Dr Emeil Kamel
Dr Emeil Kamel
Conception usually occurs about two weeks after the start of your last normal period. However, it takes about 6 days for your newly conceived baby to reach your uterus from your fallopian tube, and further 6 days for them to fully implant in the lining of your uterus, to start ‘interacting’ with your body.
Once the baby fully implants, they start to release a hormone called human gonadotrophin hormone (or HCG) into your blood stream. The HCG level rapidly increases in your system and produces early pregnancy signs. This is the reason why early pregnancy signs do not start to become noticeable until around the time the woman’s next period would have been due.
Women with twins, triplets of more may notice their pregnancy signs sooner and may be more intense, because they have higher levels of HCG in their system.
Other hormones increase during pregnancy as well, mainly progesterone and some oestrogen, which contribute to many of the early pregnancy signs.
By about 6 weeks after the last normal period, the amount of blood flowing around a woman’s newly pregnant body increases. Blood flow to her skin increases, making her feel warmer, often sweating more (particularly in her hands and feet). Her metabolism also increases, creating more body heat. A pregnant woman’s temperature will often rise to about 37.8oCelsius, when it is normally 37oCelsius. Extra blood flow in the woman’s skin can also contribute to nose bleeds and bleeding gums.
The following is some common physical changes that you may experience during the first 12 weeks of your pregnancy:
- No periods or lighter bleeding
- Breast and nipple changes
- Passing urine more frequently
- Bloating, cramps and backache
- Morning sickness
- Increased saliva
- Dizziness and fainting
- Tiredness
- Headaches
- Constipation and wind
- Libido
- No periods or lighter bleeding
- Missing your period is the most obvious sign that you are pregnant. However, few women will experience a light bleed occurs as the growing baby burrows into the lining of the uterus ‘implantation bleed’.
Occasionally, a woman will continue to have a small, red or pinkish vaginal loss for a day or so around the time that their period would have been due (for example at around 4, 8, 12 and 16 weeks of the pregnancy). This is more common during early pregnancy, but can persist into later pregnancy as well.
Early pregnancy bleeding is usually investigated by an ultrasound.
Any bleeding during pregnancy should be communicated to your caregiver.
Breast and nipple changes
When a woman becomes pregnant, her breasts start to undergo further changes from about 4 to 6 weeks after her last normal period. This is due to the milk ducts growing and maturing, in preparation for breastfeeding, as well as an increased blood supply, making the veins in the breasts become more noticeable.
The breasts will often feel tender, swollen and much ‘fuller’. Some women also experience tingling sensations. By about 12 weeks of the pregnancy, the skin of the nipple and areola may start to darken or ‘pigment’. Skin colour changes are very individual to each woman. However, women with darker hair and darker complexions tend to notice more colour change than fairer skinned, blonde or redheaded women. The nipples may become more prominent and feel quite sensitive (or even sore). You may wish to start wearing a good fitting bra to support your changing breasts.
Passing urine more frequently
This is mainly because of increasing blood flow to the kidneys leading to increase produce of urine. This increased urine peaks by about 9 to 16 weeks of the pregnancy, then settles.
Passing urine frequently can also be influenced (to a lesser degree) by pressure on the woman’s bladder from her growing uterus. Pressure on the bladder is the main reason why women pass urine frequently in the last 3 months of pregnancy, as the baby grows heavier, and moves further down into the woman’s pelvis in the weeks just before the birth.
Bloating, cramps and backache
Many women experience bloating, mild cramping and slight backache as pre-menstrual symptoms. Many women worry when they feel mild cramping, tugging and pulling in the early weeks. If there is no bleeding associated with it, then it is probably normal.
If you have strong or severe cramping or pain, you should contact your caregiver for guidance and advice.
Corpus Luteal Cysts
A corpus luteal cyst (CLC) is a very normal part of pregnancy and most women are unaware of having them. When the egg is released from the ovary at ovulation and the baby is conceived, the site of ovulation in the ovary becomes a corpus luteal cyst. It can grow to the size of a golf ball (5 to 6 cm ) and cause symptoms such as quite distressing pain and sometimes a small amount of bleeding.
Most CLC’s start to regress (or shrink) at around 10 weeks of pregnancy and disappear by about 16 weeks. In very rare cases, the pain becomes so severe that an operation is done to remove it, but this is unusual and most resolves on their own, with the pain gradually disappearing.
Generally an ultrasound will confirm the cyst. A follow up ultrasound is required in 2-3 weeks to monitor the cyst’s growth over a few weeks
Morning sickness
Morning sickness or ‘all day and all night sickness’, can involve feeling nauseated, and/or vomiting. It is one of the most common physical complaints of early pregnancy and is due to your body’s reaction to the high levels of pregnancy hormones in the body. It usually subsides by about 12 -14 weeks of the pregnancy.
Increased saliva
Many women notice they produce more saliva. It can happen on its own but it is usually associated with nausea and vomiting. Some remedies for morning sickness may help with the ‘drooling’, like eating dry, plain cracker biscuits and having small regular meals. It usually subsides when the nausea improves (usually by 12 to 14 weeks of the pregnancy).
Dizziness and fainting
Fainting during early and middle pregnancy is a very common experience. It happens because the woman’s blood vessels naturally relax and dilate under the influence of the hormone progesterone, lowering her blood pressure. Fainting is not usually a problem, just a little embarrassing if you do it in public.
Tiredness
It is normal to feel tired at different stages of your pregnancy. However, some women will feel extremely fatigued during the first 12 weeks or so. It is not unusual to have 10 or 12 hours sleep, only to get up and still feel lethargic and tired. As your body adjusts to the enormous metabolic changes that are necessary to grow your baby, the tiredness and fatigue usually subside (around 12 to 14 weeks of pregnancy.
It is important to rest whenever possible and listen to your body when you feel you need to slow down. If possible, take a rest and lie down for a while before dinner and/or have early nights.
Headaches
Frequent headaches may be caused by:
- Hormonal changes
- Increase in blood volume circulating in the woman’s system
- Stressful time
Occasionally, a woman who is prone to headaches or migraines can find she does not experience them as often during pregnancy. However, others may find they are worse.
Constipation and wind
Constipation is a common complaint, usually happening during the first (and/or last) 3 months of the pregnancy. Constipation is thought to happen because the hormone progesterone slows the movement (or ‘motility’) of the gut.
The best way to deal with constipation is to adjust your diet by increasing the fibre in your foods (whole grains) and water intake and to include fresh fruit and vegetables (and often dried fruits and fruit juices). However, some women feel they need additional remedies to deal with it.
Also, the bowel can also be affected by making you produce more gas and wind during pregnancy. This can make some women feel mild to strong wind pains occasionally. Peppermint tea or peppermint water can help with this.
Libido
Sexuality and libido often change during early pregnancy, either in a positive or a negative sense. For some, sex becomes a celebration of their pregnancy and brings with it a sense of ‘freedom’, because contraception is no longer a concern. Extra blood flow to the breasts and genitals can increase sensitivity, sexual arousal and the desire for sex. However, other women find that the first 12-14 weeks of pregnancy brings with it continual tiredness, nausea and/or vomiting, making sex the furthest thing from their mind.
For most women the 2nd trimester is the most comfortable phase of their pregnancy. However, this stage can also bring with it its own unique physical changes. For some women the physical changes of the 1st trimester can continue until 14, 16 or even 20 weeks of the pregnancy and beyond.
The following is a general common physical changes that women can experience during the middle phase of their pregnancies. They can include:
- Growing belly
- Breast changes and milk
- Aches and pains
- Braxton Hicks contractions
- Bleeding gums
- Metallic taste
- Skin, hair and nail changes
- Nose bleeds, smells, colds and sinus
- Restless legs
- Swelling, fluid retention
- Vaginal changes
- Libido
Growing belly
After about 12 weeks of the pregnancy, the uterus grows out of your pelvis. Your caregiver can actually feel the top of your uterus “the fundus”. By about the 20th week of pregnancy your fundus will be felt at around the level of your navel. As your waistline thickens and your pregnancy becomes more obvious, wearing tight-waisted clothing will no longer feel comfortable. Usually by about 20 weeks you will need to start considering wearing more stretchy or loose outfits.
As you watch yourself change, remember that every woman’s body is unique in how she changes and responds to her pregnancy. Each woman’s belly size and shape will differ according to her height and weight and will also depend on whether this is her first or subsequent baby, as will a woman’s weight gain during pregnancy.
Breast changes and milk
Many women increase in bra size as their pregnancy progresses (usually after around 20 weeks or so), but others do not notice much of an increase until after the birth and their breast milk comes in.
It is possible for a woman to start producing ‘colostrum’ any time after about 14 to 16 weeks of the pregnancy, especially if this is not your first baby. Colostrum is the first fluid a woman’s breasts produce and is a clear or creamy-yellow substance that is syrupy in consistency. If you are leaking colostrum and it is becoming annoying, you may need to wear breast pads inside your bra.
It is normal for some women to notice a small amount of blood mixed with the colostrum that may come away during pregnancy. This comes either:
From within the breast due to the rapid growth of blood vessels in the growing ductal system, in preparation for breastfeeding. or
Because the sticky colostrum temporarily ‘glues’ the nipple to the inside of the bra and a tiny bit of nipple skin is removed with the bra, which does heal.
Aches and pains
Various aches and pains can cause great concern and worry. Generally if the pain is not extreme and/or there is no bleeding associated with it, it is usually normal.
Braxton Hicks contractions
Braxton Hicks contractions usually occurs after 20 weeks of pregnancy. These are ‘practise’ contractions of the uterus (also known as tightenings). Braxton-Hicks contractions are the uterus’ way of toning this muscle as well as stimulating your baby in utero. Every time your baby feels the uterus tightening around them, it helps to stimulate their circulation, similar to a brisk rub on your own skin, or a massage!
Women often describe Braxton-Hicks contractions as a feeling of ‘hardness’ or a mild cramping of their belly. They usually ease if you change what you are doing. For many they are painless. However, for a few women they can be quite strong and even painful or ‘labour-like’, especially if this is not your first baby.
Bleeding gums
During pregnancy, the amount of blood flowing through your body increases. The increased blood flow means that your gums have a higher blood supply and are more likely to bleed with vigorous brushing and flossing, making them more prone to becoming inflamed (called ‘gingivitis’).
Metallic taste
We don’t know what cause this physical change. However, natural therapists believe the metallic taste could be a result of the body releasing toxins through the lymphatic system (your lymph glands transport and produce your body’s defence mechanisms against infection).
Skin, hair and nail changes
The skin often goes through many changes. The skin may look healthier and clearer, even ‘glowing’. But for some, their skin changes are not pleasant, e.g.:
- Heat and hormonal rashes
- Oily or dry skin
- Stretch marks
- Darkening (or pigmentation) of the skin in various areas
- Skin tags
- Red spider veins.
What each woman experiences during her pregnancy will be very individual to her and it is different changes during different pregnancies.
You may also notice changes to your hair and nails.
Nose bleeds, smells, colds and sinus
The lining of the nose has an increased blood supply during pregnancy and tends to be more sensitive and more prone to nose bleeds.
Some women find they tend to suffer more from sneezing, allergy and/or sinus problems during pregnancy and if they get a common cold or the flu, this can take a little longer to recover from.
Pregnant women also generally have a heightened sense of smell, making them less tolerable of certain odours.
Restless legs
It is hard to describe what restless legs are but the range of feelings can include:
A sensation that the legs have to move all the time
The legs feel like they have ‘butterflies’ in them
Legs that ache with the woman feeling she has to be constantly walking
These sensations can make it difficult to sit for long periods and can stop you from sleeping well at night.
Swelling, fluid retention
It affects about 65% of healthy pregnant women with a normal blood pressure and can start at any time after about 20 weeks of the pregnancy.
Swelling can be noticed in the legs, feet and hands (rings become tight).
Normal pregnancy swelling is generally more noticeable at the end of the day, although it may be worse on hot days, after a plane trip or if you are on your feet for long periods of time.
Swelling can be also associated with varicose veins of the legs.
Vaginal changes
Due to hormones of pregnancy many women notice that their vaginal discharge is different and increased. However, pregnancy can also slightly alter a woman’s vaginal acidity (or pH), making her prone to fungal infections (thrush) or an overgrowth of normal vaginal bacteria (called ‘gardnerella’).
Libido
During the middle phase of pregnancy many women find they have a renewed interest in sex. As energy levels return and the fear of miscarriage slowly subsides, a woman can feel more relaxed, with sexual arousal and sensuality often becomes heightened.
Women are often able to achieve orgasm more readily when pregnant. The extra blood supply to the vagina and clitoris increase their sensations, with the genitals being softer and more full. The nipples can be extremely sensitive to touch, being either more sensuous or perhaps uncomfortable. The breasts are larger and sometimes tender.
During the last three months of pregnancy (or 3rd trimester) many women start to feel tired, as their baby grows bigger. Along with tiredness it is common to experience other physical changes such as:
Aches and pains
Stitch pains in the groin These are due to straining of the ’round ligaments’ that support the growing uterus. It is usually felt on the left side because your uterus naturally leans to the right. Often it is sharp and sudden and can take your breath away a little but settles down with rest, heat packs, lying on the affected side.
Rib and chest wall pains
The baby is pushing up under the ribs causing the ribs to be pushed slightly outwards ‘flaring’. This can strain the muscles between the ribs (or ‘intercostal muscles’) and cause pain and discomfort. Sitting more upright and giving the baby a gentle ‘push down’ with your hand may take the pressure off.
Strong Braxton Hicks contractions
Braxton Hicks contractions are the ‘practise’ contractions of the uterus or ‘tightenings’ felt, usually after about 20 weeks of the pregnancy. For many women they are painless, but for some they can be quite strong and painful or ‘labour-like’, especially the last few weeks of the pregnancy. This is especially so if it is your second or subsequent baby.
Sometimes it can be difficult to tell if they actually are labour pains and some women are concerned about premature labour. Braxton Hicks are usually more infrequent or less regular than labour pains and either short lasting for 20-30 seconds or long (90seconds to 2 minutes).
Splitting, tearing belly pains
It is very common to experience sensations of superficial ‘tearing’ or ‘splitting’ down the centre of the belly during the last few months of the pregnancy. This is generally due to Splitting of the two large abdominal muscles ‘Rectus muscles’. Abdominal muscle separation is a normal part of late pregnancy to allow your belly to accommodate your growing baby.
This is normal and usually eases within few days. Massaging the area, using a heat pack and supporting the belly with a pillow while sleeping, may help.
Tender, sore belly button or navel
For women with everted belly button, the previously ‘protected’ skin of the navel, can rub frequently on clothing, making it feel a little raw and tender. Massaging creams or oils may be soothing.
Bruised sensations or sore spots
This is often due to the baby continually pressing on one spot of the uterus. It is more common during late pregnancy as the baby is more restricted for space.
Gently pushing the baby off this spot with your hand at times can give you temporary relief. Pelvic rocking (similar to belly dancing) can move the baby’s back more around to the front of the mother’s belly, and possibly off the ‘bruised spot’.
Low, heavy dragging aches and pains
The ligaments that act like a ‘hammock’ supporting the uterus are usually stretched and tend to hold the uterus lower. Often the pelvic floor and abdominal muscles are weakened from a previous pregnancy. Doing your Kegel “pelvic floor” exercises and some back pain exercises may help as well as yoga, swimming or belly dancing.
Backache
Backache is a part of many women’s pregnancies. Around 50-75% of pregnant women will complain of backache at some stage of their pregnancy and about 33% will find it a problem affecting their lifestyle. The pain can be felt in the upper or lower back, or both. It can also start after the birth and may be temporarily aggravated by having an epidural
Backache can sometimes be complicated by sciatica, a shooting nerve pain down the buttock and back of one leg. This is when the back and pelvis are out of alignment and pinch the nerve where the bones are joined at the sacrum by relaxed ligaments.
The common causes of backache and sciatica:
- Pregnancy Hormones (progesterone and relaxin)
- They relax the ligaments that connect the pelvis to the lower back at the ‘sacroiliac joints’.
Weakened abdominal muscles - These muscles help to perform tasks such as picking up objects and sitting up from a lying down position. The workload is shifted to the lower back muscles, straining the back and making the muscles short and tight.
Incorrect posture - Can cause a lot of backache and is hard to avoid in pregnancy as the belly increases in size and shifts the centre of gravity.
Rib flaring
- In late pregnancy the baby can push up under the ribs and cause them ribs to flare out to some degree. This can put strain on the upper back between the shoulder blades.
The position of the baby - If the baby’s back is against the woman’s back this can press on her sacrum, causing discomfort
Incorrect lifting - Incorrect lifting, sitting, and moving techniques can twist and strain back ligaments and muscles unnecessarily
Symphysis pubis pain
The Symphysis pubis is a joint at the front of the two large pelvic bones. The bones are separated by a disc of cartilage and are held together by ligaments. The pregnancy hormones progesterone and relaxin soften and relax the symphysis ligaments. This allows the pelvis to stretch and open more easily to make way for the birth of your baby but it can cause pain at the joint if the pelvic bones move. This is usually more common for women having their second or subsequent baby.
Symphysis pubis pain can be felt as an ache; sharp pain, ‘clicking’ sensation or a shooting pain into the clitoris. It can range from mild to severe debilitating pain. Movement will aggravate it. The position of the baby may affect the level of discomfort, especially if the baby’s head is engaged.
Breathlessness
Breathlessness is a common complaint during pregnancy. It is very normal and will usually come and go. A woman can be short of breath even while she is sitting and having a normal conversation.
It is due to:Pressure from the baby on the ‘diaphragm’.
- Pressure from the baby on the ‘diaphragm’.
- A higher level of carbon dioxide gas in the blood
Breathlessness that will not go away, or which is associated with pain in the chest or upper back as you breathe could be s sign of a heart or lung condition. This requires urgent medical attention.
Sitting upright or sleeping on a couple of pillows may help.
Carpal Tunnel Syndrome
This is a common condition usually experienced during late pregnancy. Fluid often accumulates in the body during pregnancy and can collect in the wrists. This puts pressure on the median nerve. The median nerve moves the muscles in the wrist and hand. Pressure on this nerve can cause numbness, stiffness, pain and ‘pins and needles’.
It will generally improve within a few weeks or so after the birth.
Constipation
Constipation is a common complaint, usually happening during the first and last 3 months of the pregnancy. Constipation is thought to happen because the hormone progesterone slows the movement of the gut.
During late pregnancy, constipation can also be due to direct pressure on the intestines from the growing baby.
For some women, being constipated also contributes to causing ‘piles’ (or haemorrhoids). Haemorrhoids are essentially varicose veins of the anus. They can be painful and are often quite itchy. They can also bleed. The pregnancy hormone ‘progesterone’ also makes the blood vessels relax, causing them to be less efficient at pumping the blood back.
Haemorrhoids should eventually go away. However, if you have had them for some time, or if they are quite large, they may decrease in size, but remain requiring an operation.
Frequent Urination
During late pregnancy (from about 30 weeks onwards) the increased weight of the growing baby and uterus start to put more pressure on the bladder.
Heartburn
Heartburn can be experienced by up to 66% of pregnant women. Heartburn can happen at any time but is more common in the last 3 to 4 months of the pregnancy. The pregnancy hormone progesterone can relax the sphincter muscle at the top of the stomach allowing acid from the stomach to regurgitate back into the gullet causing discomfort or a burning sensation.
Leg cramps
Leg cramps are painful spasms that occur in the foot, calves or thighs and can be experienced by nearly 50% of pregnant women, generally during the last few months of their pregnancy. Leg cramps will usually occur at night. It might be due to low levels of calcium, magnesium, potassium and sodium chloride (or salt) in the body. Magnesium supplements are the most likely to help.
Increase vaginal discharge
The vaginal discharge increases dramatically in pregnancy. This is because increase blood supply and pregnancy hormones, making the mucous lining produce more secretions.
The vaginal discharge (known as ‘leucorrhoea’) is usually:
- Milky white or clear
- Not offensive to smell
- Not irritating, sore or make you itch
Varicose veins
Varicose veins in the legs are generally caused by the blood back- flowing and pooling in the veins of the legs.
Causes:
The pregnancy hormone progesterone weakens the walls of the veins, relaxing the valves in the veins so they don’t close efficiently
The pressure and weight put onto the lower body by the growing baby
Varicose veins should improve (or even disappear) a few months after the birth, but some may remain requiring.
Varicose veins can occur in the vulva. They do not cause any problems for the birth process and should disappear a few days after the birth of your baby.
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