Model of Care

Also known as 'morning sickness', these symptoms can happen all day, and can occasionally be very severe. For most women who have morning sickness, the symptoms start when they're around 4 to 6 weeks pregnant and sometimes can last till as late as second trimester.

Do’s

• Have small frequent snacks of bland food to keep your stomach from being empty.
• If you are nauseous when you wake in the morning, keep some dry crackers or toast next to your bed.
• Exercise only when you feel well enough to do so.
• Poor food and fluid intake due to morning sickness can increase the risk of dehydration. Do remember to drink enough fluids and exercise in a cool environment.

Don’t’s

• Avoid foods that are fatty, acidic, or spicy.
• Avoid tobacco smoke and smells that make you nauseated.

When to seek medical attention

If you have severe vomiting, cannot retain any food, and lose more than 10% of your pre-pregnancy weight, please see your doctor immediately. There are effective anti-vomiting medications that are safe for you and your baby, thus do seek medical help early if you are unwell.

You may notice a strange taste in your mouth, crave new foods, have a more sensitive sense of smell than usual, and no longer like some foods or drinks you used to enjoy.

Do’s

• Eat a balanced diet and eat as you desire.

Don’t’s

• Avoid binging on high-calorie and high-fat food.
• Avoid raw/ undercooked meat (e.g. sashimi), raw/ partially cooked eggs.
• Avoid drinking more than 1 cup of tea or coffee in a day .
• Avoid drinking any alcoholic drinks.

It is normal to lose appetite during pregnancy. Studies have shown that 60% of pregnant women experience food aversions. Contributing factors include changing hormones and psyche during pregnancy. The loss of appetite may also be related to nausea and vomiting in pregnancy. This usually occurs in the first trimester of pregnancy, generally settling down later into the pregnancy.

Do’s

• Eat smaller, more frequent meals, and eat foods that you enjoy!
• Substitute foods that you do not have appetite for with other alternatives
• You could disguise green vegetables by having them together with fruity smoothies!
• Be creative with the ways you modify your diet to suit your changing taste buds!

Don’t’s

• Avoid eating 3 large meals every day

When to seek medical attention

If you have severe nausea and vomiting and are unable to take in fluids or food at all, or if you feel symptoms of dizziness, weakness and increasing lethargy, please see your Doctor!

A common symptom is feeling tired or run down. Hormonal changes in your body at this time can make you feel tired, sick, emotional and upset.

Management

Take frequent naps and rest when you can. Cut back on your work or daily activities, but engage in regular moderate activity, such as walking. Eat regular meals to keep energy levels even.

Exercise only when you feel well enough to do so. Remember to drink enough fluids and exercise in a cool environment.

You may have difficulty sleeping due to discomfort, sweating, leg cramps, the baby kicking, or the need to urinate.

Management

Try to unwind before going to bed with a warm bath, relaxing music, stress-relieving exercises and comfortable clothing.

Your breasts may become fuller and feel tender, just as they might do before your period. They may also tingle. The veins may be more visible, and the nipples may darken and stand out.

Management

Wear a supportive bra. They may be more comfortable than bras you currently wear.

When to seek medical attention

If you notice a lump in your breast, you should consider seeing a Doctor for review.

Headaches are common symptoms due to increased blood circulation caused by hormonal changes.

Management

Paracetamol is safe in pregnancy and may be used.

When to seek medical attention

If your headache does not resolve with paracetamol, or if it is associated with fever, neck stiffness, visual changes, or high blood pressure, please visit your Doctor immediately.

You may experience dizziness in the first 20 weeks of pregnancy as your blood pressure falls initially. Thus, if you stand for a long time or get up quickly from sitting or lying down, you may feel giddy.

Do's

• Getting up slowly from sitting or lying down is recommended.
• It is best to lie on one side with your belly supported on a small pillow.

Don't's

• Avoid standing for a long time.
• Do not go hungry.
• Do not lie flat on your back after about mid-pregnancy.

When to seek medical attention

Seek medical attention if your symptoms are accompanied by shortness of breath or palpitations.

Contractions will occur starting in the second trimester (Braxton Hicks contractions), but regular painful contractions that increase in frequency and intensity are not normal, especially when you are preterm (< 37 weeks). This may be a sign of labour.

Management

Take note of the duration and frequency of contractions.

When to seek medical attention

Do see your Doctor if you have regular pain contractions that increase in frequency and intensity.

Bleeding is never normal in pregnancy. If it happens in the first trimester, it may be a sign of miscarriage. After the second trimester, it may be a sign of labour, or placenta abnormalities.

Management

• Take note of the amount and frequency of bleeding.

When to seek medical attention

See a Doctor immediately if you have vaginal bleeding.

If you experience a gush of fluid, especially if it is persistent, you may likely have a broken waterbag or amniotic sac, also known as leaking liqour. If you are preterm (< 37 weeks), this is not normal and you need to see a Doctor immediately. If you are term (> 37 weeks), this may be a sign of labour.

Management

Take note of the amount and frequency of leaking liquor.

When to seek medical attention

See a Doctor immediately if you have leaking liquor.

You will start to experience your baby’s movements in the second trimester onwards. From the third trimester, you can start to count baby movements.

Generally, your baby should move every hour, or about 10 times a day.

Management

If you do not feel your baby moving for a while, do lie on your side in a quiet room and pay attention to baby movements.

When to seek medical attention

If you still do not feel any movements in the next 1 hour, do see a Doctor immediately.

Heartburn can feel like a burning feeling in your chest or throat. It is caused by the slowing down of your gastrointestinal tract and the relaxation of the muscles at the opening of the stomach, resulting in the reflux of the acidic gastric juices.

Do's

• Eat small, frequent snacks rather than several large meals.
• Elevate your head with propped up pillows when you go to bed.
• Antacids are safe in pregnancy so you can try it for symptomatic relief.

Don't's

• Avoid fried, spicy, or acidic foods and drinks.
• Avoid lying down after eating.

Constipation means having trouble with bowel movements. It is very common to become constipated while you are pregnant as food cannot move through your intestines as quickly as before. This is aggravated by your womb putting pressure on your bowels.

Do’s

• Eat plenty of high fibre foods such as whole grains, fruits and vegetables.
• Make sure you drink plenty of fluids to stay hydrated.
• Get regular exercise.

Don't’s

• Avoid straining when you pass motion.

Haemorrhoids (piles) are swollen veins in the anus and/or rectum. They are more common in pregnancy, and you may experience pain or bleeding from the rectum. Good news is they tend to disappear after delivery.

Do's

Stool softeners such as lactulose are safe for use in pregnancy.p>

When to seek medical attention

Do see your Doctor if you have persistent pain or bleeding from the rectum.

Loose or watery stools have the same causes in pregnancy as when you are not pregnant. It is most commonly caused by infection of the gut by germs, or irritation of the gut by spicy foods and medication. In most cases, diarrhoea will improve and go away within a few days.

Do's

• Drink lots of fluids to stay hydrated, about an additional 200mls (about a glass) after each bout of diarrhoea on top of what you normally drink
• Eat as soon as you are able
• Try eating plain foods such as rice and wholemeal bread first
• Charcoal tablets are safe in pregnancy

Don't's

• Avoid sugary drinks
• Avoid fatty, spicy or heavy food for the time being until the diarrhoea settles

When to seek medical attention

See your doctor if you suspect that you are becoming lacking in fluid, if your symptoms do not settle after 3-4 days, or if you are passing blood.

As the baby grows and compresses your diaphragm, you have less room to breathe. As you progress further into your third trimester, you may occasionally feel breathless.

Management

Try switching up positions, such as sitting upright or sleeping on propped up pillows or lying on your side to allow more space for your chest to expand while breathing. Breathing exercises with slow, relaxed and deep inhalation and exhalation can also sometimes help.

When to seek medical attention

If you feel persistent breathlessness and other symptoms such as chest pain, palpitations, or dizziness, do see your Doctor immediately.

Pregnancy hot flushes result from changing hormone levels in pregnancy. They cause an increase in blood flow to your skin, making you feel flushed and warm. Your skin can look red and blotchy as well from the heat. Hot flushes are especially common at night, and are likely to peak at around 30 weeks.

Management

Wear looser pieces of clothing, or keep your surroundings cool with a fan or aircon. You can also try taking a shower with lukewarm water, and keep hydrated with cooler drinks! Some studies have shown that yoga and working up a sweat can help to ease hot flushes. You may want to try that out!

Pregnancy hormones relax the connective tissue that holds your bones in place, especially in the pelvic area. These changes can be tough on your back, and often result in discomfort during the third trimester.

Do's

• When bending, keep your back straight and bend your knees.
• Try to develop good posture.
• Try back exercises for pregnant women.
• Supportive garments that support your back and abdomen may also be helpful.
• Paracetamol is safe in pregnancy and can give you some pain relief.
• Reduce your exercise intensity in pregnancy if you experience these symptoms.

Don't's

• Do not stay in the same position for too long—move around.
• Avoid heavy lifting.
• Do not wear heels.

When to seek medical attention

Do see your Doctor immediately if the pain is persistent despite paracetamol.

In pregnancy, there is additional mechanical stress on your joints due to weight from your growing baby and changes to your centre of gravity. This may cause pain in various joints.

Management

Stay active, continue gentle stretching and strengthening. Paracetamol is safe in pregnancy and can give you some pain relief.

When to seek medical attention

See your doctor if the pain is persistent despite paracetamol.

This is common as your body retains more fluids and your growing womb adds pressure to your legs — causing them to swell. It is worst at the end of the day especially in the third trimester.

Do’s

• Elevate your legs when possible.
• Wearing graduated compression stocking and comfortable shoes can help with leg swelling.

Don't’s

• Avoid prolonged standing.

When to seek medical attention

Seek medical attention immediately if you have high blood pressure, painful swelling of one leg, or palpitations and breathlessness.

The cause of leg cramps is not known for certain. Some believe cramps are caused by a calcium deficiency, and that calcium tablets may help. Others believe the cramps are caused by decreased circulation of blood.

Do’s

• Gentle stretching or massaging of the muscles may help relieve these symptoms

Don't’s

• Avoid sitting, standing or maintaining a fixed posture for long periods of time.

Itchy rash on the abdomen, hands and legs is quite common in pregnancy.

Management

Use moisturising shower gels, and moisturisers after, to ensure that your skin remains hydrated and not dry.

When to seek medical attention

Do see your Doctor immediately if you have itch without a rash, or a persistent rash despite the use of moisturizers.

As the enlarging uterus puts pressure on your bladder, you may need to urinate more frequently.

Management

Try to reduce your fluid intake before going to bed. Also, avoid drinks with caffeine, which can increase the frequency of urination.

When to seek medical attention

If you have pain during urination or have a fever, do see your Doctor.

The fluid your body retains in pregnancy places increased pressure on the nerve in the wrist. Common symptoms can include numbness, and pins and needles in the fingers.

Management

The following measures may help:

• Use a wrist splint, if pain is present or worse at night.
• Avoid sleeping on your hands.
• Elevate your hands.
• Keep active.
• Check work ergonomics, avoid prolonged periods in the same position.
• Wrist extension stretch – stretch your wrist backwards and press the fingers and palm towards you with your other hand.

Symptoms typically resolve after pregnancy.