Pregnancy complaints

Your uterus is made up of many different muscles. You can feel those muscles when they contract — sometimes during a period or an orgasm. When that happens in pregnancy, we call it a “harde buik” (a uterine tightening/Braxton Hicks).

During pregnancy your uterus changes enormously. Before pregnancy it could only hold a few millilitres; by the end, it holds a baby of roughly fifty centimetres, a few litres of amniotic fluid, and a placenta — together well over 4.5 kg. So the uterine muscles stretch a lot as pregnancy progresses.

In response to this stretching and growth, the muscles can suddenly contract: a tightening. Early in pregnancy this usually doesn’t happen yet, because the baby is still very small. From around 20 weeks your uterus will tighten more often. These tightenings are your uterus “practising” for labour.

Your baby is not bothered by your tightenings. You may, however, feel movements a bit less while your belly is tight.

When might you get a tightening?

• When your uterus is tired from carrying, e.g., after a hard day’s work. This is normal and not harmful.
• After a sudden movement, after an orgasm, with exertion (sports), when you’re startled, stressed, need to pee, or when your baby is very active.
• With a urinary tract infection. (If you’re having many tightenings, it’s sensible to have your urine checked by your GP for a UTI — even without other symptoms. In pregnancy, a UTI can be “silent”.)

Do you have tightenings often?
It’s very normal to have them sometimes in pregnancy. But if you have them more than four times per hour, or every evening, it may mean you’re doing too much. Ease up. Otherwise tightenings can progress into contractions — and that’s not the intention yet.

Tips

• Try wearing a belly band (support band). Many people have fewer tightenings with one. You can buy them at some lingerie or baby stores.
• Try to relax when you have a tightening.
• Rest! Work fewer hours or from home if possible, cancel appointments, or schedule them when you feel well. It’s important to listen to your body and dial things back if tightenings are frequent.
• Take a warm shower, or lie on the sofa with a warm hot-water bottle. Maybe your partner can give you a gentle massage.
• Help your uterus relax with belly breathing: place your hands on your belly; inhale calmly and let your belly rise; exhale and let it fall. It may take practice, but once you’ve got it, it’s a pleasant way to relax — also useful during labour!

What’s the difference between a contraction and a tightening?

• Contractions hurt; tightenings are uncomfortable rather than painful.
• Contractions are regular; tightenings are irregular.
• Tightenings ease when you sit or lie quietly; contractions don’t.
• Contractions lead to dilatation; tightenings do not.
• Bleeding can occur with contractions; not with tightenings.

Call us on 06-54788178

• if the tightenings don’t ease when you take it easy;
• if you’re unsure whether they are contractions or tightenings;
• if you also have bleeding;
• if you have other symptoms as well.

When you’re pregnant, your intestines work more slowly due to the hormone progesterone. You may also move less, which also slows your bowels. One advantage is that your body extracts more fluid from your stool and absorbs nutrients well—good for your baby’s health. A major disadvantage is that you may have trouble having a bowel movement. You get constipated—also called obstipation.

Tips to make bowel movements easier

• If you need to go, go right away. If you wait, your stool gets harder.
• Relax on the toilet. When you relax, it’s easier to pass stool. Straining doesn’t help—it actually makes it harder and increases the risk of haemorrhoids.
• Get a toilet stool. Research shows that squatting relieves far better than sitting, because the pelvic floor can relax. A toilet stool puts your legs at the ideal knee and leg height. And in about three years your child can use it to climb onto the toilet!
• Move more. Movement stimulates your bowels. Walking is great.
• Eat at regular times.
• Drink at least 2 litres of fluids per day.
• Adjusting your diet can help. For example, avoid very dry foods such as rusks, crackers, and cookies.
• If diet changes and plenty of exercise don’t help, you can use medication.

There are different types of medication used for constipation:

• Bulk-forming or osmotic laxatives
• Stimulant laxatives
• Various other laxatives

Which medicine will work best for you can be read on the Lareb website.

Many people think nausea is the first sign of pregnancy. But many notice they’re pregnant because their breasts feel tense and because they’re tired. The extreme fatigue is due to your growing baby and hormonal changes. Especially in the first 12 weeks, many are extremely tired; afterwards this usually improves. Some even have more energy in the second trimester than outside of pregnancy!

Fatigue can be very troublesome—sometimes so intense that daily activities like working, cooking, cycling, or socialising are hard. Try to give in to the fatigue as much as possible, especially in the first weeks. Go to bed early and discuss with your manager whether you can start work a bit later. The more you accommodate it early on, the sooner the fatigue tends to pass.

Also read the blog: Severe fatigue during pregnancy for tips and background information.

During pregnancy you may experience headaches. Possible causes include:

• Hormonal changes — there are signs these can cause headache. This is harmless.
• Low iron (anaemia). We check iron at the start of pregnancy and again at 30 weeks, and sooner if you have symptoms such as headache or extreme fatigue.
• Dehydration. Drink enough throughout the day (at least 1.5–2 litres). This is the most common cause of headache in pregnancy — so always increase fluids when you have a headache.
• High blood pressure can also cause headache. High blood pressure is dangerous in pregnancy. Always call us if you have a severe headache — even at night or in the weekend.

Pain relief

You may take paracetamol for headache: no more than 2 tablets of 500 mg at a time and max 6 tablets (3000 mg) per day. The paracetamol should not contain codeine, caffeine, or other substances. For any other medication, consult your GP or pharmacist and clearly state that you are pregnant.

Call us with headache and:

• feeling generally unwell/nauseous;
• pain under the right ribs/top right abdomen or a tight band-like feeling around the diaphragm (area behind the bra, under the breasts);
• stomach/epigastric pain;
• sensitivity to light or other visual symptoms;
• sudden swelling of face or legs;
• tingling in your fingers;
• or if you’re worried.

With heartburn, stomach acid flows back into the oesophagus, causing a burning sensation behind the breastbone. You may burp more and feel overly full after meals. Stomach acid is far too acidic for the oesophagus, so it burns — very uncomfortable. In pregnancy you can be more bothered by heartburn because several things change in your body.

Your digestion changes

• The valve between oesophagus and stomach works less well, so acid flows back more easily.
• The stomach and intestines are less active; digestion takes longer. Food stays in the stomach longer and it gets “too full”, so contents flow back into the oesophagus.

Your stomach is compressed
In the second half of pregnancy, the uterus and baby take up more space; other organs shift. The uterus pushes the stomach upward, making reflux easier — hence more heartburn.

Medicines

There are over-the-counter options that are safe in pregnancy and can help against heartburn, such as Rennie, Regla pH, or Gaviscon. These are available without prescription at the chemist or pharmacy. If symptoms are severe and you want something stronger, ask your GP for advice — and don’t forget to mention you’re pregnant.

Tips

• Eat slowly and chew well.
• Spread meals evenly over the day.
• Eat plenty of fibre-rich foods.
• Avoid fatty foods (they linger in the stomach).
• Take your time to eat; rest briefly after meals.
• Stay upright for the first hours after eating.
• Avoid heavy foods for 3 hours before bedtime.
• Move enough to stimulate digestion.
• Drink at least 1.5 litres per day.
• Sometimes a glass of milk or a small bowl of custard helps.
• Avoid tight clothing.
• Raise the head end of your bed slightly.
• Try to avoid triggers such as coffee, orange juice, spicy seasonings, soft drinks, or chewing gum.

A hemorrhoid is a slackened blood vessel of the anus. The hormone progesterone makes the muscles in your intestines and anus less firm; during pregnancy you have a lot of progesterone in your body, which increases the chance of hemorrhoids. They look like round little bumps, red or purple in color. If you strain while having a bowel movement or if your stool is hard, the blood vessels can easily get a little damaged — sometimes even without straining.

Often you first feel itchiness, and then pain. If the hemorrhoids are internal, you usually see some blood after a bowel movement. Sometimes they’re external. In that case, sitting or walking can be very uncomfortable, especially if they are large. Some women barely feel hemorrhoids at all.

Talk to us — we can give you specific tips. Below are some general ones.

Tips

• Keep your stool soft. Eat plenty of fiber, drink enough fluids, and go to the toilet as soon as you feel the urge.
• Try not to push when passing stool. Let it happen naturally.
• Get a toilet stool. Research shows that squatting relieves far better than the seated position because the pelvic floor relaxes more. A toilet stool helps you place your legs at the ideal knee and leg height. And in about three years your child can use it to climb onto the toilet!
• There are different ointments for hemorrhoids. Ask your pharmacist about them.
• It’s fine to take paracetamol if you’re in a lot of discomfort.
• Hold a washcloth with ice cubes against your anus.
• Never sit on a “doughnut” cushion. It may feel nice in the moment, but in the end hemorrhoids tend to worsen and the pain can increase.
• Keep the area clean. Because wiping can be painful, it’s wise to gently rinse with lukewarm water in the shower at least once a day.

Feeling nauseous is (unfortunately) part of pregnancy for many people. You might feel especially awful in the morning, or all day long. The good news? For most, symptoms disappear after the first trimester. That doesn’t make it any less unpleasant right now, of course.

How often does it occur?

About 85% of pregnant people experience nausea to some degree. Symptoms usually start between week 4 and 9 of pregnancy and often ease after week 14 to 16. But: in 15% it lasts longer—sometimes up to week 20—and for 1 in 10, nausea unfortunately persists throughout the entire pregnancy.

Why do you feel nauseous?

The exact cause isn’t fully clear. It’s probably a combination of heredity, hormones, and digestion. The pregnancy hormone hCG seems to play a major role. Progesterone and oestrogen are also linked to these symptoms. (Fun fact: your oestrogen production can rise up to about 1,000 times compared to normal! Oestrogen makes your body—especially your pelvis—more supple and stimulates blood flow and growth of the uterus.)

Is it harmful for your baby?

With mild nausea, no. In fact, research suggests that mild nausea may even be protective. There’s a lower risk of miscarriage, low birth weight, or premature birth. Some studies even observe positive effects on children’s IQ and behaviour. But: if you don’t experience nausea, that certainly doesn’t mean anything is wrong.

When is nausea a concern?

With a severe form—hyperemesis gravidarum—you can become dehydrated, lose a lot of weight, or develop nutritional deficiencies. This can affect your health and your baby’s. Hyperemesis is an important reason for hospital admissions in early pregnancy. In such cases there’s an increased risk of complications such as pre-eclampsia or preterm birth.

If you’re unsure whether your symptoms are too severe, always contact us. We’ll think along with you.

The impact on your daily life

Even mild symptoms can seriously affect your life. Working, caring for other children, maintaining social contacts—it can all become difficult. You won’t always get understanding from those around you, which makes it even harder. It’s normal to feel sad, frustrated, guilty, or even low because of this. You’re not alone. Discuss options with your employer if work becomes too difficult. Some people need sick leave when nausea is severe, but sometimes starting work a few hours later already helps. Discuss these options with your occupational health doctor (ARBO-arts).

See also the blog: Pregnancy nausea: what can you do? for tips on pregnancy-related nausea.

The blog Hyperemesis gravidarum: More than ordinary pregnancy nausea covers extreme nausea during pregnancy.

Pelvic pain

Many pregnant people have pelvic pain. About half experience pelvic or low-back pain. First, a bit about your pelvis so the cause makes more sense.

The pelvis consists of several bones:

• Sacrum (at the back).
• Ilium/hip bone (left and right sides; the front/top edges are palpable).
• Pubic bone (at the front, just above the vagina; the joint is the symphysis).

The sacrum connects to the ilium via joints called the sacroiliac joints (SI joints) — one on each side, low in your back above the buttocks (those two small dimples). At the front, the ilium connects at the symphysis. These joints are made of cartilage so the bones can move smoothly. Ligaments around them are elastic: they allow movement and stretching while keeping the bones together. In pregnancy, these ligaments become more supple due to hormones. That’s helpful at birth, giving a little extra “give” as your baby passes through.

Pelvic pain vs. “pelvic instability”

These days we mostly talk about pelvic pain, not “instability.” How loose the joints are doesn’t directly predict pain. Some have very supple joints without pain; others have lots of pain with only a small increase in laxity. Pelvic pain is common in pregnancy because softening ligaments can make the joints feel looser; nerves can get irritated and bones can rub uncomfortably.

It’s not only the joints: the growing uterus and baby press on the pelvis, and your posture changes as your belly moves forward, pulling on your back and pelvis. Poor posture or overloading the pelvis can worsen pain.

Right after birth, the pelvis is extra stressed, so pain can be a bit worse for a few days. Others feel immediate relief because the uterine pressure is gone. Why one person has more pain than another depends on posture, activities, your pregnancy, and how the birth goes.

What can you do yourself?

If pelvic or low-back pain is significant, see a physiotherapist or Mensendieck therapist specialized in pelvic complaints. After birth they sometimes treat at home. In our address book on the website you can find therapists we work with often.

Tips

Standing

• Standing in one spot for long is often painful. If you can, sit or walk; otherwise, keep changing posture.
• Stand in a “ballet stance”: feet next to each other, slightly turned out.
• Don’t lock your knees; keep them slightly bent so your lower back doesn’t over-arch.

Sitting

• Sitting can be painful. Try different chairs — high/low, soft/hard — and find what suits you. Some prefer a garden chair!
• Sit upright with your back against the backrest and knees at roughly 90°. Use a book or footrest if the chair is too high. Avoid crossing your legs.

Getting into bed

• Sit on the edge first. Support yourself on one arm and, in one movement, lower yourself while bringing your legs up together.

Getting out of bed

• Roll onto your side, bend your knees, swing your feet over the edge, and push up with your arm to sit.

Lying down

• Lie on your side with legs aligned; place a pillow between your knees and under your belly if helpful. Try different pillows.
• Or lie on your back with a small pillow under your knees.

Round-ligament pain

Your uterus is attached by ligaments. These run from the uterus to different parts of your pelvis and abdomen — from the vagina, groins, pubic bone, lower back, navel and the sides of your abdomen toward the uterus. During pregnancy, these ligaments stretch to keep up with your growing belly.

What does it feel like?
Round-ligament pain is a sharp, sudden, stabbing pain caused by tension on the uterine ligaments due to growth or movement. It can also feel like a nagging, period-type ache. You can feel it in the groins, vagina, pubic bone, navel, lower back or sides — ligaments sit in all these places. Each time your belly grows, your ligaments must stretch, and that can be painful — sometimes startlingly so. You can also have radiating pain into the buttocks and upper legs.

Round-ligament pain can be very annoying, but it’s not dangerous.

When might you notice it?
At any point in pregnancy. Some feel it early, others more in the last months as the belly gets heavier. You might feel it when you’re tired; getting out of bed; sneezing or coughing; stretching, lifting, making a sudden movement, or during sex.

Tips

• Sit or lie down for a moment and breathe calmly toward the painful spot.
• Apply a warm (not hot!) hot-water bottle to the area.
• Wear firm maternity briefs. They don’t weaken your abdominal muscles — those keep working. Good maternity underwear (often pricier) gives more support.
• Use a belly band; a physiotherapist can help you choose one.
• If you like to exercise and want to keep it up longer, get a belly band early for support. If you keep getting round-ligament pain after workouts, you’re likely pushing too hard — ease up.
• Swimming is great in pregnancy. If pain shows up while swimming, rest and try again later or next week. It often comes and goes.
• Is it painful or does it persist even when you try to relax? Call our emergency number (06-54788178).

Pregnancy increases progesterone, a hormone that signals your brain you need more oxygen. So your brain sends that signal sooner, and you breathe faster — sometimes out of the blue, when lying down, sitting, or after a short walk.

If you feel short of breath, keep breathing calmly; it will pass. Try not to panic, as that can make it worse. Breathe in and out toward your belly: place your hands on your belly, inhale gently letting your belly rise, exhale letting it fall. Keep chest movement to a minimum.

If shortness of breath troubles you a lot, you may tire quickly and have less energy. That’s frustrating, especially with stairs, carrying bags, or hurrying. Take it easy, rest more often, and ask others for help — e.g., let your partner, friend, or neighbour carry the groceries.

Sore breasts are one of the first signs of pregnancy. You may notice it as early as the fourth week. You might also have tender breasts during your period, but in pregnancy the pain is often stronger. After about six weeks of pregnancy, your breasts can start to grow. They swell and can hurt so much that even drying off is hard to tolerate.

What causes sore breasts?

Almost every pregnancy complaint has a cause. Sore breasts in pregnancy are due to changes in your hormones. You produce the pregnancy hormones oestrogen and progesterone. These prepare your body for pregnancy in many ways. This hormone surge can also make you nauseous. The breast pain occurs because the milk glands start to grow. New milk ducts and lactocytes (milk-producing cells) develop—your body is already preparing for breastfeeding. Blood flow to the breasts also increases, causing swelling. That swelling stimulates nerves and causes pain.

How long does the pain last?

Often until around the second trimester—roughly three months. By then your body is more used to the hormones and breast growth slows. Near the end of pregnancy and during the postpartum period, your breasts may become sore again as milk production starts or due to engorgement (the feeling your breasts are “full”).

What helps with breast tenderness during pregnancy?

No one likes pain, so here are aids that can relieve it:

• Replace regular bras with maternity bras. They offer good support so the connective tissue in your breasts isn’t unnecessarily stretched. Straps are wider and the material is soft and stretchy. They usually don’t have uncomfortable underwires and have as few seams/extras as possible. If you keep needing a larger cup, consider a nursing bra—these also work very well as maternity bras.

Other tips:

• Avoid caffeine and salt. Caffeine can raise oestrogen levels even more; salt causes fluid retention so breasts swell further.
• Apply a rich, nourishing body lotion to keep the skin supple, which reduces the tight feeling.
• Use a warm hot-water bottle or compress on your breasts.
• Try a soft sports bra at night.
• Take a shower or bath. Warm water relaxes the body and reduces pain.
• If touch isn’t too painful, gently massage your breasts with your palms.

Striae are stripe-like marks on the skin. They appear when the skin has been stretched too far and tiny scar-like lines form. These can be 1 centimetre long, but also 10 or 15 centimetres. Unfortunately, once you have striae they don’t go away, but over time they become less visible. Newly formed striae are often red or purple; later they become skin-coloured and are thankfully less noticeable.

During pregnancy you have a risk of striae because your belly grows a lot in a short time. Your hips, breasts, and arms often become a bit fuller too, so striae can appear there as well.

Some creams claim to help against striae, but this has never been proven. There’s also no definitive treatment. You can do a few things to slightly reduce the risk.

What might help a little:

• Wear supportive clothing. For example, a firm bra so the skin of your breasts stretches as little as possible, or a supportive band around your belly so the abdominal skin stretches less.
• Massage your skin to keep it supple and well-circulated.
• Eat healthily so you don’t gain weight too quickly; rapid weight gain increases the risk of striae.
• And cross your fingers… it’s often just luck.

Many women experience urine leakage during pregnancy. Some only lose a few drops; others have very little bladder control. In that case we advise seeing a pelvic-floor physiotherapist. A pelvic physiotherapist treats men, women, and children with problems in the pelvic area, lower back, abdomen, and pelvic floor. You do not need a GP referral.

Preferably don’t use pantyliners to catch urine—this actually increases the risk of candida (yeast infection). For light urine leakage we advise menstrual underwear. It absorbs urine, prevents odours, and still breathes. If leakage is too heavy for this, buy incontinence pads.

Note!
Urine leakage and amniotic fluid loss can be very similar. Unsure whether the fluid is urine or amniotic fluid? Call us!

Urinary tract infection (UTI)

Your bladder stores urine, which exits via the urethra. In a UTI, the bladder wall and/or urethra are inflamed due to bacteria. Pregnancy hormones make the vagina less acidic, so bacteria and yeast can thrive more easily. Hormones also slightly widen the urethra, making it easier for bacteria to reach the bladder. Pressure from the full uterus can prevent fully emptying the bladder; leftover urine increases infection risk.

How do you notice a UTI?

• The urge to urinate again immediately after going.
• Passing very small amounts, sometimes just drops.
• A dull, period-like lower-abdominal ache.
• Pain in your side and/or lower back.
• Nausea and vomiting.
• Urine that smells unusual.
• Cloudy-looking urine.
• Blood in your urine.
• Stinging or itching in the urethra while urinating.

If you have one or more of these symptoms, collect a urine sample and take it to your GP. The GP will test your urine. If you have a bladder infection, you’ll receive antibiotics that are safe for use during pregnancy. (Be sure to tell your GP or the assistant that you are pregnant.) A bladder infection itself isn’t dangerous for you or your baby, but during pregnancy the infection is more likely to spread to the kidneys. This can lead to a kidney infection, which is serious — it may slow your baby’s growth or even trigger premature labour.

The bacteria that cause a bladder infection can also sometimes make your baby sick if present in the vagina during birth. This can happen if the infection is caused by GBS (Group B Streptococcus). That’s why, during pregnancy, your GP will always send your urine for culture to identify which bacteria caused the infection.

How to help prevent a UTI

• Always wipe front to back and wash your hands.
• Aim to drink about 2 liters of water per day; frequent urination helps flush bacteria.
• Take your time and empty your bladder completely.
• Tilt your pelvis a few times after peeing to expel the last drops.
• Don’t do pelvic-floor exercises while urinating — that’s not good for the bladder.
• Urinate after sex to flush away bacteria.

Your bladder is located in your lower abdomen. It stores urine, which leaves the body through the urethra. A urinary tract infection (UTI) happens when the lining of the bladder and/or urethra becomes inflamed due to bacteria. During pregnancy, hormonal changes make your vagina less acidic, which increases the chance of bacteria and yeast growing there. Hormones also cause the urethra to widen slightly, making it easier for bacteria to reach the bladder. In addition, your growing uterus presses on your bladder, which can make it harder to empty completely. When urine remains in the bladder or urethra, the risk of infection increases.

How do you know if you have a bladder infection?

• You feel like you need to urinate again right after you’ve just gone.
• You urinate small amounts each time, sometimes just a few drops.
• You feel a dull pain in your lower abdomen, similar to menstrual cramps.
• You have pain in your side and/or lower back.
• You feel nauseous or you vomit.
• Your urine smells unusual.
• Your urine looks cloudy.
• There is blood in your urine.
• Your urethra burns or itches when you urinate.

If you have one or more of these symptoms, collect a urine sample and take it to your GP. The GP will test your urine. If you have a bladder infection, you’ll receive antibiotics that are safe for use during pregnancy. (Be sure to tell your GP or the assistant that you are pregnant.) A bladder infection itself isn’t dangerous for you or your baby, but during pregnancy the infection is more likely to spread to the kidneys. This can lead to a kidney infection, which is serious — it may slow your baby’s growth or even trigger premature labour.

The bacteria that cause a bladder infection can also sometimes make your baby sick if present in the vagina during birth. This can happen if the infection is caused by GBS (Group B Streptococcus). That’s why, during pregnancy, your GP will always send your urine for culture to identify which bacteria caused the infection.

Always tell us

Always let us know if you’ve had a bladder infection during your pregnancy. If the infection was caused by the GBS bacteria, we’ll need to make a plan for your care during labour.

How to prevent a bladder infection

• Always wipe from front to back after using the toilet, and wash your hands afterwards.
• Try to drink about 2 litres of water per day. Urinating frequently helps flush out bacteria.
• Take your time when urinating and make sure your bladder is completely empty.
• After urinating, tilt your pelvis a few times to help release any remaining urine.
• Don’t do pelvic floor exercises while urinating — this is not good for your bladder.
• Urinate after sexual intercourse to help flush out bacteria.

Vaginal bleeding after 14 weeks of pregnancy

There are several possible causes:

• Hemorrhoids. A stretched blood vessel of the anus can bleed a little. This is not dangerous for you or your baby.
• A small vessel in the vagina or on the cervix has ruptured, e.g., with exercise, coughing, laughing or sex. You may see a few drops — not dangerous for you or the baby.
• Urinary tract infection. Sometimes there’s blood in the urine with a UTI. Other UTI symptoms include a dull lower-abdominal ache, constant urge, and pain while urinating. Untreated, it can progress to a kidney-pelvis infection, which can be dangerous. When in doubt, have your urine checked by us or your GP.
• The cervix starts to open due to contractions or cramps. If you’re > 37 weeks, that’s fine; if you’re < 37 weeks, it could indicate preterm labor.
• A blood vessel in the placenta (afterbirth) has ruptured. This can happen:
  • if the placenta lies in front of the cervix (you’ll know after the 20-week scan),
  • if an edge of the placenta is loose,
  • if the placenta is detaching from the uterine wall (placental abruption) — this can be very dangerous for your baby.
• Sometimes no cause is found.

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• if you lose more than a few drops of blood,
• if the placenta lies in front of the cervix (known from a scan),
• if you have contractions and you’re under 37 weeks pregnant,
• if you also have abdominal pain,
• if your uterus also becomes hard,
• if your midwife has told you to call with any bleeding,
• or if you’re worried or unsure.

Together we can assess the severity and, if needed, schedule an extra check/ultrasound.

Vaginal discharge and candida (yeast)

Discharge is fluid and mucus from the vagina, produced by the vaginal wall and cervix. Discharge is completely normal. During pregnancy you often have more, because there is more blood flow to the vagina. Normal discharge is white or slightly transparent. It can be slimy or very watery, sometimes a bit grainy.

During pregnancy, discharge can be different than usual:

• sometimes a little darker in color
• thicker or thinner
• more abundant

Candida / yeast infection

Due to hormonal changes, your vagina becomes less acidic. This increases the chance of a yeast infection, as yeasts like a sweeter environment. Such a yeast infection is called candida. Candida is a yeast almost everyone carries. Normally you don’t notice it. But if you’re ill, taking medication, or pregnant, the balance in your vagina can be disturbed. The candida can overgrow and cause symptoms. Candida isn’t dangerous, just annoying. (It is not a sexually transmitted infection.)

How do you notice candida?

• a burning sensation in the vagina
• itchiness in and/or around the vagina
• stronger odor of the discharge
• discharge that is green or yellow

Do you have these symptoms? Visit your GP. They will examine the discharge. If it’s candida, you’ll get a tablet or a vaginal cream. The candida — and the symptoms — will then resolve. It’s important to treat candida not only because it’s bothersome for you, but also because it’s better not to have an active candida when you give birth. If you give birth while you have candida, the yeast can also get into the baby’s mouth and cause discomfort.

Tips

You can’t completely prevent candida, but you can reduce the risk:

• Wash your vulva and the surrounding skin with water only, not with soap.
• Wear cotton underwear.
• Sleep without underwear now and then (or always).
• Don’t use products like Lactacyd to “clean” the vagina — they disturb the natural balance and can increase the risk of yeast.
• Avoid pantyliners; they can raise the risk of candida. Do you have a lot of discharge? Menstrual underwear works very well for people with heavy discharge or frequent candida.

Varicose veins are thick, bluish veins visible through the skin. They usually occur on the legs, but can also appear on the labia.

How do varicose veins develop?

Veins carry blood back to your heart. If vein walls become weaker or valves don’t work properly, blood pools in the veins. Then there’s too much blood in them, visible as blue lines on the legs or labia. Not everyone develops varicose veins, but pregnancy increases the risk due to three things:

• Hormones make the veins laxer.
• The uterus hampers the return flow of blood to the heart—blood tends to pool in the legs.
• When pregnant, you have about a litre more blood in your body than usual.

Varicose veins aren’t pretty and can be painful. Legs can feel very heavy and tingly. Varicose veins on the labia can feel very uncomfortable—like the vagina is very big and heavy.

Tips to help prevent varicose veins
You can’t prevent them completely, but you can reduce the risk:

• Don’t stand still for long periods. If you must, keep moving in place.
• Don’t sit with your legs crossed.
• Don’t keep your legs warm for too long: avoid very long hot baths; don’t rest your legs against a heater for long; in the car, don’t direct the heater at your legs.
• Unfortunately, varicose veins are often hereditary. If a parent has them, your risk is higher.

Do varicose veins go away again?
After pregnancy, varicose veins often lessen and sometimes disappear completely. Still bothered after birth? You can have them treated. From 6 weeks postpartum, see your GP; they can refer you to a surgeon or dermatologist.

TIPS:

• Tell us if you have varicose veins. Sometimes extra checks are needed.
• Buy maternity support tights. You can find them at many department stores (e.g., HEMA). It’s best to get them before symptoms become severe.
• If you’re very troubled by varicose veins, see your GP for prescription compression stockings made to your leg measurements.
• Varicose veins on the labia? Try lying down a few times per day so blood can drain. You can also put a few ice cubes in a washcloth and gently hold it against the labia to reduce pain. You will not be hindered by labial varicose veins during labour.

About 1 in 5 pregnant women experience itching.

Often it’s caused by the stretching of the skin on the belly (and breasts, buttocks, legs) — annoying but harmless.
Unfortunately, itching is not always harmless. It can be a symptom of intrahepatic cholestasis of pregnancy (ICP), where bile flow is reduced; bile builds up and can (temporarily) damage the liver. In the worst case, bile acids enter the bloodstream.

With ICP there are risks for the baby. Bile acids cross the placenta and are likely harmful. Babies may be born too early and the risk of complications (e.g., meconium in the amniotic fluid) increases. There’s also a higher risk of stillbirth, especially when bile acids are strongly elevated.

Some facts:

• Often starts in the third trimester.
• Itching is often worst at night.
• The skin is usually normal in appearance.

Sometimes there are also:

• Nausea
• Blood in urine or dark urine
• Pale/putty-coloured stools
• Urinary tract infections
• General malaise
• Pain in the right upper abdomen
• Irritability

Call us on 06-54788178
if you have itching on the palms and/or soles, or severe itching elsewhere.