When you are pregnant your body undergoes many changes.  We have listed the most common issues and relevant advice. If you have any concerns or need some personal advice, please do not hesitate to contact us.


More women suffer with haemorrhoids during pregnancy. Also known as piles, haemorrhoids are swollen blood vessels in or around the anus and rectum. They can cause itching and much discomfort. During pregnancy the most common cause is the hormone progesterone. This hormone weakens the blood vessels and during pregnancy it is usual to have an increased blood pressure. Because of the higher pressure in your blood vessels and pelvic area you can end up with haemorrhoids. Another cause for haemorrhoids is constipation.

Haemorrhoids usually disappear quite quickly after the birth; they certainly shrink significantly during the maternity period.

Tips against haemorrhoids:

  • Don’t push too hard when emptying your bowels.
  • Rinse off with cold water.
  • Don’t have a hot bath, a shower is better. Because the hot water causes the vessels to expand.
  • Use a cold compress on the affected area.
  • Ointment such as Curanol can be helpful also

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Round Ligament Pain

Your uterus is connected to your pelvis and upper legs by ligaments. Both sides of your uterus have two ligaments which run through to your upper legs via your groin.  Additionally there are two ligaments which run through to your spine.

The more your uterus expands, the more the ligaments get stretched. This can cause a pulling, stabbing pain, especially in your groin and abdomen.  The growth of your uterus does not happen gradually but expands with spurts. So it may be the case that you will experience round ligament pain more during the beginning of your pregnancy and then not any for a long time. Round ligament pain is uncomfortable but does not harm your baby.

Tips for round ligament pain:

  • Try not to overexert yourself, walk at a calm pace and don’t overdo it.
  • Support your belly with your hands as you stand up, sneeze or walk.
  • Wear a support belt or supporting underwear if you plan to walk a lot.
  • Wear a support belt or supporting underwear if you have a job where you walk or stand for long periods of time.
  • Maternity support belts are available to buy from many maternity retailers.

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Pelvic and Back Problems

Approximately 50% of all pregnant women will experience pelvic and/or back pain. This pain is caused by the change in body weight and posture because your pelvic joints become more flexible.

‘Upper’ back pain is often the result of changing your posture due to your expanding uterus. ‘Lower’ back pain and pelvic discomfort during pregnancy is usually caused by pregnancy hormones. These hormones are responsible for weakening the tendons which connect the joints. As a result your joints become more flexible and add pressure to your ligaments and joints. This often causes pain, most common around the pubic and tailbone area.

Improving your posture can reduce pain, exercise is recommended. Make sure you bend your knees when lifting or bending down.  Support your lower back when sitting down. When getting out of bed, turn on your side and push yourself upwards from the side position.

Tips against higher back pain:

  • Mind your posture, when you are standing up, how do you move your body? Cesar therapy might be beneficial. 
  • Rotate your pelvis and tighten your pelvic floor before moving, walking or getting up.
  • Limit using shoes with heels, these could increase discomfort.
  • Do not lift heavy items
  • Keep up with exercise, for example swimming or pregnancy fitness: this will keep your muscles active.
  • When getting out of bed, turn on your side and push yourself upwards from the side position.

Tips against lower back pain and pelvic discomfort:

  • Get plenty of rest.
  • Be aware of your posture; tighten your pelvic floor before moving, walking and turning over in bed etc.
  • Be sure to keep your movements as symmetrical as possible: sit up straight, balance your weight over both legs when you are standing up. Climbing stairs can be made less difficult if for example you walk sideways.
  • Alternate between resting and exercise
  • It is recommended to apply a brisk pace rather than to stroll. As the latter can be more tiring and increase discomfort.
  • Consider the use of a pelvic support belt recommended by a physio- or Cesar therapist.
  • Support your lower back when sitting down
  • Several pelvic physiotherapists are available for self referral:
  • For more information and tips see Brochure bekkenproblematiek zwangerschap.

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Bladder Infection

While pregnant you are more likely to develop a bladder infection. Symptoms might be different during pregnancy than other times.

Symptoms such as:

  • A nagging pain in your abdomen, above the pubic area or in your lower back.
  • Frequent tight bellies, not always painful
  • Burning sensation during or immediately after urinating
  • Difficulty urinating and painful urge
  • Strong smelling and cloudy urine
  • If you suspect a bladder infection, please have a doctor check your urine and inform us of the result.

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Nosebleeds and Bleeding Gums

During pregnancy there is an increased blood circulation in your body, especially in the mucous membranes. There is an increased production of tiny blood vessels.  These tiny blood vessels are more prone to burst, extra pressure or other stimuli. Therefore these blood vessels will bleed more easily. This can cause nose bleeds or bleeding gums when brushing your teeth.


  • Make sure you look after your teeth well
  • Aside your teeth, also brush your gums gently with a soft toothbrush
  • Clean your teeth daily with a toothpick or dental floss.

If you have persistent bleeding gums, we recommend you see a dental hygienist.

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Blood Loss

Blood loss is always a reason to contact the midwife on the urgency phone number, especially from the 16th week of pregnancy.

Blood loss during pregnancy is common, especially during the first 3 months.  The blood loss can have various causes, for example the embryo attaching itself to the uterus or a small wound to the cervix. Sometimes blood loss is the first sign of an impending miscarriage.

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Acid Reflux

The pregnancy hormone progesterone weakens the sphincter of the stomach.  This may cause acids from your stomach to leak back up into your oesophagus. What you then experience is acid reflux. Certain foods such as coffee, orange juice, fat and carbon dioxide (fizzy drinks) can make acid reflux worse.  If you are suffering with acid reflux already, it’s best to avoid these foods.  It is important to treat acid reflux because the stomach acids can irritate the mucous membranes of the oesophagus.

Tips against acid reflux:

  • Avoid consuming fizzy drinks, big meals, fatty foods, hot spices, coffee, orange juice, tomato puree, chocolate and chewing gum.
  • Eat more dairy products such as custard or ‘eierkoek’, plain bread or dry crackers.
  • If possible, raise the head of your bed a little.
  • If these home remedies fail to work, try acid inhibitors such as Rennie, Antagel or Gaviscon. These items are easily available at chemists and pharmacies. 

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Carpal Tunnel Syndrome (numb or painful hands)

The median nerve travels from your lower arm through your wrist to your hand. During your pregnancy you will often retain extra fluid, also in your hands and wrists.  This causes pressure on the connective tissue and therefore also on the nerve.  You may experience a numb and tingling sensation in the ends of your fingers and even pain, similar to your hands falling asleep. These symptoms cause the most discomfort during the night and in the morning.

Tips against carpal tunnel syndrome:

  • Exercise your fingers and hands on a regular basis; ‘stress balls’ are a good aid.
  • Soak your hands in warm water every now and again.
  • When in bed, place your hands higher up next to your body so that the fluid can flow back down.
  • Sometimes you might find it beneficial to support your hands and wrists during the night, using Skeelers wrist supporters for example
  • Drink plenty of fluids

Contact us if you are concerned about your symptoms.

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Dizzy Spells and Fainting

During pregnancy your blood vessels may be a little weaker than usual and retract slower. As a result, your blood flow from your legs to your heart is affected. Additionally the relatively ‘heavy’ uterus can influence your circulation. This can cause reduced circulation to the brain.


  • Dizziness
  • Paleness
  • Perspiration (sweating)
  • Black spots in vision and tinnitus

Tips against dizziness:

  • Do not stand or sit in the same position for long periods of time.
  • Avoid sleeping on your back; this may increase the likelihood of dizzy spells.
  • Drink plenty of fluids every day, around 2 ½ litres is recommended. 
  • Prevent dizziness by getting up slowly
  • Have a sit down if you are feeling dizzy, possibly with your head resting on your knees.
  • Cold air can also be an immediate boost. Open a window or go outside for some fresh air.
  • Eat or drink something to pick you up, such as bouillon or salty crackers.

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For most people pregnancy brings along many changes. This period means many and sometimes changing emotions for you and your partner, both positive and negative. Should the negative emotions get the upper hand, please make sure you speak to someone about these.

Tips against negative emotions:

  • Get plenty of rest. If you are exhausted, you are prone to worrying.
  • Get some exercise outdoors.
  • If you have any worries, speak to us, your doctor or a friend

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Braxton Hicks contractions

Braxton Hicks contractions (a hard bellie) are caused by the uterus growing and contracting as a result. The uterus is a muscle and like other muscles it will contract and relax. The uterus is stimulated by the growth, but also by stress and movement of the baby.

You might experience a hard bellie throughout the pregnancy.  Tight bellies occur most often near the end of the pregnancy. This is because the uterus is preparing itself for labour and becomes increasingly sensitive to stimuli. Braxton Hicks contractions does not cause dilation so a hard belly occasionally does not do any harm.


  • The most important tip against a hard bellie is relaxation, rest and heat. Heat causes muscles to relax; this will also affect your uterus. A hot water bottle or a pair of warm hands will help against the hard belly. A hot shower or a bath can be very relaxing also.
  • Get plenty of rest for both body and mind. If you experience a hard bellie more often, listen to your body and try to relax more.
  • Contact us if you have any concerns. Definitely contact us when you are experiencing a hard bellies on a regular basis (every 10 minutes) or if they are painful when you are less than 37 weeks into your pregnancy.
  • Supporting your belly is more comfortable as the support protects your bellie from muscle stress and the tight sensation should therefore be less. Maternity support belts are available to buy from many maternity retailers.

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Palpitations and Breathlessness

Many pregnant women suffer with palpitations and experience a tight, breathless feeling. This is common. During pregnancy your body produces more blood, in order to supply the baby’s growth as well.  Your heart processes an increased blood flow and therefore works harder than usual. This feels like palpitations. The feeling of breathlessness is caused by the ever growing uterus pressing against the underside of the lungs.n.

Tips against palpitations and breathlessness:

  • Have a rest and sit or lie down. Breathe in through your nose and exhale through your mouth.
  • Avoid sitting down in the same position for too long. Get up every now and again and walk around, this will free up space for your lungs.

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Pregnancy hormones can cause itching. Often on your belly, sometimes on your arms and/or legs.In most cases there is no rash, just the itching. Occasionally you can experience itchy little red bumps.

Tips against itching:

  • Use menthol powder or menthol gel.
  • Cool your skin with a cold shower or cold compresses.

Contact us if the itching occurs suddenly or quickly becomes worse.

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Cold Sores

A cold sore is caused by the herpes virus. They usually begin with a painful and burning sensation around the lips.  Followed by small blisters.  After a short time these will burst and dry into scabs.

The skin is usually fully healed after 1 to 2 weeks, but the virus will unfortunately never disappear. Under certain circumstances the virus can become active again, for example when your natural resistance is weakened, during cold/windy weather, bright sunlight, frostbite, sleep deprivation, stress or fever.  A cold sore during pregnancy does not harm you or your baby.

Tips during a cold sore:

  • Do you occasionally suffer from cold sores? Prevent contamination: do not kiss another while blisters exist. Ensure good hygiene: wash your hands with soap.
  • Never pick at the scab.
  • Protect your lips during dry air, frost and bright sunlight by using lip balm.
  • Medication: Zovirax is a well known and the best treatment for cold sores.  So far there has been no increased risk for pregnant women. Zovirax is suitable to treat superficial wounds such as a cold sore. It is NOT suitable for large wounds or to be used vaginally. For advice about use with other medication, speak to your doctor. 

Tips for after the baby is born:

  • The herpes virus can be dangerous to babies. Take care that you do not infect the newborn baby. Avoid kissing and caressing your baby as long as you have blisters. However difficult you might find this. Always wash your hands thoroughly, do not share towels and such with others.
  • Try to avoid touching the cold sore, wash your hands well if you do happen to touch it.
  • Consider wearing a mouth cover mask while you are caring and nursing your baby. These are available to buy from your pharmacy.
  • If you have a visitor with a cold sore, it is recommended that they wear a mouth cover. 

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Leg Cramps

Many pregnant women suffer with leg cramps. This can be very annoying, especially at night. The leg cramps during pregnancy are likely caused by a reduced and more difficult blood circulation.

Tips during leg cramps:

  • It can be helpful to raise your legs slightly while sleeping. It is better to raise the foot end of your mattress rather than to place a pillow under your legs.
  • Get a massage or have alternating hot and cold baths to stimulate circulation.
  • Stretch your calves on a regular basis in order to prevent cramps.

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Breasts begin producing milk during the pregnancy. Occasionally this starts early in the pregnancy but more often production begins near the end of the pregnancy. It is a common but often inconvenient occurrence.

Tips during milk production:

  • Wear a good quality, robust bra.
  • Consider using breast pumps to collect milk.
  • Keep your breasts clean and dry.
  • Don’t try to squeeze the milk out of your breasts.

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The pregnancy hormone HCG causes many women to feel nauseous in the early stages of the pregnancy.  This usually involves morning sickness and vomiting. The pregnancy hormones cause an increase in the production of saliva in your mouth and at the same time slow down your digestive system. As a result fluids build up in your stomach. Especially in the morning this can cause discomfort. Not eating can actually makes symptoms worse. 

But the nausea can also occur later in the day or become worse.  Fatigue plays a big part in how much nausea you are experiencing.  It is also possible that you become intolerant to the smell of certain foods, such as cooked meat and coffee.  The nausea usually passes after the first 3 or 4 months of the pregnancy.

Tips against nausea:

  • Drink and eat something when you wake up, preferable before getting out of bed! Ask your partner to bring you breakfast in bed (for example a cup of tea or a breakfast biscuit) or have something on your bedside table, ready to eat in the morning, such as a cracker, rice waffle.
  • Eat and drink several times a day but small amounts. This prevents your stomach from being empty. This way you can limit the amount of nausea you experience. For example, eat a small sandwich or fruit in between your main meals.
  • Drink plenty of fluids, especially when you are vomiting as a result of the nausea. But do not eat large amounts of food in a single meal, especially in the morning.
  • Do not drink anything that is carbonated (fizzy)
  • Avoid greasy or spicy food.
  • Take your time when getting up from a chair/bed.
  • The nausea can cause weight loss but this is usually no reason for concern.

Contact us on the emergency number if you:

  • Cannot keep anything down, including water or tea
  • Urinate less often than normal
  • Losing a lot of weight
  • Need advice or you have concerns

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Because pregnancy weakens your immune system, you are more likely to catch a cold or have a cold for a longer period of time.

You are also more likely to suffer from nasal congestion because the pregnancy hormones cause the mucous membranes to thicken. (This may also cause you to snore)

Tips against rhinitis:

  • Steaming, this will alleviate the symptoms by opening your nasal passages. You do not need to add anything medicinal to the water, camomile is optional.
  • Use of physiological saline solution such as Otrivin baby nasal spray.
  • Should symptoms persist, contact your doctor for advice.

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Varicose Veins

During pregnancy you are more likely to develop varicose veins.  Some women have them in their legs. They can also occur in the labia. The growing uterus puts pressure on the blood vessels running from your legs back to your heart. This causes an increased pressure in your lower body and varicose veins become more likely. In addition the pregnancy hormones cause the blood vessel walls to weaken so varicose veins are more likely to develop. After the baby is born the varicose veins usually reduce in size.

Tips against varicose veins:

  • Get plenty of exercise. Movement stimulates your leg muscles sending blood in the right direction.
  • Do not sit with your legs crossed or sit on your knees for long periods of time; this causes the veins to constrict.
  • Avoid wearing tight fitting clothes, such as knee socks etc.
  • Raise your legs somewhat while sleeping.In this position blood will flow back to your heart more easily.
  • Do not place your legs on a pillow, but raise the foot of the bed by e.g. placing a pillow underneath the mattress. 
  • If you believe you need surgical (support) stockings, please contact your doctor for advice.

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Urinating Frequently

During pregnancy the muscles of your bladder become a little weaker than usual. In addition the growing uterus presses on your bladder. The flow through your kidneys increases and stimulates urine production.  Near the end of the pregnancy the head of the baby will be pressing down on your bladder. As a result of all these changes you will need to urinate more frequently, usually this is all part of being pregnant. In the final trimester it is also possible to experience mild incontinence.

Tips against frequent urination:

  • Do not limit your fluid intake; this will increase the chances of a bladder infection.
  • Go to the toilet as soon as you feel the urge; do not try to hold it in.
  • Empty your bladder completely by sitting up straight when urinating. In this position the cervix is unable to block the bladder neck and allows all the urine to leave the bladder.

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Vaginal Discharge

An increase in vaginal discharge during pregnancy is very common. As the result of an increased blood circulation in your vagina, more dead skin cells are being released. The hormone oestrogen stimulates the production of glycogen, which provides a breeding ground for certain types of bacteria and fungus. This increases your chances of contracting a vaginal yeast infection. (Thrush)

Tips against vaginal discharge:

  • Wear 100% cotton underwear.
  • Do not use sanitary pads as they make your vaginal area warm and moist, which can stimulate more discharge. It is recommended to change your underwear more often instead.
  • As an option, sleep without underwear.
  • Avoid using soap when washing your vaginal area.

Contact your doctor if:

  • The discharge changes colour
  • The discharge has a strong odour
  • The affected area starts to itch or becomes painful
  • Your vagina and immediate area becomes red and irritated

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Almost every pregnant woman experiences fatigue, especially in the beginning and near the end of the pregnancy. The fatigue is due to various factors.

  • Pregnancy brings along many changes, in different areas, both physically and mentally.  Strong emotions can be the result and requires a lot of energy.
  • Nausea, which causes less appetite, especially during the early stages of pregnancy. Even though you will not experience many physical changes during the early stages,   there is happening plenty to aid the growth and development of your baby.   This also requires a lot of energy.
  • Being pregnant is equivalent to an extra 3 hours of work daily. With regards to energy consumption you in fact work an additional 20 hours a week. 
  • Not sleeping well, tight bellies and your baby moving in the night. These happen especially during the late stages of your pregnancy. 
  • Anaemia (iron deficiency), you will be tested for this on a regular basis during your pregnancy.   If you feel extremely fatigued and are experiencing headaches and/or dizzy spells, contact us.

Tips against fatigue:
There is really only one good advice against fatigue: give in to it and have an early night or a nap and don’t overexert yourself.  

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The pregnancy hormones also affect the muscles of your intestines, which causes your digestive system to work slower and may result in constipation.

Tips for a healthy bowel movement:

  • Drink a lot, a minimum of two litres a day is recommended.
  • Eat foods high in fibre such as wholemeal/rye bread, at least two pieces of fruit and 200gr of vegetables a day.
  • Do not eat white bread, croissants or ‘beschuitjes’.
  • Have meals at regular intervals and especially do not skip breakfast.
  • Consider adding bran to your food.  Use 1 to 3 table spoons a day, for example in yogurt or custard. Because bran absorbs a lot of water in the digestive system it is important to drink plenty when consuming bran.
  • Do not eat/drink chocolate, strong tea and ripe bananas. They will make the constipation worse.
  • Do not drink laxative tea; these are not suitable during pregnancy.
  • Consider drinking Roosvicee Laxo or Stimulance by Nutricia, these work as laxatives and are available from supermarkets.
  • Never ignore the urge for a bowel movement, go to the toilet as quick as possible and take your time.
  • Get plenty of exercise; this will stimulate your digestive system.
  • Tilt your pelvis during a bowel movement; lean backwards a little.

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Water Retention

During the pregnancy your body retains more water. In addition the growing uterus restricts the water being expelled from your lower body which then affects the flow of fluid from your legs back towards your heart.  This causes a build up, heat and lack of exercise can make symptoms worse.

Tips against water retention:

  • Drink plenty, this helps to expel the water.
  • Alternate regularly between exercise and sufficient rest (lying down.)
  • You may find it beneficial to raise the foot end of your bed a little, so that your legs are raised during the night. Place a cushion underneath the mattress, not on top.

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Mask of Pregnancy and Pigmentation

During pregnancy UV radiation may cause brown spots (melasma). Moles and freckles can also develop quicker or become more apparent. Over the course of the pregnancy many women develop Linea Nigra, which is a brownish vertical line that appears down the middle of your belly. This line and spots usually disappear quite quickly once the pregnancy is over.

Tips against mask of pregnancy and pigmentation:

  • Be careful in the sun: try to stay in the shade as much as possible.
  • Use a high SPF suntan lotion for your face.
  • Avoid using a sunbed or a UV lamp.

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