What to Expect when you are pregnant
What is normal discomfort? When to seek help for symptoms?
In general, minor (less than 2/10) aches and pains that last only for 1-2 days, do not get progressively worse, are manageable with self-stretches, icing and avoiding painful activities, do not require you to see a health care provider. If the pain is greater than a 2/10, or lasts longer than 2 days, or gets progressively worse, or recurs, then you should schedule an appointment to see a healthcare provider. Common areas for problems to arise are the mid and low back, neck, hips and feet. Swelling on one leg or the entire leg is not normal and you should consult with your OBGYN right away. Pain that is worse when you are sedentary like sleeping or lying down is not normal and you should consult with your OBGYN right away. Pregnant women have thicker blood and in rare circumstances, these symptoms can indicate blood clots.
The earlier in the pregnancy that you seek care for a condition, the easier it is to control the discomfort and keep you active during your pregnancy. However, it is never too late to make a difference. If you had any trouble during a previous pregnancy or have a history of a chronic issue, it is very important to start care for it before it gets worse.
Relaxin: the catch 22 hormone
Relaxin is produced in both pregnant and nonpregnant females; it rises to a peak within approximately 14 days of ovulation, and then declines in the absence of pregnancy, resulting in menstruation. This happens for every cycle of a woman’s life. During the first trimester of pregnancy, levels rise. Relaxin’s peak is reached during the 14 weeks of the first trimester and at delivery. It relaxes all soft tissue including all the ligaments and joints of your body. This is very important to allow the birthing canal to widen for the baby to descend through but very challenging for the mother as it creates instability in the feet, knees, hips and back. Your muscles easily get overused trying to make up for the lack of passive support in these areas. Unfortunately, your body does not just snap back into place following the pregnancy. It is a great idea to participate in postnatal rehab in order to regain or develop core and lower extremity stability, especially, before you start to try to exercise to lose the baby weight.
Weight gain guidelines
Proper nutrition can require planning and discipline but so does the wonderful world of parenthood. It is a myth that you need to “eat for two”. You need to eat for one adult and one growing infant. The average woman should gain between 25-35 pounds during her pregnancy. Eating for two “adults” can lead to excessive weight gain and leave you at risk for high blood pressure, increased joint pain, heartburn, a potentially more challenging delivery and the more weight you gain the more you have to lose after your pregnancy.
Ergonomics and Posture
As you progress through the pregnancy it is very common for your shoulders and head to round forward, your pelvis to tilt forward, your hips to rotate inwards and your arches in your feet to drop. This all happens as a result of relaxin production, the subsequent ligamentous laxity and the increase in weight combined with a shift in your center of gravity. It is important to try to maintain a neutral joint position (neutral posture) with the chin and shoulder back and down, the pelvis held in a neutral position by lifting the baby up and back, the feet supported and hips in a neutral position. We recommend using an orthotic for your feet at all times in addition to doing strengthening exercises for the intrinsic muscles of the feet. The less that you allow your joints in your feet to deform the less likely they will cause you problems during and after the pregnancy. A good high semi-rigid custom orthotic is the best, but if that is not an option, then as rigid and high a non-custom orthotic as possible is second best. At a minimum, use a good walking or running shoe as much as possible and avoid high heels and narrow non-supportive pumps. Use a supportive shoe indoors if possible at all times.
If you already practice yoga, or take it up during pregnancy, make sure to focus on doing a short foot (keeing the arch high) while standing at all times. This will help to open up the hips and keep them in a neutral position. In some cases, when you have pain, you should use a supportive shoe with an orthotic during the yoga.