What to expect when you're expecting (106 page)

You can add massage or local heat for added relief, but don’t massage or add heat if neither flexing nor cold helps the situation.

Make sure you’re drinking enough fluids—at least eight glasses a day.

Eat a well-balanced diet that includes plenty of calcium and magnesium.

Really bad cramps (like a charley horse) can cause muscle soreness that lasts a few days. That’s nothing to worry about. But if the pain is severe and persists, contact your practitioner because there’s a slight possibility that a blood clot may have developed in a vein, making medical treatment necessary (see
page 563
).

“I’m dreading getting hemorrhoids—I’ve heard they’re common during pregnancy. Is there anything I can do to prevent them?”

It’s a big pain in the butt, but more than half of all pregnant women experience hemorrhoids. Just as the veins of the legs are more susceptible to varicosities at this time, so, too, are the veins of the rectum. Pressure from your enlarging uterus, plus increased blood flow to the pelvic area, can cause the veins in your rectal wall to swell, bulge, and itch (how’s that for a pleasant thought?).

Constipation can aggravate, or even cause, hemorrhoids (also called piles because of the resemblance these swollen veins sometimes bear to a pile of grapes or marbles), so your best prevention is to avoid constipation in the first place (see
page 173
). Doing your Kegels (see
page 295
) can also ward off hemorrhoids by improving circulation to the area, as can taking the pressure off by sleeping on your side, not your back; avoiding long hours of standing or sitting; and not lingering on the toilet (keep this book and other reading material out of the bathroom so you aren’t tempted to just sit and read). Sitting with your feet on a step stool may make that other stool easier to pass.

To soothe the sting of hemorrhoids, try witch hazel pads or ice packs. A warm bath might reduce discomfort, too. If sitting is a pain, use a doughnut-shaped pillow to ease pressure. Ask your practitioner before using any medication, topical or otherwise. But forget about your grandma’s cure—downing a spoonful of mineral oil—which can carry valuable nutrients right out the
back door.

Hemorrhoids can sometimes bleed, especially when you’re bearing down during a bowel movement, though anal fissures (painful cracks in the skin of the anus caused by straining from constipation) can also be the cause of rectal bleeding. Rectal bleeding should always be evaluated by your physician, but hemorrhoids or fissures are probably the culprits. Hemorrhoids aren’t dangerous (just uncomfortable) and usually go away after delivery—though they can also develop postpartum as a result of pushing during delivery.

“I’m worried about a small tender lump on the side of my breast. What could it be?”

Though you’re still months away from being able to nurse your baby, it sounds like your breasts are already gearing up. The result: a clogged milk duct. These red, tender-to-the-touch, hard lumps in the breast are very common even this early in pregnancy, especially in second and subsequent pregnancies. Warm compresses (or letting warm water run on it in the shower) and gentle massage will probably clear the duct up in a few days, just as it will during lactation. Some experts suggest that avoiding underwire bras also helps, but make sure you get ample support from the bra you do wear.

Keep in mind that monthly self-exams of your breasts shouldn’t stop when you’re pregnant. Though checking for lumps is trickier when you’re expecting because of the changes in your breasts, it’s still important to try. Show any lump to your practitioner at your next visit.

Bleeding in Mid- or Late Pregnancy

It’s always unsettling to see pink or red on your underwear when you’re expecting, but light or spotty bleeding in the second or third trimester is generally not a cause for concern. It’s often the result of bruising to the increasingly sensitive cervix during an internal exam or sexual intercourse, or it is sometimes simply triggered by causes unknown and innocuous.

Still, let your practitioner know about any bleeding or spotting in case it’s a sign something more serious is going on. If you’re bleeding heavily or if the spotting is accompanied by pain or discomfort, give your practitioner a call right away. An ultrasound exam can often determine whether or not there’s a problem.

“I’m eager to become a mother, but not so eager to experience childbirth. Mostly, I worry about the pain.”

Almost every expectant mother eagerly awaits the birth of her child, but few look forward to labor and delivery—and far fewer still to the pain of labor and delivery. And many, like you, spend much of the months leading up to this momentous event obsessing about the pain. That’s not surprising. For those who’ve never experienced significant discomfort (except maybe a toothache here, a pulled muscle there), the fear of labor pain—which is, after all, an unknown quantity of pain—is very real and very normal.

But it’s important to keep in mind the following: Childbirth is a normal
life process, which women have been experiencing as long as there have been women. Sure it comes with pain, but it’s a pain with a positive purpose (though it won’t necessarily feel positive when you’re in it): to thin and open your cervix, and bring your baby into your arms. And it’s also a pain with a built-in time limit. You might not believe it (especially somewhere around the 5-cm mark), but labor won’t last forever. Not only that, but the pain of childbirth is a pain you don’t even have to put up with at all. Pain medication is always just a request away, should you end up wanting it or needing it—or both.

So there’s no point in dreading the pain (especially because you have the option of avoiding it, or at least, avoiding most of it), but there’s a lot to be said for being prepared for it—and for preparing realistically and rationally, with eyes wide open to every option and every eventuality. Preparing now (both your body and mind—since both are involved in how you experience pain) should help reduce the anxiety you’re feeling now and the amount of discomfort you’ll feel once those contractions kick in.

Diagnosing Preeclampsia

Chances are you’ve heard of (or know) someone who developed preeclampsia (or pregnancy-induced hypertension) during pregnancy. But the reality is that it isn’t that common, occurring in only 3 to 7 percent of pregnancies, even in its mildest form. And luckily, in women who are receiving regular prenatal care, preeclampsia can be diagnosed and treated early, preventing needless complications. Though routine office visits sometimes seem a waste of time in a healthy pregnancy (“I have to pee in a cup again?”), the earliest signs of preeclampsia can be picked up at such visits.

Early symptoms of preeclampsia include sudden weight gain apparently unrelated to overeating, severe swelling of the hands and face, unexplained headaches, pain in the stomach or the esophagus, all-over itching, and/or vision disturbances. If you experience any of these, call your practitioner. Otherwise, assuming you are getting regular medical care, there’s no reason to worry about preeclampsia. See
pages 524
and
548
for more information on and tips for dealing with high blood pressure and preeclampsia.

Get educated.
One reason earlier generations of women found labor so frightening was that they didn’t understand what was happening to their bodies or why. They only knew that it hurt. Today, a good childbirth education class can reduce fear (and ultimately pain) by increasing knowledge, preparing women and their coaches, stage by stage and phase by phase, for labor and delivery. If you can’t take a class or if you just don’t want to, read up as much as you can on the subject of labor and delivery. What you don’t know can worry you more than it has to. Taking classes makes sense, by the way, even if you’re planning on having an epidural—or even if you have a cesarean delivery scheduled.

Get moving.
You wouldn’t consider running a marathon without the proper physical training. Neither should you consider signing up for labor (which is no less challenging an event) untrained. Work out with all the breathing, stretching, and toning-up exercises your practi
tioner and/or childbirth educator recommends, plus plenty of Kegels.

Team up.
Whether you have your partner there to comfort you and feed you ice chips, a doula (see
page 298
) to massage your back, or a friend to wipe your brow—or if you really like company, all three—a little support can go a long way in easing your fears. Even if you end up feeling more tense than chatty during labor, it will be comforting to know that you’re not going it alone. And make sure your team is trained, too. Have your coach attend childbirth classes with you, or if that’s not possible, suggest that he read the section on labor and delivery beginning on
page 380
, so that he’ll know what to expect—and how best to help.

Have a plan—and a backup plan.
Maybe you’ve already decided that an epidural has your name on it. Maybe you’re hoping to breathe your way through those contractions—or use hypnosis or another CAM approach to pain management. Maybe you’re waiting to make that decision until you see how much pain you’re facing. Either way, think ahead, and then keep your mind open (because labor has a way of not always following plans). In the end, you’ll need to do what’s best for you and your baby (even if that’s accepting pain relief when you were hoping to tough it out). Remember, you don’t have to be a martyr to be a mother. This is one time when you can have the gain without the pain. In fact, sometimes pain relief’s absolutely necessary to keep a laboring mom at her most effective. See
page 301
for more on pain relief during labor and delivery.

“I’m afraid I’ll do something embarrassing during labor.”

That’s because you’re not in labor yet. Sure, the idea of screaming, cursing, or involuntarily emptying your bladder or bowel might seem embarrassing now—but during labor, embarrassment will be the furthest thing from your mind. Besides, nothing you can do or say during labor will shock your birth attendants, who’ve seen and heard it all before—and then some. So check your inhibitions when you check into the hospital or birthing center and feel free to do what comes naturally, as well as what makes you most comfortable. If you are ordinarily a vocal, emotive person, don’t try to hold in your moans or hold back your grunts and groans—or even your ear-shattering screams. But if you’re normally very soft-spoken or stoic and would prefer to whimper quietly into your pillow, don’t feel obligated to out yell the woman next door.

“I have pretty definite ideas of what I’d like to happen during labor and delivery. I don’t like the idea of losing control of the situation.”