Pregnancy Symptoms and Management - Pregnancy

<html><head></head><body><h2>Sleep and irritability</h2>
Getting a good night’s sleep while you’re pregnant is easier said than done. Your newly enlarged shape makes it difficult to get comfortable, and your mind is usually racing with questions and worries about your impending labor. Of course, everyone tells you to sleep now before your little bundle of joy arrives to keep you up all night, but sometimes you just can’t relax. As in life before pregnancy, a lack of sleep can make us feel more irritable and more bummed out than usual. A recent study shows that the same holds true for women who are pregnant, and maybe even more so. The study was designed to explore proper treatments for women who were well into their pregnancy. There are some drawbacks to taking anti-depressants while pregnant if you’ve never taken them before, so alternative treatments are necessary. Interestingly enough, the study’s results showed that the best treatment for depression during pregnancy was not really a depression remedy at all. Instead, they showed that women who were depressed in the second or third trimester were usually those who were extra tired from lack of sleep.
<h2>Fatigue or depression?</h2>
The irritability and fatigue from exhaustion were usually confused with depressive symptoms. Therefore, the best way to treat these women for their perceived depression was to assist them in getting a proper night’s sleep. In other words, your depression towards the end of your pregnancy might not actually be depression at all. You could simply be fatigued and run down from a lack of rest, and the remedy is as simple as getting enough rest. Of course, getting enough rest is not always that simple, but it is far less complicated than treating actual depression with medication and anti-depressants. If you really do feel that you are depressed during your pregnancy, make sure you speak with your healthcare provider right away. If it’s not just a result of your fatigue, it should be handled as early as possible to improve your quality of life and your baby’s health. If you think sleep might be the cause, try new ways to sleep through the night. Exercising during the day, eliminating all caffeine from your diet, and eating well-balanced meals could all help you sleep better at night. If you’re still having trouble, make sure you speak with your healthcare provider about remedies to cure insomnia that are safe to take during your pregnancy. Source: SY Tsai et al: Daily Sleep And Fatigue Characteristics In Nulliparous Women During The Third Trimester Of Pregnancy. College of Medicine Department of Nursing Volume 35 Issue 2 pp. 257-262 February 2012</body></html>

Getting a good night’s sleep while you’re pregnant is easier said than done. Your newly enlarged shape makes it difficult to get comfortable, and your mind is usually racing with questions and worries about your impending labor. 

Your Depression During Pregnancy Could Actually Be Fatigue

Suffering from a brief bout of mild depression is common for women who have just given birth. Some women will fight through the depression and come out within a few weeks feeling better than ever before. Other women will suffer from baby blues symptoms that lead to a deeper more clinical-style depression. Suffering from a brief bout of mild depression is common for women who have just given birth. Some women will fight through the depression and come out within a few weeks feeling better than ever before. Other women will suffer from baby blues symptoms that lead to a deeper more clinical-style depression. There is nothing wrong with going to your obstetrician to talk about your personal baby blues. Obstetricians understanding the hormonal effects and pressures of having a new baby and often work with psychologists and psychiatrists to help her feel better quickly. Baby Blues: Mild Depression <a title="Postpartum depression baby blues" href="/postpartum/the-baby-blues-or-postpartum-depression">Baby blues </a>are characterized by mild mood changes and a general feeling of worthlessness. Sleep deprivation, thanks to those two hour time windows between feedings, can make depression symptoms feel even worse. Pressure, both real and self-imposed, about raising a new baby, returning to work, and making ends meet financially are all contributing factors to baby blues symptoms. Postpartum Depression <a title="Baby blues postpartum depression" href="/postpartum/the-baby-blues-or-postpartum-depression">Postpartum depression is different from baby blues.</a> When a woman suffers from postpartum depression, her feelings of depression may be deeper and more noticeable. Lack of appetite, inability to sleep, sleeping all the time, ignoring motherly duties, refusing to care for the baby and immense sadness are all symptoms of postpartum depression. The only thing difference between clinical depression and postpartum depression is the act of having a baby.
<a title="edinburgh-postpartum-depression-quiz" href="/edinburgh-postpartum-depression-quiz">Check the Edinburgh Postpartum Depression Quiz</a> What Can Family Do? Family members can watch the woman who just gave birth closely, but treatment may be needed before she feels any better. Every year, hundreds of thousands of women seek out treatment for some form of depression after giving birth. Being depressed does not make you a bad mom, woman, wife or person. Family members can talk to the woman about her feelings to try and gauge how depressed and worthless she is feeling; it is important not to forcefully push or insist that she seek out mental care.

Baby Blues Symptoms and Postpartum Depression

<html><head></head><body><h2>Fetal kick count and movements</h2>
Most women feel the baby's first movements after 18-20 weeks of the pregnancy. A baby or fetal kick count is among the most important observations to ensure the baby's health. It is among the most important observations to ensure the baby's health.
Check out our <a href="https://babymed.com/tools/baby-kick-count" target="_blank">interactive baby kick count tool!</a>
An active baby is usually a healthy baby and you usually feel your baby stretch, kick, roll and turn every day. Some babies are more active than others. All babies have periods of sleep during which they are not as active. You will get to know your baby’s pattern of movements and when your baby is most active.
<h2>Is a fetal kick count effective in reducing adverse outcomes?</h2>
In some studies, decreased fetal movement has been associated with poor pregnancy outcomes including <a title="stillbirth" href="http://www.babymed.com/after-stillbirth-take-your-time">stillbirth</a>, and about 50% of women with a stillbirth reported that they felt a gradual decrease of fetal movements before intrauterine death. This is why many women and doctors use a fetal movement count to assess the baby's well-being.
Recently, however, some studies have questioned whether decreased fetal movement can prevent poor perinatal outcome such as stillbirths.&nbsp;In a recent 2018 study in <a style="font-size: 0.9em;" href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31543-5/fulltext" target="_blank">The Lancet</a>&nbsp;the authors did not find a decrease in stillbirths with decreased fetal movements.
Maternal perception of decreased fetal movement has been reported in 15% of pregnancies during the third trimester and around 50% of women notice a gradual reduction of fetal movement days before intrauterine death.&nbsp;<a id="WhenFeelBabyKick" name="WhenFeelBabyKick"></a>
<h2>When will I feel my baby kick? </h2>
Most women will feel the baby's movements after 18-20 weeks of the pregnancy. You should feel movements throughout the day, each day from 24 weeks of the pregnancy until the baby is born. The fetal kick count is done usually after 24 weeks of the pregnancy to monitor the fetal health.

<h2>How to do a kick count</h2>
There are many different ways to do a kick count. Here is the "count-to-ten" method to do the Kick Count (<a title="Graph Fetal Kick Count" href="https://babymed.com/pregnancy/fetal-kick-count-movements">Download the graph here</a>):
<ul>
<li>Count fetal movements once a day, preferably at the same time every day and within 1 to 2 hours after a meal. Early evening after dinner is a good time because the fetus is usually more active then.</li>
<li>Get a sheet of paper and pen to indicate the movements.</li>
<li>Have a clock or watch nearby to observe the time passed.</li>
<li>Lie on your side while counting, preferably on your left side.</li>
<li>Mark down the start time.</li>
<li>Count any movement you feel - a roll, a kick, or a "swish" - except for the smallest flutters.</li>
<li>Count until you have felt ten fetal movements.</li>
<li>Ideally, you want to feel at least 10 movements within 2 hours.&nbsp;Most likely you will feel 10 movements in much less time</li>
<li>Mark down the finish time, and the total amount of time it took to count the ten movements.</li>
</ul>
Talk to your doctor or midwife about what you should do if there's a problem with your baby's movements. Many providers ask their patients to contact them or go to the labor and delivery unit if:
<ul>
<li>You don't feel your baby move all day.</li>
<li>It takes progressively longer from one day to the next to count four movements.</li>
<li>It takes more than an hour to count four movements.</li>
</ul>
You might want to start a notebook of your own or use a fetal kick chart to record the time you start, place a checkmark for the time of the 10th movement. This will help you observe patterns and discover how long it normally takes for your baby to move 10 times. Keep in mind that you are looking for significant deviations from the pattern.
<h2>What is the best time and position to do the kick count?</h2>
Try to schedule the kick count during your baby's most active time of day, but also when you will be able to record movements over three or four hours. You will need to record movements starting from about the same time each day.
You may want to have a meal or snack before starting as you probably have noticed, food often makes your baby active. Alternatively, try a few minutes of exercise or take a brisk walk. Some moms prefer sitting with a good backrest with their arms holding their belly. Other moms prefer lying on their left side, which they find most effective for monitoring their baby. Lying on your left side also allows for the best circulation which could lead to a more active baby. Be sure you have a clock in view, and note on the kick count chart what time you start to record movements.<a id="WhenCallPhysicianMidwife" name="WhenCallPhysicianMidwife"></a>

<h2>When should I call my physician or midwife?</h2>
Your doctor may ask you to count your baby’s movements once every day. Count your baby’s movements to be sure that you feel at least 10 (in Canada some say 6) movements in 2 hours. If you think there is a decrease in your baby’s movements this is an important sign that your baby may not be well.
If you haven't concentrated on counting the baby movements then it's possible you may have missed them. Focus on the baby movements and count your baby's movements, lie on your left side with support under your bump. Stay still for a couple of hours, during which time you should feel at least 10 separate movements.
You're more likely to be aware of your baby's movements when you're lying down rather than sitting, and you'll probably be least aware of them when you're standing.
Here are some quick ways to encourage your baby to move:
If your baby starts to move around, all is probably well. But keep an eye on his movements from now on, and seek help sooner rather than later if you have any concerns.
<ul>
<li>If you have followed the above recommendations and have not felt 10 kicks by the end of the second hour, wait a few hours and try again. If after trying a second time, you do not feel 10 movements within 2 hours you should contact your healthcare provider.</li>
<li>If you notice a significant deviation from the pattern over the course of 3 to 4 days.</li>
<li>Put your feet up, have a snack, and relax. Your baby may be rocked to sleep while you're moving around, in which case he may wake up when you stop and have something to eat.</li>
<li>Have a really cold drink. Your baby may feel the change in temperature and try to move away from it. A sugary cold drink may also give him a sugar boost to encourage movement. Make some noise. </li>
<li>Play loud music or slam a door to see if he responds.</li>
</ul>
<h2>How to manage reduced fetal movements?</h2>
There are several recommendations how to address decreased fetal movements after 28 weeks of the pregnancy. In addition to check for risk factors of stillbirth additional recommendations include:
<ul>
<li>Delivery if 39 weeks or more pregnant</li>
<li>Nonstress testing</li>
<li>Check a blood test for fetal-maternal hemorrhage (<a href="https://babymed.com/kleihauer-betke-test">Kleihauer-Betke test</a>)</li>
<li>Sonogram to make sure the fetus is not too small</li>
</ul>
<h2>Literature on reduced fetal movements and outcomes</h2>
A recent study in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31543-5/fulltext#seccestitle80" target="_blank">The Lancet </a>showed no reduction of stillbirth when women reported reduced fetal movements. However, the study did not mention how they defined "reduced fetal movements" making it difficult to interpret the findings. An <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31720-3/fulltext" target="_blank">editorial</a> claimed that encouraging&nbsp; awareness of reduced fetal movements may be harmful.&nbsp;“note that the advice to pregnant women in the study ‘was that they should monitor changes in movements from 24 weeks and that they should refer themselves immediately if they detected altered movement after 28 weeks.’” The editorialists observed, “With hindsight, the recommendation to encourage mothers to report changes from as early as 28 weeks might have been misguided.” They added, “Although overall deaths were not stratified by duration of gestation, it is plausible that limiting awareness campaigns to beyond 37 weeks would be safer.”

Yaffe H Daily fetal movement recording and fetal prognosis. Obstet Gynecol. 1973; 41: 845-850
Heazell AEP Budd J Li M et al. Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study. BMJ Open. 2018; 8: e020031&nbsp;
Stacey T Thompson JM Mitchell EA Ekeroma A Zuccollo J McCowan LM Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth study. Birth. 2011; 38: 311-316
Sovio U White IR Dacey A Pasupathy D Smith GCS Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet. 2015; 386: 2089-2097
Thornton JG Hornbuckle J Vail A Spiegelhalter DJ Levene M Infant wellbeing at 2 years of age in the Growth Restriction intervention Trial (GRIT): multicentred randomised controlled trial. Lancet. 2004; 364: 513-520
Mangesi L Hofmeyr GJ Smith V Smyth RM Fetal movement counting for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2015; 10 (CD004909.)
Grant A Valentin L Elbourne D Alexander S Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons. Lancet. 1989; 2: 345-349
NHS England Saving Babies' Lives: a care bundle for reducing stillbirth. https://www.england.nhs.uk/wp-content/uploads/2016/03/saving-babies-lives-car-bundl.pdf
Tveit JV Saastad E Stray-Pedersen B et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines—a clinical quality improvement. BMC Pregnancy Childbirth. 2009; 9: 32
Norman JE Marlow N Messow CM et al. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet. 2016; 387: 2106-2116
Walker KF Bugg GJ Macpherson M et al. Randomized trial of labor induction in women 35 years of age or older. N Engl J Med. 2016; 374: 813-822
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Most women feel the baby's or fetus' first movements after 18-20 weeks of the pregnancy. A baby or fetal kick count is among the most important observations to ensure the baby's health. 

Counting Fetal Movements: The Baby Kick Count

During pregnancy, the ligaments located on the left and right side of the abdomen may create some abdominal discomfort from time to time. It is not uncommon to feel sharp pains on the sides of the tummy as well as with the growth of the fetus.
<h2>Causes of round ligament pain</h2>
Ligaments are located on the sides of the abdomen. These run from the top of the tummy to the groin area. As the baby grows, the tummy gets larger and larger and the thick bands of connective tissue must stretch in order to accommodate the new size. As the ligaments stretch, some aches and pains are often felt by pregnant women. Increased blood flow to the area may also cause some pain which is also common.

<h2>Important facts about abdominal achiness</h2>
Sudden changes in body position are enough to trigger round ligament pain. Getting up quickly, lying down or even a sharp cough can cause new stretching of the ligaments that can be painful. These pains often last only a few brief moments, but it is not uncommon for the soreness to linger for a few hours. If the pains are associated with spotting, cramping, change in body temperature, or fever, it is important to seek out medical attention regarding the pain.
<h2>Treatment for round ligament pain</h2>
Abdominal achiness is something that comes along with pregnancy, but that does not mean mom has to sit around in pain for the duration. Sitting down with feet propped up is one of the best solutions. If resting does not relieve the pain or the achiness turns into a sharper pain, contact your attending physician for more advice.

During pregnancy, the ligaments located on the left and right side of the abdomen may feel achy from time to time.

Abdominal Discomfort During Pregnancy

<h2>What is roseola?</h2>
Roseola is a disease in young children, usually up to 4 years of age. It is characterized by high temperatures (103-105 degrees F) that last 3-5 days which usually resolves on its own. This is then followed by the appearance of a rash that lasts a few hours to a few days, mostly on the upper arms, legs, and face. The rash is usually most prominent on the neck and trunk and consists of many small red 2-5mm spots that blanch when pressed. The agent responsible for Roseola is a virus called HHV-6 or human herpes virus 6. 
<h2>Who gets roseola?</h2>
Most young children get infected with roseola, but they are not diagnosed with it because they only have a fever and usually no rash. Once you are infected, you are immune for the rest of your life and you cannot get it again. 
<h2 class="MsoNormal" style="margin: 0in 0in 0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto;">How is it spread?</h2>
The Roseola virus is usually spread by tiny droplets of fluid from the nose and throat of an infected child, and it could be could picked up from another child's hands or tissues, or drinking glass, or just by being in the same room. Make sure all family members — especially those taking care of the baby — wash their hands frequently. (This is a good idea whenever your child has a fever because you won't know that you're dealing with roseola until you see the classic rash).
<h2 class="MsoNormal" style="margin: 0in 0in 0pt;">Is it harmful in pregnancy?</h2>
Pregnant women get exposed to the virus all the time. By the time they are pregnant most women carry the antibody which means they had the disease already, so they are immune and cannot get it again.
There are only very few reported cases where Roseola has affected the fetus, so the risk to the fetus after exposure is generally considered very low, especially when the vast majority of women are immune.

Most young children get infected with roseola, but they are not diagnosed with it because they only have a fever and usually no rash. Once you are infected, you are immune for the rest of your life.

Is Roseola Harmful During Pregnancy?

<html><head></head><body>Most women experience breast tenderness at some point in their lives. Breasts may feel achy, have shooting pains, or simply feel full and heavy. By the time we get pregnant, most of us have already experienced the discomfort that breast tenderness brings. Sore breasts typically occur due to hormonal fluctuations. Pregnancy, puberty, and menopause are times when normal fluctuations are high.
<h2>What causes breast tenderness?</h2>
<ol>
<li>Ovulation:&nbsp;It is normal for a woman to experience breast tenderness after ovulation, and most of the time&nbsp;breast tenderness after ovulation is&nbsp;due to hormonal changes. During this time, an increase in the hormone progesterone,&nbsp;which is produced by the corpus luteum (the area in the ovary where the egg originated) can cause achy or sore breasts.</li>
<li>Pregnancy:&nbsp;Breast soreness due to pregnancy rarely, if ever, occurs before missing a period. It&nbsp;is often one of the first symptoms of pregnancy.&nbsp;If you missed your period and you have breast tenderness, it makes sense to do a pregnancy test.</li>
<li>Other reasons For breast tenderness: —Menstruation: your period also causes hormonal surges —Puberty, in both girls and boys —Breastfeeding —Approach of <a title="menopause" href="https://babymed.com/menopause">menopause</a> (once your menstrual periods have stopped completely, breast tenderness often goes away unless you are taking hormone replacement therapy)</li>
</ol>
No matter the cause, caffeine is thought to increase this sometimes painful sensation, so being mindful of your caffeine intake may help alleviate the discomfort. If you have a hard time weaning away from coffee completely try opting for a good decaf or herbal tea instead.
If your discomfort becomes more pronounced, you may want to think about taking acetaminophen or ibuprofen if the tenderness is caused by PMS, your period, or menopause. However, if you think you may be pregnant, speak with your doctor first before taking any medication.
<h2>When should you call your doctor?</h2>
<ul>
<li>If you've given birth within the last week and your breasts are swollen or hard</li>
<li>If you've noticed a new lump associated with the pain that does not go away after your menstrual period</li>
<li>Have persistent, unexplained breast pain</li>
<li>Discharge from your nipples, especially blood or pus</li>
<li>Any signs of a breast infection, including localized redness, pus, or fever</li>
</ul>
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Most women experience breast tenderness from time to time. Breasts may feel achy, have shooting pains, or simply feel full and heavy. Sore breasts typically occur due to hormonal fluctuations.

Is Breast Tenderness a Pregnancy Sign?

Being nauseous is usually an early sign of pregnancy. However, nausea as a sign and symptom of pregnancy rarely appears before you miss your period and before you have a positive pregnancy test.
&nbsp;
If you are nauseous before you miss your period then you could be pregnant because nausea is among the <a href="/early-pregnancy-symptoms-signs">typical pregnancy symptoms</a>. Nausea usually occurs because of an increase in the pregnancy hormone hCG, human chorionic gonadotropin. However, by the time your nausea appears as a sign of pregnancy you would expect to have a positive pregnancy test.
Only a positive&nbsp;pregnancy test will tell you whether you are pregnant or not. As you might already know, nausea is one sign of pregnancy but it's not among the earliest signs. The <a title="earliest signs of pregnancy" href="http://www.babymed.com/pregnancy-symptoms/what-earliest-i-can-feel-pregnancy-signs-and-what-are-typical-pregnancy-signs">earliest signs of pregnancy</a> are a missed period and a positive pregnancy test. Nausea as a typical pregnancy symptom rarely, if ever, happens until&nbsp;after you miss your period, 2-4 weeks after ovulation and fertilization.&nbsp;

Being nauseous is usually an early sign of pregnancy. However, nausea as&#13;
 a sign and symptom of pregnancy rarely appears before you miss your&#13;
 period and before you have a positive pregnancy test.

Is Nausea Associated With an Early Pregnancy?

Swelling or edema is one of the most common symptoms (and complaints) during pregnancy. The female body stores extra fluid to ensure that both you and your baby stay healthy. Unfortunately, some of that fluid will gather on the surface and cause mild swelling also known as edema, especially in the feet and ankles.
<h2>Causes of Edema</h2>
Swelling in the feet and ankles can be attributed to an accumulation of extra fluid which is naturally pulled toward the earth by the same force that allows humans to walk without flying into space. The extra fluid is there, however, for a food reason as both you and your baby need extra fluid to maintain good health.
<h2>Important Facts About Edema</h2>
While mild swelling is reported in 75% of pregnancy cases, severe swelling can mean something different. Excessive storage of fluid in the body during pregnancy could be a sign of preeclampsia and should be reported to the attending obstetrician immediately. Edema is measured by pressing a finger into the swollen area of the body. The amount of time it takes the indentation to fill in measures the severity of edema. If it takes longer than a few seconds to fill in, call the doctor just in case.
<h2>Treatment for Edema</h2>
Most often, standing or walking for too long will make edema worse. For every hour spent on the feet, 15 minutes of rest with the legs propped up above the heart will help to lessen the effect of swelling on the lower body. Drinking more water and decreasing salt intake can also help. Support pantyhose that do not restrict circulation can also help keep water from collecting.

Swollen legs, ankles, and feet during pregnancy and the postpartum/postbirth period can be normal or a sign of more serious problems such as a blood clot in your leg.