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Ask Dr. Sears: Answers to Common Pregnancy Questions

Growing a baby will challenge your body, your mind, your marriage, your job, and your whole being as you experience feelings you've never had before. Pregnancy can be summed up in one word: change! Everything will change, from making breakfast to making love. Yet when you consider that you are bringing forth a life in just nine short months, it will make the inconveniences and discomforts much easier to bear. While pregnancy is a journey unique to every woman, most mothers-to-be have the following questions and concerns...

Morning Sickness

Q. What causes morning sickness? And when will it end?

A. As with so many other complaints of pregnancy, morning sickness is caused by hormones. These hormones affect much more than your reproductive system. They can unsettle your stomach and slow your digestion, enhance your sense of smell, and leave you exhausted at the end of the day. Long before the rest of the world can see that you are pregnant, you may feel as if your body has been taken over by aliens who seem to enjoy making you miserable.

As most pregnant women discover, "morning" sickness can strike any time of the day or night, with queasiness that can be triggered by hunger, the smell of the neighborhood hot dog stand, or just getting out of bed in the morning. Fortunately, it usually ends sometime during the third or fourth month. One thing that can be said about pregnancy nausea: Two or three months of feeling crummy can really help you appreciate feeling the surge of energy and appetite that comes when it's over.

To keep early morning sickness at bay, many women eat saltines or wheat crackers before getting out of bed. Eating six mini-meals throughout the day rather than three larger ones makes digestion easier and can help prevent hunger-triggered nausea. Fruit smoothies are also a good choice, as they're rich in nutrients and, because they're cold, they often don't have a strong scent to upset your stomach. If your prenatal vitamin is making you sick, try taking it with food, and talk to your doctor if you're having trouble keeping it down. There are medications as well as new vitamin options that are designed for women who are suffering from severe morning sickness.

Swelling

Q. My hands and feet are swollen. Is this normal?

A. Your blood volume surges by 40 percent during pregnancy, slowing down your circulation, which can cause a swelling in your hands and feet known as edema. Your growing uterus can compound the problem by putting pressure on your vena cava (the large vein that brings blood back from your lower limbs). So put away the pinchy pumps and look for some loose-fitting loafers.

To help control swelling, avoid sitting or standing for long periods of time. Get up and get moving -- exercise such as walking or swimming improves the circulation in your hands and feet. Elevating your feet and ankles for an hour, especially at the end of the day, will also help. Whatever you do, don't restrict fluids -- your body needs to be hydrated to maintain a healthy pregnancy.

If you're worried about swelling, try this test: Press your finger against a swollen ankle. If it leaves a noticeable dent, try elevating your legs for an hour. Then press your ankle again, and if this still leaves a mark, you'll want to talk to your doctor about it. Excessive swelling can be a sign of preeclampsia, which produces high blood pressure in the mother and prevents the baby from growing normally. At regular visits, your doctor will check you for other signs of the condition: high blood pressure, sudden weight gain, or the presence of protein in your urine. Tell your doctor if you are worried about the swelling, but if your blood pressure and urine are normal, you need not be concerned about the health of your baby.

Constipation and Hemmorrhoids

Q. What can I do about constipation and hemorrhoids?

A. Constipation is an occupational hazard of pregnancy and the postpartum period because hormones slow down the movement of food in your digestive system. The iron in your prenatal vitamin can add insult to injury. Remember the two F's of constipation prevention: Eat more fiber and drink more fluids. Fruits, vegetables, and whole grains soak up water in your intestines and help keep waste moving along -- try prunes, pears, figs, apricots, carrots, zucchini, and celery. Eating whole wheat breads, cereals, and pastas will also help you bulk up your fiber intake. Another easy trick: Add a few tablespoons of wheat germ to your cereal or to a fruit and yogurt smoothie. To increase your fluids, make a water bottle your constant companion. Try to drink at least eight glasses of water a day, and treat yourself to different types of fiber-rich juices such as apricot, prune, and pear nectars.

Hemorrhoids can be a side effect of constipation. Pressure from the enlarging uterus along with the increased blood volume of pregnancy can cause the veins in the rectal wall to enlarge, bulge, bleed, and itch. Hemorrhoids are harmless, but they are a pain in the butt! Constipation and straining during elimination aggravate the pain and can make you miserable.

Fluids and fiber in the diet will help keep hemorrhoids to a minimum. For a nutritious stool softener, we recommend adding one tablespoon of flax oil to a daily smoothie. Kegel exercises (tightening and releasing the muscles in your pelvic floor at least 50 times a day) will improve blood flow to the area and strengthen the tissues. Exercise also helps because it prevents blood from stagnating in the lower areas of the body.

To soothe the itching and sting of hemorrhoids, use cool compresses, such as crushed ice in a clean sock. A cotton ball soaked in witch hazel will help shrink hemorrhoids and ease discomfort, and a warm bath may be soothing as well. Talk to your doctor before trying any over-the-counter remedies available at the drugstore.

False Labor

Q. How can I tell the difference between false labor and the real thing?

A Veterans of childbirth may be inclined to answer this question by exclaiming, "Oh, you'll know!" But the early stages of labor, especially in a woman's first birth, can be hard to distinguish from the Braxton-Hicks or pre-labor contractions that are common in late pregnancy. So how will you know?

Contractions become more noticeable in late pregnancy, and for some mothers the precise time at which labor began can be identified only with hindsight. We use the 1-5-1 formula to recognize the beginning of the true labor. If your contractions last for at least 1 minute, are 5 minutes or less apart, and continue for at least 1 hour, it's time to call your health care provider and announce that you are in labor! The timing of contractions may not be precise to the minute, but if you chart them, you'll see the 1-5-1 pattern emerge if this is the real thing.

Pre-labor contractions tend to be irregular -- they follow no discernible pattern and do not become longer, stronger, or closer together. Changing what you are doing will often make them go away. For example, if you've been lying down, get up and take a walk. Contractions in false labor are usually only felt in the front of your body, whereas in true labor, they'll begin in the back and move toward the front. If you think you're in labor and it's well before your due date, listen to your instincts and go to the hospital. Pre-term births do happen, but they are the minority.

Arriving at the hospital only to be sent home again with a diagnosis of "false labor" is nothing to be embarrassed about. It happens to plenty of pregnant couples, especially first-timers. Pick up something good to eat on the way home and enjoy a few more days of peace and quiet before the baby comes.

Shortness of Breath

Q. I feel short of breath. Is something wrong?

A. Most shortness of breath during pregnancy has a logical explanation. As the uterus expands upward, your lungs can't expand downward as they take in air. It's like trying to breathe deeply while wearing tight jeans -- there's no room for expansion. Your body may compensate for the lower volume of air by breathing just a bit more quickly.

Good posture may help alleviate breathlessness. With your chest lifted and your shoulders back, you can breathe more easily than you can when your body sags into a slump. Sleeping with your head raised can help as well. Sudden, severe shortness of breath, accompanied by chest pain and rapid breathing, calls for immediate medical attention. This could be a blood clot in the lungs -- a rare but serious problem.

Itching

Q. Why am I itching all over?

A. Skin that's stretching over the abdomen, hips, thighs, and breasts may itch. Or you may have developed a prickly heat rash in some of those new folds and creases that you've acquired during pregnancy.

During pregnancy, drink lots of water to hydrate your skin and apply moisturizer or another emollient to seal in moisture when your body is still slightly damp after a bath or shower. Avoid long, hot showers and harsh soaps (try using an oatmeal-based soap), as these can rob your skin of the natural oils that keep it smooth.

If prickly heat is the problem, use lotion in the area to smooth skin and minimize irritation from bras, underwear, and other clothing. Avoid synthetic clothing that keeps your skin from breathing, and you may want to skip the pantyhose altogether. Treat your skin to a massage, a soothing touch we like to call "vitamin T." Late in pregnancy, you may notice small red bumps known as pruritic urticarial papules and plaques of pregnancy (PUPP) on your abdomen, thighs, or arms. These are harmless and should disappear after delivery.

Pregnancy causes so many changes in your body that it can be unnerving. These changes are normal and are probably not any cause for concern. Don't be afraid to contact your doctor or midwife with any questions, and try to remember what a special time this is.

Contributing editor William Sears, M.D., and his wife, Martha Sears, R.N., are authors of The Pregnancy Book.

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