FAQ for pregnancy

Please see below for advice on common pregnancy problems and answers to frequently asked questions.

Is it safe to sleep on my back in pregnancy?

We advise not going to sleep on your back after 28 weeks of pregnancy, as it is safer for your baby.

For more information please see: Sleep position in pregnancy Q&A | Tommy's (tommys.org)

There is also a great video about this from Tommy’s: How to sleep safely during pregnancy - Tommy's - YouTube

Is it safe to have sex in pregnancy?

Yes, it is safe to have sex during an uncomplicated pregnancy. You should be aware that sexually transmitted diseases can still be shared when you are pregnant.

What foods should I avoid in pregnancy?

Most foods are safe during pregnancy. A healthy diet with 5 portions of fruit and vegetables is recommended. Meat should be well cooked and dairy products should be pasteurised. High fibre foods can help prevent constipation. Some soft cheeses, pate, raw eggs, liver products and shark/marlin/swordfish/raw shellfish should be avoided. Caffeine (found in tea, coffee, chocolate and some fizzy drinks) should be limited to 200mg a day. This would be equivalent to 2 mugs of instant coffee, 2-3 cups of teas or 2 cups of tea and a can of cola. Further information on the amount of caffeine in food and drinks is available at the NHS Website.

Update 4/4/22: Following concerns regarding a possible Listeria outbreak linked with smoked fish pregnant people are advised to ensure smoked fish is thoroughly cooked before eating as smoked fish is a high risk food for listeriosis. For more information visit: Food Standards Agency website 

What about alcohol?

Alcohol consumption during pregnancy can harm the developing unborn baby or the breastfeeding baby.

In 2016 the Department of Health published new guidelines for pregnant women in England, Wales and Northern Ireland to be clear that no level of alcohol is safe to drink in pregnancy.

The safest choice is not to drink alcohol in your pregnancy.

If you are breastfeeding, not drinking alcohol is the safest option.

What about vitamin and mineral supplements?

Folic Acid 400mcg daily is recommended before and during pregnancy. Vitamin D 10mcg is recommended in pregnancy. Vitamin A supplements should be avoided. You may be entitled to free vitamins - ask your midwife.

Will smoking harm my baby?

Cigarettes can restrict the essential oxygen supply to your baby, so their heart has to beat harder every time you smoke. Protecting your baby from the harm of tobacco smoke is one of the best things you can do to give your baby a healthy start in life. No matter what stage you are in your pregnancy, it’s not too late to give up smoking. Stopping completely will provide immediate benefits for you and your unborn baby (including being is less likely to be born too early, being born underweight, reducing the risk of cot death and stillbirth) and is recommended by experts rather than cutting down.

One You Leeds, is a free service to provide both mums and dads with what they need to stop smoking. Call them free on 0800 1694219 or visit the One You Leeds Website.

Is it normal to have vaginal discharge in pregnancy?

Yes. Almost all women have more vaginal discharge in pregnancy. This is normal, and helps prevent any infections travelling up from the vagina to the womb.

Towards the end of pregnancy, the amount of discharge increases further. In the last week or so of pregnancy, it may contain streaks of sticky, jelly-like pink mucus.

This is called a "show", and happens when the mucus that's been present in your cervix during pregnancy comes away. The show can have spots or streaks of blood within the mucous consistency which is normal.

It's a sign that the body is starting to prepare for birth. You may have a few small "shows" in the days before you go into labour.

 Thrush in pregnancy

Thrush is an infection that can cause unusual vaginal discharge. If you get thrush when you're pregnant, it can easily be treated - talk to your midwife or doctor.

Thrush can cause:

• increased vaginal discharge which is usually white (like cottage cheese), and doesn't usually smell
• itching and irritation around the vagina

Always talk to your doctor, pharmacist or midwife if you think you have thrush, as there are some thrush medicines you shouldn't use while you're pregnant.

You can help prevent thrush by wearing loose cotton underwear, and some women find it helps to avoid perfumed soap or perfumed bath products.

 What is a "show”?

During pregnancy, there's a plug of mucus in your cervix. This plug comes away just before labour starts, or when in early labour, and you may pass it out of your vagina. This small amount of sticky, jelly-like pink mucus is called a show.

It may come away in one blob or in several pieces. It's pink in colour because it's bloodstained. It's normal to lose a small amount of blood mixed with the mucus. 

If you're losing more blood, it may be a sign something is wrong, so phone MAC straight away.

A show indicates that the cervix is starting to open/soften. Labour may follow on the same day or may take a few days. 

Bleeding in pregnancy

Bleeding during pregnancy is relatively common and doesn't always mean there's a problem but it is always important that you phone and speak to MAC about any further vaginal blood loss that you experience.

Common causes of bleeding in later pregnancy can be due to:

Cervical changes - Pregnancy can cause changes to the cervix, and this may sometimes cause bleeding – after sex, for example.

Vaginal infections - If you feel this may be the cause of your bleeding then please contact the Maternity Assessment Centre to discuss further

Following a vaginal examination or speculum - If you have had an examination then this sometimes cause’s some bleeding, especially if you have had a stretch and sweep. This is not harmful and should settle after a few hours.

Please wear a pad and observe your loss and call back if you experience any further blood loss pv, any pain, reduced fetal movements or any other concerns.

Is vomitting in pregnancy normal?

Yes. Many women suffer from nausea and/or vomitting in pregnancy. For most it goes away after 3-4 months, but some women experience nausea/vomitting throughout the entire pregnancy. If you are suffering from vomitting drink plenty, have small amounts of food often and do not stop eating. Try to distract yourself, the more you think about it the worse it gets. Severe vomitting may lead to dehydration and may require hospitalisation.

When will I start to feel my baby move?

Every women is different! You may start to feel movements from around 18 to 22 weeks pregnant. At first, you feel a fluttering or bubbling, or a very slight shifting movement, maybe a bit like indigestion.

Why does my midwife keep asking me about my baby's movements?

An active baby is a happy baby. Your baby will have its own unique pattern of movements which you will soon get to recognise. Babies move during the day and the night time. Your midwife is trying to ensure that you are aware of your baby's movement pattern and report immediately any change.

For more information on the importance of your baby moving please Click Here -information is also available in different languages.

Back pain in pregnancy

Back pain during pregnancy is a common complaint. As your body changes and grows, your center of gravity changes, and your hormones are relaxing the ligaments in the joints of your pelvis. Three quarters of all women experience backache during their pregnancy. Suffers report the pain to increase towards the end of the day.

Here are a few tips on how to practice good posture

• • • Stand up straight and tall.
    • Hold your chest high.
    • Keep your shoulders back and relaxed.
    • Don't lock / cross your knees.
    • When you stand, use a comfortably wide stance for the best support.

• Wear low-heeled — not flat — shoes with good arch support. Avoid high heels.
• Lift properly. When lifting a small object, squat down and lift with your legs. Don't bend at the waist or lift with your back. It's also important to know your limits. Ask for help if you need it.
• Sleep on your side. Left side. Keep one or both knees bent. Consider using pregnancy or support pillows between your bent knees, under your abdomen and behind your back.
• Try heat, cold or massage
• Include physical activity in your daily routine, such as walking or water exercise.
• Consider complementary therapies like acupuncture.
• For back stretches see NHS website for information and example diagrams.
• Keep in mind that back pain during pregnancy might be a sign of preterm labor or a urinary tract infection.
• Know when to consult your midwife or GP. Sever back pain, back pain which has lasted over two weeks. Back pain during pregnancy that's accompanied by vaginal bleeding, fever or burning during urination, contact your health care provider right away.
• Taking paracetamol. If you are normally able to take paracetamol, you can have 2 (500mg total 1000mg equal to 1g) tablets every 4 to 6 hours, but not more than 8 tablets in 24hours, the same as you can if you are not pregnant.

Some women (less than 1%) will have sciatica during pregnancy. Sciatica is a pain that travels down the leg to the foot along the path of the sciatic nerve, which may be accompanied by pins and needles. It is caused by irritation to the sciatic nerve or in some cases by a prolapsed disc in the lower spine. If this occurs contact your midwife or GP.

Abdominal Pain in Pregnancy

Stomach (abdominal) pain or cramps are common in pregnancy. They’re usually nothing to worry about especially if the pain is mild and goes away when you change position, have a rest, open your bowels (do a poo) or pass wind. You may also feel light period-like discomfort or cramps at the end of your pregnancy.

Harmless stomach pains that can be dull or sharp may be caused by:

• Ligament pain (often called “growing pains” as the ligaments stretch to support your growing bump) this can feel like a sharp cramp on one side of your lower tummy.
• Constipation - which is common in pregnancy
• Trapped wind
• Braxton hicks contractions

Ligament pain

The hormones of pregnancy soften your muscles and ligaments to allow your body to change and adapt in pregnancy. As pregnancy continues and your baby grows your muscles stretch and more strain is put on your ligaments.  Ligament pain is very common in pregnancy and although uncomfortable/painful for pregnant women there is no harmful effect for baby. If the discomfort/pain eases when resting and after analgesia then ligament pain is likely to be the cause, ligament pain often worsens when moving and/or towards the end of the day.

Braxton hicks contractions

Braxton Hicks contractions are a sign that the muscles of your womb are tightening. This can happen from as early as 16 weeks, but are more common in later pregnancy. Braxton Hicks are when the womb contracts and relaxes. Sometimes they are known as false labour pains or practice pains. Not all women will have Braxton Hicks contractions. If you do, you’ll usually feel them during the second or third trimester. Braxton Hicks are completely normal and many women experience them during pregnancy.

Braxton Hicks’ contractions are:

• irregular (more than 10 minutes apart)
• short-lasting
• Uncomfortable more than painful.

You do not need to contact your maternity unit or midwife unless your contractions become painful and regular (less than 10 minutes apart).

What do Braxton Hicks feel like?

They may be uncomfortable, but they are not painful. Women often describe Braxton Hicks contractions as feeling like mild/strong menstrual cramps or a tightening in a specific area of the stomach that comes and goes.

Why will I get Braxton Hicks?

We don’t really know why women get Braxton Hicks contractions. But we do know some of the things that trigger them, such as:

• being very active
• having a full bladder
• having sex
• being dehydrated.

What’s the difference between Braxton Hicks and labour contractions?

Unlike labour contractions, Braxton Hicks contractions:

• vary in length and strength
• happen infrequently, are unpredictable and non-rhythmic
• are more uncomfortable than painful
• do not increase in frequency, duration or intensity
• lessen and then disappear, only to reappear at some time in the future.

Compared with Braxton Hicks, labour contractions: 

• are noticeably, and increasingly, longer
• are more regular
• are more frequent
• are painful
• increase in intensity.

Nearer the end of your pregnancy, Braxton Hicks contractions may form more of a pattern and increase in frequency and intensity. Lots of women often mistake Braxton Hicks contractions for the start of labour. But, unlike labour contractions, Braxton Hicks contractions do not cause the cervix (the entrance to the womb) to open (dilate).

How are Braxton Hicks contractions treated?

There is no treatment for Braxton Hicks contractions. But there are things you can do to ease them, such as:

• changing position
• lying down if you’ve been very active 
• going for a walk if you’ve been sitting down for a long time
• relaxing, such as taking a warm bath, having a massage, or having a nap
• Drinking some water to rehydrate.

When should I contact my midwife?

It’s always best to contact MAC for advice if you are not sure whether you are having Braxton Hicks or labour contractions.

It’s also a good idea to call them if the tightenings continue, especially if you are less than 37 weeks pregnant.

Call your midwife or maternity unit straight away if:

• you have any vaginal bleeding
• your waters break
• you have strong contractions every five minutes that last 30-60 seconds)
• these twinges become very painful
• you have any concerns about your baby’s movements.

How to avoid constipation

The hormonal changes in your body may cause you to become constipated very early on in your pregnancy.

To help prevent constipation, you can:

• Eat foods that are high in fibre, such as wholemeal breads and cereals, fruit and vegetables and pulses such as beans and lentils
• Exercise regularly to keep your muscles toned
• Drink plenty of water

When will my waters break?

Most women's waters break during labour, but it can also happen before labour starts.

Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it's time for your baby to be born, the sac usually breaks and the amniotic fluid drains out through your vagina. This is your waters breaking.

If your waters break naturally, you may feel a slow trickle or a sudden gush of water you can't control. Amniotic fluid can be clear, pale pink or a pale straw colour. Sometimes it's difficult to tell amniotic fluid from urine. 

Please put a maternity pad on and mobilise and observe PV loss over next hour and call us back. If you experience the following your waters may have broken so it is really important to call MAC and inform us if you experience:

• a popping sensation followed by a gush or trickle of fluid
  • an unusual amount of dampness on your pad / underwear that doesn’t smell like urine
• Uncontrollable leaking of small or large amounts of fluid from the vagina that does not smell like urine.

When your waters break, the water may be a little bloodstained to begin with.

If you notice any green or brown colour to the loss or any significant bleeding please do not delay contacting MAC.

If there is continued watery loss noticed and you feel your waters have broken then ring MAC at the hospital you are booked at. If it sounds like your waters may have broken you will be asked to wear a sanitary pad and make your way into the Maternity Assessment Centre with your maternity notes for assessment.

I think I am having contractions, what should I do?

Before established (active) labour begins the cervix (neck of the womb) is firm, long and closed. Before active labour many people can experience contractions that are irregular, short lasting and mild in strength, this stage of labour is called the Latent phase of labour.  During the latent phase of labour the cervix (neck of the womb) starts to soften, thin out and dilate (open up).   Once the cervix starts to open more and contractions are regular and lasting around 40 seconds, labour is usually established.

The latent phase of labour can last several days before established labour starts. This is normal. Some women experience ‘period’ type cramps and backache and some will experience short periods of contractions lasting a few hours, which can stop and start up again the following day.

Remember, the latent phase of labour can last a long time, especially for first time mums, a ‘start-stop’ pattern of contractions is common in the latent phase.  Research evidence suggests that staying calm and relaxed at home during the latent phase is linked with fewer childbirth interventions.

Coping strategies for the latent phase of labour:

Find something to distract yourself from the contractions, something that you would do normally to help you feel relaxed. This might include:

• Going out for a walk
• Breathing in gently and sighing out slowly through each contraction
• Taking a nap
• Having a warm bath or shower
• Listening to a playlist of your favourite music or watching a DVD
• Try sitting on your gym ball if you have one and leaning against your bed or a chair
• Put a hot water bottle on areas that ache, such as your lower back, underneath your bump or between your thighs. Please be mindful not to use a hot water bottle directly on your skin and place it over a layer of clothing.
• Ask your birth partner to massage your back/shoulders/arms
• Remaining up and mobile can help you progress more quickly as this will allow gravity to work on your side
• Drink plenty of fluids and eat little and often. Water, energy drinks and carbohydrates such as bread, pasta, rice and cereal will help to keep you hydrated and build and store your energy supplies
• Some women find it helpful to use a TENS machine
• Taking paracetamol. If you are normally able to take paracetamol, you can have 2 (500mg total 1000mg equal to 1g) tablets every 4 to 6 hours, but not more than 8 tablets in 24hours, the same as you can if you are not pregnant.

Preparation is the key!

No two births are the same but having an understanding of what is happening to your body and knowing what you can do to help yourself will have a positive impact upon your birth experience.  Have the confidence that your body is perfectly designed to birth your baby.

Over time your contractions will become longer lasting, stronger and more intense. If this is your first baby, you normally need to be experiencing a minimum of two to three contractions every ten minutes that last for 45 seconds to a minute, for a few hours, before you are in the active phase of labour.  It is possible for active labour to start more suddenly, particularly if you have already had a vaginal birth. Remember every labour is different, so it is best to stay relaxed and be prepared for whatever happens.

It is a good idea to try to stay at home until your labour is established but please ring the Maternity Assessment Centre and speak to a midwife in the following situations:

• If your baby’s movements slow down.
• If you think you are going into labour before 37 weeks.
• If your waters break.
• If you are bleeding vaginally.
• If you have a headache, fever or are generally unwell.
• When you are having strong, regular contractions.
• If you are finding it hard to cope at home and need some advice.

Always telephone the Maternity Assessment Centre (MAC) before coming in, even if you are sure you are in labour and always remember to bring your hand held notes whenever you come to the hospital.

My waters have broken but I am not in labour. What will happen next? 

If your waters break before labour starts this is called Spontaneous Rupture of Membranes (SRoM). This means that the protective sac of fluid around your baby has gone. The water will continue to come away until your baby is born.

You can chose to go home and await the onset of your labour (expectant management) of have your labour started or induced straight away by the use of a hormone drip. It is important you are aware:

• 60% of women will go into labour within the next 24 hours
• There is no difference in the maternal or neonatal outcomes between immediate induction and expectant management with the exception of the risk of serious neonatal infection after PROM is 1% (compared to 0.5% in women with intact membranes)
• Induction after 24hours is reasonable

If you choose to go home and await events it is important that the following advice and guidelines are followed to help ensure the safety and wellbeing of yourself and your baby.

 You should contact the Maternity Assessment Centre (MAC) for advice if you experience any of the following or are concerned in any way about your pregnancy or baby:

• You feel unwell or hot and feverish
• Your temperature is 37.5°C or above (see below information on taking your temperature)
• The colour of the water changes from clear, cloudy or pale pink to any other colour e.g. brown, green or red
• The smell of the water changes
• You notice that your baby is not moving as much as normal
• You experience pain or contractions, stronger or different to normal

Personal hygiene is important to prevent infection

• Change your maternity pad frequently, at least every 4 hours during the day, or whenever wet.
• Do not use tampons
• You may take a bath or shower as you wish, but do not use any bath products e.g. foams or oils
• Do not go swimming
• Do not use any perfume, deodorant or talc around the genital area
• Refrain from any form of sex as this may be a source of infection

 Labour will normally start spontaneously within 24 hours

If you are not in labour 24 hours following your waters breaking you should attend Delivery Suite for induction of labour at the date and time provided by your midwife

We recommend that you take your temperature at home every four hours during hours that you are awake. You will be provided with disposable thermometers to take home with you if needed and advised n how to use these. If your temperature is 37.5°C or above please telephone MAC.

Feeling faint or dizzy

Pregnant women can often feel faint. This is due to hormonal changes. You are most likely to feel faint if you stand up too quickly from a chair or out of a bath but it can also happen when you are lying on your back.

Avoiding feeling faint

Here are some tips to help avoid feeling faint:

• try to get up slowly after sitting or lying down.
• if you feel faint when standing still, find a seat quickly and the faintness should pass, if it doesn't, lie down on your left side.
• if you feel faint while lying on your back, turn onto your left side.
• keep well hydrated - 2-3 liters of water per day, try having a glass of water before getting out of bed.
• eat regularly.

It's better not to lie flat on your back in later pregnancy or during labour. You should avoid going to sleep on your back after 28 weeks as it has been linked to a higher risk of stillbirth. The advice is to lay on your left side.

Are headaches normal in pregnancy?

Some pregnant women find they get lots of headaches. They are most common in early pregnancy & usually improve or stop completely during the last 6 months.

Headaches do NOT harm your baby, but they can be uncomfortable for you.

Headaches can sometimes be a symptom of pre-eclampsia, pre-eclampsia can lead to serious complications if it is not monitored & treated.

Call your midwife or maternity assessment immediately if you have:

• A severe headache
• Problems with vision, such as blurring or seeing flashing lights
• Pain just below your ribs
• Vomiting
• A sudden increase in swelling of your face, hands, feet or ankles

Coping with headaches in pregnancy:

Paracetamol is the first choice of painkiller if you are pregnant or breastfeeding (as long as you are not allergic to it). For safety in pregnancy & breastfeeding take it for the shortest possible time.

• Taking paracetamol. If you are normally able to take paracetamol, you can have 2 (500mg total 1000mg equal to 1g) tablets every 4 to 6 hours, but not more than 8 tablets in 24 hours, the same as you can if you are not pregnant.

You should avoid non-steroidal anti-inflammatory drugs (NSAIDS) like Ibuprofen whilst pregnant.

Try to drink plenty of fluids to prevent dehydration. Get enough sleep, rest & relax.

Is heartburn normal in pregnancy?

Indigestion / heartburn will feel like a strong burning sensation in the chest and can be extremely uncomfortable. It is also known as acid reflux and indigestion (NHS Choices, 2017). Hormones and, later in pregnancy, your uterus presses on your stomach. This can sometimes leave you bloated, burping, nausea or with a nasty heart burning sensation.

Indigestion / heartburn is not harmful to your baby.

• Make a note of what sets it off. Try to avoid these foods (spicy foods, chocolate and fruit juice are often to blame), especially in the evenings.
• Try eating smaller meals more frequently.
• Sit up straight when you’re eating to take the pressure of your stomach.
• Raise your head when in bed or resting by approximately 10-15cm.
• Finish eating about three hours before bedtime.
• Try drinking milk when you get heartburn (and keep a glass handy in the night).
• Prop yourself up with pillows in bed.
• Ask your midwife or GP about medication.

See your midwife or GP if you need help managing your symptoms or if changes to your diet and lifestyle do not work. Speak to your midwife or GP if your heartburn is severe and the above suggestions do not help.

You should also see your midwife or GP if you have any of the following:

• difficulty eating or keeping food down
• weight loss
• stomach pains

Is itching normal in pregnancy?

Many women find their skin itches during pregnancy. Some itching around the abdomen is normal as your skin is stretching around your growing baby. While this is normal for most women, occasionally it’s a sign of a liver disorder, intrahepatic cholestasis of pregnancy (ICP, also called obstetric cholestasis). The hands and feet are usually affected, but other areas of the body may be itchy too, and the itching may be particularly bad at night. If diagnosed ICP can be treated.

If itching occurs contact your midwife or Antenatal Day Unit (LGI 3926588 SJUH 2065326). Depending on gestation itching needs to be investigated. A blood test to check your liver function (LFT) and measure your bile acid levels (BA). If confirmed ICP / obstetric cholestasis your bloods will be reviewed regularly in the Antenatal Day Unit. Creams and medication maybe prescribed.

Mild itching:

• Wearing loose clothes may help prevent itching.
• You may also want to avoid synthetic materials and opt for natural ones, such as cotton, instead. These are "breathable" and allow the air to circulate close to your skin.
• A cool bath or applying lotion or moisturiser can help soothe the itching.
• Some women find that products with strong perfumes can irritate their skin, so you could try using unperfumed lotion or soap.
• Mild itching is NOT usually harmful to you or your baby.

I keep getting cramp in my legs, is this normal?

Cramp is a sudden, sharp pain, usually in your calf muscle or feet that happen when a muscle suddenly shortens and becomes tight (spasms). They can last from a few seconds to 10 minutes and it can even be difficult to move when they hit. Even when the leg cramp has stopped, you might feel tenderness in the muscle for up to 24 hours. It is most common at night. Nobody really knows why it happens.

Avoiding cramp

Regular gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and may help prevent cramp. Try these foot exercises:

• Bend and stretch your foot vigorously up and down 30 minutes
• Rotate your foot 8 times one way and 8 times the other way
• Repeat with the other foot
• Try doing these exercises 3 times a day
• Keep well hydrated

What can I do if I get leg cramps while sleeping?

Annoyingly, leg cramps usually happen at night. Leg cramps can really get in the way of a good night’s sleep (Allen and Kirby 2012; NHS Choices 2015). This is hard when you’re feeling so exhausted already.

Here are a few ideas that might help with night time leg cramps:

• If you get leg cramp at night, you could try getting out of bed to walk around on your heels for a little while before heading back to (a hopefully undisturbed) sleep.
• Keep bedding loose so that your feet and legs have space to move around.
• Raise your feet by propping them up on a pillow, and try not to have your toes pointing down.
• Some people also find that soaking in a warm bath before bed helps their muscles relax.
• To ease cramp it usually helps if you pull your toes hard up towards your ankle and rub the muscle hard.

Be mindful of the signs of DVT

During pregnancy it's common to experience swelling or discomfort in your legs, so this on its own doesn't always mean there's a serious problem. Deep vein thrombosis (DVT) is a serious condition where a blood clot forms in a deep vein in the body, usually in the leg.

DVT isn't common in pregnancy. But pregnant women at any stage of pregnancy, and up to 6 weeks after the birth, are more likely to develop DVT than non-pregnant women of the same age. If you have any of the following symptoms then it is important that you contact MAC.

• pain, swelling and tenderness in one leg, usually at the back of your lower leg (calf) – the pain may be worse when you bend your foot up towards your knee
• a heavy ache or warm skin in the affected area
• red skin, particularly at the back of your leg below the knee

What are Varicose Veins?

During pregnancy, the amount of blood increases to help support the developing baby. This puts extra strain on your veins and areas swell. Increased hormone levels during pregnancy also cause the muscular walls of the blood vessels to relax, which also increases your risk.

 Varicose veins may also develop as the womb (uterus) begins to grow. As the womb expands it puts pressure on veins in your pelvic area, which can sometimes cause them to become varicose.

 Although being pregnant can increase your risk of developing varicose veins, most women find their veins significantly improve after the baby is born.

 Varicose veins can be uncomfortable but aren't harmful. They most commonly affect leg veins. You can also get varicose veins in the vaginal opening (vulva), although these usually get better after the birth.

 If you have varicose veins, you should:

• Avoid standing for long periods of time. Change position while standing.
• Try not to sit with your legs crossed.
• Try not to put on too much weight, as this increases the pressure.
• Sit with your legs up as often as you can to ease the discomfort.
• Try compression tights; speak to your midwife / GP.
• Try sleeping with your legs higher than the rest of your body – use pillows under your ankles or put books under the foot of your bed.
• Do foot and other antenatal exercises, such as walking and swimming, which will help your circulation.

• Apply cold compresses to your vulva. This might ease your discomfort.

Try these foot exercises:

• Bend and stretch your foot up and down 30 times.
• Rotate your foot 8 times one way and 8 times the other.
• Repeat with the other foot.

 Varicose veins do not always need treatment. If your varicose veins are not causing you discomfort, you may not need to have treatment.

 Treatment of varicose veins is usually only necessary to:

• Ease symptoms – if your varicose veins are causing you pain or discomfort.
• Treat complications – such as leg ulcers, swelling or skin discolouration.
• Some people also get treatment for cosmetic reasons – but this kind of treatment is rarely available on the NHS, so you'll usually have to pay for it to be done privately.

What is Pelvic Girdle Pain (PGP)?

Symptoms of PGP

PGP can be mild to severe but is treatable at any stage in pregnancy and the sooner it is treated, the more likely you are to feel better. It is more common later in pregnancy. Symptoms include:

• pain in the pubic region, lower back, hips, groin, thighs or knees
• clicking or grinding in the pelvic area
• pain made worse by movement, for example:
  • walking on uneven surfaces/rough ground or for long distances
  • moving your knees apart, like getting in and out of the car
  • standing on one leg, like climbing the stairs, dressing or getting in or out of the bath
  • rolling over in bed
  • during sexual intercourse

What can I do to help my symptoms?

The following simple measures may help:

• keeping active but also getting plenty of rest
• standing tall with your bump and bottom tucked in a little
• changing your position frequently – try not to sit for more than 30 minutes at a time
• sitting to get dressed and undressed
• putting equal weight on each leg when you stand
• trying to keep your legs together when getting in and out of the car
• lying on the less painful side while sleeping
• keeping your knees together when turning over in bed
• using a pillow under your bump and between your legs for extra support in bed.

You should avoid anything that may make your symptoms worse, such as:

• lifting anything heavy, for example heavy shopping
• going up and down the stairs too often

• stooping, bending or twisting to lift or carry a toddler or baby on one hip
• sitting on the floor, sitting twisted, or sitting or standing for long periods
• standing on one leg or crossing your legs.

What are my treatment options?

Your physiotherapist will suggest the right treatment for you. This may include:

• advice on avoiding movements that may be aggravating the pain. You will be given advice on the best positions for movement and rest and how to pace your activities to lessen your pain.
• exercises that should help relieve your pain and allow you to move around more easily. They should also strengthen your abdominal and pelvic floor muscles to improve your balance and posture and make your spine more stable.
• manual therapy (hands-on treatment) to the muscles and joints by a physiotherapist, osteopath or chiropractor who specialises in PGP in pregnancy. They will give you hands-on treatment to gently mobilise or move the joints to get them back into position, and help them move normally again. This should not be painful.
• warm baths, or heat or ice packs
• hydrotherapy
• acupuncture
• a support belt or crutches.

For most women, early diagnosis and treatment should stop symptoms from getting worse, relieve your pain and help you continue with your normal everyday activities. It is therefore very important that you are referred for treatment early. PGP is not something you just have to ‘put up with’ until your baby is born.

I’ve tried these measures but I’m still in pain. What are my options?

Being in severe pain and not being able to move around easily can be extremely distressing. Ask for help and support during your pregnancy and after the birth. Talk to your midwife and doctor if you feel you are struggling. If you continue to have severe pain or limited mobility, it is worth considering:

• regular pain relief. Paracetamol is safe in pregnancy and may help if taken in regular doses. If you need stronger pain relief, your doctor will discuss this with you.
• aids such as crutches or a wheelchair for you to use on a short-term basis. Your physiotherapist will be able to advise you about this. Equipment such as bath boards, shower chairs, bed levers and raised toilet seats may be available.
• changes to your lifestyle such as getting help with regular household jobs or doing the shopping.
• if you work, talking to your employer about ways to help manage your pain. You shouldn’t be sitting for too long or lifting heavy weights. You may want to consider shortening your hours or stopping work earlier than you had planned if your symptoms are severe.

How long will I bleed for after my birth?

You will bleed from your vagina after the birth. It will be quite heavy at first. Change your sanitary towels frequently & wash your hands before & after changing them.

 It is not a good idea to use tampons until after your 6 week postnatal check because they can increase your risk of infection.

 The bleeding will carry on for a few weeks. It will gradually turn a brownish colour & decrease until it finally stops.

If you are losing blood in large clots, tell your midwife or ring Maternity Assessment. You may need some treatment.

If you have had stitches after tearing or an episiotomy (cut) bathe them every day to help prevent infections. Have a bath or shower with plain water then carefully pat yourself dry.

Painkillers can help. If you are breastfeeding you are fine to take paracetamol and Ibuprofen as long as you do not have any known allergies to these medications or have previously been advised not to take Ibuprofen outside of pregnancy. For paracetamol take 2 500mg tablets up to 4 times in 24 hours and for Ibuprofen the usual dose for adults is one or two 200mg tablets 3 times a day.

Stitches usually dissolve by the time the cut or tear healed.