Common Complaints during Pregnancy or

1. Common Complaints during Pregnancyor “Doctor, How come…?” Siri L. Kjos, MD

2. Common Complaints • Do not discount their complaints • Explain how rapidly and drastically their body is changing over a short time • Explain that we might not always know why but the change does not appear to be harmful to you or your baby • Give reassurance that these changes are normal, commonly seen • When possible give them something “healthy” that could help alleviate their complaint

3. How come my skin … • Is Dry? • Is Oily? • Has developed Acne? • Is Itchy? • Has developed Stretch Marks? • Has become Darkened? • Has developed Skin Tags? • Hair and nails growing faster?

4. How come my skin is Dry? • Your body fluids go to make extra blood, body fluid and pregnancy • To do: • Drink lots of water • Use gentle cleanser, soap or shower gel for dry skin • Use rich, emollient moisturizer and sunblock • Take short, lukewarm showers • Remove flaky skin with mechanical exfoliant • Facials OK: powerpeels and microderm abrasion

5. How come my skin is Oily? • Pregnancy hormones, androgens & progesterone increase (like before your period) • To do: • 1st trimester avoid medications, see your dermatologist • Use gentle non-drying cleansers • Use clarifying masks weekly • Use oil-free moisturizer and sunblock • Look for noncomedogenic or nonacnegenic • Clear pores with mechanical exfoliants • Do not: • Use Vitamin A derivatives, retinol • Accutane, Retin-A, Differin, Tazorac

6. How come my skin has developed Acne? • Not clear • Pregnancy hormones, androgens & progesterone • Some women get acne for 1st time in pregnancy • To do: • Follow advice for oily skin • Most non-prescription acne medicines should be safe, check with your provider • Do not: • Use Vitamin A derivatives, retinol • Accutane, Retin-A, Differin, Tazorac

7. How come my skin has developed Stretch Marks? • Pinkish, reddish or purplish streaks on swelling breasts and belly (~½ of pregnancies) • A sign of skin that has been stretched too quickly • Some women are more prone than others • Keeping your weight normal my help • Marks likely to fade after delivery but may never disappear • No “anti-stretch mark” creams proven to prevent stretch marks Advice • Keep skin supple and well toned with creams, lotion, oil of choice

8. How come my skin has become Darkened? • Due to Pregnancy hormones • Common changes: • Cholasma: mask of pregnancy • Linea nigra • Vascular spiders • Darkening of pre-existing freckles/moles • If mole changes shape, bleeds: need to evaluate • Darkening around the areolas • All are normal • Wear sun-block, hats • Avoid direct sun

9. How come my skin has developed Skin Tags? • Tiny, floppy growths, can appear anywhere on body • Are not dangerous • Likely not to go away after pregnancy • Can be removed after pregnancy by a dermatologise • By freezing, cauterizing, laser

10. Why are my Nails and Hair growing faster? • Pregnancy increases your metabolic rate, which nourishes your skin cells, making them grow faster • May appear on arms, legs, back, belly and face • Most disappears within 6 months after delivery After birth will I lose a lot of hair? • Conversion of hair follicles from growing state to resting state • Goes back to normal after ~ 3months after delivery

11. What’s the matter with my stomach? • Morning Sickness? • Constipation? • Gassiness? • Heartburn? • Why do I drool all the time? • Why do I crave clay or laundry starch?

12. Why do I have Morning Sickness all day long? • Nausea and vomiting • Generally worst at 6-13 weeks, then improves • ~Half of women affected • Why? • Hormones—βHCG • Accelerated starvation • Heightened sense of smell • Tired, fatigue • Slowing of digestive tract Memorizing the bathroom tile!

13. Morning Sickness Remedies • Don’t let yourself get too hungry • Small frequent meals • Nibble: • Before bed and getting up, • Carry snacks; Crackers • Sip: Increase fluids—you loose it when you vomit • Fruits, juices, soups, broth • Melons, citrus fruit • Meal supplements • Gatorade, lemon water • Suck ice chips

14. Morning Sickness Remedies Homeopathic Remedy • Ginger • Sliced or grated • Candied • Tablet • Tea • Peppermint Tea • Sea-Sickness bands: Wrist band with plastic nodule applying pressure to acupressure point for nausea • Vitamin B6 : 50 mg/d

15. Morning Sickness Remedies • Keep odors at bay: get queasy from different smells • Carry citrus fruit or candies • Brush teeth • Open windows: fresh air • Avoid smoke • Eat bland food • Gentle exercise • Walk outdoors • Sour & salty • Lemonade & pretzels • Cider vinegar, honey in hot water

16. Why do I salivate so much? Called ptyalism or excessive salivation Common with morning sickness Harmless, infrequent Why do I crave clay and starch? Pica interferes with good nutrition Counseling Check hemoglobin Other GI complaints

17. Why am I Constipated? • Reasons (20-50%) • Digestive system slows; iron pills • Mechanical obstruction from uterus • Your fluids go to make baby and blood; • Drink, drink, drink • Eat fiber, bran, prunes • Move, walk, get physical • Stool softeners, • Fiber supplements

18. Why am I Gassy? • Both ends: burping and flatulence • Digestive system slows • Change in diet • Avoid Gassy foods: • brussel sprouts, broccoli, onions, beans • Eat small meals, eat slowly

19. Why do I have Heartburn? Acid reflux--Digestive system slows, esophageal sphincter relaxes; • Small meals (early light dinner!) • Avoid fried, fatty, or spicy foods • Eat antacids (have calcium too) • Sit up after meals • Sleep more upright (pillows) • Prescription medications

20. Why do I have Back Pain? • 50-80% have back/hip pain • Sacroiliac Joint Pain • Radiate where spine joins hip • Often one-sided • Relaxed over-stretched ligaments→ Inflammation of joint • Lumbar Spine Pain • Low central pain • Center of gravity moves forward • Stretched abdominal muscles • Sciatica • Sharp knife-like pains down butt, legs & thighs • Pressure against sciatic nerve • Sit on tennis ball on hard surface • Deep massage and eases pain

21. Wall Sit • The wall sit exercise strengthens your back, trunk, and thigh muscles, helping you maintain a healthy lower back. • Stand with your back 10in. to 12in. away from a wall. • Lean into the wall until your back is flat against it. • Slowly slide down until your knees are slightly bent, pressing your lower back into the wall. • Hold for a count of 10, then slide back up the wall. • Repeat 8 to 12 times. • Aerobic exercise: walking, swimming, running, and biking. • Non–weight-bearing exercise, such as swimming, a better choice. • Walking in water up to your waist or chest: good aerobic exercise. • Take it easy, short walks • You can increase intensity of aerobic exercise within 1 or 2 weeks after symptoms of back pain start. • Begin with 5 to 10 minutes a day and gradually work up to 20 to 30 minutes of continuous activity per day.

22. Low Back Pain Exercises • Standing • Stand with ball between your low back and wall. • Slowly bend knees 45 ° to 90 ° . Hold 5 seconds. Straighten knees. • Slowly bend knees 45 ° to 90 ° while raising both arms over head. • Wall Squats • Stand with back leaning against wall. • Walk feet 12 inches in front of body. • Keep abdominal muscles tight while slowly bending both knees 45 degrees. • Hold 5 seconds. • Slowly return to upright position. • Repeat 10 times.

23. Lie on the floor on your back with your knees bent at a 90-degree angle. Your feet should be flat on the floor, about 12in. from your buttocks. • Cross your arms over your chest. • Slowly contract your abdominal muscles and raise your shoulder blades off the floor. • Keep your head in line with your body-don't press your chin to your chest. • Hold this position for 1 or 2 seconds, then slowly lower yourself back down to the floor. Repeat 8 to 12 times. Low Back Pain Exercises Sitting on Ball Sit on ball with hips and knees bent 90°and feet resting on floor. Slowly raise arm over head and lower arm, alternating right and left sides. Slowly raise and lower heel, alternating right and left sides. Slowly raise one heel and raise opposite arm over head. Alternate opposite arm and heel. Marching: Slowly raise one foot 2 inches from floor, alternating right and left sides.

24. Cat Curl

25. Joint Pain, Backache and Pelvic Pressure • Pelvis composed of 3 bones • Non-pregnant: no movement between symphysial and sacroiliac joints • Pregnancy: endocrine relaxation of joints permits movement • Unstable pelvis → produce pain • Tight Girdle, Belt may reduce pain

26. Back Pain: When to call your doctor • Extreme pain is not normal • Normal pain relievers do not alleviate pain • You lose your feeling in your groin • Pain spreads beneath your ribs (CVAT) • Back pain with fever or vaginal spotting

27. Prevention of back pain Don’t • Wear high heels • Lift heavy objects • Slouch Do • Exercise • Improve posture—use abdominal muscles • Use pillows for support • Maternity girdle • Local heat, back rubs

28. Leg Cramps: The Middle of the Night Charley Horse Unknown reason • Mineral imbalances (Ca+2, Mg+2, K+) • Switch to calcium carbonate (not calcium phosphate) • Try Magnesium citrate • Massage, knead leg • Regular exercise • Avoid pointing toes when stretch in bed

29. I got Cancles & Varicose Veins Don’t remember pre-pregnancy Ankles? • From increased blood volume & compression of veins from uterus • Swim, short walks • Elevate legs • Support hose • Avoid long periods standing & sitting • Stop smoking • Risk: DVT

30. My fingers are numb: Carpal Tunnel Syndrome • Excess fluids in wrist press against median nerve (2-35%) • Numbness, tingling, pain in fingers, wrist • Worse with repetitive motion • Wear wrist splint • Avoid repetitive motion • Vitamin B6

31. I have Sore, Tender & Growing Breasts • 1 of 1st signs of pregnancy • Pain worst in 1st 4 mos • Growth just continues! • Wear nursing or sports bra with good support • Use 24 Hours when nursing • Breasts may sag after pregnancy & breastfeeding • Only support is ligaments • Usually return to pre-pregnancy size • Drop an intercostal space

32. Why do I have Mood Swings and Depression? • Blame the hormones! • Get good night’s sleep • Vent and talk with partner • Exercise • Yoga • Help some, volunteer • Stay active

33. Why can’t I sleep? A few reasons: Gotta pee, heartburn, back pain… Use pillows—many or big Behaviors: • Read, Relaxation tapes, Music • Yoga, relaxation • Chamomile tea, hot milk and honey • Light snack • Massage, foot rub

34. Breathlessness: “I am short of Breath” • Baby pushes up against diaphragm →crowding of lungs • Relaxation of lung muscles, poor posture • Actually, oxygenation increases in pregnancy • Lightening at term: baby dropping into pelvis • Have patient Inhale deeply raising arms above head—Better? • Avoid slumping, use good posture, Take big breaths often • Sleep semi-upright

35. I have lots of Headaches • Hormonal changes, Low blood sugar, Hunger, Sinus, fatigue, stress… • warm compress across forehead, face • Cat nap in dark room • Eat small snack • Head & neck massage • Acupunture, exercise • Yoga, meditation • Ice pack on back of neck • Relaxing bath

36. Can I dye my hair? Get a body wax?

37. Can I sunbathe? Can I get a Massage?

38. Can I get a Facial? Can I whiten my teeth?

39. Can I use the Can I get a Hot Tub/Sauna? Pedicure?

40. Can I have sex? Can I go to the Dentist?

41. Spoil yourself: do something for you