogen, progesterone and prolactin, change the maternal body into a suitable environment for the foetus. Most of these bodily changes are normal.

  • Most of the minor ailments in pregnancy will spontaneously subside after delivery. Therefore, pregnant women do not need to worry.
  • Herbs and medicines should be avoided especially during early pregnancy because they can enter the foetal circulation through the placenta. Some medications exert toxic or teratogenic effect on the foetus. One should always seek doctor’s advice before taking any medications.
  • Some essential oils for aromatherapy may not be safe during pregnancy. Please consult healthcare professionals before using aromatherapy.
  • Increase in progesterone during pregnancy causes dilation of blood vessels, thereby accumulating blood in the lower limbs.
  • Meanwhile, the growing foetus increases pressure on abdomen and affects circulation. This results in varicose veins, swelling in the lower limbs and leg cramp.

Leg Cramps

  • This usually occurs at rest and therefore can affect sleep. It usually results from muscle tension.
  • Sometimes severe vomiting can lead to low level of calcium and potassium in blood, resulting in cramps.
  • If severe vomiting presents at the same time, hospitalisation for electrolyte replacement may be necessary.

Stretching the calf muscles regularly or before going to bed can help expectant mother to reduce leg cramps.

Exercises that can reduce leg cramp

  1. Stand in front of a wall with an arm distance or about 60 centimeters. Place your hands on the wall.
  2. Step your left foot forward. Bend your left knee slightly. Keep your right leg straight. Hold for 10 seconds. Then relax.
  3. Repeat on the other leg. Repeat the whole set 3 times.
  1. Sit on a chair
  2. Straighten right leg. Pull sole towards yourself with a towel. Hold for 10 seconds, then relax.
  3. Repeat on the other leg. Repeat the whole set 3 times.

Tips

  • Slightly stretch your calf muscles in case of leg cramps
  • If you are standing, stretch the cramped leg by keeping it straightened
  • Massage or apply a hot pad to the calf if leg cramp persists

Varicose Veins

  • Varicose veins are swollen veins that bulge near the surface of the skin, usually in legs, sometimes in vulva during pregnancy.

Tips

  • Avoid standing for long periods of time
  • Avoid sitting with your legs crossed
  • Wear flat shoes instead of high heel as your calf muscles move better and foster healthy circulation
  • Sit with your legs up as often as you can, to ease the discomfort
  • Sleep with your legs higher than the rest of your body –use pillows under your ankles or put books under your feet
  • Do foot exercises and other antenatal exercises, walking and swimming, which will help your circulation
  • To prevent blood from pooling in your legs, put the stockings on before getting out of bed in the morning, while you are still lying down. It makes it easier for blood to flow up toward your heart.

If you have varicose veins or need to stand for a long period of time, you should consult healthcare professionals about wearing compression stockings

Exercise can strengthen calf muscles and improve circulation in the lower limbs.

  1. Stand with hands holding on a chair. Then slowly raise up heels and stand on the toes. Hold 5 seconds, then relax. Repeat 5 to 10 times as a set. Perform several sets a day.
  2. You can perform the second exercise when sitting on a chair. Turn the foot upwards and downwards.
  3. Rotate the foot clockwise or anti-clockwise.

Foot pain

Weight gain and change in centre of gravity during pregnancy affect the way you walk. The leg muscles get tired easily.

The plantar fascia ligament is under additional strain leading to heel pain, foot pain and plantar fasciitis.

Choose comfortable footwear with enough space and good arch and ankle support. Shoes with wide heel and moderate height help disperse the stress on the sole of the foot.

Neck, shoulder and back pain

Neck, shoulder and back pain are common during pregnancy

Causes

  1. The hormonal changes cause ligaments to become stretchy. The spinal joint, pelvic and pubic joints become loosen, resulting in neck, back and pubic pain.
  2. As the foetus grows, mother’s centre of gravity shifts forward. This adds burden on the abdominal and back muscle. Good body postures, regular physical activities and stretching exercises, can relieve muscle pain.

Ways to improve your postures

  1. When standing
    • Bear weight on both feet evenly. Relax shoulders and pull them slightly backwards. Keep back straight
    • Keep the head up straight. The earlobes are in line with shoulders to keep neutral neck position
    • Tighten the abdominal and pelvic floor muscles

If you need to stand for some time, shift the weight bearing to different side from time to time.

  1. When sitting
    • When working at a desk, adjust the height of the seat, to keep the neck in neutral position
    • Adjust the seat height or use a foot rest so that both feet should rest on the floor and the knees are at right angle
    • The back should be well supported by back of the chair. Use cushions or pillows for support if necessary

Avoid sitting in the same positon for a long time. Change posture after a while. Gently tighten abdominal and pelvic floor muscles to support the back when you move.

  1. When standing up from sitting position
    • Tighten abdominal and pelvic floor muscles
    • Place your hands on the thighs or arm rest of the chair as support
    • Then lean the body forward to stand up
  2. To get out of bed
    • Keep legs together and bend the knees. Roll onto one side
    • Tighten abdominal and pelvic floor muscles. Push up the body with both hands and sit at bedside
    • Place the hands on thighs as support. Lean forward, then stand up
    • Avoid getting up like doing sit up
  3. Sleep by lying sideways and rest the back on a wedge to support the lower back

Lifting a heavy object

  1. When lifting a heavy object, stand close to it.
  2. Bend the knees. Straighten the legs to lift.
  3. Remember to tighten the abdominal muscles and keep the back straight when you lift.
  4. When carrying heavy objects, use both hands or use a cart.
  5. Avoid supporting a child with abdomen. Use both sides of the waist as support if you need to hold the child.

Ask for assistance if needed

Stretching exercises that can relieve shoulder, neck and back pain

  1. Neck stretching exercises
    1. To stretch the neck muscles, sit on chair with the back straight
    2. Tuck in the chin. Pull the head slightly backwards. Hold for 5 seconds, then relax
    3. Repeat 10 times
  2. Shoulder stretching exercise
    • Gently roll the shoulders upwards, then backwards and downwards
  3. Upper limb stretching exercise
    • You can do it either sitting or standing
      1. Keep back straight. Interlace fingers with palms facing out. Then lift arms above the head till the upper back and arms are slightly stretched. Hold for 5 seconds, then relax. Repeat 10 times
      2. Both hands touch each other behind the back. Interlace finger with thumbs pointing downwards. Then raise arms till the chest and arms are slightly stretched. Hold for 5 seconds, then relax. Repeat 10 times
      3. Keep back straight. Interlace fingers with palm facing out. Straighten the arms and reach forward till the upper back are slightly stretched. Hold 5 seconds, then relax. Repeat 10 times
  4. Lower back stretches
    1. Stand with the back and buttocks against a wall. Keep the feet shoulder’s width apart
    2. Lean your back and buttocks against a wall
    3. Breathe naturally. Tighten abdomen to press the lower back against the wall
    4. Hold for 5 seconds and relax
    5. Repeat 10 times

Pregnant women should stop the exercise if feeling unwell

Wear maternity belt and physiotherapy can reduce lower back pain, seek medical advice if condition get worse

Haemorrhoid (Piles)

  • As the uterus grows larger in later pregnancy, pelvic pressure increases and haemorrhoid may result.
  • Pelvic pressure is even higher during vaginal delivery and the haemorrhoid may become bigger.
  • Very often, the haemorrhoid will subside spontaneously a few months after delivery.

Tips

  • Drink adequate fluid every day and consume a high fibre diet to avoid constipation.
  • Apply local application to soothe the pain.
  • Consult doctor if there is large amount of bleeding while opening the bowel.

Skin Problems

Itchy Rash

During pregnancy, the skin becomes more sensitive and sometimes itchy because of the hormonal changes. You may notice some tiny, slightly raised, red spots or slightly bigger wheals especially over your tummy, legs and buttock. In most cases, there is nothing to worry about and it would go away several weeks after delivery.

Tips

  • Try not to scratch as this could worsen the itchiness and might cause skin infection
  • Avoid showering with hot, steamy water, rubbing the towel against your skin and using excessive soap
  • Wear loose, cotton clothing
  • Apply adequate amount of moisturizers

If you have the following symptoms, you should seek medical advice immediately. It could be related to obstetric cholestasis or pregnancy complications.

  • Vesicles
  • Severe and persistent itching which might have affected sleep
  • Fever, jaundice (yellowing of the whites of the eyes and skin), the colour of your urine darken, joint pain

Acne

You may have exacerbation of acne when you are pregnant due to the hormonal changes.

Tips

  • Keep your skin clean
  • Avoid eating hot and spicy food
  • You should consult a doctor instead of using over-the-counter medications for worsening acne. Some acne medications could lead to malformation of your baby

Stretch Marks (Striae)

  • Stretch marks are often the result of the rapid stretching of the skin. Many pregnant women develop striae during the second half of pregnancy, especially those bearing heavier baby or with multiple pregnancy.
  • It commonly appears on the skin of tummy, thighs and breasts. Initially, it appears as pink, as the baby growth, it turns purple. After delivery, it gradually turns white. Yet, it might never disappear completely.

Tips

  • Up till now, no cream is found to be effective in preventing striae completely.
  • Keeping the skin well moisturised by applying lotion or olive oil helps to decrease the severity of striae.
  • Striae will gradually fade after delivery. Postnatal exercise can help to tighten the skin in abdomen. (Please refer to “Postnatal exercise” leftlet)

The information is prepared by the Department of Health and the physiotherapy department of Hospital Authority

(Content revised 01/2020)