Rebecca Moore divulges into the journey of pregnancy, birth and more… as she uncovers some of the topics we don’t like to talk about.
Your skin’s glowing, you look and feel great, and you actually rather enjoy this pregnancy malarkey. A textbook pregnancy some may say, but there are a fair few of us who enjoy the perfect gestation. However, there are also a whole host of us who don’t. And unfortunately many will suffer the unglamorous nature that pregnancy and childbirth advocates, in silence.
Many will be too embarrassed to talk about the changes in their body. This feature sets out to break down that barrier, whether you’re finding hair in unexpected places or you’re needing to change your pants several times a day due to discharge, let the shame be lifted as this feature explores some of the ultimate pregnancy taboos. Pregnancy and childbirth is one of the most natural things that you can endure, so don’t be ashamed (constipation, incontinence and all).
Increase in hair
Due to the extra blood flow and additional hormones your body is dealing with, you may find you’re housing some extra hair. Many women notice extra hair on their tummies, which may come as a bit of a shock. The upside though, is that the hair on your head will thicken and appear glossier – because when pregnant you shed less hair and your metabolic rate increases, which means the hair grows faster. Although post-birth you can expect to lose a considerable amount of hair as it goes back to its pre-pregnancy cycle condition.
Haemorrhoids, Varicose Veins & Constipation
It’s not out of the ordinary to be greeted with haemorrhoids, or commonly named piles, in your third trimester (in fact in the third trimester you’ll find most of the side effects come out of the woodwork). Haemorrhoids are dilated veins around the inside and outside of the anus, which are caused by the pressure of the baby’s weight in your pelvis. And can unfortunately cause throbbing pains and itching around the anal area, you may also notice some light red bleeding after going to the toilet.
There are a few things to help ease the pain though, over-the-counter creams containing a lubricant will reduce discomfort (but make sure they’re safe to use during pregnancy), or try cold packs. Consultant Obstetrician and Gynaecologist Ashok Kumar suggests, “Try soaking your bottom in warm water for 10-15 minutes three to four times each day.” There are simple things to remember too; keep yourself hydrated, and up your fibre intake, this will prevent constipation (another glamorous side effect of pregnancy), which only worsens piles due to straining when going to the toilet.
When pregnant, you’ll probably notice your newly welcomed sluggish digestion, which may make you constipated, leaving you feeling heavy and irritable. Piles could take a little while to clear up (around three months) after delivery, but will go away. “Constipation is a common problem during pregnancy,” says Dr Kumar, “it can also cause or aggravate haemorrhoids. Make sure you’re eating a high-fibre diet – plenty of whole grains, beans, fruits, and vegetables, and drink plenty of water (eight to ten glasses a day).”
Alike to those pesky haemorrhoids, along come the varicose veins (mainly towards the end of pregnancy). These can appear in your legs, vulva, and anal area. Highly recommended are compression tights. It’s imperative to know, when purchasing ‘support’ hosiery, to make sure they’re manufactured with an mmHg – a medical measurement of compression – as without this, the hosiery will not provide any medically correct therapeutic benefits at all.
Vaginal Discharge & Urinary Incontinence
It is normal for vaginal discharge to increase from the second trimester onwards. There’s no need to panic if it remains clear and mucus-like, odourless or just mildly smelling – similar to the discharge you may have experienced, before the start of your period. It’s recommended to slip a panty liner in, just in case. If things change down there, tell your midwife. It’s also common to experience at least one episode of thrush during pregnancy. It’s uncomfortable but generally speaking innocent. This is due to the vaginal environment becoming less acidic from the pregnancy hormones.
You may also be leaking small quantities of urine when you sneeze, cough or laugh – this is called stress incontinence and normally happens towards the end of the pregnancy. It’s no surprise due to the weight pressing on your bladder. To help, work on your pelvic floor exercises, or try cutting out tea and coffee and drink plenty of water in the day (avoid just before bed though!). It’s also crucial to do pelvic floor exercises daily after baby is born too, (as pushing a baby out ruins your pelvic floor muscle!). It’s really important you rebuild the muscle to prevent incontinence when you’re older.
Changes to Skin
Being pregnant can do all types of funny things to your skin. Most pregnant women will develop some stretchmarks caused by the collagen beneath the skin tearing as it stretches to accommodate your enlarging body. Skin Expert, Nataliya Robinson says, “It’s important to try to ensure you prevent stretchmarks with early treatment,” she suggests, “moisturising with either cocoa butter, calendula cream/oil, or rosehip oil. Massage into the “growing areas” during pregnancy such as your breasts and stomach.”
Due to the complex hormonal activity going on in your body, you may also notice varying degrees of dark and light coloured pigmentation at the end of the first or the beginning of the second trimester, the most noticeable being the development of a linea nigra or “black line” of pigmentation, which stretches down the centre of the abdomen, but this will all fade once your baby has arrived.
You’re also more likely to tan when pregnant because there is more melanin in the body, which causes you to tan, but you must avoid long periods of time in the sun.
Perineal Tears & Episiotomies
This may be one of the most feared pregnancy side affects: the perineal tear (your perineum being the tissue between your vagina and anus). And the big question on many expectants’ lips is ‘to cut, or not to cut.’ Research says it’s better to tear naturally than to be cut, but each has its advantages and disadvantages, so find out as much as you can about your hospital’s policy on episiotomies during the antenatal period. Perineal tears come in four degrees, beginning with just affecting the perineal skin to as severe as injuring the perineum and anal sphincter.
Consultant Obstetrician and Gynaecologist Ashok Kumar, says, “Routine episiotomies are no longer recommended. However, the episiotomy may be helpful in certain situations, such as when extensive vaginal tearing appears likely, or the baby is in fetal distress and needs to be delivered quickly.”
The procedure involves a deliberate incision made in the stretched perineum and posterior vaginal wall to prevent uncontrolled tearing of the mother’s tissue as the baby’s head is delivered. Dr Kumar explains, “Local anaesthesia is used to numb the area before performing the procedure. The most commonly used is medio-lateral (cut angled away from the vagina and rectum), the midline episiotomy (cut straight down from the bottom of the vagina towards the rectum) is rarely carried out in the UK.”
Once the baby and placenta has been delivered, your midwife or doctor will repair the episiotomy with stitches. “Dissolving stitches are used so that they do not need to be removed. Stitches should heal within one month of the birth. It is normal to feel pain around the cut for two to three weeks after giving birth, particularly when walking or sitting,” shares Dr Kumar. Furthermore, women may experience itching when the stitches are dissolving; whether from a tear or an episiotomy as the skin heals.
Fortunately though, there are things on the market to soothe the pain. “Painkillers, such as paracetamol, ibuprofen, diclofenac sodium can help to relieve pain and are safe to use. Using a doughnut-shaped cushion or squeezing buttocks together while sitting may also help.” Dr Kumar also suggests, “Keeping an ice pack wrapped in a towel over, but not directly on, the episiotomy.”
If you’re suffering with the healing process, “You can try exposing the stitches to fresh air by not wearing underwear to encourage the healing process, for around 10-15 minutes every 8 to 12 hours. The episiotomy and the surrounding area should be kept clean to prevent infection. After going to the toilet, pour warm water over the vaginal area to rinse it and keep the area dry,” recommends Dr Kumar.
Although the facts and figures surrounding postnatal depression are indefinite, a lot of us will have known a sufferer, or even suffered ourselves. Elaine Hanzak Postnatal Depression Expert on Greatvine.com comments, “Postnatal depression has always been an illness as a search through historical documents will verify. In our modern society we have simply become more aware of it. This is a good thing as it means there is more hope for sufferers to get help if they know what to look out for.” But the uncertainty that surrounds this subject is mainly down to women feeling ashamed. As mothers we have this innate maternal desire to be a bearer of the ‘supermum’ cape. And we’re experts at making ourselves feel guilty. Elaine feels the modern day lifestyle could be a contributing factor. “We could argue that the pressures of our lifestyles today add to the ‘guilt’ that new mothers feel. We may have more material and practical aids these days yet we have ‘lost’ a sense of family, community and support. Often mothers suffer in silence.”
When Fay Broomfield, mother to Max (5 years) and Phoebe (2 years), had hit rock bottom, she was worried about the reaction she’d receive from other parents. “When you say you’ve got postnatal depression people assume this means you simply aren’t looking after your children. I was scared to open up, because I wasn’t ready to be judged.” Elaine says, “During pregnancy we tend to have expectations of ourselves and ‘what it will be like’. When postnatal depression strikes these expectations can be shattered. The illness clouds your perception and you are very judgmental of yourself and can easily consider yourself to be a bad and failing mother. In reality you are poorly.” However, the reaction that Fay received was quite the opposite. “I felt so supported, a lot of people were going through the same thing.”
Postnatal depression can occur because of a variety of reasons. Elaine argues, “Research shows a wide range of risk factors that may contribute, these include biological factors, history of mental ill-health for example. There may be social issues such as cultural isolation, loss of a loved one or domestic violence.” In January 2010, Fay’s father went into hospital to have half of one of his lungs removed, after being diagnosed with lung cancer. The operation was a success. However, on a routine scan a couple of months later, the cancer had come back and it was aggressive. After several rounds of chemotherapy and radiotherapy and the removal of very large tumour, Fay’s dad passed away when she was 8 and half months pregnant with Phoebe. “It was the most devastating thing that has ever happened to me. The fact that I was pregnant just made everything so much harder. After Phoebe was born on 8 December, I lost my way and found myself experiencing my first panic attack.”
Fay went to her doctors when Phoebe was just 6 days old and was diagnosed with postnatal depression. “He thought it wasn’t just PND but my grieving for dad as well. I lost all my baby weight in 3 weeks, I didn’t eat, or sleep and I suffered with panic attacks every day whilst trying to look after my children. I was put on antidepressants straight away and over time they helped me considerably.” It took around 7 months until Fay felt better, she then spoke with the doctor about reducing her antidepressants to every other day, which she did for another month before she stopped them completely. “When I look back on pictures from Phoebe’s first Christmas I hardly recognise myself. Phoebe’s first few months are still a blur,” explained Fay.
Elaine recommends during pregnancy and early days of motherhood to minimise as many stress factors as possible, such as major life changes like moving house. “If excessive tears, feeling hopeless, exhausted, possibly aggressive feelings continue beyond two weeks then seek professional help. Accept and ask for practical help. Suffering in silence will make you feel worse and prolong it. Accept that postnatal depression is an illness and with time, support and treatment, you will get better.”
Post Traumatic Stress Disorder
Post traumatic stress disorder (PTSD), or more aptly titled postnatal post traumatic stress disorder (or birth trauma) can be seen to overlap postnatal depression, and although some symptoms are the same, they need to be treated as individual illnesses.
Deearna Withey, a Newborn Educator and Maternity Nurse, says, “PTSD occurs as the result of a trauma that one is finding difficult to forget and move on from.” It can normally transpire from a stressful labour, this may have been due to the length and pain, an assisted birth with forceps/ventouse, or an occurrence of a severe tear – or even just the total opposite birth from what you had planned.
There are quite a few symptoms to look out for, from utter avoidance regarding talking about birth to blame and anger towards your partner. “You may experience reoccurring nightmares or intrusive memories of the birth. Some sufferers may struggle to bond with baby, and might even refuse to breastfeed,” explains Deearna.
Similarly to PND there’s a whole host of support networks out there, to get sufferers through this tough time. Deearna recommends that you, “Write down how you feel including specific memories and what you feel you have experienced during the birth, you can ask for your medical records surrounding the birth and talk to your GP/midwife about what you are experiencing.”
All these different side affects that you may experience at different parts of the journey, no matter how large or small, all have one thing in common… they’re curable. If you experience anything you’re unsure of, don’t shy away even if it’s just for your own peace of mind. Help is out there, for a reason, at the end of the day we’re all human, and who said pregnancy was glamorous…?
• Your Pregnancy Week by Week: By Lesley Regan Professor of Obstetrics and Gynaecology, Dorling Kindersley Press, £19.99
• Ashok Kumar, Consultant Obstetrician and Gynaecologist at The Portland Hospital, www.theportlandhospital.com
• Deearna Withey, Newborn Educator and Maternity Nurse, deearnas-maternity-agency.co.uk
• Elaine Hanzak, Postnatal Depression Expert, www.greatvine.com
• Nataliya Robinson, Skin Expert, www.nataliyarobinson.co.uk
• Sophie Freeman, Midwife, University Hospital Southampton NHS Foundation Trust