| Discomfort and Cause | Health Teaching |
|---|
| Morning sickness—first 3 months; nausea and vomiting; may occur anytime, day or night; cause: hormonal, psychological, and empty stomach |  Alternate dry carbohydrates and fluids hourly; take dry carbohydrates before rising, stay in bed 15 more minutes; avoid empty stomach, offending odors, and food difficult to digest (e.g., food high in fat); avoid acidic foods (e.g., citrus) |
| Fatigue (sleep hunger)—first 3 months; cause: possibly hormones; often returns in late pregnancy when physical load is great | Iron supplement if anemic—foods high in iron, folic acid, and protein; adequate rest |
| Fainting (syncope)—early pregnancy, due to slightly decreased arterial blood pressure; late pregnancy, due to venous stasis in lower extremities |  Elevate feet; sit down when necessary; when standing, do not lock knees; avoid prolonged standing, fasting |
| Urinary frequency—enlarging uterus presses on bladder, turgescence of structures from hormone stimulation; relieved somewhat as uterus rises from pelvis; recurs with lightening | Kegel exercises; limit fluids just before bedtime to ensure rest; rule out urinary tract infection |
| Vaginal discharge—months 2–9; mucus less acidic, and increases in amount (leukorrhea) | Cleanliness important; treat only if infection sets in; douche contraindicated in pregnancy |
| Hot flashes—heat intolerance, due to increased metabolism → diaphoresis | Alter clothing, bathing, and environmental temperature prn |
| Headache—cause unknown; possibly blood pressure change, nutritional, tension (unless associated with preeclampsia) | If pain relief needed, consult physician ( avoid over-the-counter drugs without prescription); reduce tension |
| Nasal stuffiness—due to increased vascularization; allergic rhinitis of pregnancy |  Antihistamines and nasal sprays by prescription only |
| Heartburn—enlarging uterus and hormones slow digestion; progesterone → reverse peristaltic waves → reflux of stomach contents into esophagus | Physician may prescribe an antacid; avoid use of antacids containing sodium; instead of leaning over, bend at the knees, keeping torso straight; sit on firm chairs; limit fatty and fried foods; small, frequent meals |
| Flatulence—altered digestion from enlarging uterus and hormones | Maintain regular bowel habits, avoid gas-forming foods; antiflatulent may be prescribed
|
| Insomnia—fetal movements, fears or concerns, and general body discomfort from heavy uterus | Medication by prescription only; exercise; side-lying positions with pillow supports; change position often; back rubs, ventilate feelings |
| Shortness of breath—enlarging uterus limits expansion of diaphragm | Good posture; cut down/stop smoking; position—supine and upright |
| Backache—increased elasticity of connective tissue, increased weight of uterus, and increased lumbar curvature | Correct posture, low-heeled, wide-base shoes, and abdominal support (binders); do pelvic rock often; avoid fatigue |
| Pelvic joint pain—hormones relax connective tissue and joints and allow movement within joints | Rest; good posture; will go away after giving birth, in 6–8 weeks; avoid prolonged standing/walking |
| Leg cramps—pressure of enlarging uterus on nerve supplying legs; possible causes: lack of calcium, fatigue, chilling, and tension | Stretch affected muscle and hold until it subsides; do not rub (may release a blood clot, if present); ↑ calcium intake |
| Constipation—decreased motility (hormones, enlarging uterus) and increased reabsorption of water; iron therapy (oral) | Diet—prunes, fruits, vegetables, roughage, and fluids; regular habits; exercise; sit on toilet with knees up; avoid enemas, mineral oil, laxatives |
| Hemorrhoids—varicosities around anus; aggravated by pushing with stool and by uterus pressing on blood vessels supplying lower body | As above, avoid constipation; pure Vaseline or Desitin is mild and sometimes soothing; use any other preparation with prescription only |
| Ankle edema—normal and nonpitting; gravity | Rest legs often during day with legs and hips raised |
| Varicose veins—lower legs, vulva, pelvis; pressure of heavy uterus; relaxation of connective tissue in vein walls; hereditary | Progressively worse with subsequent pregnancies and obesity; elevate legs above level of heart; support hose may help |
| Cramp in side or groin —round ligament pain; stretching of round ligament with cramping | To get out of bed, turn to side, use arm and upper body and push up to sitting position |