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Oh baby, baby

Pregnancy can be one of the most exciting times in a new mother’s life and involves many great changes within body. Expectant mothers may look to the pharmacy for support

Pregnancy is often publicly portrayed as one of the happiest times in an expectant mother’s life. Indeed, the pregnancy “glow” is a common trope throughout the three trimesters.

Despite this, there are many symptoms, and even conditions, that come along with pregnancy and can be extremely difficult for new mothers to cope with. 

What can make this harder is that these negative implications often go unspoken about. As an important part in a new mother’s journey, the pharmacy is the perfect place to open up this kind of conversation. But what are these not so “glamorous” aspects of pregnancy and how can the pharmacy team help? 

Morning sickness

Arguably the most well-known side-effect of pregnancy, morning sickness, can affect pregnant women at any time of the day or night. Very common in early pregnancy, it usually clears up by weeks 16-20 and does not put the baby at any risk. Whilst hormonal changes in the first 12 weeks of pregnancy are cited as the main cause, other risk factors for morning sickness are having multiple children (twins or triplets), tending to get motion sick, obesity, stress and family history. 

As every pregnancy is different, there’s no set treatment for morning sickness, however, there are a variety of lifestyle changes pharmacy teams can recommend to try to ease symptoms including getting plenty of rest; eating small, frequent, high-carb, low-fat meals of plain foods; drinking plenty of fluids and consuming food/drink containing ginger.

If the nausea and vomiting become severe and there is no improvement, refer the patient to the pharmacist who may recommend they see a GP for an anti-sickness medicine that’s safe to use in pregnancy. 

Swollen feet

Most women will experience swelling due to increased water retention during pregnancy. Typically, the pressure of a growing womb can affect blood flow in the lower body, causing fluid to build up in the legs, ankles and feet. 

Like morning sickness, while there’s no cure, pharmacy teams can offer new mothers some lifestyle advice to help reduce the swelling. They should wear comfortable shoes and socks, rest their feet as much as possible, drink plenty
of water, exercise and avoid standing for long periods of time.

Staff can also recommend exercises to relieve pressure which can be done whilst sitting or standing. These include bending and stretching the foot up and down 30 times and rotating each foot in a circle eight times one way and eight times the other. 

If a customer comes in complaining of a sudden increase in swelling, problems with vision, severe pain below the ribs or a very bad headache, they should be referred directly to the pharmacist as these could be symptoms of pre-eclampsia which must be monitored closely.

Pre-eclampsia

Pre-eclampsia is a condition that affects pregnant women, often during the second half of their pregnancy or soon after their baby is delivered. There is no known cause, however, it is thought to develop when there is an issue with the placenta, the organ that links the mother’s blood supply to the baby’s. 

Pre-eclampsia is characterised by having high blood pressure, sometimes alongside fluid retention and protein in the urine. These early symptoms often go unnoticed by the patient but should be picked up during routine antenatal appointments. Other more obvious, but less common, symptoms include severe headache, vision problems, vomiting and the sudden swelling of the face, hands or feet.

Some conditions can increase a mother’s chance of developing pre-eclampsia, including diabetes, kidney disease, some autoimmune conditions (e.g., lupus) and suffering from the condition in a previous pregnancy. Other factors include: 

  • Family history of pre-eclampsia
  • Being over 40 years old
  • Expecting multiple babies
  • Having a body mass index (BMI) of 35 or more. 

Whilst pre-eclampsia is usually a mild condition, it can lead to serious complications if left un-monitored or un-treated. The earlier it is diagnosed and monitored, the better the outlook for mother and baby. If customers come into the pharmacy experiencing any of these symptoms, pharmacy teams should advise them to get in touch with their midwife. 

Incontinence

As the body adapts to growing a baby, the bladder can be placed under lots of pressure causing many pregnant women to experience incontinence. Furthermore, being pregnant – and eventually, giving birth – often weakens the muscles that control the flow of urine from the bladder. 

Strengthening these muscles by doing pelvic floor exercises whilst pregnant may reduce incontinence risk. The NHS provides these instructions for women wanting to attempt pelvic floor exercises:

  • Close up your bottom, as if you’re trying to stop yourself going to the toilet
  • At the same time, draw in your vagina as if you’re gripping a tampon 
  • Do this exercise quickly, tightening and releasing the muscles immediately
  • Then do it slowly, holding the contractions for as long as you can before you relax
  • Try to do three sets of eight squeezes every day. 

Fatigue

Fatigue is another very common side effect of pregnancy and is usually due to hormonal changes. Feeling tired will not have any effect on the baby, but may make the day-to-day life of the expectant mother more difficult. 

Lifestyle choices such as eating a healthy diet and making sure to get plenty of rest may influence initial symptoms. Additionally, as the baby grows, pregnant women may find it gets even harder to find a comfortable position to sleep. To help combat this, staff can recommend: 

  • Sleeping on their side
  • Supporting their bump with pillows
  • Putting a pillow between their knees.

Body image and mental health 

During pregnancy, a woman’s body naturally undergoes great change. Even after giving birth, the body may take a while to get back to the way it was before, if at all. For some women, this can take a significant toll on their mental health. In fact, over 41 per cent of women who had been pregnant said they felt more negative about their bodies afterwards, according to a survey conducted by the Mental Health Foundation. Additionally, 18 per cent felt “much more negative” and 23 per cent felt “slightly more” negative. 

For those with existing body issues, these concerns only become exacerbated. “These issues can become increasingly complex during pregnancy, as it is naturally a time where weight gain and changes in our body are inevitable, rapid and largely out of our control,” says Dr Marielle Quint, chartered clinical psychologist. 

“There is also something about pregnancy that seems to give others often well-intended, but ill-perceived, licence to comment on shape and size. Ordinarily, unacceptable comments can feel incredibly difficult for women struggling to inhabit their constantly evolving pregnant bodies.”  

The pharmacy can be a safe space where pregnant women can air any concerns they may have. Staff should endeavour to remind customers that it is natural to gain weight during pregnancy. As well as the baby themselves, aspects such as the placenta, amniotic fluid, water retention and growing breasts all contribute to this.

To help with mental wellbeing, staff could also recommend that pregnant customers focus on staying active. “Staying active throughout pregnancy will not only keep [the mother] physically fit but can help [them] feel better psychologically,” says Tina Prendeville, midwife at pregnancy charity Tommy’s. “There are lots of pregnancy safe exercises, such as swimming, cycling, running, walking and strength training.”

If staff are worried about the mental health of a pregnant customer struggling with body image issues, they should refer them to the pharmacist for further counselling. 

“Over 41 per cent of women who had been pregnant said they felt more negative about their bodies afterwards”

Men and miscarriage

Throughout pregnancy, most of the focus from medical professionals, friends and family alike is (rightly) on the mother. But, whilst women bear the physical burden of pregnancy, it is important to consider how their partners feel, particularly when it comes to miscarriage. 

It is estimated that one in every five pregnancies in the UK will end in miscarriage, according to pregnancy charity Tommy’s. Yet, whilst support for women is available through multiple different avenues, their partners are often forgotten about. It is crucial that this changes, as one in 12 partners of women who experience a miscarriage suffer from post-traumatic stress disorder (PTSD), according to research by the charity. “It’s really vital to recognise that both parents experience the loss,” says Amina Hatia, midwife at Tommy’s. 

“It’s just not acceptable in  Western culture for men to be as devastated about a pregnancy loss as a woman,” adds Dr Sandra Wheatley, social psychologist. “It   can multiply that burden when they feel they must hide it.”

The stigma attached to men asking for help is often to blame for them not seeking mental health support when needed. However, when it comes to miscarriage the main reason cited as to why men didn’t seek support is usually the lack thereof. In fact, a study conducted by Tommy’s found that “three-quarters felt there was nothing available for them”.

To help combat this, in 2021 after his wife Jade suffered a miscarriage, Chris Whitfield set up Miscarriage for Men, a charity that serves as a platform for men to not feel  quite so alone. 

If they think it appropriate, pharmacy  staff could signpost new parents, or new mothers who stress concern for their partners, to the charity’s website which includes helpful links, videos and a discussion forum. Just visit: miscarriageformen.com to find out more.

Gestational diabetes

Gestational diabetes is high blood sugar developing during pregnancy that usually disappears after giving birth. More common in the second or third trimester, the condition occurs where – like in type 1 and type 2 diabetes – the body cannot produce enough insulin to meet the extra demands of pregnancy. 

Any woman can develop gestational diabetes, but there are risk factors that can make it more common, including a body mass index (BMI) of over 30; previously having a baby who weighed 10lb or more at birth; having a parent or sibling with diabetes; being of south Asian, Black, African-Caribbean or Middle Eastern origin. 

In recent years, cases of diabetes have risen in the UK with recent reports indicating that the number of women with gestational diabetes in Northern Ireland has increased by 27 per cent since 2018. An increase in type 2 diabetes, caused by lifestyle factors, such as being overweight, could be to blame. “We have an epidemic of gestational diabetes and that is because obesity is on the rise,” says professor Lucilla Poston, director of the Tommy’s Maternal and Foetal Research Unit. 

Gestational diabetes often does not have much effect on the pregnancy or baby. However, it can cause issues including baby growing larger than usual; polyhydramnios – too much amniotic fluid in the womb, potentially provoking premature labour or delivery problems; premature birth; pre-eclampsia (see boxout below); baby developing jaundice; and still birth (although this is very rare). 

It is during the first antenatal appointment that a midwife will ask some questions to determine if a mother-to-be is at an increased risk for gestational diabetes. If they fit at least one of the categories required, they’ll be offered a screening test called an oral glucose tolerance test (OGTT). The OGTT is usually conducted when a person is between 24 and 28 weeks pregnant – although it will be offered earlier if they’ve experienced the condition during past pregnancies. 

Gestational diabetes does not usually cause any obvious symptoms and most cases are only discovered when blood sugar levels are tested during screening. If blood sugar levels get too high before this, some women may develop symptoms such as increased thirst, needing to urinate more frequently, a dry mouth and tiredness. 

These symptoms are also common during pregnancy, so pharmacy staff should recommend a customer speak with their midwife if they have any concerns. 

“There are lots of pregnancy safe exercises such as swimming, cycling, running, walking and strength training”

Childhood immunity

Once new mothers have given birth, attention quickly turns to the health of their child. It is of course extremely important to make sure that all children have a healthy immune system and it is reasurring that parents can make simple changes to their diets to ensure this. 

Eva Hill Hamilton, clinical nutritionist for VIVIO Junior, has three concepts for parents to introduce to their child’s day-to-day routine:

  1. Plenty of sleep – just like adults, a child’s immune system is most active during sleep with a lack of sleep increasing stress hormones and suppressing their immune function. Making sure children have a regular bedtime and avoiding blue light devices for at least an hour before bed is key to a restful night’s sleep
  2. Regular exercise – regular moderate exercise, especially in the fresh air, can have immune-enhancing effects whilst reducing cortisol (the stress hormone) levels and increasing vitamin D too
  3. Healthy diet – fresh fruit and vegetables contain high amounts of vitamin C which is key in supporting immune systems. Simple tweaks to their diet, such as adding fresh fruit juice to their water, will have a positive effect.
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