The early weeks of pregnancy are fragile—and confusing. Here, the answers to your questions.
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Kim Six weeks into her pregnancy, Kim Schuler thought all was lost. After learning she was pregnant with her second child, Schuler, now 41 and a mother of three in Allentown, Pa., started bleeding and cramping. “My husband and I were sure we were losing the baby,” she says, “but soon the doctor found a heartbeat.” A trouble-free seven months later, Schuler gave birth to a healthy girl, Meredith.
Though Schuler’s case was unusually alarming, few women pass through pregnancy without an anxious moment along the way. Fortunately, most go on to have normal pregnancies and healthy babies. While women with special health conditions or a history of premature labor, or those who are carrying multiples need to pay heed when anything unusual occurs, most women can relax and let nature take its course.
We’re here to help you do just that. Following are the most common concerns among pregnant women, with information about why you probably don’t need to worry—and when you should. Keep in mind that these are only guidelines; call your doctor if you have questions or concerns specific to your pregnancy.
Nausea Though morning sickness (which can last all day) feels bad, it’s not bad for the baby, says Richard Frieder, M.D., an OB-GYN at Santa Monica-UCLA Medical Center in Santa Monica, Calif., and clinical professor at the UCLA School of Medicine. To help alleviate nausea, try eating several small meals a day, rather than three larger ones; also try nibbling on some soda crackers before getting out of bed. Some women say that foods and drinks containing ginger or lemon help to settle a queasy stomach, as do seasickness bands. And if all else fails, keep in mind that morning sickness usually abates by about the 12th week. When to call the doctor: Nausea is a concern when severe vomiting causes dehydration. Infrequent urination, as well as urine that’s dark and strong-smelling, are key signs. If you notice either of these, call your doctor; she may want to put you on an IV to ensure adequate hydration. Also call your doctor if you can’t keep food down or are losing more than 1 pound a week.
Bleeding For many women, bleeding is perhaps the scariest symptom they might experience because they associate it with miscarriage. But bleeding during pregnancy, especially in the first trimester, is more common than many realize: About 25 percent of women experience some type of bleeding in the first 13 or so weeks; of those, more than half go on to have perfectly healthy babies.
Though bleeding—especially when accompanied by cramping—can be one sign of miscarriage (see “The Facts About Miscarriage” below), it often has other causes. The most common is in association with implantation of the egg in the lining of the uterus, says Daniel Landers, M.D., vice chairman and director of maternal-fetal medicine at the University of Minnesota, Twin Cities. Benign cervical polyps, which are fairly common whether you’re pregnant or not, may also be to blame. Another potential cause is cervical bleeding, which can occur after intercourse in women with tender cervices. Finally, bleeding can occur when the mucous plug is lost in early labor. When to call the doctor: Regardless of the possible cause, any bleeding—no matter when it happens—should be reported to your doctor right away.
Cramping Many women feel something akin to menstrual cramps in the early stages of pregnancy. That achy heaviness in the pelvic area is caused by increased blood flow to the uterus and pelvic organs and is a normal part of early pregnancy. When to call the doctor: If you notice consistent cramping on only one side, tell your doctor so she can rule out an ectopic pregnancy or ovarian cyst. Also report cramping if it’s accompanied by bleeding. Serious cramping in the second or third trimester is more worrisome, as it could indicate early labor, so report that right away as well.
Contractions Many women experience random contractions, often called Braxton-Hicks contractions, after 24 weeks. These are normal as long as they are irregular and sporadic (as opposed to real labor contractions, which occur at regular intervals and increase in frequency and intensity). “Although no one knows for sure what purpose these contractions serve,” Landers says, “the important difference between Braxton-Hicks contractions and the contractions of real labor is regularity.” When to call the doctor: If contractions seem regular (time them to be sure), call your doctor. She’ll want to make sure you’re not in real labor.
Reduced Movement Women usually start to feel their babies move sometime between weeks 18 and 24. After that first kick, the movements gradually become stronger and more frequent; it can be scary if they suddenly seem to cease. Less movement can be a simple matter of a woman being so busy that she doesn’t notice her baby moving, Frieder says, or of the baby sleeping or being in a quiet state. When to call the doctor: If you haven’t felt your baby kick by the 20th week, call your doctor. Chances are the baby has been moving but you simply haven’t felt it; your doctor will determine whether she wants to follow up. As far as reduced movement goes, if you haven’t felt your baby move all day, have some juice or crackers, then sit or lie down with your hands on your belly, Landers says. If an hour or two go by and you still haven’t felt any action, call your doctor. Chances are there’s nothing wrong, but she might have you come in for a little monitored reassurance.
Discharge Unusual and excessive discharge is a part of pregnancy. Your cervix is undergoing many changes, which create normal mucous discharge, Landers says. When to call the doctor: If discharge is accompanied by burning, itching or a foul smell, see your doctor. You could have an infection.
Wetness When a pregnant woman sees wet sheets, she thinks, My water has broken! But more likely, that little wetness on your sheets or underpants is only urine. Because pregnancy can put pressure on the bladder, many women leak urine without realizing it. When to call the doctor: If the wetting persists or seems like a lot, call your doctor. She’ll want to be sure you’re not leaking amniotic fluid, which is a concern before the 37th week because such leakage could trigger labor or lead to infection.
Swelling Pregnant women retain excess fluid because of the extra water-retaining hormones in the body. In addition, a woman’s blood volume increases by 30 to 50 percent in preparation for labor and delivery. Unfortunately, there’s not much you can do about the puffiness. “It has nothing to do with how much or how little water or salt you ingest,” Frieder says.
If you’re swollen, keeping your legs up will help; so will swimming. Even sitting in a pool up to your chin will help redistribute the water in your body. When to call the doctor: Sudden swelling accompanied by a headache may be a sign of preeclampsia, a dangerous condition of pregnancy. Call your doctor if you experience this after your 28th week.
Despite the myriad concerns that attend pregnancy, it’s important to remember that the vast majority of babies come out just fine. Besides her bleeding scare, Schuler admits she had other worries during her three pregnancies, including chronic vomiting with one and lack of movement with two. “Now that I’ve had three perfectly healthy babies,” she says, “I look back and realize I could have worried a lot less.”