Department of Family and Community Medicine and St. Michael’s Academic Family Health Team
Services: Pre-natal care - What to expect
What many of us feel
When you’re pregnant, you feel different from your usual self. This is likely to get more intense as the pregnancy grows. Pregnancy can feel beautiful and awful; it’s important to know that you are not alone. Some (or all) of the following may be what you are going through.
First trimester: you might be sleeping more (and better), but this is not all. You are likely to have less energy during the day and not be able to do all the things you could previously. Don’t worry ... this is temporary but it is your body helping you relax. Simplify your life and don’t ‘burn the candle at both ends’. This is a time to take it easy, shrink your ‘to do’ list and focus on you and the baby.
Second trimester: As the uterus grows, so does the amount of blood in your body (which the baby uses to grow). Your heart is hard at work in moving this fluid. The growing uterus begins to push up on the diaphragm (which is what helps you to take a breath). Finally, your growing body weighs more and more each week (a normal part of second and third trimesters). All of this might make you more tired and less able to move around quickly, lift things and exercise. You may find yourself feeling more ‘faint’ or exhausted after what used to be a normal day. Take it easy and listen to your body. Pregnancy is not a time to push yourself beyond the limits. If you have fainting spells or you feel the fatigue is worrying you, you should talk about this with your doctor or nurse practitioner.
At first, the third trimester feels very similar to the second. But, as your baby grows, there is increasing pressure and discomfort for the pregnant mom. This may seem a negative aspect of pregnancy, but it is necessary. This discomfort makes most mothers ready to experience the delivery by the time they begin to labour. In fact, the fear of the labour goes down (sometimes even goes away) because you cannot wait to feel comfortable again. This lets you participate more fully during your delivery and be as free from fear as possible. Keeping calm during the third trimester and during labour is very important. Your health care provider is here to answer any questions. Always get medical attention if you are worried about your or the baby’s health.
From very early on you may notice that your belly feels and looks bigger, even though the little one is only a few centimetres long. Most women feel at least some nausea and many even have vomiting. You can help this by avoiding a completely empty or a very full stomach; by eating small light meals throughout the day. If you feel as though you cannot keep meals down, your nurse practitioner or doctor can help with medications. The important thing is to keep hydrated (drink small volumes often while awake and keep yourself urinating at least three to four times daily). Nausea tends to get better in the second and third trimesters. If this is still an issue for you, especially if you are still vomiting and having trouble gaining weight, please speak to your provider. You may need extra help to keep you and your baby healthy.
Your bowel movements will likely also change. Most will tend towards constipation but some will experience looser movements. Keep your diet high in fibre (25g of fibre or more per day) in order to keep regular. Whole grains, lentils, bran and apples are all examples of foods with high fibre. Drinking lots of fluid and exercising also helps. When this is not enough, softeners and fibre such as Prodiem, Metamucil or Surfak are safe to take.
Motherisk Nausea and Vomiting of Pregnancy Helpline toll free: 1-800-436-8477
If you are healthy, your blood pressure is naturally low and will decrease even further while pregnant. This may result in light headedness when getting up from lying or sitting. Light headedness or even fainting can happen suddenly or with very little emotional upset. Keep yourself hydrated (urinating at least three to four times daily), well-fed and take it easy - this is not the time to start a new intensive workout routine, nor to work 15 hour days.
As the womb grows, there is more pressure in your stomach which causes heartburn (also called acid reflux). You may feel a burning sensation in your throat. There are safe medications to treat this, should this feeling start to bug you. Sleep propped up on pillows if heartburn gets worse at night. Try to avoid a completely empty stomach by eating frequent, small meals and drink water often. Avoid caffeine, alcohol and vigorous exercise to help with this issue. Antacids such as Gaviscon, Tums, Maalox and Zantac may help. Liquid antacids often work better than tablets.
The second trimester comes along with more blood in your system (to feed the growing baby) and a growing womb (where the growing baby is kept). Also, the pregnancy hormones make it more difficult for blood vessels (veins) to move blood towards the heart. All of these factors mean more pressure in the veins of your legs. This can cause hemorrhoids, varicose veins and swelling of the limbs. The swelling in the hands can cause “carpal tunnel syndrome” (numbness or tingling of the hands).
This is what can help:
- keep your legs up when you’re sitting,
- walk and exercise as much as is comfortable (which pumps the extra liquid out of the legs)
- wear pressure stockings
Talk to your provider if swelling becomes bothersome to you or if you have had numbness or tingling. It is important to mention face swelling to your doctor or nurse practitioner if this is happening to you.
Aches and pains
Hormones can soften the joints (intersection between bones) and ligaments (strings that connect bones with bones) in the pelvis. This can cause a less stable, less balanced lower back and lower belly. Because of this imbalance in your body, it can put extra stress on your muscles and joints which is felt as pain. Good posture and strong body muscles help prevent and/or relieve this discomfort. There are some exercises you can do at home to improve your posture and muscle strength. When standing, place one foot in front of the other and rock slightly back and forth. Your provider may suggest you see massage and chiropractor services for your back pain. Support belts for the back are also sold in maternity stores.
Leg cramps can be caused by overstretching of the muscles or dehydration. Stand on the affected leg, or stretch your cramped leg. Ask your health care practitioner about hydration, nutrient supplements and other treatments.
You may need to urinate more often throughout the day and night. This can happen for many reasons. When you are pregnant your womb slowly grows into the largest organ in your belly because your baby is growing inside, and presses more and more on your bladder. This makes you feel the need to urinate more and more often. By the end of your pregnancy you may need to empty your bladder every hour. This is perfectly normal for late into your pregnancy and unfortunately there is not much you can do. Try to drink less fluid in the evening to avoid having to get up as many times throughout the night. Ask your doctor or nurse how to do pelvic floor exercises for better control of your bladder.
There are a few warning signs you should watch out for. If you suddenly need to urinate more and more, have burning smelly urine, red urine, or feel fever, nausea, vomiting you should let your provider know as soon as you can. You could have a urine infection.
Hemorriods and varicose veins
Pressure from the womb slows blood flow from your legs. Blood levels are also more relaxed due to your hormone levels. In some women these natural changes result in varicose veins, leg swelling and hemorrhoids. If your family has a history of varicose veins, it is more likely that you will too. Avoid standing for long periods of time, and walking around throughout the day is even better. Raise your legs many times a day and wear support stockings. This will help with blood flow from the veins. Support stockings are also available by prescription. Constipation can make hemorrhoids worse. To avoid this, eat a high fibre diet (25g/day minimum) to keep your bowel movements regular. Whole grains, lentils, bran and apples are all examples of foods with high fibre.
It hurts down there
Large varicose veins may spread to the vulva, which is the area around the female genitals. These will look like big, bluish blood vessels on the area around the vagina. Along with the varicose veins, you may also feel swelling or pressure. If you are feeling uncomfortable, try lying flat on your left side to get some rest. Ask your doctor or nurse about using special padding in your underwear for relief of vaginal pain.
Why aren’t I sleeping well?
It is common to have trouble sleeping during the third trimester in pregnancy. As your baby grows, you might find it is hard to get into a comfortable sleeping position. The womb and your baby will be pressing on your diaphragm (the muscle that helps you breathe), making it harder to take breaths. The extra weight your body is carrying from your baby might give you pain in your back and legs. You may also have cramping of the legs, especially in the middle of the night.
There are a few things you can do to help you get the best possible sleep. For cramping, massage the area and try to stretch the cramping muscle during the cramp. To prevent cramping drink 2-3 litres of water per day, eat one banana per day and take a calcium/magnesium supplement daily. If cramping is not better address this with your doctor or nurse practitioner at the next available visit.
Why is my skin and hair different?
Most women talk about how both skin and hair become more beautiful during pregnancy, and this may be true! Due to the increased hormones (estrogen and progesterone) in the blood stream, blood vessels in the skin swell and cause a ‘glow’ or flushing which can be very attractive. Hormonal changes also act on hair roots to stop them from dying. This means that women may have more hair during pregnancy.
Hormone changes during pregnancy can also result in acne, coarse hair, or even hair in unwanted places (such as the face or body). If this is you, do not worry too much. Pregnancy is temporary and you have the pleasure of knowing that when it is all over, your own naturally beautiful skin and hair will return.
Skin changes can include: a dark line on the belly (linea nigra), a “mask of pregnancy” or darkening of the facial skin, darkening of the nipples and stretch marks. All skin changes are caused by higher levels of hormones which can make your skin look darker. These changes usually fade after you have your baby. Stretch marks are caused by stretching of the skin but are also influenced by hormones. Some women are more likely to get stretch marks than others. Alhtough there are many creams “against stretch marks”, science has so far found nothing that actually works to stop them. Keeping moisturized with your usual moisturizer is a good way to stop itching and does no harm, though.
You may notice that you are sweating more than usual during your pregnancy. This can become uncomfortable because it makes your skin itchy. If you find you are sweating a lot, try taking showers or bathing more often to soothe your skin. Another good tip is to avoid body lotions that are scented, these can actually make your skin even drier.
Sex and libido
Just like the changes to your appearance, libido also changes with the hormones of pregnancy. Early pregnancy can, for some women, mean increased sexual drive as well as increased orgasm. For others however, this time in their lives marks a drop in libido, increased vaginal dryness and more painful intercourse. Part of the pain during intercourse is caused by the enlarging womb. How women respond to their changed libido is a personal, cultural, and emotional issue, it is different for everyone. If any of the above are distressing to you, do not hesitate to bring this up to your healthcare provider during your regular appointments. You may obtain helpful advice on lubricant use, positions to avoid due to discomfort during this time, or support in abstaining from intercourse if that is what you wish. One thing is certain, sex is not dangerous to a normal pregnancy and does not cause miscarriage during the first trimester. Your health care provider will discuss any abnormalities during your pregnancy which may make sex harmful. If the pregnancy is proceeding normally, what you do is your decision and will be supported by your medical team.
Mood and wellness
Feeling different emotionally during pregnancy is not just a myth. Some, not all, women will find themselves crying unexpectedly, brooding over relationship issues or the general future. On the other hand, you may be lucky enough to find yourself happier than usual, more at peace, or even giddy. Be patient. Give yourself some leeway and encourage those around you to do the same. If you find your emotions interfere with your day, your sleep or your life in general, speak with your healthcare provider to explore if you may be depressed or manic (too emotionally high). Either of these disorders can have serious consequences on your pregnancy and your baby’s welfare. Neither should be ignored.
Colds never used to be so bad
If you find you have a cold, we have suggested many medicines that are safe for you and your baby. For a minor cold you may take Benylin, Buckley’s or Robitussin cough syrup. If you have nasal congestion you may use Dristan or Otrivin nasal spray. If there is any fever or headache it is okay to use Tylenol. For sore throat, you may use Halls or Bradasol throat lozenges, gargle with salt and water or use Listerine. For allergies, Claritin, Benedril, Reactine and Chlor-Tripolon are safe to use.
Healthy pregnancy resources
Public Health Agency of Canada’s Healthy Pregnancy website
Telehealth Ontario: 1-866-797-0000
Available 24 hours/7 days a week to answer all your questions and concerns regarding pre- and post-natal care
What to eat
To eat or not to eat - that is the question
What should I be eating?
Depending on your nausea, and if it’s relieved by food in the stomach, the amount you eat could increase or decrease. Stay away from extreme changes in your diet. This is not time to limit your eating and if you are having a hard time keeping food down see your doctor or nurse practitioner for advice and medicinal relief. Hydration is the most important, as well as taking your maternal vitamins. Eat smaller meals, more often during the day and stay away from fatty foods or foods you have a hard time digesting. If you find yourself losing weight, you should see your health care provider.
Likewise, greatly increasing the calories you ingest is also unhealthy. Too much weight gain puts you at risk for gestational diabetes and obesity in pregnancy, which can harm you and your baby. (See Weight below)
Aim for a nutritious diet and remember that the Canada Food Guide applies during pregnancy just as before or after it. Make sure you get enough calcium (found in leafy green vegetables, dairy products or prenatal vitamins). There are some foods we recommend avoiding, as they may contain toxins or bugs that can hurt the baby. Ask you doctor or nurse for their recommendations on raw or undercooked fish, milk products and predator fish which may contain larger amounts of mercury.
Finally, in the second half of pregnancy the fetus is growing at a faster rate than before, and this requires calories. You could find yourself craving more food in general and certain specific foods. Maintain a balanced diet and do not keep yourself hungry. On average, a pregnant woman in her second and third trimester requires 200- 300 kcal more per day. If you were already overweight it may be better for you to increase your intake by less that this amount and you should speak to your provider for details regarding your diet during this time.
- Daily Bread Food Bank: 416-203-0050
- North York Harvest Food Bank: 416-635-7771
- Yonge Street Mission: 416-929-9614
One of the least fun things about pregnancy is the inevitable weight gain during this stage of life. For some, the losing control of our appearance (especially weight) can be frightening and even depressing. Remember that pregnancy weight is not like weight gained by inactivity or unhealthy diet. Just as the body naturally gains pregnant weight, it also has ways to naturally (and GRADUALLY) shed it off after the pregnancy.
So what is the SHOULD of weight gain in pregnancy? The medical truth is that it depends on your pre-pregnancy weight and body mass index. Pregnancy is not the time to lose weight, nor is it the time to become obese or diabetic.
There are many resources to help you figure out the right amount of weight gain during your pregnancy. Here is a reliable resource published by Health Canada:
Vitamins and mineral supplements
During pregnancy your growing baby will need lots of nutrients to make them healthy. Your baby will get these nutrients from your body. Depending on your nutrition, this may leave you with too little for yourself. Prenatal vitamins make sure that you have enough of all vitamins and minerals to continue to have a healthy body and a healthy baby. During the first trimester, the folate in prenatal vitamins helps avoid spina bifida (a birth defect). Also, you may take extra vitamin D (1000 units daily) to help protect your bones.
Vitamins/supplements for ODP recipients
Exercising during a healthy pregnancy is not harmful. This is not the time to start high endurance training, but keeping up your usual pre-pregnancy routine is generally safe. Due to the changes in your body, you may find yourself getting tired more easily, having pain or even feeling new problems during your routine (such as nausea, lightheadedness, bleeding, cramping in the abdomen). Listen to your body. Lighten your exercise and do not push yourself if you feel unwell. Review all your exercise related symptoms with your doctor or nurse practitione to make sure nothing harmful is happening.
As your pregnancy progresses remember that your growing womb in becoming an important, ever larger part of your belly. It is no longer protected by the bones of your pelvis. Avoid contact sports, that may expose you to falls, always wear your seatbelt (whether pregnant or NOT) and avoid heavy lifting or straining. If you have had what may be trauma to the belly (motor vehicle accident, fall, hit to the belly) please report to your nearest obstetrical hospital for a checkup.
Working or physical activity are healthy for a normal, uncomplicated pregnancy. There are some problems (discomfort, fatigue and stress) that can happen from this activity. All of these possible problems are more likely as the pregnancy grows. Feeling well is very important during this time in your life. Let yourself a pause when needed and limit yourself when you feel strained (whether physically or emotionally). Speak to your health care provider when you feel your level of work is more than you can handle. They can tell you how much is too much for you and your specific pregnancy.
On the other side, travel can be risky when it involves prolonged sitting. The chance of blood clots is greater during pregnancy due to the increased levels of Estrogen in your system. So it is important to speak to your provider before you travel to review how to do it safely. It is important to decrease immobility as much as possible by getting up for small walks in an airplane or train, taking frequent breaks from a car ride and even exercising your legs while sitting (ex. pointing your feet and squeezing your calf muscles repetitively every hour or so). This activity will also decrease the amount of leg swelling which can develop in pregnancy.
Other risks of airplane travel involve the radiation from being high up and closer to the sun For this reason, plane travel is best avoided during the first three months if possible. Finally, travel involves contact with a totally new environment. Speak to your healthcare provider or go to a travel clinic for advice on how to minimize risk of infections, sun exposure, irritants etc.
Being pregnant with HIV can happen in a healthy way that avoids harm to the mom or baby. The St. Michael’s Family Health team provides a positive space for positive pregnant moms. Please see below some helpful tools to educate yourself on pregnancy care and speak with your doctor or nurse practitioner about how to care for you and your baby during this special time.
- Motherisk HIV Healthline: 1-888-246-5840
- Ontario AIDS Hotline: 1-800-668-2437 (English and 15 other languages) 1-800-267-7432 (French) Toronto: 416-392-2437
- Service Ontario INFOline: 1-866-532-3161 (Toll-free) Toronto: 416-314-5518 TTY: 1-800-387-5559
Throughout your pregnancy the little one is developing inside your body, especially during the first third of pregnancy when he/she is forming all of the vital organs which will be with him/her during their entire lifetime. Everything you ingest during this time is used in part to make your baby and it is important to be very aware and careful about what enters your pregnant body. Smoking and street drugs should be avoided completely. The safe level of alcohol to drink is as of yet unknown, so the safest amount is none.
Since what you ingest can also get passed to your baby, any medication taken should be reviewed for safety in pregnancy. Be sure to let your health care provider know of any medications you are ingesting, whether over the counter, supplement or prescription. The Hospital for Sick Children has an excellent website to help give you pregnant mothers safety information about specific products/supplements/medications during pregnancy (and breastfeeding):
When taking ANY medications or using any drugs, please inform the prescriber that you are pregnant. For some women, and for many reasons, this is very difficult or nearly impossible. Please speak to your doctor or nurse practitioner about safer ways to reduce harm to your baby in pregnancy.
Substance Use in Pregnancy Program: This is available through our family medicine obstetrical group. Call us if you think we can help.