Is this normal?
Here’s how you can identify the aches and pains of pregnancy.
Pregnancy brings with it new sensations, and with them come new concerns. Is this pain dangerous or completely normal? All the signals the baby gives about itself aren’t gentle kicks, instead some of them are changes occurring in the mother’s body and symptoms resulting from them. Leena Rahkonen, HUS’ specialist in gynaecology, obstetrics and perinatology, tells us which aches and pains are normal and when to seek a doctor.
Aches and pains
Lower abdominal pains
The uterus grows and causes new sensations in the lower abdomen. The need to urinate also increases. Due to the expanding uterus, you may feel various small and passing pains, which are completely normal. You should avoid self-medicating during pregnancy. Paracetamol is a safe painkiller as long as you follow the dosage instructions. “If the pain isn’t continuous or worsening and it comes and goes, it’s quite natural. It’s related to the growth of the uterus”, Leena Rahkonen explains.
Call your doctor…
If the pain persists or gets worse and won’t go away, call the hospital’s gynecological emergency care number.
Lower back pains
Two thirds of pregnant women experience back pains and one fifth experience pain in the pelvic area. The pains often increase as the pregnancy progresses and may affect daily chores, sleep and your ability to work. Safe exercise can reduce the pain. During early pregnancy, general abdominal pains may sometimes be felt as lower back pain.
There are different kinds of back pain: joint pain and muscle pain. Muscle pains often increase towards the end of the pregnancy and often result from the heavy belly. The muscles in the back and pelvic area in particular are strained as they maintain the position of the hip and back.
Joint pain is caused by hormonal changes. The changes loosen the ligaments, which can cause pains in the hip, the lower joints of the spine and the pubic symphysis. Exercise can make the pain worse.
For more information about back pain and safe exercise, visit the Selkäkanava website (in Finnish) and the Terveyskylän Naistalo website (in Finnish).
Call your doctor…
You should see a doctor if the lower abdominal or lower back pains are severe, intensifying, won’t go away or are accompanied by bloody discharge.
Sharp abdominal pains
The uterus expands during the early stages of mid-pregnancy, which may cause sharp pains in the abdominal area. The sharp pains are due to the fact that the uterus is attached to the pelvic walls through connective tissue and as the uterus expands, the connective tissue stretches. These kinds of sharp mid-pregnancy pains aren’t related to the functioning of the fetus or placenta.
“If the sharp pains are temporary and come every now and then, you don’t have to be concerned”, Leena Rahkonen advises.
Call your doctor…
If the pain is persistent, and immediately if it is accompanied by vaginal bleeding.
Muscle pains
Muscle pains increase towards the end of the pregnancy. Muscles can become sore as the belly grows and carrying it becomes harder. Generally, light exercise helps with muscle pain. You should monitor the pain yourself.
During late pregnancy, the pelvic cartilaginous joint begins to relax. This cartilaginous joint pain is referred to as pubic symphysis pain. It means that the pubic symphysis is relaxing for delivery, which may cause the mother to experience pain in the pelvic area. This can also make moving more difficult.
Read more about pelvic area pain from the Terveyskylän Naistalo website (in Finnish).
Muscle pains can also manifest as back pain. Read more from the Selkäkanava website (in Finnish).
Call your doctor…
If the pain feels similar to menstrual pain and is spreading to the groin.
Swelling
Swelling during pregnancy is usually normal, especially in the lower limbs. However, there are some situations where you should see a doctor because of swelling. You may experience swelling right from the beginning of pregnancy. The longer the pregnancy progresses, the more swelling may occur. This is because the amount of blood in the mother’s body pumped by the heart grows as the pregnancy develops.
Swelling normally occurs in the legs, because blood pools there easily and cannot necessarily flow back up. Standing and sitting for long periods of time cause pooling of blood and swelling. You can ease the swelling by lifting your feet up and avoiding salty food. Wearing compression stockings can also help.
“You have to drink enough water, even though people often mistakenly think that drinking increases swelling”, Rahkonen says.
Read more about swelling from the Terveyskylän Naistalo website (in Finnish).
Call your doctor…
If lower limb swelling and pain occurs only in one leg. This means there is a possibility of deep vein thrombosis and it is good to seek a doctor. Similarly, you should see a doctor if the swelling is accompanied by high blood pressure or if the swelling also occurs in the arms and face.
Contractions
Contractions occur especially towards the end of pregnancy. The number of contractions and the sensations accompanying them are very different for each individual. As many as 90% of women already experience contractions during pregnancy. Just 10 percent experience them only once they go into labour.
“Uterine contractions are normal towards the end of the pregnancy, because they prepare the uterus for delivery”, Leena Rahkonen explains.
Premature contractions
Premature contractions can be a sign of premature birth. Birth is premature if it happens over three weeks before the due date. If contractions occur four times within 20 minutes or every ten minutes for an hour, they are referred to as premature contractions.
“If contractions occur this often, you should discuss the issue when you visit your clinic or call your maternity hospital’s emergency unit for further instructions. Only a small number of women who have premature contractions give birth prematurely, however”, Rahkonen says.
What does imminent premature birth feel like?
If you are at imminent risk of premature birth, common sensations include feelings of heaviness in the lower abdomen and pelvis, contractions, lower abdomen pains and bloody, watery or mucous discharge. In this case you should contact the maternity hospital’s emergency unit.
Discharge and infections
Bloody discharge
Bleeding may occur at any stage of pregnancy. You should always contact the maternity clinic or doctor if it occurs.
Early pregnancy may involve thin bloody discharge as the fertilised egg attaches to the uterine wall. This happens at the time when you have missed a period.
“If the discharge is thin, bloody and mucous when you wipe, there’s no need to be alarmed. You can monitor the situation and wait for the ultrasound screenings in peace”, Rahkonen says.
The first free ultrasound screening provided by municipal healthcare will take place between the 10th and 13th weeks of pregnancy. You should avoid intercourse as long as bleeding occurs. Intercourse can increase the risk of bleeding.
Heavy bloody discharge in early pregnancy can be a sign of miscarriage, and a sign of placental abruption towards the end of the pregnancy.
Read more about bloody discharge during early pregnancy (in Finnish) and bloody discharge during late pregnancy (in Finnish) from the Terveyskylä Naistalo website.
Call your doctor…
If the bloody discharge is thin, mucousy and bloody, contact the maternity clinic. If the blood is similar to menstrual bleeding and heavy, contact your doctor.
White discharge
White discharge can occur more than usual during early pregnancy and its consistency may be different than usual. The discharge can be more watery than usual.
“You don’t have to be scared of that, it’s normal”, Leena Rahkonen says.
White discharge occurs when the vagina’s mucous membranes and cervical canal secrete fluid and mucus. You can try to reduce the discharge with lactic acid products available from the pharmacy, because sometimes the abundance of discharge is related to changes in the vagina’s acid-base balance.
Read more from the Terveyskylän Naistalo website (in Finnish).
Call your doctor…
If the white discharge has a strong odour or if it is notably more abundant than before, it may be an infection, in which case you should seek a doctor. You should also seek a doctor if the white discharge is accompanied by pain when urinating, lower abdominal pain or if it is tinged with blood.
Yeast infection
Yeast infections are more common than usual during pregnancy. Yeast infections are characterised by intense vaginal irritation, itching, soreness and whitish-gray clumpy discharge. You can treat yeast infections yourself with over-the-counter antifungal treatments. If the treatments don’t help, you should seek a doctor.
Read more from the Terveyskylän Naistalo website (in Finnish).
Call your doctor…
If the yeast infection is accompanied by symptoms other than the ones listed above, such as a fever or lower abdominal pains.
Water breaking
The fetal membranes can rupture prematurely, which is called premature rupture of membranes, or premature water breaking. The fetal membranes can rupture at any point during the pregnancy. In most cases, the rupture is caused by an infection, which cannot be anticipated in advance. It should be noted that often ordinary white discharge can also be very runny and watery due to pregnancy hormones.
Is the fluid white discharge or amniotic fluid?
“The liquid is more likely to be amniotic fluid if it really flows out and your pants get wet. White discharge can also be runny, but it is a bit more sticky than amniotic fluid”, Rahkonen explains. Towards the end of the pregnancy, the urethral sphincters can also occasionally fail when, for example, straining oneself and even urine can leak into your pants.
Amniotic fluid can also slowly trickle out instead of gushing out all at once, which makes it harder to identify. Often, contractions or a feeling of heaviness in the lower abdomen can accompany the discharge. You should contact the maternity hospital’s emergency unit if this is the case. The rupture of membranes can easily be confirmed with a dipstick test done at the hospital. The dipstick test detects proteins in the amniotic fluid that aren’t otherwise present in the vagina.
When is water breaking a risk?
The fetal membranes can rupture at any stage of pregnancy and the water can break. If the water breaks before the 22nd week of pregnancy, it is referred to as a miscarriage, that is, pregnancy loss. From the 22nd week of pregnancy onwards it is referred to as premature birth if labour is triggered as a consequence of contractions or the water breaking. The fetus is able to survive from the 23rd to 24th weeks of pregnancy onwards, in which case the newborn goes into so-called active treatment. In active treatment, every possible effort is made to save the child. There are major health risks involved with premature birth.
Read more about premature water breaking on the Terveyskylän Naistalo website (in Finnish).
Premature birth
During late pregnancy, the most common concern of mothers is premature birth. Intense and repeated contractions are a sign of imminent premature birth. If birth begins before the 37th week of pregnancy, it is referred to as premature birth. Birth is usually not prevented if the duration of pregnancy is over 34 weeks. If there are less than 34 weeks of pregnancy, delivery will try to be stopped or delayed with medicine that prevents and slows contractions.
In Finland, 5–6% of children are born prematurely (THL Birth Register).
Premature birth symptoms
Symptoms of imminent premature birth are painful contractions that come less than 10 minutes apart, mucousy, bloody discharge or trickling of the amniotic fluid. Irregular, weak contractions are part of normal pregnancy. Other symptoms of imminent premature birth can include lower abdominal or lower back pains and a feeling of heaviness in the pelvis.
The risk of premature birth can be easily established with a dipstick test done at the hospital. If the dipstick test is negative, the risk of premature birth during the next two weeks is very low. If the test is positive, the risk of premature birth has increased. In this case, the pregnant woman requires closer monitoring, sometimes even unit monitoring in the maternity hospital. The dipstick test excludes the possibility of premature birth within a few minutes. In addition to the result of the dipstick test, the state of the cervical canal at the time of examination affects premature birth risk assessment.
Prevention of premature birth
A large number of premature births cannot be prevented. Usually, premature birth is caused by an infection in the uterus. Bacteria that has entered the womb can weaken the fetal membranes and at some point as the uterus grows and stretches, the fetal membranes may rupture. This may result in premature rupture of membranes.
You cannot anticipate or completely prevent yourself from getting an infection. However, good hygiene and healthy lifestyle habits can help you avoid getting one. The reason why bacteria cause some women to get an infection but not others is unknown. However, you shouldn’t wash your nether regions with antibacterial soaps or antibiotic treatments that reduce bacteria.
“The vagina is meant to have bacteria and they’re not all harmful, instead they’re vital and protect us”, Rahkonen says.
Urinary tract infections and sexually transmitted diseases increase the risk of premature birth. That is why these infections should be actively treated. Sexually transmitted diseases and infections can be prevented during pregnancy by using a condom during intercourse. You can, of course, have sex when pregnant but it is not recommended when you are experiencing bloody discharge or contractions,
Read more about premature birth on the Terveyskylän Naistalo website (in Finnish).
Lack of fetal movement
The maternity clinic states that the baby’s earliest movements can be felt during the 18th to 24th weeks of pregnancy. At that point they are still just very small touches. After the 30th week of pregnancy you should monitor the movements daily.
Each baby has their own movement rhythm, which the mother learns to know. Normally, a baby moves 3–50 times per hour and has 20–40 minute periods of rest when it sleeps.
“A baby moves in different ways at different times of the day. Often when the mother is moving about and speaking the baby is enjoying itself, but when the mother stops and begins to rest, the baby wakes up and starts to give signals of itself”, Rahkonen says.
Rahkonen reminds us that each baby moves very differently, but monitoring their movements is important.
Read more about monitoring the baby’s movements on the Terveyskylän Naistalo website (in Finnish).
How do you count the baby’s movements?
Lie down on your side daily and write down the movements you notice during an hour. You should feel at least 10 movements during the hour. All clearly distinct motions can be counted as movements, but not hiccups, however.
Call your doctor…
If there are less than 10 movements during an hour, lie down on your side after one or two hours to count the movements. If there are still less than 10 movements during an hour or if they are only weak, contact the hospital’s delivery ward regardless of the time of day.
Sources: Interview of Leena Rahkonen of HUS, Terveyskylä Naistalo (in Finnish), Terveyskirjasto (in Finnish), Selkäkanava (in Finnish).