Doctor's Notes: Coping with Issues Moms Face During & After Pregnancy

Pregnancy isn’t always a bed of roses. Women face various physical and emotional challenges during pregnancy, childbirth and puerperium. While many of these issues may be due to physiological changes in pregnancy, some are complications and need prompt intervention from healthcare providers. 

The range and intensity of issues during pregnancy vary from woman to woman. For some, they are mild. While for others, they can be quite debilitating. Here we tackle some of the common problems and coping strategies.

Issues during pregnancy

Morning sickness

Nausea and vomiting affect almost 70% to 80% of women. It usually starts within the first 8 weeks of pregnancy and resolves by week 16 in majority. The term “morning sickness” is a misnomer and the symptoms can occur at any time of the day. Hyperemesis gravidarum is severe, intractable vomiting that affects a minority and needs medical intervention.

Sniffing lemon and taking ginger tea can help relieve the symptoms. Take your prenatal vitamins and eat small frequent meals. Antihistamines and other pharmacological options have been proven safe in pregnancy and are available on prescription.

Extreme tiredness and backache

The hormonal changes in early pregnancy can cause fatigability in your first trimester, which usually resolves by the early second trimester, only to recur with the increasing baby weight later in pregnancy. Take a healthy and balanced diet and get plenty of rest and sleep. Sleep on your side and use pillows to support the bump for a comfortable position.

The back pain is also caused by the baby bump getting bigger, and the ligaments become softer under the hormonal influence in preparation for labor, thus putting strain on your joints. Avoid lifting heavy objects, wear flat shoes, keep your back straight while sitting and use a firm, supportive mattress for sleep. You can also join backcare classes or seek a referral to a physiotherapist.

Heartburn and indigestion

While the growing baby occupies more and more of the space in your abdomen, your stomach gets compressed, and the issues of heartburning and regurgitation become frequent. The movement of the gut muscles also slows down under hormonal influence leading to delayed stomach emptying.

Eat small meals frequently rather than 3 large meals. Avoid spicy or fatty food and caffeinated drinks. Eat your last meal 2 hours before going to bed and keep your head propped up with the help of pillows to prevent acid from regurgitating. Your doctor may prescribe you antacids if these lifestyle measures fail.

Urinary and bowel problems

Urinary frequency and incontinence are common during pregnancy due to the pressure effect of the gravid uterus. It's important to get screened for urinary tract infections as physiological changes of pregnancy can lead to ureteral dilation and urinary stasis, making one prone to infections.

Constipation is experienced by a third of women. It is caused by decreased gut motility secondary to hormonal influence and is worsened by reduced dietary fiber intake. Take plenty of fresh fruits and vegetables, eat wholemeal bread and keep yourself hydrated.

Swelling in legs, feet and fingers

Some degree of swelling in your limbs is normal in pregnancy. It is due to water retention in the dependent areas of the body. The pressure of the gravid uterus also affects the blood circulation of your lower limbs leading to swollen feet.

Avoid standing for long, do foot exercises to increase their blood flow and rest your feet up as much as you can. A sudden increase in swelling, especially in your face, can be a warning sign of preeclampsia and needs medical consultation.

Issues after pregnancy

Problems with breastfeeding

Difficulty in initiating lactation, poor baby latching and nipple soreness are the commonest issues faced by new mothers. A nutritious diet, plenty of fluid intake, frequent feeds, and skin-to-skin contact with the baby can improve the milk supply. Watch video tutorials on proper latching techniques to avoid sore nipples or take guidance from a lactation support nurse.

Painful and engorged breasts are experienced by almost half of women at some point in their breastfeeding journey. The reason is usually the imbalance between milk production and infant consumption. Continuing nursing on demand, gentle massages, emptying the breasts manually or with a breast pump and wearing a supportive nursing bra alleviates discomfort. 

If you are running a fever, feel unwell and notice red hot tender areas on your breast or pus coming through the nipples, consult your healthcare provider as these are signs of breast infection.

Postpartum blues

Depressed mood is a common issue faced by women after giving birth. It is essential to address this as emotional well-being is crucial to nurture babies. The baby blues, experienced by more than half of women, usually start within the first two or three days of giving birth. There are frequent bouts of crying, anxiety, fatigue and worry. The partner, family and friends' physical and emotional support are most needed at this time. The symptoms usually resolve in 2 weeks.

It is important to differentiate postpartum blues from postpartum depression. Depression is also fairly common and affects 1 in 8 postpartum women. The woman usually has severe symptoms of anxiety, sorrow and hopelessness. Thoughts of hurting self and baby can occur. The condition requires further support from a mental health professional. 

Problems with intimacy

Childbirth can cause vaginal laxity, perineal damage and scarring. This makes intimacy less pleasurable and at times, even painful. The low estrogen levels in breastfeeding women further aggravate the problem by causing vaginal dryness and loss of vaginal elasticity as well as decreasing sex drive. Most of these physical changes reverse by 6 months. The hormonal changes also revert once the woman has established her regular menstrual cycles. However, for some women the physical issues persist. In this case, consult with a qualified health care professional who can recommend solutions that help improve sexual arousal and gratification.

Perineal pain

Giving birth stretches and sometimes tears the perineum, the visible area between vagina and anus. This is also the area where your doctor gives episiotomy to assist with the delivery. The discomfort is usually alleviated with painkillers and by applying cold compresses or warm water baths. 

Occasionally the scarring and discomfort of the damaged perineum persist. In such cases, perineoplasty may be considered to reverse the scarring, relieve discomfort and improve sexual function.

Urinary incontinence

Involuntary leakage of urine in the postpartum period is relatively common. The culprit is usually difficult vaginal deliveries with prolonged pushing phases with or without instrumentation to deliver the baby. This causes damage to the muscles and nerves of the pelvis and bladder neck. Engage in regular workouts after pregnancy and practice kegels exercises to restore your core body strength and the tone of pelvic muscles. The problem usually resolves around 3 months postpartum.

In summary

The journey of pregnancy, childbirth and postpartum recovery are both gratifying and challenging at the same time. Women in any of these stages need to be aware of the unique issues they might face and the coping strategies to smoothly navigate this phase of motherhood.

About the Author

Dr. Ammar Mahmoud is a highly respected cosmetic gynecological surgeon known for his expertise in minimally invasive procedures. He has a particular focus on sexual wellness and function. He has trained at St. George’s University, where he served as Vice President of the Medical Honor Society and on the board of the Anatomical Clinical Research Society. Dr. Mahmoud also completed his residency at the State University of New York Downstate, where he currently serves as a clinical associate professor. In recent years, he has given a keynote speech on advanced labiaplasty and vaginoplasty techniques and has been a faculty member at the International Cosmetic Gynecology Conference in 2018 and 2019. Dr. Mahmoud is a member of the American Society of Cosmetic Surgeons and the American Society of Cosmetic Laser Surgery. He is dedicated to providing his patients compassionate and professional care based on individual needs.