This is a long list of ALL of the symptoms in LATE pregnancy. Ok, not all. It is already the longest episode we have ever recorded. But if you’ve been wondering if you should worry about the itch on your belly or your swollen ankles or what you can do about not sleeping at night then you need to listen to this podcast.
In this episode we talk about:
Good benefits of late stage pregnancy. Yes we found a few.
Carpal tunnel syndrome
All the different types of varicose veins
Anxiety and depression
Links to go with this podcast:
Pat mentions: World Health Organisation pregnancy weight gain calculator. This is no longer available but this is a good substitute
Brigid mentions some help for antenatal depression. Some links we suggest are:
[00:00:36] Welcome, everyone. This is episode 22 and it's one that's timely. It's all about the late pregnancy symptoms and some of the late pregnancy symptoms are issues, you know, that can last a few weeks and make a pregnancy in the last month or so feel pretty uncomfortable and they need to be watched. But then there are some that, you know, you need to head off to your doctor about and to get a good understanding of all the different late pregnancy symptoms. We turned to our Instagram community, didn't we? We do. It's a really big and comprehensive list. And I bet as you listen to this episode, you'll go, yeah, that didn't happen to me or. Oh, yeah, yeah, I had that.
[00:01:15] So before we get into the list, I think Bridget's got some news for us today.
[00:01:20] Yes, I do. We've got a local beautiful magazine that goes to the whole Central Highlands area and it's called Uncover. And it's just a beautiful magazine. And I've got my third article in it and I'm really excited by it.
[00:01:35] And it's about talking to the kids about difficult things and the benefit of doing that in the car. Yeah, well, they're a captive audience.
[00:01:44] Yes. You know, somebody said to me that they're sick of always hearing the bad stories about parenting. You know, how kids ruin your lives and you start to need a drink at 3:00 in the afternoon. And I thought actually that that is so true. You look at our Instagram feed, it's full of like how difficult it is. And really an object objective for that blog or that article is to actually just talk about the light, fun things that happen and and say, yeah, this is the third article, so if you are in our region at all. Pick up a copy of the uncover put together by the Lucy. Brilliant. Lucy does such a good job.
Patrick [00:02:18] Okay. So late pregnancy symptoms. I've been looking forward to this one because I get this all the time and it's nice to be able to reassure people who are listening here that a lot of it's normal. Doesn't mean there's nothing you can do about it. We'll talk about some of the things you can do about it, but it's really good to know in advance that a lot of what's going on is just normal and some of it seems weird and wonderful. But it is actually just a routine part of late pregnancy.
Brigid [00:02:43] I want to start somebody reminded me on our Instagram community there are some good benefits to late pregnancy. Which of those? Well, this poster said good thick hair with lots of lustre. Some people got good skin. Good skin. Yeah. Yeah, some people don't. But we'll get onto the strong nails. Yeah. Yeah.
Patrick [00:03:04] Well some people have the opposite.
Brigid [00:03:04] That's true isn't it.
Patrick [00:03:07] Listen to me all negative. Yeah. Yeah.
Brigid [00:03:09] This is the good part! Yeah.
Patrick [00:03:11] So you might get good hair, good skin, good nails.
Brigid [00:03:13] Got bigger boobs.
Patrick [00:03:15] Oh yeah. Yeah, yeah. Yeah. For people that start off as a A there's some times once you get to the end of your pregnancy you think hang on. They're pretty good.
Brigid [00:03:24] I like they found big boobs moving right along with sleeplessness.
Patrick [00:03:31] Okay. These are the not so good symptoms that in late pregnancy sleep listeners like that just seems like a cruel twist doesn't it? Yes. But when you most needed to calm, you know that you can't get it. And the amount of times people said to me, it's just preparing you for when your baby's born like that doesn't help.
Patrick [00:03:49] Yeah. Yeah. I think that's like punching yourself in the face to prepare yourself for all the future punches in the face. So don't make any sense at all.
Brigid [00:04:00] Yeah. But insomnia is real. I remember with my fourth oh my gosh. When I really needed sleep, I was awake between, you know, 2:00 am to 4:00 AM and it was just so harsh.
Patrick [00:04:12] Yes. And it's not just the foetal movements or the full bladder. People report just that they they can't sleep. So normally, if someone who can't sleep, who isn't pregnant goes to the doctor to talk about insomnia or sleeplessness, then the standard medical advice would be to say to that person, for God's sake, don't sleep in the daytime, you know, because you want to be tired at night and sleep and sleep better. Pregnancy is a little bit different because we know that there's a hormonal basis to the sleeplessness and that that's going to end at the end of the pregnancy when the baby's out or more accurately, when the when the placenta is out, then because there's an end to it, it actually does make sense to sleep in the daytime. We'll just leave whenever you can.
Brigid [00:04:53] Yeah, and not big naps either. Now, you might be rejuvenated after a 10, 15 minute power nap.
Patrick [00:04:58] The power nap. Yeah. So a lot of my patients who who are still working, maybe they're 32 weeks. They're still going to work another month. They're starved all the time. They'll come home from work. Ideally, this is someone having their first baby so they don't have other kids look out when they get home and they'll have 10, 15, 20 minutes on the couch and they'll get up, have dinner, the rest of the day. And then, yeah, then I think go to sleep. You know, even a quick catnap at lunchtime, if that's possible for people to have. I don't think that's unreasonable. It's not only the best sleeping habits because we know there's an end coming.
Brigid [00:05:31] That's. Yeah. And your body just needs it. It's. I really feel the lag coming. For me it's about 2 p.m., and that's when I used to have a little little nap. I could have been 10 am too. It really didn't matter. By the time. Yeah.
Patrick [00:05:45] And if you wake up in the middle of the night and it's for no reason like that, your bladder is empty and the baby is not jumping everywhere and you just can't go back to sleep. This is the effect of placental hormones on this thing in your brain stem called the Sleep Wake Centre, which helps you go to sleep and wake you up again in the morning, and it's nothing you can really do about that. But women in advanced pregnancy have still got waves to the sleep. It's a cyclical sleep and the depth of sleep still comes and goes during the night. So the sleep experts would say that you should try and catch the next wave. Yeah. So if you're awake and if you're lying there awake, one of the most common things to do is to start worrying about general worries, worries related to the pregnancy or how you're going to cope the next day if you don't get some sleep. Yes. Oh, my gosh. So what they say is to get up out of bed and go and do something that is not too stimulating, not too interesting. And that takes about 20 minutes and then get back into bed with minimal stimulation and try and catch the next wave through to sleep again.
Brigid [00:06:49] I am troubled by insomnia. And the things that I find really useful is don't turn on the lights. If you're going to get up. Yeah. If it's safe to do so, please don't bump your belly into things because it's dark. But if it's safe to do so, don't turn on the lights. Go to the toilet. Have a drink of water. Do some breathing exercises. Come back to bed. And that generally works for me. And the other thing is being comfortable in bed, having a pillow is gold that you can either look at one of those big body pillows or one that you can put in between your knees just to make sure that you're not waking up because you're uncomfortable. Yeah. All right. So onto our next issue in late pregnancy. And this is one I definitely had, which was various veins. No, I didn't. My older sisters and my mum. Well, there was two older sisters and mum all had terrible varicose veins in their legs. I didn't get those. I got haemorrhoids.
Patrick [00:07:46] So varicose veins, haemorrhoids. And the thing called vulval varicosities.
Brigid [00:07:53] Oh, my God. What are they?
Patrick [00:07:54] Well, that's varicose veins around the vaginal opening around the vulval, within the labia. And that's that's a pregnancy only phenomenon pretty much. But yeah, it's tough. So they're all kind of the same thing. Dilated veins from the effect of pregnancy hormones on the valves within the veins. Yeah. And whilst the varicose on your legs, the best thing for those is compression. So as soon as you even ideally before you get it right in the morning, before the veins have a chance to fill up and start getting sore, you'll put on whatever compression that you've got.
Brigid [00:08:28] Now are those TED stockings. Those white stockings. Yeah.
Patrick [00:08:30] Ted stockings. Good. There's also some brand name products that are like exercise shorts and all of them try to grip. They've got some elasticity and grip in them. Yeah. And they provide some pressure back on the vein to stop it filling up and getting really sore because they're mostly sore when they're full of blood. Yeah. Yeah. So for the vulval varicosities it's hard to compress the vulva. It's much easier to compress your ankles. So the things that you have to do is either wear your tightest undies with a couple of pads inside to really push back against the vulva or some of those pregnancy shorts. Yeah. But will also provide compression in that area. But that's all.
Brigid [00:09:13] Or does the vulval varicose? Is that a problem during the actual labour and the delivery.
Patrick [00:09:18] Not really. Then they're not they're usually not huge. I've seen some huge ones but they're usually not huge, but they're soft. You know, they retract normally as the head comes out and they tend to all go don't they.
Brigid [00:09:31] Apart from maybe the Varicose veins in your legs.
Patrick [00:09:34] But yeah, the veins in your legs will usually get better. Yeah, but if you're prone to varicose veins, mostly from family history, then they'll be back the next time you're pregnant and they'll be back next time your pregnant and they'll often stick around after you've had your last baby. Obviously the treatment for that long term, the best treatment is surgery, but we don't get people to get their veins treated until they've had all their babies or their babies because it just might come back. It'll come back. Yeah. Yes. If you spend all your money, time on it on a good focus for its operation and have another baby, they'll come back. Yeah. Yeah. So go off to friendly vascular surgeon once once you're done with babies.
Brigid [00:10:06] Yes. Yeah. And then because I can be really painful. I know both my sisters have a lot of pain from their varicose veins and you know, that makes mum and the two sisters, they've all had surgery now. Yeah.
Patrick [00:10:18] So the Vulval varicosities just go away when you when you're not pregnant. And I've never seen those. Stick around after the last baby and haemorrhoids are similar. Some people have just got him age anyway. But if you get them only because you're pregnant, then I'll probably go away again. Between pregnancies. And after your last baby is done and there's some cream and stuff. Absolutely, yes. So the haemorrhoid creams are safe and there's some good ones that look got a mixture of a little bit of local anaesthetic and a little bit of cortisone in them. And they shrink a bit and make them a lot less painful.
Patrick [00:10:51] So what most women do with haemorrhoids in pregnancy is nothing. If they're not painful or bleeding and if they're painful or bleeding, then we start with simple things like the creams. Yeah. And there's a fair bit of putting up with it, sitting on haemorrhoid cushions and so forth. And occasionally, you know, if they get really bad, we'll get an opinion from a colorectal surgeon or a haemorrhoid specialist and they'll say, wait, until your baby comes.
Brigid [00:11:18] Yes. Yeah. Yeah. I can't imagine having any sort of surgery on something like that.
Patrick [00:11:21] No, it doesn't make any sense when there's a when there's a natural cure for just around the corner. And so there's there's a fair bit of putting up with bad cases until the baby comes and then we reassess afterwards. Typically, it's much better.
Brigid [00:11:32] And it's a lot of being conscious of the fact that maybe you need to have a rest or maybe you need to just have a lie down and take some of that pressure off the valves. Yeah. Yeah. All right. One thing that definitely had which you sort of forget about, seriously forget about, then that's headaches. Yeah. Most of my well I think all four pregnancies. Just the constant headache.
Patrick [00:11:55] Yeah. So this is near universal. Yeah. So. So headache in pregnancy it's under underrated. Not everyone knows about it, but it's just about everyone gets it. It's thought to be times during the pregnancy when home when placental hormone output is higher, probably progesterone and they cause headaches.
Brigid [00:12:16] And how do I know if they're just normal or that they're worse than they're signifying something else?
Patrick [00:12:21] Yes. So pregnancy headaches can be severe, but should still respond to usual things that you might do for a headache like a couple of panadol and a lie down. Yes. And headache as a severe symptom is if it's happening as part of pre-eclampsia. Okay. So if someone, for example, is known to have high blood pressure, but that's all. But then suddenly gets a headache that severe, persistent associated with blurred vision, then that headache can be part of the development of preeclampsia. And that's that's much more serious.
Brigid [00:12:55] I find it really hard when when health care provider says something severe. How do I judge that? It's so subjective.
Patrick [00:13:03] OK, it is. But I think that to help the patient, to know what you mean, you say if it has if it responds to none of the usual things that you do. Okay. Okay. So two panadol. No difference Had a sleep no difference. In fact, over the last six hours began worse. And despite all those things and now I've got some blurred vision. Well, this is not a standard pregnancy headache.
Brigid [00:13:26] What about those women that suffer from migraines? Are they worse or better during pregnancy?
Patrick [00:13:33] Some were some better. I think so. Well, no.
Patrick [00:13:37] Know that there's with some people like you look at some people's asthma, some get better, some of the same, some worse. But I again, with migraines, migraines should run true to form in an individual. So they should be the same old migraines that that woman knows and loves.
Brigid [00:13:51] So she'll be able to distinguish between a pre-eclampsia headache and a migraine headache.
Patrick [00:13:56] Typically, she would. Yes. If it was exactly the same as every other migraine she'd ever had, then she would say it's just my migraines. I'll try treat it in whatever way we've discussed. But a severe headache that was very different. No. Yeah, that checked out.
Brigid [00:14:09] And for headaches. Is it only Panadol I can take?
Patrick [00:14:13] Yeah. We'd like people to steer clear of anti inflammatories in pregnancy. Certainly a dose or two probably does nothing bad but consistent use of anit-inflammatory in pregnancy is best avoided. And paracetamol safety protocol in pregnancy is pretty good. So a lot of people like taking nothing. You know, the first thing we should be reaching for if we're going to treat mild to moderate pain is probably paracetamol.
Brigid [00:14:36] I also love like if I can is I really do love lavender for headaches. I'm just weighing in on the essential oils, which I love that. And then the the cooling eye patch that you can put on your eyes and just have a lie down with the lavender and just sort of, you know, give yourself a break. Give yourself a rest if you can.
Patrick [00:14:56] Absolutely. So if those things are working and working nicely, that's fine. But a headache that's persistent, severe needs attention.
Brigid [00:15:03] Yes. All right. Another favourite that came up a lot on now Instagram post was urinary frequency. Yes. Weeing a lot.
Patrick [00:15:11] Yes. So that's obviously perfectly normal. Our bladders are not very good at knowing the difference between being full or being externally compressed.
Brigid [00:15:19] Is that what it is? Because, you know, you can go. And then like a minute later you feel like going again. It's because the baby's pressing on the bladder. Exactly.
Patrick [00:15:27] Yes. So if a foot or a head squishes firmly on the bladder in the third trimester, you'll feel like you need to go. Even if you don't really. In terms of the volume that's in the bladder, you might go on as a disappointing volume when you go, well, that was fun, go back to bed. And then there's incontinence. So the valves dont work quite as well either. So some women in advance pregnancy will leak if they cough or sneeze, but only then when they're not pregnant, the valves working fine.
Brigid [00:15:52] And is that okay or am I getting some treatment if I'm doing that?
Patrick [00:15:56] Well, it's one of the reasons why I think everyone should see a pelvic floor physiotherapist during pregnancy. You know, like all my private patients to do that because because we've got one who works with us at the rooms, but because it's just so valuable, even if your incontinence in pregnancy was going to resolve, you haven't wasted your time by going to the physio because they're going to teach you a pelvic floor technique to strengthen the bladder outlet that will last you the rest of your life. Yeah.
Brigid [00:16:21] And I I'm a big fan of this because actually when I went and had my visit with Belinda I actually worked out, we worked out together that I was doing my pelvic floor exercises incorrectly. Yes. I was actually pushing down rather than zipping up. And I actually needed to kind of retrain my brain, really, to get which muscle I needed to pull where and Belinda really helped me to do that.
Patrick [00:16:44] That's right. So doing the pelvic floor exercises incorrectly is probably not terribly helpful at all. And worst case scenario might be making it worse. Yeah. And doing gym work, that's not good for your pelvic floor. It might mean making you worse. So a good pelvic floor consultation with the pelvic floor physiotherapist doesn't only cover how to get that muscle, that keeps pelvic floor strong how to actually had to actually exercise it. But also how to get the most out the gym, you know how to even crazy things like the correct position to be sitting on. That's right. On the toilet. Yeah. Yeah, yeah. So we should have a little platform so our feet can sit higher.
Brigid [00:17:25] Oh yeah that's right. Yeah. Yeah. We've got a little platform. It's there in the boys bathroom is something for them to think that so they can reach that well or brush their teeth. That's what they think it's there for. But anyway, keeping on the wee theme. What about UTIs.
Patrick [00:17:42] So yep. UTIs are different. If you've got a little bit of bladder urgency or some little bit of stress incontinence that's one thing. If you've got decent symptoms of a UTI. That's like burning or stinging when you urinate or lots of frequency. That's different because a proper UTI is associated with an increased risk of premature labour. So it's gotta be treated.
Brigid [00:18:00] What's that setting off?
Patrick [00:18:01] Or just the bladder and the body's right next door to the uterus. And if the bladder is all inflamed and sore, then the uterus gets irritable and start to labour. Wow. Plus, if you get a very bad UTI with pyelonephritis infection that spreads out towards the kidneys, then that can cause an infection that can trigger labour as well.
Brigid [00:18:17] And I realize we've used an acronym. So UTI, I stands for?
Patrick [00:18:21] Urinary tract infection.
Brigid [00:18:23] And, what do I do? I go in and I see my doctor?
Patrick [00:18:27] Yeah. So you just get a dipstick done through the doc or midwife or wherever you're being cared for and they will diagnose the UTI with a high degree of certainty off the stick, but also send urine off culture in the laboratory and we can start treatment. And then the culture result comes in after a couple of days and confirms that the antibiotic that we started is the right one.
Brigid [00:18:47] It's so funny, isn't it, because with UTIs I could probably take a wild guess and say that every woman listening to this podcast has probably had at least one in their life. Yeah, and they're a real nuisance. And you sort of go God, now I've got to find a GP that's open. Now I've got to find a chemist that's open because normally it's happening in the middle of the night.
Patrick [00:19:04] Yeah, some anti-social hours.
Patrick [00:19:06] And the other thing in pregnancy is they don't always cause the typical symptoms. All right. So if you ever wonder why we're taking checking people's urine at the drop of a hat. Yeah. One of the reasons why is that we want to make sure people don't have UTIs because in pregnancy, the symptoms are not always the classical ones.
Brigid [00:19:20] Right. So, you know, in non pregnancy, I would think of it as a nuisance. But actually, you've got to ramp that up a bit. It is an issue that you've got to get onto pretty much straight away.
Patrick [00:19:30] Yes, absolutely. Got to take that very seriously. Oh, good.
Brigid [00:19:35] And I should have done this one first. But thirst, that's causing the excessive weeing. But, you know, because you're drinking all the time that I remember feeling that nothing would quench my first year. I just needed to drink and drink and drink. It's just you know, it's not it's not just me. Other people said that. What I found was that I needed to work out what it was that my body needed. And sometimes it was to suck ice. And at some stage, I needed warm water, not super cold water. So it just sort of like I needed to work out what it was that would actually slake my thirst. You are looking at me as if I'm weird. It's a thing!
Patrick [00:20:14] No, no, no, no. I think it's just a manageable amount so that you don't cause the other problem by filling a bladder up to me. That's true. Indigestion, reflux, heartburn. Oh yeah. Another massively common one. Yeah. Yeah.
Patrick [00:20:28] So the hormones from the pregnancy affect the valve in our stomach. And also, the growing uterus starts to actually compress the stomach, especially in the third trimester, so that acid that would normally be down the stomach can get pushed up the other way. Problems, it can be minor. Just the odd sort of nasty, acidic taste in the back of the mouth. Right up to someone with pretty severe problems. Thankfully, we can treat it. So. So some of the anti reflux medications are safe for use in pregnancy.
Brigid [00:21:01] What are we talking there?
Patrick [00:21:03] We used to be ranitidine a fair bit, but a bit hard to get that now. So some other drugs, primazole and so forth, have a good pregnancy rating for our safety rating for brains.
Brigid [00:21:12] You need a prescription to get that?
Patrick [00:21:14] Yeah, but you can get antacids and we really tend to start with those. So the liquids that you drink or the ones that you chew are.
Brigid [00:21:22] So like Mylanta?
Patrick [00:21:24] So if there are enough then then that's fine enough.
Brigid [00:21:28] Is too much of that too much?
Patrick [00:21:30] Well, I think if you're using if you're using, say, a dose each day or something, but it seems to absolutely do the trick. That's okay. But we want people who are using that treatment and it's getting them nowhere to come and talk to us because some of the bigger gun drugs are actually, say, for use in pregnancy.
Brigid [00:21:44] Yeah, right. I also felt that, you know, sometimes it's positioning, too. So it would remind me that to sit up straight and.
Patrick [00:21:52] What you eat too.
Patrick [00:21:54] Yeah, I think that's really important because some people it's about certain food that's tipping them off. And you can that can be avoided.
Brigid [00:22:04] Yeah. I can't remember. But I do think it was sort of like a lot of bread. And if I had a big meal, that's the other thing. Like if you if you're really thinking that you're starving, hungry and you look at a big plate and you want to eat all of that and you know, the end result will be that you'll have a little bit of a reflux, heartburn, indigestion. Yes. Small mouthfuls, small small plate falls. All right. So this one I've put in because of my previous history. So I don't know if we've actually mentioned this before, but I actually started my career as a podiatrist and someone on my list put cracked heals. Yeah. Yeah. And look, it is it is really common. And I think one of the problems is, is because we want to feel comfortable in our shoes. So we put on flip flops, thongs, slide ons that don't have backs in them. And actually what that is doing is every step that you're taking the fat pad around your heel is actually squishing out over the shoe. So to really solve that problem is to put some lace ups, something with a heel counter. And at night you can obviously put creams on and stuff. And I know it's tricky, isn't it? It's getting down, doing those laces up. But that's what you're partners for.
Patrick [00:23:13] Bleeding gums, you know, normal. No. Yeah. So another I'm not sure the exact way the pathology works on this, but it'll be something to do with the effect of placental hormones on the gums and. Yeah, normal. I don't see people who are troubled by this every day, but certainly people who report it from time to time.
Brigid [00:23:37] And it's worth sort of mentioning here though, is don't avoid your dentist.
Patrick [00:23:41] Yeah, absolutely. So if you want to get a review from the dentist. Absolutely. And we encourage everybody who's leading into their first pregnancy if they're organized enough, go to the dentist first. Often I'll get phone calls from people saying I need dental treatment, during pregnancy. Is that is it safe? Yes, it is. But also, the risk of not treating yourself is worse. So infections that get in through a really bad tooth cavity can trigger pre labour. Yeah. So you are better off getting that treatment. And dentists are very good at asking for advice if they need to liaise with the obstetrician. So if you got some bleeding gums, by all means, you know, get it checked out. But it's probably a pregnancy phenomenon. And don't stop brushing your teeth, even if brushing your teeth is causing the bleeding games. You got to rub them like you love them. Yes, it's better to. It's better to look after your teeth and make sure that you don't get holes in the teeth that can let infection in.
Brigid [00:24:37] Yeah. Don't get too vigorous. Like just, you know, you've got to do good teeth brushing. Morning and night. And you just know that that's gonna be part and parcel. But yes, I remember with the third pregnancy, I had to have a wisdom tooth pulled out. You remember that? Yeah. And I think I would have been about 30 weeks or so.
Patrick [00:24:56] Perfect example. Yeah. Are there risks to being treated? Not many. Are there risks to not being treated? Tons. Yeah.
Brigid [00:25:02] Yeah. So I just did have to take some antibiotics, just as some to be careful. And so I suppose that's just in consultation with your health care provider and your dentist. Yeah. All right. So a lot of people said that they just get this sort of cramping pain, pain, that it goes from their lower tummy down their legs or Braxton Hicks or. Yeah, yeah. Yeah.
Patrick [00:25:24] Just so you feel for people don't you. Cramping abdominal pain, you know, can be perfectly normal in pregnancy. You've got an organ that's going from a golf ball to a watermelon and that can hurt. Then all of the ligaments within the pelvis are trying to hold that pregnancy up and that hurts. Braxton Hicks of course are a special thing. They are a form of contraction of the uterus thought to be the uterus, trying to keep some tone in itself in preparation for the big day. And they that's a special type of sort of moving pelvic pain that moves through the through the uterus and are said to run true to form in any one individual. So if you think it's a Braxton Hicks. Then next day and get another one the same. And they're always the same. Then then that's what they'll be. So I often say to people, if you get something totally different, you kind of say, that's my question takes because they're supposed to be the same. Yeah, you're one woman's might be different to another woman's, but that woman's own one should always be the same. So if it's something totally different. I think well hang on a minute, this could be labour. You better start concentrating on it, mapping the pain out and maybe calling my mike carers.
Brigid [00:26:33] Yeah, we definitely need to do a podcast on what's early labour. What? How do I know? How do I know I'm in labour? Yeah. For sure. So what about the woman that gets sharp pain.
Patrick [00:26:43] Yeah. Like this. Like someone's put a knife in my vagina. Stella. Yeah. Yep. So again, that's thought to be a form of ligament pain in pregnancy where we're one of the ligaments that holds the uterus up is sort of in spasm. And I think that we want to see that for what it is. It can be very severe and very sharp, but ultimately not dangerous. And I encourage people to look for any other signs of anything that's going on. Like, do we have pain that's persistent, that's getting worse, that's associated with other problems, vaginal bleeding, decreased foetal movements. Without those things, we check it out.
Patrick [00:27:19] Yeah, but none of those things we observe for a little bit because they seem sort of sporadic, like, you know, you could be just standing and talking to somebody and all of a sudden you get a sharp pain. You know, I could just imagine your baby's sort of getting in the way of something or. Yeah.
Patrick [00:27:32] So it can be severe, but ultimately not dangerous. But if it's persistent, very severe or associated with other things, that needs needs checking out.
Brigid [00:27:43] So the next one is carpal tunnel. And I'm very grateful that I didn't have this because I think it would really slow you down, particularly if you've got a toddler at home as well. What is carpal tunnel syndrome?
Patrick [00:27:53] Carpal tunnel syndrome, which you get if you're pregnant or not pregnant, refers to compression of the median nerve as it comes down through your wrist, into the into your hand. And the nerve actually runs through this little tunnel in the wrist bones. And it's liable to getting compressed at that point. And it gives you a hand that can be painful. Pins and needles and sometimes a bit weak. Yeah, right. And most people who get carpal tunnel syndrome are older people with arthritis where the little spurs of arthritis on the wrist bones are compressing the nerve and that can be fixed with an operation. But in pregnancy, it's swollen wrists that are doing it. So if your wrists swell as well as your ankles, you can't really see it on the wrist. So your ankles get a lot of swelling because we walk around standing up and you know, you can push and you can push into your ankles and leave a fingerprint and that swelling is in your wrist as well, but harder to see.
Patrick [00:28:48] But down around the median nerve, there can be easily enough compression to give you a temporary pregnancy related hormonal carpal tunnel syndrome.
Brigid [00:28:58] And so what can I do about that? Yeah, it's difficult. Some people recommend, you know, bracing the wrist. I think that's probably more successful, to be honest, in the older person with arthritis than it is in the pregnant person because they're not really addressing the underlying cause. But some people have had some benefit with bracing, but it doesn't stack up all that well as a treatment. Massage can be a little bit useful. It's hard to shift the fluid from exactly where it needs shifting. Elevation works to drain fluid out of your arms if you put him up in the air. But people will often complain of this at night-time and the minute you're asleep, your arms are gonna fall back down by your side. So again, it's difficult. So acupuncture has got a reasonable effect and I certainly encourage people to give that a try. And then the pain relief. Yeah, but there's like Panadol or. Yeah, but there's a lot of, you know, cold compress like like ice pack on the wrist. But there's a lot of putting up with that one. Yeah. Like a lot of these. Yeah. They involve a fair bit of put up with it and certainly a mild to moderate case of carpal tunnel is a lot of soldiering, oh poor things.
Brigid [00:30:10] And then does it go immediately after you have the baby like that.
Patrick [00:30:13] Yeah. It takes a few days but the fluid. Yeah. So once the placenta is out of your body, good circulation returns to normal. The excess fluid that you've been holding on to gets recirculated and you weigh it out. And women will often report 3, 4, 5 days after a baby comes. They're doing a much bigger ways than they would expect. And that's the extra fluid just coming out of your body.
Patrick [00:30:33] Now, commenters actually said it took about three months for her to have relief from carpal tunnel. Yeah, that's nasty. Yeah, because it does it does complicate. Imagine trying to hold the baby while you're trying to get positioning, right. For feeding and you've got hands that are sore and painful. Gonna be tough. All right. So you've mentioned ankles or like cankles. Yeah, I definitely had cankles there.
Patrick [00:30:59] So, you know, it's this one's tricky because it can be totally normal. Yeah. To have some fluid around the ankles in pregnancy. But it can also be part of a preeclampsia type situation. So when we see pregnant women in the clinic, we check out the ankles. And if there's a decent amount of swelling, first thing we're doing, of course, is checking for the other signs of preeclampsia, like, um, like high blood pressure and protein in the urine. But if you don't have either of those things and it's just the swelling. Yeah, that's not preeclampsia. That's just swollen ankles cause you're pregnant.
Brigid [00:31:27] Yeah. And that for me went immediately after having a baby.
Patrick [00:31:31] Starts within hours. Yeah. It's often all gone within days. Yeah. And you can start seeing your ankles again. The bones. It's all good to get back to normal. Yeah.
Patrick [00:31:39] So important for people to realize that that is usually normal but can be significant if it's getting suddenly worse. Yeah. And that compression helps. So you know, compression with those tight same things like for the veins, and elevation helps. Yeah. Yeah. So if you if your ankles if your legs are sore because they're swollen, if you lie down and put your feet up the wall and some you'll get some relief from from gravity.
Patrick [00:32:03] Yep. And that's a feeling of feeling tight all over. Like, you know you've just got fluid everywhere and it feels quite uncomfortable, particularly towards the end, 38, 39 weeks.
Patrick [00:32:14] These are the crunch time at the end. We just have to keep soldiering on and people come in and say to you, I just want to have the baby. So one thing that I definitely had in the fourth pregnancy was pelvic instability, some pubic synthesis disorder.
Patrick [00:32:30] So, again, I think this is near universal to get to get some pelvic musculoskeletal pelvic pain. Yeah. And, you know, I'm always worried about people who report that in the second trimester. You know, they're reporting that by 20 weeks. And I'm like, well, because we are not nearly there. Yeah, yeah. We've got a long way to go. Yeah. Yeah. So the answer is pregnancy physiotherapy. Yeah. And through a good pregnancy physiotherapist, an exercise program concentrating on stability and flexibility in the middle third of your body.
Brigid [00:33:03] Yeah. Like Pilates.
Patrick [00:33:04] Pilates is great. Yeah. Water aerobics is great. Yeah. Yoga. Yes. Great. Things that keep the middle third of your body flexible and so that not only do you get less pain but you go better in labour.
Brigid [00:33:17] Yeah. And I'm gonna go back to the pillow between your legs when you're sleeping as well. But for me was something that really, Belinda, again our physio recommended and it was it was a bit of a game changer. Yeah. When I side with my side with a pillow between my legs. Definitely. And also Belinda also said, you know, to look after your body by how you're doing, everyday movements sort of like, how you get out of bed. How you push a trolley. And actually, we we filmed a lot of this. So in our GrowMyBaby, so people can actually see what we mean by all of this, because there are just ways that you can protect your posture and that musculoskeletal system.
Patrick [00:33:54] Yes. So the shopping trolley is a classic because even pushing a shopping trolley when you're not pregnant, it's a slightly unusual movement yeah. Bent slightly forward at the hips and with your hands extended in front of you. Yeah. And then because the trolley it's so mind of its own. Well not only that, but it doesn't allow you to swing the leg forward than you normally would. And then add to that a big tummy in front of you and you try to push that thing from behind. It's like you're leaning way forward.
Brigid [00:34:21] So here's a quick tip for everybody. You just have to turn the trolley on the side and have one hand on the end of the trolley and one my hand on the front of the trolley and push it sideways and walk next to. Yep, yep. Next to it. All right. So we're up to shortness of breath.
Patrick [00:34:35] Yes. So shortness of breath is an interesting one. There's two mechanisms for this. One is that some of those placental hormones creator a feeling sometimes that you just can't quite get your breath no matter no matter what. And that could be a little bit distressing for people, but is ultimately harmless. And it passes, sometimes you very aware of it and other times not at all. And then, of course, there's a literal compression of the lungs that happens when you've got a big full term tummy and it's just hard to fully inflate those lungs. And both of those are harmless things. Sudden onset, severe shortness of breath is never harmless. Right. That can be a blood clot on your lungs that needs to be checked out. But vague shortness of breath throughout at any time, throughout pregnancy is usually completely normal.
Brigid [00:35:27] Yeah. Blood noses. I had a couple of blood noses. Not many, but some people suffer a lot with blood noses.
Patrick [00:35:34] Yet another one of placental hormones that dries out the mucous membranes in the nose. And they're more likely to bleed and get sinusitis and sinusitis. So the bleeding will happen from time to time. It just needs you to lean forward and pinch the soft part of your nose near the nostrils and it'll it'll stop.
Brigid [00:35:58] Should I be worried if I'm having a really bad blood nose?
Patrick [00:36:02] The treatment's the same. Lean forward. Squeeze the soft part of your nose. And if if it's very severe in one stop, you go the hospital emergency department, they'll fix it. And in people with really no recurrent bleeding, things like that, we often check their blood clotting and platelet levels and so forth. But usually it's just that the mucous membranes of the nose have become very dry as a reaction to pregnancy hormones. And then the sinusitis, people tell me they've got hay fever for the first ever time. And it's usually a combination of actual hay fever, but also that the mucous membranes are dry from the pregnancy and you can use most of the usual treatments. So steam inhalation. Yes. Saline nasal spray. Yes. And even the cortisone based nasal spray. Oh, really? Yeah. So they're safe for pregnancy. And you can just you can give it a spray of those and it helps. It really helps to settle things down. Again, like most things in pregnancy. It only bother using a drug, even a safe one if the problem was significant and persistent.
Brigid [00:37:01] Yeah. And can you take Panadol too? If you had a like a sinusitis headache? You can. Yeah, but that's it. You couldn't take any of the telfast etc.
Patrick [00:37:08] So I know most of those have got big problems. So the ones that are safe for pregnancy are the old fashioned sedating antihistamines, which we sometimes use in pregnancy for other reasons. But they they're very sedating. Right. The old style antihistamines and then the new ones. We don't know enough about the pregnancy safety of those. The non sedating ones. Yeah. So the best of all at best avoided.
Brigid [00:37:35] All right. So our next on his weight gain and that seems obvious.
Patrick [00:37:40] Yeah, you're suppose to gain some! Yeah. Yeah.
Patrick [00:37:42] So one thing that I really try to do with my patients, especially someone who has a weight issue to start with, and I say weight issue in too small or too big. And that is that it's really, really good to have a plan for the pregnancy. And I don't think we can expect a lot of success if we just say to people, what something vague, you know, watch what you eat or watch your weight. Yeah, but we need some data, maybe something helpful, some targets and something helpful. Exactly. So it depends what your weight is when you come into the pregnancy. And I use a little calculator. The World Health Organization have produced, which you can you can easily Google World Health Organization, pregnancy, weight gain. And it's a little counter that says if you come into the pregnancy weighing blah, blah, blah, then a reasonable, healthy amount of weight gain is blah blah blah. Yeah. Okay. And obviously, if someone comes in underweight, then it allows for a much higher amount of weight gain. And if someone comes in overweight, then it's a modest amount of weight gain. Roughly what we'd be looking for would be for an overweight woman in pregnancy for her to weigh the same or less at the end. Once you subtract subtracted the baby, the water and the placenta and the big uterus. So it says, okay, if you gain six to nine kilos and most of that is pregnancy, then your own actual body weight has stayed pretty stable for the duration.
Brigid [00:39:08] Yeah. Because it does, you know, there's complications either side isn't there. The optimal range is normal healthy weight.
Patrick [00:39:16] Yeah, that's right. So we don't see too many people in the community who are dangerously underweight in pregnancy, but occasionally and that's something that needs to be taken very seriously. But much more common. We're dealing with people who are mild to moderately to severely overweight. And it's not a little thing. There's some it really affects pregnancy outcomes. So we take seriously and manage it with some lifestyle advice, some dietary advice and some exercise. Yes.
Brigid [00:39:46] All right. Well, on our again, our Instagram feed, which I keep mentioning. But I mean, say that it's at grow. Underscore my underscore, baby, our lovely friend said about itching. Yeah. What? What sort of itching is a problem and what is it?
Patrick [00:40:02] Yeah. So there's a few different things that can cause itching. So some people just get itching related to the development of, you know, sort of a mild itching related to the development of some stretch marks. Yes. Yes. And but severe itch in pregnancy is not normal. And there's a couple of conditions that severe itch can indicate and they need to be checked out once a thing called cholestasis of pregnancy, which is where you liver is not working properly when you're pregnant. And it can be serious. And sometimes it will present with a severe and persistent itch and some blood test and some treatment if you've got it. And then there's another thing called PUPPS, which has a rash on your belly that's itchy and PUPPS rashes can also be associated with some problems in pregnancy. But the main thing about it is it's intensely itchy and very irritating and it can respond to cortisone cream. So that's what we can actually treat. You just put it on your tummy like topical. Yeah, it's got a typical appearance. It's got to raise rash like hives. Yeah. So. So that's different to the the other ones which cause an itch. But the skin looks normal.
Brigid [00:41:06] It all causes of you being itchy have to be investigated. Is that what you're saying? If it's severe and persistent. Yes. OK. The other thing is lactation. Sometimes you can start lactating can't you?
Patrick [00:41:18] Yeah, that's that's actually not always a problem. No, I would. We shouldn't put that on a good symptom. You can be good because it's going to be good for a couple of reasons. One is if it's your first got reassures you that that system is working properly. And that you're going to be a good breastfeeder. If you're already if you're already lactating and baby hasn't even come yet. And the thing that a lot of people do these days start collecting it. So you never know if your baby is really hungry on the first day before the milk comes in, on the second day before the milk comes in, or if there's any sort of expected problem that was going to be born sick or premature and a baby might be in the nursery. And they're saying, look, you know, babies even too sick to get on the breast wouldn't put nasal gastric tube down and give the baby some food. Well, if you've got some thawed frozen breast milk. Fantastic.
Brigid [00:42:01] They're already on to a good start.
Brigid [00:42:04] So just with a little syringe there, like a little syringe and get one from your care or through the from a pharmacy. And as the milk beats up on the nipple, you to suck up in the syringe and then put it into a jar, like a little urine collection jar and freeze it. Yeah. Yeah. Good luck to those some more tomorrow.
Brigid [00:42:21] Yes. And also it doesn't matter if you're not doing that, doesn't indicate that you won't be good breastfeed or either.
Patrick [00:42:27] No, no. It's just like a little bonus that if you if you'd say it's working already, then it's likely it work fine until the baby comes. And then if you don't want it, then minimizing stimulation of the breast makes you make less milk. Yes. So if you wear a looser bra and looser clothes, then you'll make less milk. All right. OK. Constipation Pat. No, I'm fine. Thank you. It's. Yeah. Very common. Yeah. Rare for it to be a major, major, major issue. But you know, mild comfortable and mild to moderate is very common.
Brigid [00:42:59] Your poor old bowel doesn't know which ends up really. Yes.
Patrick [00:43:04] Yes there are two issues. Hormonal and also the baby's taking up all of your abdominal cavity and the bowels are all squished. Really. Yeah. And the bowels are a co tenant in your belly with the growing pregnancy and it's just hard for it to work properly. Yeah. So what do you do? Exercise helps. Yes, dietary fibre helps. Pear juice works just as well as prune juice and taste miles better, Yeah. So you can get pear juice from a supermarket sometimes. So. Or a health food store.
Brigid [00:43:31] Or blend it up yourself. Yeah. And it tastes way nicer and it works just as well. Yeah. And lots of water. Although it's going to cause you got to weigh those up.
Patrick [00:43:43] Also there are some things that help with you about like lactulose or dulcolax or that are safe for use in pregnancy. Yeah. So after discussion with your care providers you can get onto some of those.
Brigid [00:43:55] Yeah, this might be another one like the first where you looked at me strangely. But you know, some people do say that they feel hot all the time. Yeah.
Patrick [00:44:04] That's cause you're hot. So. So your body temperature a little but higher in pregnancy then and then when you're not. Yeah. Right. And that's that's the origin of the old bun in the oven. Oh, throwaway line.
Patrick [00:44:15] You are actually hotter and your heart's beating a bit faster and you're breathing.
Brigid [00:44:20] You've got more blood.
Patrick [00:44:21] You're going about your breathing a bit faster and your, thing called stroke volume. How much how much your heart pumps out with each pump is way high. Right. So you're thumping.
Brigid [00:44:32] Oh yeah. Yeah. Well, take a look at me. Strange. That's right. That's a real thing. OK.
Patrick [00:44:36] And we have one more on our list. And it's a big one. And I think needs it definitely needs its own podcast. But it is the thought of the actual birth process and the fear and the anxiety about that. Plus, you as a mother, you know that that is a real issue for a lot of women, isn't it?
Patrick [00:44:53] Absolutely. And it sometimes it flares up the closer you get to the big day. Yeah. So it's a universal thing for the transition between, especially with your first baby, for that transition from full time working non parent you over into the you that's a parent and initially a full time parent. That is stressful and anxiety provoking and all of those happy feelings about upcoming birth they are not all happy, good feelings. So certainly very that's normal. And when does it become pathological or a disease or a thing that needs treatment. It's when it's I say this whole time, it's when it's a persistent and severe. Yeah. But also when negative feelings when it's only them.
Brigid [00:45:43] Yeah. When you can't find joy in anything. Yeah.
Patrick [00:45:46] So one of the tests for whether someone's just having a bad day or whether they've got depression is do you still find joy in the things that used to give you joy. Yeah. I say to people the time when you think about the future for you and your family, do you feel happy and confident and are you able to enjoy happy activities? And lastly, you have to ask you just have to ask, are you having thoughts about self-harm, harm to the baby or suicide? So unfortunately, just have to ask and get for health care providers gets less and less awkward the more you ask. Yeah.
Brigid [00:46:22] Yeah, but there's you can't not ask it because there's some stats that show that people are more likely to tell their health care provider if they've asked been asked the right questions.
Patrick [00:46:31] Absolutely. Absolutely. So that's been proven over and over again. Also, they are perhaps more likely to speak up in pregnancy about a longstanding undiagnosed mental health condition because they know that it's going to be a big deal to take baby home. Yeah. And suddenly their mental health is for two years. And also because tragically, we lose a handful of women in Australia each year to suicide, of pregnant women, to suicide. Unbelievable. Preventable tragedy because there might have been signs that were missed. Yeah. Yeah.
Brigid [00:47:07] And so what do we do for those women?
Patrick [00:47:09] Well, there's good supports for those women. So if someone's got actual diagnosed depression, anxiety, then it opens the door to mental health plan that can fund a lot of the cost of treatment from a clinical psychologist. Sometimes people need a psychiatrist, especially if they're in the sort of needing medication realm. There's mother baby units when the baby comes so that the mum and baby can go and stay in a mother baby unit for a week or two weeks and get the parenting underway under supervision and assistance and perinatal mental health support services deal with everything from someone who needs somewhere to go for a cup of tea. If they're out walking a baby around and crying right up to someone who needs inpatient mental health support with the full with the full works.
Brigid [00:47:59] Yeah. Yeah. All right. So in our show notes, I'll put some links to different organizations that people can access if they feel like they have lost the joy and feel like they might have an issue. Yeah. Your first port of call, obviously, is to talk to your health care provider. But, you know, there are some other resources on top of that as well. Yeah.
Patrick [00:48:19] So we used to think postnatal depression was a bit random. Yeah. And it turns out it's more predictable than we thought. And if we pay attention to antenatal during the pregnancy risk factors, then we can pick much better who we should be directing resources to. Yeah, right. And that's some that's becoming more standard practice. Yeah, we will. Questionnaires when you book into the hospital. Yes. There are some red flags that mean that you're a bit of a sitting duck for perinatal or postnatal depression. Depression around the birth or after the birth. And there's some that are a bit obvious, like I've had severe depression diagnosed in the past. But there are some that we're only just learning about the significance of like drug and alcohol and family violence. Yeah, right. So those things correlate very strongly with the risk of perinatal and postnatal depression. So we should know about that. So we can start that treatment in advance. Yeah.
Brigid [00:49:18] All right. Well, that was a very long list. Yeah. Might have been even longer than the first trimester list anyway. Now that's it. You know, every woman is different with her symptoms and every pregnancy is different. And even from my own experience, I would say that my first and fourth pregnancy, even though I had my pelvis problems in my fourth pregnancy, I was actually in much better Nick. I looked after myself a little bit better. I made sure that I was exercising. I was running after, you know, three other boys. So that sort of helped in terms of activity.
Patrick [00:49:55] The Magnum a day from the first pregnancy, probably.
Brigid [00:49:58] With that aside, I gave up that, which I think did keep me in not just the Magnum, but other things. But you know that the impact of keeping yourself in good nick throughout the pregnancy can't be understated. Absolutely. Mm hmm. All right. Well, everyone, thank you so much. That was a big list. If we've missed something, we're going to put this post up and just say, hang on a minute, you missed. I don't know. Something that we've never heard of. And we'd like to hear all the gossip with weird, wacky and unusual symptoms in late pregnancy.
[00:50:28] And as always, if you've enjoyed this, please go and rate our podcast. We love. Reading your reviews and we look forward to having you company next week, we'll see you next time.