Vaginal bleeding

Bleeding during pregnancy is relatively common, but it can be a dangerous sign, and you should always contact your midwife or GP immediately if it happens to you.

In early pregnancy you might get some perfectly harmless light bleeding, called "spotting". This is when the developing embryo plants itself in the wall of your womb. This often happens around the time that your first period after conception would have been due.

Causes of bleeding in early pregnancy

During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy. However, many women who bleed at this stage of pregnancy go on to have normal and successful pregnancies.

Miscarriage

If a pregnancy ends before the 24th week of pregnancy, it's called a miscarriage. Miscarriages are quite common in the first three months of pregnancy and around one in five confirmed pregnancies ends this way.

Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can be other causes of miscarriage, such as hormone or blood clotting problems.

Most miscarriages occur during the first 12 weeks (three months) of pregnancy and, sadly, most cannot be prevented.

Read about symptoms of a miscarriage

Ectopic pregnancy

Ectopic pregnancies (when a fertilised egg implants outside the womb – for example, in the fallopian tube) can cause bleeding, but are less common than miscarriages.

It's a dangerous condition, because the fertilised egg can't develop properly outside the womb. The egg has to be removed – this can be through an operation or with medicines.

Find out about symptoms of an ectopic pregnancy

Causes of bleeding in late pregnancy

  • Cervical changes – can lead to bleeding, particularly after sex.
  • Vaginal infections  
  • A "show" – when the plug of mucus that has been in the cervix during pregnancy comes away, signalling that the cervix is becoming ready for labour to start. It may happen a few days before contractions start or during labour itself. Find out about the signs of labour.
  • Placental abruption – a serious condition in which the placenta starts to come away from the womb wall. Placental abruption usually causes stomach pain, and this may occur even if there is no bleeding.
  • Low-lying placenta (or placenta praevia) – when the placenta is attached in the lower part of the womb, near to or covering the cervix. Bleeding from a low-lying placenta can be very heavy and put you and your baby at risk. You may be advised to go into hospital for emergency treatment, and usually a caesarean will be recommended.
  • Vasa praevia – a rare condition where the baby's blood vessels run through the membranes covering the cervix. Normally, the blood vessels would be protected within the umbilical cord and the placenta. When your waters break, these vessels may be torn and cause vaginal bleeding. The baby can lose a life-threatening amount of blood. It is very difficult to diagnose vasa praevia, but it may occasionally be identified before birth by an ultrasound scan. Vasa praevia should be suspected if there is bleeding and the baby's heart rate changes suddenly after the rupture of the membranes.  

Finding out the cause of bleeding in pregnancy

To work out what is causing the bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels. Your doctor will also ask you about other symptoms, such as cramp, pain and dizziness. Sometimes the cause of bleeding cannot be found.

If your symptoms are not severe and your baby is not due for a while, you will be monitored and, in some cases, kept in hospital for observation. How long you need to stay in hospital depends on the cause of the bleeding and how many weeks pregnant you are. Being in hospital allows staff to keep an eye on you and your baby, so they can act quickly if there are further problems.

Tiredness and sleep

It's common to feel tired, or even exhausted, during pregnancy, especially in the first 12 weeks.

Hormonal changes at this time can make you feel tired, nauseous and emotional. The only answer is to try to rest as much as possible. Make time to sit with your feet up during the day, and accept any offers of help from colleagues and family. Being tired and run-down can make you feel low. Try to look after your physical health – make sure you eat a healthy diet and get plenty of rest and sleep.

Later on in pregnancy, you may feel tired because of the extra weight you are carrying. Make sure you get plenty of rest. As your bump gets bigger, it can be difficult to get a good night's sleep. You might find it uncomfortable lying down or, just when you get comfortable, you have to get up to go to the loo.

Feeling tired won't harm you or your baby, but it can make life feel more difficult, especially in the early days before you've told people about your pregnancy.

Strange dreams during pregnancy

Some women have strange dreams or nightmares about the baby and about labour and birth. This is normal. Talking about them to your partner or midwife can help you. Remember, just because you dream something, it doesn't mean it's going to happen. Relaxation and breathing techniques may be helpful in reducing any anxiety you might be feeling.

Bump-friendly sleep positions  

Sleep however you feel comfortable. Lying on your back after around 16 weeks of pregnancy can be uncomfortable, and later on can also mean that your womb presses on one of the main blood vessels. This can make you feel faint.

Sleeping on your side might be more comfortable. You can try supporting your bump with pillows, and putting a pillow between your knees. Towards the end of pregnancy, as your bump becomes heavy, you might find it more comfortable to prop yourself up with pillows so that you're almost in a sitting position. Sleeping propped up like this can sometimes help with pregnancy heartburn as well.

Insomnia remedies in pregnancy

Try not to let it bother you if you can't sleep, and don't worry that it will harm your baby – it won't. If you can, nap during the day, and get some early nights during the week. Avoid tea, coffee or cola drinks in the evening, as the caffeine can make it harder to go to sleep.

Try to relax before bedtime so that you're not wide awake. Relaxation techniques may also help. Your antenatal classes may teach relaxation techniques, or you could borrow a relaxation tape, CD or DVD from your library.

You could join an antenatal yoga or pilates class. Make sure the instructor knows that you are pregnant. Exercise can help you to feel less tired, so even if you're feeling tired during the day, try to get some activity, such as a walk at lunchtime or going swimming. If the lack of sleep is bothering you, talk to your partner, a friend, doctor or midwife.

Read about preventing insomnia, including daytime habits such as exercising, and bedtime habits such as avoiding caffeine, alcohol and smoking.

Medical reasons for insomnia in pregnancy

Occasionally, sleeplessness – when accompanied by other symptoms – can be a sign of depression. If you have any of the other symptoms of depression, such as feeling hopeless and losing interest in the things you used to enjoy, speak to your doctor or midwife. There is treatment that can help.

healthtalk.org has videos and written articles of women talking about their symptoms and feelings in the early weeks of pregnancy, including tiredness.

Morning sickness

Nausea and vomiting in pregnancy, also known as morning sickness, is very common in early pregnancy. It's unpleasant, but it doesn't put your baby at any increased risk and usually clears up by weeks 16 to 20 of pregnancy.

Some women get a very severe form of nausea and vomiting called hyperemesis gravidarum (HG), which can be very serious. It needs specialist treatment, sometimes in hospital. Find out more about hyperemesis gravidarum.

With morning sickness, some women are sick (vomit) and some have a feeling of sickness (nausea) without being sick. The term "morning sickness" is misleading. It can affect you at any time of the day or night, and some women feel sick all day long.

It's thought hormonal changes in the first 12 weeks of pregnancy are probably one of the causes of morning sickness.

Symptoms should ease as your pregnancy progresses. In some women, symptoms disappear by the third month of pregnancy. However, some women experience nausea and vomiting for longer than this, and about 1 woman in 10 continues to feel sick after week 20.

How common is morning sickness?

During early pregnancy, nausea, vomiting and tiredness are common symptoms. Around half of all pregnant women experience vomiting, and more than 80% of women (80 out of 100) experience nausea in the first 12 weeks.

People sometimes consider morning sickness a minor inconvenience of pregnancy, but for some women it can have a significant adverse effect on their day-to-day activities and quality of life.

Treatments for morning sickness

If you have morning sickness, your GP or midwife will initially recommend that you try a number of changes to your diet and daily life to help reduce your symptoms. These include:   

  • getting plenty of rest – tiredness can make nausea worse
  • if you feel sick first thing in the morning, give yourself time to get up slowly – if possible, eat something like dry toast or a plain biscuit before you get up
  • drinking plenty of fluids, such as water, and sipping them little and often rather than in large amounts, as this may help prevent vomiting
  • eating small, frequent meals that are high in carbohydrate (such as bread, rice and pasta) and low in fat – most women can manage savoury foods, such as toast, crackers and crispbread, better than sweet or spicy foods
  • eating small amounts of food often rather than several large meals – but don't stop eating
  • eating cold meals rather than hot ones as they don't give off the smell that hot meals often do, which may make you feel sick
  • avoiding foods or smells that make you feel sick
  • avoiding drinks that are cold, tart (sharp) or sweet
  • asking the people close to you for extra support and help – it helps if someone else can cook, but if this isn't possible, go for bland, non-greasy foods, such as baked potatoes or pasta, which are simple to prepare
  • distracting yourself as much as you can – the nausea can get worse the more you think about it
  • wearing comfortable clothes without tight waistbands

If you have severe morning sickness, your doctor or midwife might recommend medication.

Anti-sickness remedies

If your nausea and vomiting is severe and doesn't improve after you make changes to your diet and lifestyle, your GP may recommend a short-term course of an anti-sickness medicine that is safe to use in pregnancy.

This type of medicine is called an antiemetic. The commonly prescribed antiemetics can have side effects. These are rare, but can include muscle twitching.

Some antihistamines (medicines often used to treat allergies such as hay fever) also work as antiemetics. Your doctor might prescribe an antihistamine that is safe to take in pregnancy. See your GP if you would like to consider this form of treatment.

Ginger eases morning sickness

There is some evidence that ginger supplements may help reduce nausea and vomiting. To date, there have not been any reports of adverse effects being caused by taking ginger during pregnancy.

However, ginger products are unlicensed in the UK, so buy them from a reputable source, such as a pharmacy or supermarket. Check with your pharmacist before you use ginger supplements.

Some women find that ginger biscuits or ginger ale can help reduce nausea. You can try different things to see what works for you.

Find out more about vitamins and supplements in pregnancy  

Acupressure might help morning sickness

Acupressure on the wrist may also be effective in reducing symptoms of nausea in pregnancy. Acupressure involves wearing a special band or bracelet on your forearm. Some researchers have suggested that putting pressure on certain parts of the body may cause the brain to release certain chemicals that help reduce nausea and vomiting.

There have been no reports of any serious adverse effects caused by using acupressure during pregnancy, although some women have experienced numbness, pain and swelling in their hands.

When to see a doctor for morning sickness

If you are vomiting and can't keep any food or drink down, there is a chance that you could become dehydrated or malnourished. Contact your GP or midwife immediately if you:   

  • have very dark-coloured urine or do not pass urine for more than eight hours
  • are unable to keep food or fluids down for 24 hours
  • feel severely weak, dizzy or faint when standing up
  • have abdominal (tummy) pain
  • have a high temperature (fever) of 38C (100.4F) or above
  • vomit blood

Urinary tract infections (UTIs) can also cause nausea and vomiting. A UTI is an infection that usually affects the bladder but can spread to the kidneys.

If you have any pain when passing urine or you pass any blood, you may have a urine infection and this will need treatment. Drink plenty of water to dilute your urine and reduce pain. You should contact your GP within 24 hours.

Risk factors for morning sickness

A number of different factors may mean you are more likely to have nausea and vomiting in pregnancy. These include:

  • nausea and vomiting in a previous pregnancy
  • a family history of nausea and vomiting in pregnancy, or morning sickness
  • a history of motion sickness – for example, in a car
  • a history of nausea while using contraceptives that contain oestrogen
  • obesity – where you have a body mass index (BMI) of 30 or more
  • stress
  • multiple pregnancies, such as twins or triplets
  • first pregnancy

Heartburn

Indigestion  also known as dyspepsia  in pregnancy is partly caused by hormonal changes, and in later pregnancy by the growing womb pressing on your stomach. 

As many as eight out of 10 women experience indigestion at some point during their pregnancy. The symptoms of indigestion can include feeling full, feeling sick or nauseous, and burping. The symptoms usually come on after eating food.

Heartburn is a strong, burning pain in the chest caused by stomach acid passing from your stomach into your oesophagus (the tube that leads from your mouth to your stomach). 

You can help ease the discomfort of indigestion and heartburn by making changes to your diet and lifestyle, and there are treatments that are safe to take in pregnancy. Talk to your midwife, GP or pharmacist. You can also find out more by reading this page or clicking on the links to go directly to the relevant information.

Symptoms of indigestion in pregnancy

Symptoms of indigestion and heartburn in pregnancy are the same as for anyone else with the condition. The main symptom is pain or a feeling of discomfort in your chest or stomach. This usually happens soon after eating or drinking, but there can sometimes be a delay between eating a meal and developing indigestion.

You may experience indigestion at any point during your pregnancy, although your symptoms may be more frequent and severe during later pregnancy, from 27 weeks onwards. As well as pain, indigestion may cause:

  • heartburn, a burning sensation caused by acid passing from the stomach into the oesophagus
  • feeling uncomfortable or heavy
  • belching (burping)
  • regurgitation (food coming back up from the stomach)
  • bloating
  • nausea (feeling sick)
  • vomiting (being sick)

Causes of indigestion in pregnancy

The symptoms of indigestion (dyspepsia), including heartburn, are caused by stomach acid coming into contact with the sensitive protective lining (mucosa) of your digestive system.

The stomach acid breaks down the mucosa, which causes irritation and leads to the symptoms of indigestion. When you're pregnant, you are more likely to have indigestion due to: 

  • hormonal changes that your body is going through
  • your growing womb (uterus) pressing on your stomach
  • the relaxing of the lower oesophageal sphincter (ring of muscle) that acts like a gate between your stomach and your oesophagus, allowing stomach acid to leak back up

You may be more likely to get indigestion in pregnancy if:

  • you had indigestion before you were pregnant
  • you have been pregnant before
  • you are in the latter stages of pregnancy

Your GP or midwife will usually be able to diagnose indigestion or heartburn from your symptoms and by asking you some questions. For example, they might ask: 

  • how the symptoms are affecting your day-to-day life
  • what your usual eating habits are
  • if you have tried any treatments already
  • if you experienced indigestion or any other stomach conditions before you were pregnant

Your GP or midwife may also examine your chest and stomach. They may press gently on different areas of your chest and stomach to see whether this is painful.

Treatments for indigestion and heartburn in pregnancy

In some cases, changes to your diet and lifestyle may be enough to control indigestion, particularly if the symptoms are mild.

If you have severe indigestion, or if changes to your diet and lifestyle don't work, your GP or midwife may suggest using medication to help ease your symptoms. Several indigestion medicines are safe to use during pregnancy. However, check with your GP, midwife or pharmacist before taking anything they have not recommended.

The types of medicines that may be prescribed for indigestion and heartburn during pregnancy are:

Antacids

Antacids are a type of medicine that can provide immediate relief from indigestion. They work by neutralising the acid in your stomach (making it less acidic) so that it no longer irritates the protective lining (mucosa) of your digestive system.

Alginates

Some antacids are combined with another type of medicine known as an alginate. This helps relieve indigestion caused by acid reflux. Acid reflux occurs when stomach acid leaks back up into your oesophagus and irritates its protective lining.

Alginates work by forming a foam barrier that floats on the surface of your stomach contents. This keeps stomach acid in your stomach and away from your oesophagus. In most cases, antacids and alginates can effectively control the symptoms of indigestion during pregnancy.

Choice and dosage

A number of antacids are available over-the-counter from your pharmacist without a prescription. Ask your pharmacist for advice about which ones are suitable for you.

You may only need to take antacids and alginates when you start to experience symptoms. In other cases, your GP may recommend that you take these medicines before your symptoms are expected, such as:

  • before a meal
  • before bed

It is safe to use antacids and alginates while you are pregnant as long as you do not take more than the recommended dose. Follow the instructions on the patient information leaflet that comes with the medicine to ensure that you take it correctly. Side effects from antacids are rare, but can include:

Iron supplements

If you are prescribed an antacid medicine and you are also taking iron supplements, do not take them at the same time. Antacids can prevent iron from being properly absorbed by your body. Take your antacid at least two hours before or after your iron supplement.

Acid-suppressing medicines

If antacids and alginates do not improve your symptoms of indigestion, your GP may prescribe a different medicine that suppresses the acid in your stomach. There are two acid-suppressing medicines that are safe to use during pregnancy:

  • ranitidine
  • omeprazole

As with antacids and alginates, follow the dosage instructions on the patient information leaflet or packet.

Ranitidine

Ranitidine is usually prescribed as tablets to be taken twice a day. Follow the dosage instructions, as your medicine may not work if you only take it when you have symptoms. Ranitidine rarely causes any side effects.

Omeprazole

Omeprazole is usually prescribed as a tablet to take once a day. After five days, your symptoms should have improved. If not, your dose may need to be increased. In some cases, omeprazole may cause side effects such as:

  • headaches
  • diarrhoea
  • nausea
  • vomiting

Self-help tips for indigestion in pregnancy

You may not need medicine to control your symptoms. Your GP or midwife may suggest some of the following changes to your diet and lifestyle. In many cases, these changes can be enough to ease your symptoms.

Stop smoking to banish indigestion

Smoking when you're pregnant can cause indigestion and seriously affect your health, as well as the health of your unborn baby. Smoking increases the risk of: 

When you smoke, the chemicals you inhale can contribute to your indigestion. These chemicals can cause the ring of muscle at the lower end of your oesophagus to relax. This allows stomach acid to leak back up into your oesophagus more easily (known as acid reflux).

If you smoke, quitting is the best thing that you can do for your own and your baby's health. You can speak to your GP or midwife for more information, or you can call the Smokeline, which offers support and encouragement to help you quit smoking, on 0300 123 1044.

Avoid alcohol to ease indigestion

Drinking alcohol can contribute to the symptoms of indigestion. During pregnancy, it can also put your unborn baby at risk of developing serious birth defects. Find out more about alcohol and pregnancy.

The Department of Health recommends that all pregnant women avoid drinking alcohol completely during pregnancy. It advises that if you do choose to drink while you're pregnant, to minimise risks to your baby you should not drink more than 1-2 units of alcohol once or twice a week, and should not get drunk.

The National Institute for Health and Care Excellence (NICE) recommends that pregnant women and women planning to become pregnant should avoid drinking alcohol in the first three months of pregnancy because there may be an increased risk of miscarriage.

One UK unit is 10ml (or eight grams) of pure alcohol. This is equal to: 

  • half a pint of beer, lager or cider at 3.5% alcohol by volume (ABV: you can find this on the label)
  • a single measure (25ml) of spirit, such as whisky, gin, rum or vodka, at 40% ABV 
  • half a standard (175ml) glass of wine at 11.5% ABV

You can find out how many units there are in different types and brands of drinks with the Drinkaware unit calculator.

If you have difficulty cutting down what you drink, talk to your midwife, doctor or pharmacist. Confidential help and support is available from local counselling services.

Eat healthily to avoid indigestion

You are more likely to get indigestion if you are very full, so regularly eating large amounts of food may make your symptoms worse. If you are pregnant, it can be tempting to eat more than you would normally, but this may not be good for you or your baby. You don't need to "eat for two".

During pregnancy you do not need to go on a special diet, but it is important to eat a variety of different foods every day to get the right balance of nutrients that you and your baby need. Find out more about eating a healthy diet in pregnancy and foods to avoid.

Change your eating habits

In some cases, you may be able to control your indigestion by making changes to the way you eat. For example: 

  • it may help to eat smaller meals more frequently, rather than larger meals three times a day
  • avoid eating within three hours of going to bed at night
  • sit up straight when you eat because this will take the pressure off your stomach

Drinking a glass of milk may relieve heartburn (the burning sensation from stomach acid leaking up into your oesophagus). You may want to keep a glass of milk beside your bed in case you wake up with heartburn in the night.

Avoid indigestion triggers

You may find that your indigestion is made worse by certain triggers, such as: 

  • drinking fruit juice
  • eating chocolate
  • bending over

Make a note of any particular food, drink or activity that seems to make your indigestion worse and avoid them if possible. This may mean:

  • eating less rich, spicy and fatty foods
  • cutting down on drinks that contain caffeine, such as tea, coffee and cola 

Prop your head up

When you go to bed, use a couple of pillows to prop your head and shoulders up, or raise the head of your bed by a few inches by putting something underneath the mattress.

The slight slope should help prevent stomach acid from moving up into your oesophagus while you sleep. 

Prescription medicines

Speak to your GP if you are taking medication for another condition, such as antidepressants or non-steroidal anti-inflammatory drugs (NSAIDs), and you think it may be contributing to your indigestion. Your GP may be able to prescribe an alternative medicine.

Never stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional who is responsible for your care.

Backache

During pregnancy, the ligaments in your body naturally become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause backache.  

Avoiding backache in pregnancy

There are several things you can do to help prevent back pain from happening, and to help you cope with an aching back if it does occur.

The following tips should be remembered everyday and can help to protect your back, they include: 

  • avoid lifting heavy objects
  • bend your knees and keep your back straight when lifting or picking up something from the floor
  • move your feet when turning round to avoid twisting your spine
  • wear flat shoes as these allow your weight to be evenly distributed
  • work at a surface high enough to prevent you stooping
  • try to balance the weight between two bags when carrying shopping
  • sit with your back straight and well supported
  • make sure you get enough rest, particularly later in pregnancy

A firm mattress can also help to prevent and relieve backache. If your mattress is too soft, put a piece of hardboard under it to make it firmer. Massage can also help.

Exercises to ease backache in pregnancy

The gentle exercise below helps to strengthen stomach (abdominal) muscles and this can ease backache in pregnancy:

  • start in a box position (on all fours) with knees under hips, hands under shoulders, with fingers facing forwards and abdominals lifted to keep your back straight
  • pull in your stomach muscles and raise your back up towards the ceiling, curling your trunk and allowing your head to relax gently forward – don't let your elbows lock
  • hold for a few seconds then slowly return to the box position
  • take care not to hollow your back – it should always return to a straight, neutral position
  • do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully
  • only move your back as far as you can comfortably

The National Institute for Health and Care Excellence (NICE) advises that exercising in water, massage therapy, and group or individual back care classes might help to ease back pain in pregnancy.

Some local swimming pools provide aquanatal classes (gentle exercise classes in water, especially for pregnant women) with qualified instructors. Ask at your local leisure centre. Being in water will support your increasing weight.

When to get help for backache in pregnancy

If your backache is very painful, ask your doctor to refer you to an obstetric physiotherapist at your hospital. They can give you advice and may suggest some helpful exercises.

Find out about more common problems in pregnancy, including pelvic joint pain

Healthtalk.org has interviews with women talking about their experiences of pelvic pain in pregnancy and how they coped

Stretch marks

Stretch marks are narrow pink or purplish streak-like lines that can develop on the surface of the skin.

If you get them, they usually appear on your tummy, or sometimes on your upper thighs and breasts, as your pregnancy progresses and your bump starts to grow. When this happens will be different from woman to woman.

The first sign you notice might be itchiness around an area where the skin is becoming thin and pink.

Stretch marks aren't harmful. They don't cause medical problems and there isn't a specific treatment for them.

After your baby is born, the marks should gradually fade into white-coloured scars and become less noticeable. They probably won't go away completely.

What causes stretch marks?

Stretch marks are very common in the general population and don't just affect pregnant women.

They can happen whenever the skin is stretched, for example when we're growing during puberty or when putting on or losing weight. Hormonal changes in pregnancy can affect your skin and make you more likely to get stretch marks.

They happen when the middle layer of skin (dermis) becomes stretched and broken in places. 

Whether or not you get stretch marks depends on your skin type, as some people's skin is more elastic. 

Pregnancy weight gain

You are more likely to get stretch marks if your weight gain is more than average in pregnancy. Most women gain between 10kg and 12.5kg (22 and 28lb) in pregnancy, although weight gain varies a great deal from woman to woman.

How much weight you gain depends on your weight before you were pregnant.

It's important that you don't diet to lose weight when you're pregnant, but you should eat a healthy, balanced diet.

If you are worried about your weight, talk to your midwife or GP. They may give you advice if you weigh more than 100kg (about 15.5 stone) or less than 50kg (about eight stone).  

Preventing stretch marks

Some creams claim to remove stretch marks once they've appeared, but there is no reliable evidence that they work. There is also limited evidence about whether oils or creams help prevent stretch marks from appearing in the first place.

A review of two studies looking at two specific creams marketed as preventing stretch marks found that massaging the skin may help to prevent stretch marks in pregnancy.

However, more research is needed into whether creams or massaging the skin can help to prevent stretch marks.

Vaginal discharge

All women, whether they're pregnant or not, have some vaginal discharge starting a year or two before puberty and ending after the menopause. How much discharge you have changes from time to time, and it usually gets heavier just before your period.

Is it normal to have vaginal discharge in pregnancy?

Yes. Almost all women have more vaginal discharge in pregnancy. This is quite normal and happens for a few reasons. During pregnancy the cervix (neck of the womb) and vaginal walls get softer, and discharge increases to help prevent any infections travelling up from the vagina to the womb.

Towards the end of pregnancy, the amount of discharge increases and can be confused with urine.

In the last week or so of pregnancy, your discharge may contain streaks of thick mucus and some blood.

This is called a "show" and happens when the mucus that has been present in your cervix during pregnancy comes away. It's a sign that the body is starting to prepare for birth, and you may have a few small "shows" in the days before you go into labour.

Increased discharge is a normal part of pregnancy, but it's important to keep an eye on it and tell your doctor or midwife if it changes in any way.

When to see your midwife or GP

Tell your midwife or doctor if:

  • the discharge is coloured
  • it smells strange
  • you feel itchy or sore

Healthy vaginal discharge should be clear and white, and should not smell unpleasant. If the discharge is coloured or smells strange, or if you feel itchy or sore, you may have a vaginal infection.

Thrush in pregnancy

The most common infection is thrush, which your doctor can treat easily. You should not use some thrush medicines in pregnancy.

Always talk to your doctor, pharmacist or midwife if you think you have thrush. You can help prevent thrush by wearing loose cotton underwear, and some women find it helps to avoid perfumed soap or perfumed bath products.

You should also tell your midwife or doctor if your vaginal discharge increases a lot in later pregnancy.

Bleeding in pregnancy

If you have any vaginal bleeding in pregnancy, you should contact your midwife or doctor. Lots of women lose a small amount of blood during pregnancy, and this is usually nothing to worry about.

However, it can sometimes be a sign of a more serious problem, such as a miscarriage or a problem with the placenta.

Swollen ankles

Ankles, feet and fingers often swell a little in pregnancy as your body is holding more water than usual.

Towards the end of the day, the extra water tends to gather in the lowest parts of the body, especially if the weather is hot or if you have been standing a lot. The gradual swelling isn't harmful to you or your baby, but it can be uncomfortable.

Avoiding and easing swollen ankles

There are some steps you can take to prevent swollen feet and ankles. These can also help to ease the discomfort if your feet and ankles are feeling swollen already. Try to:

  • avoid standing for long periods
  • wear comfortable shoes – avoid tight straps or anything that might pinch if your feet swell
  • put your feet up as much as you can – try to rest for an hour a day with your feet higher than your heart; for example, propped up with cushions as you lie on the sofa
  • do the foot exercises described below

Foot exercises

You can do foot exercises sitting or standing. They improve blood circulation, reduce swelling in the ankles, and prevent cramp in the calf muscles:

  • bend and stretch your foot up and down 30 times 
  • rotate your foot in a circle eight times one way and eight times the other way
  • repeat with the other foot

Get more tips on exercising in pregnancy

When swelling can be serious

You should seek medical attention immediately if your face, feet or hands swell up suddenly. A pregnancy condition called pre-eclampsia can cause sudden swelling, although most women with swelling don't have pre-ecplampsia. 

If it happens to you, contact your midwife, doctor or hospital immediately. If you do have pre-eclampsia, you'll need to be monitored carefully, as the condition can be serious for both you and your baby.

Other signs of pre-eclampsia can include:

  • severe headache
  • problems with vision, such as blurring or flashing before the eyes
  • severe pain just below the ribs
  • vomiting

Risk factors for pre-eclampsia include:

  • being aged 40 or older
  • not having had children (nulliparity)
  • a 10-year gap since your last pregnancy
  • a family history of pre-eclampsia
  • having had pre-eclampsia before
  • a body mass index (BMI) of 30 or above
  • pre-existing high blood pressure
  • kidney disease
  • a multiple pregnancy (having more than one baby)

The Royal College of Obstetricians and Gynaecologists (RCOG) has information on what you need to know about pre-eclampsia.

Headaches

Headaches in women are often caused by hormones, and many women who are not pregnant notice a link with their periods. 

Menopause and pregnancy are also potential triggers. Some pregnant women find they get a lot of headaches.

Headaches can get worse in the first few weeks of pregnancy, but they usually improve or stop completely during the last six months. They don't harm the baby, but they can be uncomfortable for you.

Coping with headaches in pregnancy

Changes to your lifestyle may help prevent headaches. Try to get more regular rest and relaxation. You could try a pregnancy yoga class, for example. If you're having problems sleeping, you can find out more about tackling this in tiredness and sleep in pregnancy.   

Taking paracetamol in the recommended dose is generally considered safe for pregnant women. However, there are some painkillers you should avoid in pregnancy, such as those containing codeine, unless prescribed by your doctor. 

Speak to your pharmacist, midwife, GP, nurse or health visitor about how much paracetamol you can take and for how long. Find a pharmacy near you.

Learn more about whether you can take ibuprofen and paracetamol in pregnancy

When to seek help for headaches

If you often have bad headaches, tell your midwife or doctor so they can advise you. Severe headaches can be a sign of high blood pressure and you should seek urgent advice, as this could indicate a serious condition called pre-eclampsia. 

Pre-eclampsia is a condition that affects some pregnant women during the second half of pregnancy or immediately after the delivery of their baby.

Women with pre-eclampsia have:

  • high blood pressure
  • fluid retention (oedema)
  • protein in the urine (proteinuria)

If it's not treated, it can lead to serious complications. Pre-eclampsia can cause growth problems in the unborn baby.

Find out more about pre-eclampsia 

Itching

Itching is common in pregnancy. Usually it's thought to be caused by raised levels of certain chemicals in the blood, such as hormones.

Later on, as your bump grows, the skin of your tummy (abdomen) is stretched and this may also feel itchy.

However, itching can be a symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC).

ICP needs medical attention. It affects 1 in 140 pregnant women in the UK, around 5,500 a year. 

Mild itching

Wearing loose clothes may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation.

You may also want to avoid synthetic materials and opt for natural ones, such as cotton, instead. These are "breathable" and allow the air to circulate close to your skin.

You may find having a cool bath or applying lotion or moisturiser can help soothe the itching.

Some women find that products with strong perfumes can irritate their skin, so you could try using unperfumed lotion or soap.

Mild itching is not usually harmful to you or your baby, but it can sometimes be a sign of a more serious condition, particularly if you notice it more in the evenings or at night.

Let your midwife or doctor know if you are experiencing itching so they can decide whether you need to have any further investigations. 

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a potentially serious liver disorder that can develop in pregnancy.

Normally, bile acids flow from your liver to your gut to help you digest food.

In ICP, the bile acids don't flow properly and build up in your body instead. There's no cure for ICP, but it should go once you've had your baby.

ICP seems to run in families, but it can occur even if there is no family history. It is more common in women of South American, Indian and Pakistani origin.

If you have had ICP in a previous pregnancy, you have a high chance of developing it again in a subsequent pregnancy.

Some studies have found that babies whose mothers have ICP have a higher chance of being born prematurely or stillborn.

The most recent research suggests the risk of stillbirth is between 1 and 2 in 100 for those women whose bile acid levels are greater than 40µmol/L.

The risk of stillbirth rises to between 4 and 5 in 100 when the bile acids are 80µmol/L.

Because of the link with stillbirth, you may be offered induction of labour at around 37-38 weeks of pregnancy if you have ICP.

Some specialists might advise earlier induction than this if the condition is severe (defined as bile acids over 40µmol/L).

If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team. 

Symptoms of ICP

Symptoms of ICP typically start from around 30 weeks of pregnancy, but it is possible to develop the condition as early as eight weeks.

The main symptom is itching, usually without a rash. The itching is often more noticeable on the hands and feet, but can be all over the body.

For many women with ICP, the itching is unbearable and can be worse at night, preventing sleep. For others, the itching is mild.

Other symptoms can include dark urine, pale bowel movements (poo) and, less commonly, yellowing of the skin and whites of the eyes (jaundice). 

Diagnosis and treatment of ICP

ICP is diagnosed by excluding other causes of the itch. Your doctor will probably talk to you about your medical and family history, and order a variety of blood tests.

These will include tests to check your liver function (LFT) and measure your bile acid levels (BA).

Monitoring your condition

If you are diagnosed with ICP, you will have regular liver function tests so your doctor can monitor your condition.

There is no agreed guideline on how often these tests should happen, but the Royal College of Obstetricians and Gynaecologists (RCOG) and the British Liver Trust advise weekly tests.

The UK's largest research group investigating ICP also recommends weekly bile acid measurements. These readings help doctors recommend when your baby should be born. 

If your LFTs and bile acids are normal and you continue to have severe itching, the blood tests should be repeated every week or two to keep an eye on them. 

Creams and medications for ICP

Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching.

There are some medications, such as ursodeoxycholic acid (UDCA), that help reduce bile acids and ease itching.

UDCA is considered safe to take in pregnancy, although it is prescribed on what is known as an "informed consent" basis as it hasn't been properly tested in pregnancy.  

You may also be offered a vitamin K supplement. This is because ICP can affect your absorption of vitamin K, which is important for healthy blood clotting.

Most experts on ICP only prescribe vitamin K if the mother-to-be reports pale stools, has a known blood clotting problem, or has very severe ICP from early in pregnancy.

If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

Further information

The Royal College of Obstetricians and Gynaecologists (RCOG) has more information about obstetric cholestasis, including what it means for you and your baby, and the treatment that's available. You can also get information from the British Liver Trust.

Pelvic pain

Some women develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PPGP) or symphysis pubis dysfunction (SPD).

Symptoms of PPGP

PPGP is a collection of uncomfortable symptoms caused by a stiffness of your pelvic joints or the joints moving unevenly at either the back or front of your pelvis. 

PPGP is not harmful to your baby, but it can cause severe pain around your pelvic area and make it difficult for you to get around.

Different women have different symptoms, and PPGP is worse for some women than others. Symptoms can include:

  • pain over the pubic bone at the front in the centre
  • pain across one or both sides of your lower back
  • pain in the area between your vagina and anus (perineum)

Pain can also radiate to your thighs, and some women feel or hear a clicking or grinding in the pelvic area. The pain can be most noticeable when you are:

  • walking
  • going upstairs
  • standing on one leg (for example, when you’re getting dressed or going upstairs)
  • turning over in bed

It can also be difficult to move your legs apart – for example, when you get out of a car.

There is treatment to help, and techniques to manage the pain and discomfort. If you get the right advice and treatment early on, PPGP can usually be managed and the symptoms minimised. Occasionally, the symptoms even clear up completely.

Most women with PPGP can have a normal vaginal birth. 

Who gets pelvic pain in pregnancy?

It's estimated that PPGP affects up to one in five pregnant women to some degree.

It's not known exactly why pelvic pain affects some women, but it's thought to be linked to a number of issues, including previous damage to the pelvis, pelvic joints moving unevenly, and the weight or position of the baby.

Factors that may make a woman more likely to develop PPGP include:

  • a history of lower back or pelvic girdle pain
  • previous injury to the pelvis – for example, from a fall or accident
  • having PPGP in a previous pregnancy
  • a physically demanding job 

When to get help for pelvic pain in pregnancy

Getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort. Treatment by a physiotherapist usually involves moving the affected joint, which helps it work normally again.

If you notice pain around your pelvic area, tell your midwife, GP or obstetrician. Ask a member of your maternity team for a referral to a physiotherapist who specialises in obstetric pelvic joint problems.

These problems tend not to get completely better until the baby is born, but treatment from an experienced practitioner can significantly improve the symptoms during pregnancy.

Treatments for pelvic pain in pregnancy

Physiotherapy aims to relieve or ease pain, improve muscle function and improve your pelvic joint position and stability. This may include:

  • manual therapy to make sure the joints of your pelvis, hip and spine move normally
  • exercises to strengthen your pelvic floor, stomach, back and hip muscles
  • exercises in water
  • advice and suggestions, including positions for labour and birth, looking after your baby and positions for sex
  • pain relief
  • equipment, if necessary, such as crutches or pelvic support belts 

Coping with pelvic pain in pregnancy

Your physiotherapist may recommend a pelvic support belt to help ease your pain, or crutches to help you get around.

It can help to plan your day so that you avoid activities that cause you pain. For example, don't go up or down stairs more often than you have to.

The Pelvic Obstetric & Gynaecological Physiotherapy (POGP) network also offers this advice:

  • Be as active as possible within your pain limits, and avoid activities that make the pain worse.
  • Rest when you can.
  • Get help with household chores from your partner, family and friends.
  • Wear flat, supportive shoes.
  • Sit down to get dressed – for example, don't stand on one leg when putting on jeans.
  • Keep your knees together when getting in and out of the car – a plastic bag on the seat can help you swivel.
  • Sleep in a comfortable position – for example, on your side with a pillow between your legs.
  • Try different ways of turning over in bed – for example, turning over with your knees together and squeezing your buttocks.
  • Take the stairs one at a time, or go upstairs backwards or on your bottom.
  • If you're using crutches, have a small backpack to carry things in.
  • If you want to have sex, consider different positions, such as kneeling on all fours.

POGP suggests that you avoid:

  • standing on one leg
  • bending and twisting to lift, or carrying a baby on one hip
  • crossing your legs
  • sitting on the floor, or sitting twisted
  • sitting or standing for long periods
  • lifting heavy weights, such as shopping bags, wet washing or a toddler
  • vacuuming
  • pushing heavy objects, such as a supermarket trolley
  • carrying anything in only one hand (try using a small backpack)

You can download the POGP leaflet Pregnancy related pelvic girdle pain for mothers-to-be and new mothers.

Labour and birth with pelvic pain

Many women with pelvic pain in pregnancy can have a normal vaginal birth. Plan ahead and talk about your birth plan with your birth partner and midwife.

Write in your birth plan that you have PPGP, so the people supporting you during labour and birth will be aware of your condition.

Think about birth positions that are the most comfortable for you, and write them in your birth plan. Being in water can take the weight off your joints and allow you to move more easily, so you might want to think about having a water birth. You can discuss this with your midwife. 

Your 'pain-free range of movement'

If you have pain when you open your legs, find out your pain-free range of movement.

To do this, lie on your back or sit on the edge of a chair and open your legs as far as you can without pain – your partner or midwife can measure the distance between your knees with a tape measure. This is your pain-free range.

To protect your joints, try not to open your legs wider than this during labour and birth. This is particularly important if you have an epidural for pain relief in labour, as you will not be feeling the pain that warns you that you are separating your legs too far.

If you have an epidural, make sure your midwife and birth partner are aware of your pain-free range of movement of your legs.

When pushing in the second stage of labour, you may find it beneficial to lie on one side. This prevents your legs from being separated too much. You can stay in this position for the birth of your baby, if you wish.

Sometimes, it might be necessary to open your legs wider than your pain-free range to deliver your baby safely, particularly if you have an assisted delivery (for example, with the vacuum or ventouse). Even in this case, it is possible to limit the separation of your legs. Make sure your midwife and doctor are aware that you have PPGP.

If you go beyond your pain-free range, your physiotherapist should assess you after the birth. Take extra care until they have assessed and advised you.

healthtalk.org has interviews with women talking about their experiences of pelvic pain in pregnancy.

Find maternity services or physiotherapy services near you

More common problems

Your body has a great deal to do during pregnancy. Sometimes the changes taking place will cause irritation or discomfort, and on occasions they may seem quite alarming. There is rarely any need for alarm, but you should mention anything that is worrying you to your maternity team.

Constipation in pregnancy

You may become constipated very early on in your pregnancy due to the hormonal changes in your body.

Avoiding constipation

There are a few things you can do to help prevent constipation. These include:

  • eating foods that are high in fibre, such as wholemeal breads and cereals, fruit and vegetables, and pulses, such as beans and lentils (read more about healthy eating in pregnancy
  • exercising regularly to keep your muscles toned (read more about exercise in pregnancy)  
  • drinking plenty of water
  • avoiding iron supplements, as they can make you constipated – ask your doctor if you can manage without them or change to a different type

You can read more about the symptoms of constipation and treatment of constipation, including the safe use of laxatives during pregnancy.  

Cramp in pregnancy

Cramp is a sudden, sharp pain, usually in your calf muscles or feet. It is most common at night. Nobody really knows what causes it, but there are some ideas about causes of cramp and why it can happen in pregnancy.

Avoiding cramp

Regular, gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and may help to prevent cramp occurring. Try these foot exercises:

  • bend and stretch your foot vigorously up and down 30 times
  • rotate your foot eight times one way and eight times the other way
  • repeat with the other foot

How to ease cramp

It usually helps if you pull your toes hard up towards your ankle or rub the muscle hard. NHS Choices has more information on the treatment of cramp, but remember to always consult your midwife, GP or pharmacist before taking painkillers in pregnancy.

Feeling faint in pregnancy

Pregnant women often feel faint. This is because of the hormonal changes occurring in the body. Fainting happens if your brain is not getting enough blood and therefore not enough oxygen.

You are most likely to feel faint if you stand too quickly from a chair or out of a bath, but it can also happen when you are lying on your back. 

Avoiding feeling faint

Here are some tips to help you cope:

  • try to get up slowly after sitting or lying down
  • if you feel faint when standing still, find a seat quickly and the faintness should pass – if it doesn’t, lie down on your side
  • if you feel faint while lying on your back, turn on to your side

It’s better not to lie flat on your back in later pregnancy or during labour. The symptoms that might mean you're going to faint include, a sudden, clammy sweat, ringing in your ears and fast, deep breathing. You can also find out about treating faintness, including what to do to help someone who is about to faint.

Feeling hot in pregnancy

During pregnancy you’re likely to feel warmer than usual. This is due to hormonal changes and an increase in blood supply to the skin. You’re also likely to sweat more. It helps if you:

  • wear loose clothing made of natural fibres, as these are more absorbent and breathe more than synthetic fibres
  • keep your room cool – you could use an electric fan to cool it down
  • wash frequently to help you feel fresh

Incontinence in pregnancy

Incontinence is a common problem both during and after pregnancy. Pregnant women are sometimes unable to prevent a sudden spurt of urine or a small leak when they cough, laugh or sneeze, or when they move suddenly, or just get up from a sitting position. This may be temporary, because the pelvic floor muscles (the muscles around the bladder) relax slightly to prepare for the baby's delivery. You can find out more about the causes of incontinence and preventing incontinence. You can help to prevent incontinence by doing pelvic floor exercises.

When to get help

In many cases, incontinence is curable. If you have a problem, talk to your midwife, doctor or health visitor. You could also call the confidential Bladder and Bowel Foundation helpline on 0845 345 0165, Monday to Friday, 9.30am to 1pm. 

Urinating a lot in pregnancy

Needing to urinate (pass water, or pee) may often start in early pregnancy, sometimes continuing throughout pregnancy. In later pregnancy, it is the result of the baby’s head pressing on your bladder.

How to reduce the need to pass urine

If you find that you need to get up in the night to pass urine, try cutting out drinks during the late evening. However, make sure you drink plenty of non-alcoholic, caffeine-free drinks during the day. Later in pregnancy, some women find it helps to rock backwards and forwards while they are on the toilet. This lessens the pressure of the womb on the bladder, so you can empty it properly. 

When to get help

If you have any pain while passing water or you pass any blood in your urine, you may have a urine infection, which will need treatment. Drink plenty of water to dilute your urine and reduce pain. You should contact your GP within 24 hours of first noticing these symptoms. Read more about:

Don't take any medicines without asking your midwife, doctor or pharmacist whether they are safe in pregnancy.

Skin and hair changes in pregnancy

Hormonal changes taking place in pregnancy will make your nipples and the area around them go darker. Your skin colour may also darken a little, either in patches or all over.

Birthmarks, moles and freckles may also darken. Some women develop a dark line down the middle of their stomach. These changes will gradually fade after the baby is born, although your nipples may remain a little darker.

If you sunbathe while you are pregnant, you may find you burn more easily. Protect your skin with a high-factor sunscreen and don’t stay in the sun for a long time. Read more about keeping skin safe in the sun.

Hair growth can also increase in pregnancy, and your hair may be greasier. After the baby is born, it may seem as if you are losing a lot of hair, but you are simply losing the extra hair.

Varicose veins in pregnancy

Varicose veins are veins that have become swollen. Leg veins are most commonly affected. You can also get varicose veins in the vulva (vaginal opening), although these usually get better after the birth.

If you have varicose veins you should:

  • try to avoid standing for long periods of time
  • try not to sit with your legs crossed
  • try not to put on too much weight, as this increases the pressure
  • sit with your legs up as often as you can, to ease the discomfort
  • try support tights, which may also help to support your leg muscles – you can buy them at most pharmacies
  • try sleeping with your legs higher than the rest of your body – use pillows under your ankles or put books under the foot of your bed
  • do foot exercises and other antenatal exercises, such as walking and swimming, which will help your circulation

Try these foot exercises:

  • bend and stretch your foot up and down 30 times
  • rotate your foot eight times one way and eight times the other
  • repeat with the other foot

 

Piles

Piles, also known as haemorrhoids, are enlarged and swollen veins in or around the lower rectum and anus. Anyone can get piles – they don't just happen in pregnancy. When you're pregnant, piles can occur because hormones make your veins relax.

Piles may itch, ache or feel sore. You can usually feel the lumpiness of piles around your anus. They may also bleed a little and can make going to the toilet uncomfortable or painful. You may also notice pain when passing a stool (faeces, poo) and a discharge of mucus afterwards. Sometimes, you may feel as though your bowels are still full and need emptying.  

Piles usually go away within weeks after the birth. Find out about the symptoms of piles.

How to ease piles

Constipation can cause piles. If this is the case, try to keep your stools soft and regular.

You can help to ease piles, and prevent them, by making some changes to your diet and lifestyle, such as:

  • eating plenty of food that is high in fibre, like wholemeal bread and fruit and vegetables, and drinking plenty of water – this can help to prevent constipation, which can make piles worse (read about healthy eating in pregnancy)
  • avoiding standing for long periods
  • taking regular exercise to improve your circulation
  • using a cloth wrung out in iced water to ease the pain – hold it gently against the piles
  • if the piles stick out, push them gently back inside using a lubricating jelly
  • avoiding straining to pass a stool, as this may make your piles worse
  • after passing a stool, cleaning your anus with moist toilet paper instead of dry toilet paper
  • patting, rather than rubbing, the area

There are medicines that can help soothe inflammation around your anus. These treat the symptoms, but not the cause, of piles. Ask your doctor, midwife or pharmacist if they can suggest a suitable ointment to help ease the pain. Don't use a cream or medication without checking with them first.

Bleeding gums

Some women get swollen and sore gums, which may bleed, in pregnancy. Bleeding gums are caused by a build-up of plaque on the teeth.

Hormonal changes during pregnancy can make your gums more vulnerable to plaque, leading to inflammation and bleeding. This is also called pregnancy gingivitis or gum disease.

Your dentist will be able to help with this. Dental care is free during pregnancy and until one year after your due date. You can read more about treating gum disease.

To get free dental care, you need to apply for a maternity exemption certificate (MatEx). Ask your doctor, nurse or midwife for form FW8. You complete parts one and two of the form, and your doctor, midwife or nurse signs it to confirm that the information you've given is correct.

You can find an NHS dentist near you

Keeping teeth and gums healthy in pregnancy

It's very important to keep your teeth and gums as clean and healthy as possible while you're pregnant. The best way to prevent or deal with gum problems is to practise good oral hygiene.

Go to the dentist so they can give your teeth a thorough clean and give you some advice about keeping your teeth clean at home.

Here's how you can look after your teeth and gums: 

  • Clean your teeth carefully twice a day for two minutes with fluoride toothpaste – ask your dentist to show you a good brushing method to remove all the plaque.
  • Brushing is best with a small-headed toothbrush with soft filaments – make sure it's comfortable to hold.
  • Avoid having sugary drinks (such as fizzy drinks or sweet tea) and sugary foods too often – try to keep them to meal times.
  • If you're hungry between meals, snack on vegetables and avoid sugary or acidic foods (get tips on healthy snacks). 
  • Avoid mouthwashes that contain alcohol.
  • Stop smoking, as it can make gum disease worse.

If you have morning sickness (nausea and vomiting), rinse your mouth with plain water after each time you vomit. This will help prevent the acid in your vomit attacking your teeth.

Do not brush your teeth straight away as they will be softened by the acid from your stomach. Wait about an hour before doing so.

Find out about the symptoms of gum disease

Dental treatments to avoid in pregnancy

When you go to the dentist, make sure they know you're pregnant.

Discuss with your dentist whether any new or replacement fillings should be delayed until after your baby is born. The Department of Health advises that amalgam fillings shouldn't be removed during pregnancy.

If you need a dental X-ray, your dentist will usually wait until you've had the baby, even though most dental X-rays don't affect the tummy (abdomen) or pelvic area.

Read more about dental health, including check-ups and brushing

Severe vomiting

Sickness in pregnancy is common. Around 7 out of every 10 pregnant women experience nausea and/or vomiting, and this doesn't just occur in the morning.

For most women, this improves or disappears completely by around week 14, although for some women it can last longer.

Some pregnant women experience excessive nausea and vomiting. They might be sick many times a day and be unable to keep food or drink down, which can have a negative effect on their daily life.

This excessive nausea and vomiting is known as hyperemesis gravidarum (HG), and often needs hospital treatment.

Exactly how many pregnant women get HG is not known as some cases may go unreported, but it's thought to be around 1 in every 100.

If you are being sick frequently and can't keep food down, tell your midwife or doctor, or contact the hospital as soon as possible. There is a risk you may become dehydrated, and your midwife or doctor can make sure you get the right treatment.

Symptoms of hyperemesis gravidarum

HG is much worse than the normal nausea and vomiting of pregnancy ("morning sickness").

Signs and symptoms of HG include:

  • prolonged and severe nausea and vomiting – some women report being sick up to 50 times a day
  • dehydration – not having enough fluids in your body because you can't keep drinks down; if you're drinking less than 500ml a day, you need to seek help
  • ketosis – a serious condition that results in the build-up of acidic chemicals in the blood and urine; ketones are produced when your body breaks down fat, rather than glucose, for energy
  • weight loss
  • low blood pressure (hypotension) when standing

Unlike regular pregnancy sickness, HG may not get better by 14 weeks. It may not clear up completely until the baby is born, although some symptoms may improve at around 20 weeks.

See your GP or midwife if you have severe nausea and vomiting, ideally before you start suffering from dehydration and weight loss.

There are other conditions that can cause nausea and vomiting, and your doctor will need to rule these out first.

See the healthtalk.org website for videos and written interviews of women talking about their experiences of hyperemesis gravidarum and how they coped.

What causes hyperemesis gravidarum?

It's not known what causes HG, or why some women get it and others don't. Some experts believe it is linked to the changing hormones in your body that occur during pregnancy.

There is some evidence that it runs in families, so if you have a mother or sister who has had HG in a pregnancy, you may be more likely to get it yourself.

If you have had HG in a previous pregnancy, you are more likely to get it in your next pregnancy than women who have never had it before, so it's worth planning in advance.

Treating hyperemesis gravidarum

There are medications that can be used in pregnancy, including the first 12 weeks, to help improve the symptoms of HG. These include anti-sickness (anti-emetic) drugs, vitamins (B6 and B12) and steroids, or combinations of these.

Evidence suggests that the earlier you start treatment, the more effective it will be. You may need to try different types of medication until you find what works best for you.

The UK teratology information service has a website called bumps (best use of medicines in pregnancy) where you can find out about the safety of specific medicines in pregnancy.

If your nausea and vomiting cannot be controlled, you may need to be admitted to hospital. This is so doctors can assess your condition and give you the right treatment to protect the health of you and your baby.

Treatment can include intravenous fluids, which are given directly into a vein through a drip. If you have severe vomiting, the anti-sickness drugs may also need to be given via a vein or a muscle.

Will hyperemesis gravidarum harm my baby?

HG is unpleasant with dramatic symptoms, but the good news is it's unlikely to harm your baby, if treated effectively.

However, if it causes you to lose weight during pregnancy, there is an increased risk that your baby may be born smaller than expected (have a low birth weight). 

Other symptoms you may experience

Pregnancy Sickness Support is in touch with many women who have had HG, and who report having some or all of the following symptoms in addition to the main symptoms listed above: 

  • extremely heightened sense of smell
  • excessive saliva production (ptyalism)
  • headaches and constipation from dehydration
  • pressure sores from long periods of time in bed
  • episodes of urinary incontinence as a result of vomiting combined with the pregnancy hormone relaxin

If you experience these symptoms, you are not alone. Many women have them and, although they can be distressing, they will go away when the HG stops or the baby is born.

How you might feel

The nausea and vomiting of HG can have a huge impact on your life at a time when you were expecting to be enjoying pregnancy and looking forward to the birth of your baby.

It can affect you both emotionally and physically. The symptoms not only make your life a misery, but may lead to further health complications, such as depression or tears in your oesophagus.

Severe sickness can be exhausting and stop you doing everyday tasks, such as going to work or even getting out of bed.

In addition to feeling very unwell and tired, you might also feel:

  • anxious about going out or being too far from home in case you need to vomit
  • isolated because you don't know anyone who understands what it's like to have HG
  • confused as to why this is happening to you
  • unsure whether you can cope with the rest of the pregnancy if you continue to feel very ill

If you feel any of these, don't keep it to yourself. Talk to your midwife or doctor, and explain the impact HG is having on your life and how it is making you feel. You could also talk to your partner, family and friends if you want to.

Bear in mind that HG is much worse than regular pregnancy sickness. It is not the result of anything you have or haven't done, and you do need treatment and support.

Another pregnancy

If you have had HG before, it's likely you will get it again in another pregnancy.

If you decide on another pregnancy, it can help to plan ahead, such as arranging child care so you can get plenty of rest.

Think back to what helped you last time – for example, specific drinks – and make sure you implement these measures this time around.

Talk to your doctor about starting medication early.  

Blood clots and hyperemesis gravidarum

Because HG can cause dehydration, there's also an increased risk of having a blood clot (deep vein thrombosis), although this is rare. 

If you are dehydrated and immobile, there is treatment that you can be given to prevent blood clots.

Read more about how to prevent deep vein thrombosis