Pregnancy is a very special time in a woman’s life and is a time of physical, hormonal and emotional changes. It is important to understand that most of these changes are normal and natural, and can occur during the entire pregnancy or during specific periods.
A pregnancy lasts about 40 weeks, counting from the first day of the last period. It is divided into a practical three quarters.
- FIRST QUARTER: the first day of the last period to week 16.
• SECOND QUARTER: week 17 to 28 (inclusive).
• THIRD QUARTER: week 29 to 40.
There are times when a number of factors make a pregnancy high risk and in this situations both analytical work and ultrasounds may be somewhat different from normal pregnancies. It is important for you and your gynaecologist know your background and possible risk factors in order to properly monitor the pregnancy.
Risk factors during pregnancy
- Multiple gestation
- Primiparity at very advanced maternal age
- Repeated miscarriages
- History of premature labour
- History of intrauterine growth restriction
- History of foetal malformation
- History of neonatal mortality
- Uterine malformation
- Cervical incompetence
- History of breast disease: hypertension, heart disease, kidney disease, etc.
Women may begin to experience new and different sensations in the first trimester of pregnancy. One of the most common and unpleasant effects is known as “morning sickness” or nausea. There are dietary measures to take to help prevent nausea, although in many cases medical treatment is required. It is advisable to eat a number of small meals a day, especially during the first trimester when morning sickness most often occurs. Avoiding very spicy and hot foods that might upset the stomach is also recommended. An empty stomach, is in many cases the cause of nausea and go away after eating a small amount of food (breadsticks, whole wheat cookies, piece of fruit, etc.).
Hormonal changes during pregnancy slow the intestine and digestion is heavy and often uncomfortable. Women often have constipation during pregnancy and, although in some cases adding more fibre in the diet is sufficient, in other cases medical treatment is necessary. Women should try to avoid going to sleep shortly after dinner and dinner should be a light meal.
Women often experience a constant need to urinate during the first and particularly the last trimesters. This is essentially due to the pressure that the baby places on the bladder.
In most cases women feel extreme fatigue during this period, which usually disappears after the first 10-12 weeks.
Nose bleeds and bleeding gums are common in the first trimester and are most often the result of increased mucosal vascularity. This is normal and no cause for alarm: it will go away as the pregnancy progresses. The belly does not usually start to get bigger during the first three months of pregnancy, although some physical changes in body shape may be noticed. It is very common that women notice a remarkable increase in breast size and, in some cases, although mostly in the third quarter, discharge from the breast of a milky substance called colostrum. Many pregnant women report that they “lose their waistline” as the body begins to change due to the growth of the baby in utero. In many cases this growth may cause pain similar to those associated with menstruation. These pains are normal, and if they are bearable, should not cause alarm.
Apply a stretch mark cream on the abdomen and breasts is recommended starting in the second month of pregnancy. Sometimes stretch marks do not appear during pregnancy and are only apparent after giving birth. Some pregnant women report itching on the abdomen and breast, which may be caused by the skin stretching without being sufficiently hydrated, after which it distends and forms stretch marks.
The second trimester is much calmer. In most cases nausea goes away and women begin to feel much better. The excessive fatigue of the first trimester begins to disappear. Pregnant women have much more energy than during the first trimester. Women begin to look pregnant, not just like they’ve “put on a few extra pounds”, and wearing comfortable, loose clothes and low-heeled shoes are recommended at this time.
We will later discuss the exercise recommended during pregnancy.
During the third trimester (although sometimes before) women may experience back pain and sciatica. Sciatica is irritation of a spinal nerve root that can be compressed towards the end of pregnancy and therefore hurt, causing pain that runs from the bottom of the buttocks to almost the knee. In some cases intramuscular medication is even required. A support belt to strengthen the lower back and relieve the burden on that area of the body is recommended, especially for women who have to remain standing for prolonged period or start to experience back pain.
In many cases the feet begin to swell due to fluid retention, called oedema. Drinking plenty of fluids, juices, teas, etc. is recommended because, paradoxically, being well hydrated minimises oedema, forcing the kidneys to work harder and eliminate the retained fluid.
In many cases women suffer from indigestion and notice shortness of breath. The baby is already much larger, almost ready to be born, and exerts pressure on the lungs and ribcage that can make breathing and in some cases digestion difficult. Not all pregnant women suffer from haemorrhoids during this trimester, but it is uncomfortable when they do. These are also the result of the pressure the baby puts on the pelvic area.
Other possible symptoms that are completely normal and are no cause for alarm during this trimester are insomnia, increased vaginal discharge, urine leakage, etc.
From the week 35-36 of pregnancy, or sometimes even before, isolated contractions may be felt starting at week 35-36 of pregnancy: not extremely painful, these non-rhythmic contractions are called Braxton-Hicks and prepare the uterus for childbirth.