Ask A Midwife – Back Pain, Swelling, Amnios & Hemorrhoids

Editor’s Note: Good Morning. It’s time for our Ask A Midwife column from Plum Midwifery. We had four interesting and provocative questions posed to this team of midwives from women throughout the OBE community and are excited to share their insightful response.

The Plum Midwifery crew includes Joanne Daviau, Amy Kelly, Emma Gledhill and Jessie Shannon, as well as the team of second attendants and students. This warm group of women has been caring for women and babies during pregnancy and birth for a collective 50+ years and I am completely inspired by their stories, experience and expertise.

As always, we invite you to submit your questions to the Plum Midwifery team at [email protected]

Pregnancy is a beautiful time in a woman’s life. It’s also a time fraught with common complaints like swollen ankles, hemorrhoids and back ache, as our featured ladies will attest to. Isn’t motherhood wonderful?

Q: From Renee: I am having strong back pain, especially in the evenings, and am only 9 weeks pregnant. I had heard that heat like a hot water bottle or a hot bath can be dangerous during pregnancy. I love my hot water bottle and it always seems to do the trick. Can I still use it?

A: Sorry to hear about your back pain. There are two parts to your question I want to address. One is the question of heat and pregnancy and the other is the back pain itself.

The concern with heat was based on previous studies that indicated that if a woman’s core temperature was elevated during the time of embryogenesis ( when the embryo is forming) it would cause congenital anomalies. Another concern that the shift in circulation from the embryo or fetus to the maternal muscle( such as with a hot bath, aerobic activity) would cause a shift of oxygen and nutrients and affect problems with growth.

Subsequently, studies have shown that this concern was probably a bit too conservative and that short, intermittent exposure to heat, (as with exercise, hot compresses, baths) was likely harmless to the growing baby. (SOGC Guideline: “Exercise in Pregnancy and the Postpartum” Dowloadable PDF) The exception being if you were to develop a fever which would warrant contacting a health care professional.

So the hot compress or hot bath isn’t a problem for your baby. Generally, a guideline for women is to listen to their bodies. Avoid situations where your skin looks like a cooked lobster, where your pulse races above target range or you start to feel faint. Women in all sorts of hot climates have babies without problems, so it’s just a matter of knowing your own personal limits.

My concern with your question is why are you having this reoccurring back pain? Perhaps this should be something you explore with your health care provider. Issues that indicate this could be something worth further exploring would be:

• Is this pain related to your posture, activity during the day, recent weight gain or recurrent back problem? You might want to access the services of a massage therapist or chiropractor as the strain on your back will only be exacerbated as your pregnancy progresses.
• Are you having signs of a urinary tract (bladder) infection? As a pregnant woman undoubtedly you are having to pee more often than ever before, but is there burning, straining to pee and nothing is coming out? These might be indications that you have a bladder infection. Should a bladder infection go unchecked it could give rise to a kidney infection (pylonephritis) which is the number one reason pregnant women are admitted to the hospital. If this is the case then you may want to talk to your health care provider about having a urine culture and sensitivity done.
• How recent and often is this pain happening? Are you also experiencing menstrual-like cramping or bleeding? I am sure you would have mentioned this in your question and we don’t mean to scare, but signs of imminent miscarriage can include back pain. Perhaps you want to discuss this further with your health care provider as well as the possibility of an ultrasound to check viability?

I hope some of these suggestions help.

Q: From Andrea – I’m wondering what I can do for swelling in my legs and breasts. I’m 4.5 months pregnant and my breasts are already so big that they are causing major backache. Also, my legs are quite swollen, especially at night, even though I walk or do some type of moderate exercise every day.

A: You are well ahead of the game in that you are keeping a moderate level of activity. Swelling can be a normal part of pregnancy in that those lovely hormones that keep your uterus relaxed and from going into labor early also cause the lining of your veins to relax. This, compounded with the fact that your uterus is larger and heavier than it’s ever been (unless you’ve had a baby before), can start to slow circulation. So blood will pool in your veins, your lymphatic system doesn’t drain properly, and so you have swelling. Swelling on its own is not a concern, but your health care provider will be more concerned with it if you have:

• protein in your urine,
• high blood pressure,
• sudden onset of swelling, or
• it’s one sided.

These might indicate that you’re developing something called pregnancy induced hypertension (what used to be called pre-eclampsia),  or in the case of lopsided (in one leg only) swelling deep vein thrombosis (blood clot in your vein). Both of which are very unlikely.

Measures you can take to control normal swelling would be:

• maintain activity level,
• keep from sitting or standing for long periods of time,
• keep well hydrated,
• limit salt (although there is some debate about the role diet plays),
• ensure you’re eating adequate calcium,
• Elevate your feet at night. and
• take a bath with epsom salts.

The increase in your breast size is another story. This is largely due to a combination of growing milk ducts and an increase in fatty deposits in your breasts. Unfortunately there isn’t much to be done for this, but I would suggest getting properly fitted for a bra to relieve your back pain. A bra with the right tension around the waist will take some of the stress off of your back. One of the bra stores in Courtenay should be able to help you out with a fitting. Typically, you’ll want a snug fitting waist that you will want to buy an expander for as your ribs are pushed up and out by your growing uterus. Thanks for your question.

Q: From Michelle – This is my first baby, and I’m going to be 40 years old this year. The doctor is recommending strongly that we have an amniocentesis and I’ve heard that it can put you at risk to lose your baby. Are there any other tests that are less invasive – even ones that are private pay – that we can do as an alternative to this?

A: Genetic screening is a very personal subject matter and I really appreciate the fact that you would be brave enough to broach it on a public forum. Especially in this time of so many advances in reproductive technology, there is a lot of information that you can find out about your growing fetus. It can seem overwhelming. The underlying question that helps a woman navigate towards a choice that is meaningful to her is: “What am I going to do with this information?” Let’s discuss some of your choices and then the meaning of this question might seem clearer.

First of all, your health care provider is absolutely right in offering you an amnio. A woman who is 40 in BC has the right to bypass all of the other genetic screening and undergo a procedure called an amniocentesis, which is considered the gold standard of genetic screening. During this procedure, a needle is inserted in the uterine cavity and some amniotic fluid is withdrawn. From the circulating fetal cells in the amnitotic fluid geneticists can tell if the baby is genetically “normal” and what gender the baby is.

The results of this test are considered to be 99.99 % accurate. Unfortunately, this test carries with it a 1/200 chance of miscarriage. Because of this risk it used to be only women over the age of 36 who were offered amnio, as their age related risk (1/281) to carry a baby with down syndrome, or other genetic disorders, made it worth the potential risk of miscarriage. However, this left many babies with down’s syndrome born to younger moms undetected. So they created a screen.

A screening device is not a test. It can’t tell you if you have a baby with a problem. What it can do is tell you what your likeliness of having a baby with a problem is. A screening device is like the metal detector at the airport—not everyone who beeps has a gun, there are just certain factors that suggest that a person needs to be looked at more closely. So we have screening devices:

• Integrated Prenatal Screen ( two blood draws and an ultrasound) IPS,
• Serum Integrated Prenatal Screen (two blood draws), and
• Quad screen (one blood draw).

Depending on your age, how far along in your pregnancy you are and your history you can access the above. For you Michelle, you health care provider might talk about the IPS with you. This would mean that you would have an ultrasound to look at something called the nuchal translucency and have two blood draws.

The first blood draw would be between 10 and 14 weeks and the second between 15 and 21 weeks. They will look at the amounts of specific factors in your blood combined with the ultrasound to tell you your chances of having a baby with either down syndrome, trisomy 18 or an open neural tube defect. Your chances will be expressed in what is called an odds ratio. This is like when you hear someone has a 1 in 350 chance to win a fight. It doesn’t actually tell you they’ve won, it tells you their likelyhood. They will either call your screen positive if it’s very likely, or screen negative if it’s unlikely. If it’s deemed very likely then the next step might be to consider having an amnio.

In this whole process the information you get is only as useful as you will make it. Meaning, what will you do with these results? If you need to have all of the information on the table, then the screening might be right for you. If you would terminate a pregnancy based on carrying a baby with one of the mentioned conditions, then genetic screening would be right for you.

However, if you answer no to either of those questions then perhaps you don’t need to screen at all as the information provided won’t cause you to take action. It’s a very personal journey to begin asking yourself and your partner about. It becomes so much more about our ethics. For more information visit this link.

Q: From Anne – I am early on in my pregnancy and am already experiencing hemorrhoids. They are so painful. I am wondering if things like Preparation H are safe, or what the best treatments may be. My doctor said they will subside after birth, but that is a really long time away for me and I need some relief.

A: You can definitely use Preparation H for hemorrhoids. Tucks and Anusol have also been proven safe for pregnancy. Alternatively, a bottle of witch hazel in the fridge and applying it cold with a cosmetics pad. The other aspect of hemorrhoids to consider is if you’re straining at the toilet. You might want to ensure you are well hydrated and are consuming adequate fiber to help with this.

Tags: amniocentisis, back pain, genetic testing, health, hemorrhoids, midwifery, Our Big Earth Media Co., Plum Midwifery, pregnancy, swelling, women

Category: INSPIRED ACTION, Pregnancy