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 doctor or midwife.

If you think that something may be seriously wrong, trust your own judgement and get in touch with your doctor or midwife straight away.

We have listed, in alphabetical order, the changes you are most likely to notice and their causes - where these are known - plus suggestions on how to cope.

Common minor problems

Backache

During pregnancy ligaments 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. As the baby grows, the hollow in your lower back may increase and this may also cause backache

Massage can also help, or you might like to try a support corset - these can be prescribed by your doctor. Make sure you get enough rest, particularly later in pregnancy.

If your backache is very painful, ask your doctor to refer you to an obstetric physiotherapist at your hospital. He or she will be able to give you some advice and suggest some helpful exercises.

Constipation

You may become constipated very early in pregnancy because of the hormonal changes going on in your body. It will help to:

• make sure you include plenty of fibre in your diet through eating foods like wholemeal breads, wholegrain cereals, fruit and vegetables, and pulses such as beans and lentils;
• exercise regularly to keep your muscles toned up;
• make sure you drink plenty of water;
• avoid iron pills if they cause constipation - ask your doctor whether you can manage without them or change to a different type; if not, you may have to accept having constipation.

Cramp

Cramp is a sudden, sharp pain, usually in your calf muscles or feet. It is most common at night, but nobody really knows what causes it. It usually helps if you pull your toes hard up towards your ankle or rub the muscle hard. Regular, gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and may help to prevent cramp occurring.

Discharge from breasts

You may notice a discharge from your nipples. This is very common and nothing to worry about. However, see your doctor or midwife if it becomes bloodstained.

Faintness

Pregnant women often feel faint. This happens when not enough blood is getting to the brain. If the oxygen level gets too low you may actually faint. It's more common in pregnancy because of hormonal changes taking place in your body. You're most likely to feel faint if you stand still for too long or get up too quickly from a chair or hot bath. It often happens when you are lying on your back.

• Try to get up slowly after sitting or lying down.
• If you feel faint when standing still, find a seat quickly and the faintness will 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.

If during or after birth you have pain in the hips, groin, lower abdomen and inner thighs and have difficulty walking or climbing stairs you should inform your GP, midwife or hospital doctor. This may be due to a gap in a joint in the pelvic girdle, which gaps naturally during the birth to allow for the baby's head, not closing up. This condition is known as Symphysis Pubic Dysfunction (SPD). It affects very few women but early diagnosis and appropriate treatment will help to minimise the pain and avoid long term discomfort. If you are diagnosed with SPD you can contact the British SPD Support Group for support and information.

Feeling hot in pregnancy

During pregnancy you're likely to feel warmer than normal. This is due to hormonal changes and to 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 - consider using an electric fan;
• wash frequently to stay fresh.

Headaches

Some pregnant women find they get a lot of headaches. A brisk walk may be all you need, as well as a little more regular rest and relaxation. Although it is wise to avoid drugs in pregnancy, an occasional paracetamol tablet is generally considered safe.

If you often have bad headaches, tell your doctor or midwife so that they can advise you. Severe headaches may be a sign of high blood pressure.

Indigestion and heartburn

This is partly caused by hormonal changes and later the growing womb pressing on the stomach. If you suffer from indigestion:

• try eating smaller meals more often;
• sit up straight when you are eating as this takes the pressure off your stomach;
• avoid particular foods which cause trouble, for example fried or highly spiced ones, but make sure you are still eating well (see this page i nformation on healthy eating).

Heartburn is more than just indigestion. It is a strong, burning pain in the chest. It is caused by the valve between your stomach and the tube leading to your stomach relaxing in pregnancy, so that stomach acid passes into the tube.
It is often brought on by lying flat. To avoid heartburn you could:

• sleep well propped up - try raising the head of your bed with bricks or have plenty of pillows;
• try drinking a glass of milk - have one by your bed in case you wake with heartburn in the night;
  
• avoiding eating or drinking for a few hours before you go to bed;
• ask your doctor or midwife for advice;
• don't take antacid tablets or mixture before checking that they are safe in pregnancy.

Itching

Mild itching is common in pregnancy because of the increased blood supply to the skin. In late pregnancy the skin of the abdomen is stretched and this may also cause itchiness. Wearing loose clothing may help.

Itching can, however, be a sign of a more serious problem called obstetric cholestasis. If itching becomes severe, or you develop jaundice (yellowing of the whites of the eyes and skin), see your doctor. Itching which is associated with a rash may also need treatment if it is severe.

Nausea And morning sickness

Nausea is very common in the early weeks of pregnancy. Some women feel sick, some are sick. Some feel sick in the mornings, some at other times, some all day long.

The reasons are not fully understood, but hormonal changes in the first three months are probably one cause. Nausea usually disappears around the 12th to 14th week. Nausea can be one of the most trying problems in early pregnancy. It comes at a time when you may be feeling tired and emotional, and when many people around you may not realise you are pregnant and expect you to be your normal self.

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. Your partner could bring you some sweet tea.

• Get plenty of rest and sleep whenever you can. Feeling tired can make the sickness worse.
• Eat small amounts often rather than several large meals, but don't stop eating.
• Drink plenty of fluids.
• Ask those close to you for extra support.
• Distract yourself as much as you can. Often the nausea gets worse the more you think about it.
• Avoid the foods and smells that make you feel worse. It helps if someone else can cook but, if not, go for bland, non-greasy foods such as baked potatoes, pasta and milk puddings, which are simple to prepare.
• Remedies containing ginger may be helpful.
  
• Wear comfortable clothes. Tight waistbands can make you feel worse.

If you can't keep anything down see your doctor or midwife.

Nose bleeds

Nose bleeds are quite common in pregnancy because of hormonal changes. The nose bleeds are usually short but can be quite heavy. To help the bleeding stop, press the sides of your nose together between your thumb and forefinger just below the bony part of your nose for ten minutes. Repeat for a further ten minutes if this is unsuccessful. As long as you don't lose a lot of blood, there is nothing to worry about. Blow your nose gently and try to avoid explosive sneezes. You may also find that your nose gets more blocked up than usual.

Passing water often

Needing to pass water often is an early sign of pregnancy. Sometimes it continues right through pregnancy. In later pregnancy it's the result of the baby's head pressing on the bladder.

If you find that you're having to get up in the night, you could try cutting out drinks in the late evening but make sure you keep drinking plenty 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 that you can empty it properly. Then you won't need to pass water again quite so soon.

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

Sometimes pregnant women are unable to prevent a sudden spurt of urine or a small leak when they cough, sneeze or laugh, or when moving suddenly or just getting up from a sitting position. This may be temporary because the pelvic floor muscles relax slightly to prepare for the baby's delivery.

The growing baby will increase pressure on the bladder. If you find this a problem, you can improve the situation by doing exercises to tone up your pelvic floor muscles. Ask a midwife or obstetric physiotherapist for advice.

Piles

Piles, also known as haemorrhoids, are swollen veins around the back passage which may itch, ache or feel sore. You can usually feel the lumpiness of the piles around the back passage. Piles may also bleed a little and they can make going to the toilet uncomfortable or even painful. They occur in pregnancy because the veins relax under the influence of pregnancy hormones. Piles usually go shortly after delivery. If you suffer from piles you should:

• eat plenty of food that is high in fibre, like wholemeal bread, fruit and vegetables, and you should drink plenty of water - this will prevent constipation, which can make piles worse;
  
• avoid standing for long periods;
• take regular exercise to improve your circulation;
• sleep with the foot of the bed slightly raised on books or bricks;
• use an ice pack to ease discomfort, holding this gently against the piles, or use a cloth wrung out in iced water;
• if the piles stick out, push them gently back inside using a lubricating jelly;
• ask your doctor, midwife or pharmacist if they can suggest a suitable ointment;
• consider giving birth in a position where the pressure on your back passage is reduced - kneeling, for example.

Skin and hair changes

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 running down the middle of their stomachs. These changes will gradually fade after the baby has been born, although your nipples may remain a little darker.

If you sunbathe while you are pregnant, you may find you tan more easily. Protect your skin with a good, high-factor sunscreen.

Don't stay in the sun for very long.

Hair growth is also likely to increase in pregnancy. Your hair may also be greasier. After the baby is born it may seem as if you're losing a lot of hair. In fact, you're simply losing the increase that occurred during pregnancy.

If you sometimes can't help wetting or soiling yourself, you can get help. Incontinence is a very common problem. It can affect anyone, sometimes during and after pregnancy. In many cases it is curable, so if you've got a problem talk to your doctor, midwife or health visitor, or ring the confidential Continence Foundation on (020) 7831 9831 (9.30-4.30 Mon-Fri).

It might be more comfortable to lie on one side with a pillow under your tummy and another between your knees.

If you aren't sleeping well

• Try not to let it bother you. Don't worry that it will harm your baby - it won't.
• It might be more comfortable to lie on one side with a pillow under your tummy and another between your knees.
• Relaxation techniques may help. Your antenatal class may teach relaxation techniques, or you could borrow a cassette from your library.
• A warm, milky drink, a warm bath, some gentle exercise or some restful music before bedtime may help.
• A rest during the day can help you to feel less tired.
• Talk to your partner, a friend, doctor or midwife.

Sleeplessness

Late in pregnancy it can be very difficult to get a good night's sleep. You're uncomfortable lying down, or just when you're beginning to get comfortable you have to get up to go to the toilet. Some women have strange dreams or nightmares about the baby and about the birth. Talking about them can help you. Just because you dream something, it doesn't mean it's going to happen. Relaxation and breathing which are taught in antenatal classes might be helpful.

Stretch marks

These are pink or purplish lines which usually occur on the tummy or sometimes on the upper thighs or breasts. Some women get them, some don't. It depends on your skin type. Some people's skin is more elastic. You are more likely to get stretch marks if your weight gain is more than average.

It's very doubtful whether oils or creams help to prevent stretch marks. After your baby is born the marks should gradually pale and become less noticeable.

Swollen ankles, feet and fingers

Ankles, feet and fingers often swell a little in pregnancy because the body holds more water than usual. Towards the end of the day, especially if the weather is hot or if you have been standing a lot, the extra water tends to gather in the lowest parts of the body. You should:

• try to avoid standing for long periods;
• wear comfortable shoes;
• put your feet up as much as you can - try to rest for an hour a day with your feet higher than your heart;
• try to do your foot exercises (see page 17) - these will help.

Teeth and gums

Bleeding gums are caused by a build-up of plaque (bacteria) on the teeth. During pregnancy, hormonal changes in your body can cause the plaque to make the gums more inflamed. They may become swollen and bleed more easily. To keep your teeth and gums healthy, you should:

• pay special attention to cleaning your teeth. Ask your dentist to show you a good brushing method to remove all the plaque;
• avoid having sugary drinks and foods too often. Try to keep them only to meal times;
• remember that dental treatment is free while you are pregnant and for a year after your baby's birth, so have a check-up now;
• discuss with your dentist whether any new or replacement fillings should be delayed until after your baby is born.

Vaginal discharge

Almost all women have more vaginal discharge in pregnancy. It should be clear and white and it 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. Tell your doctor or midwife. The most common infection is thrush which your doctor can treat easily. You can help prevent thrush by wearing loose cotton underwear.

If vaginal discharge, of any colour, increases a lot in later pregnancy, tell your doctor or midwife.

Varicose veins

Varicose veins are veins which have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in the vulva (vaginal opening).

They usually get better after delivery. 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 support the muscles of your legs - you can buy them at most pharmacists;
• try sleeping with your legs higher than the rest of your body - use pillows under your ankles or put bricks or books under the foot of your bed;
• do foot exercises and other antenatal exercises which will all help your circulation, such as walking, cycling, and swimming.

More serious problems

Slow-growing babies

Many of the tests in pregnancy check the growth of your baby. If you have previously had a very small baby, or if you smoke heavily, the midwives and doctors will already be monitoring your pregnancy closely. Blood pressure checks may also pick up signs of trouble. If there is concern about your baby's health, further tests may be carried out and more frequent monitoring of your baby may be recommended.

In the last weeks of pregnancy you may also be asked to keep track of your baby's movements. If you notice your baby's movements becoming less frequent or slowing down, or if they stop, contact your midwife or doctor immediately.

If tests show that your baby is not growing well in the womb, early delivery by induction of labour or Caesarean section may be recommended.

Tiredness

In the early months of pregnancy you may feel tired or even desperately exhausted. 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. Towards the end of pregnancy, you may feel tired because of the extra weight you are carrying. Make sure you get plenty of rest.

Other symptoms

You should contact your GP if you have a sudden 'acute' illness like diarrhoea, vomiting, abdominal pain or a high fever.

High blood pressure and pre-eclampsia

During pregnancy your blood pressure will be checked at every antenatal appointment. This is because a rise in blood pressure can be the first sign of a condition known as pre-eclampsia - often called pregnancy-induced hypertension (PIH) or pre-eclamptic toxaemia (PET) - which can run in families and affects 10% of pregnancies. Your urine will also be checked for protein.

If you do have pre-eclampsia, you will probably feel perfectly well. Some women experience symptoms such as headaches, visual disturbances, swelling and abdominal pain. Pre-eclampsia can still be severe, however, without any symptoms at all. Although most cases are mild and cause no trouble, it can get worse and be serious for both mother and baby. It can cause fits in the mother (eclampsia) and affect the baby's growth, and be life-threatening if left untreated. That is why routine antenatal checks are so important.

Pre-eclampsia usually happens towards the end of pregnancy, but problems can occur earlier. Rarely, it can happen after the birth. The earlier in pregnancy it starts, the more severe it is likely to be. If it does get worse, the treatment ranges from rest at home or in hospital to drugs to lower the high blood pressure or, occasionally, early delivery of the baby.

Vaginal bleeding

Bleeding from the vagina at any time in pregnancy can be a danger signal. In early pregnancy, bleeding may be a sign of an ectopic pregnancy or a miscarriage, although many women who bleed at this time go on to have normal and successful pregnancies. If you have bleeding with pain contact your GP straight away.

Bleeding after about five months may be a sign that the placenta is implanted in the lower part of the uterus (placenta praevia) or that it has started to separate from the uterus (placental abruption). Both of these can be dangerous for you and the baby, so contact your midwife or doctor immediately.

The cells on the surface of the cervix often change in pregnancy and make it more likely to bleed, particularly after intercourse. This is called a cervical erosion. Vaginal infections can also cause a small amount of vaginal bleeding.

Some causes of vaginal bleeding are more serious than others, so it's important to find the cause straight away. The most common sort of bleeding in late pregnancy is the small amount of blood mixed with mucus, known as a 'show'. This is a sign that the cervix is changing and becoming ready for labour to start. It may happen a few days before contractions start or during labour itself. You should always report this to your doctor or midwife as soon as it occurs.

Severe itching and obstetric cholestasis

Although itching is very common in normal pregnancy, severe generalised itching, without a rash, particularly in the last four months of pregnancy, may be the only sign of an uncommon condition called obstetric cholestasis. This is a potentially dangerous liver disorder which seems to run in families, although it can occur without any family history. It is important to contact your doctor if you have troublesome itching because obstetric cholestasis may lead to premature labour, stillbirth or serious health problems for the baby, and to an increased risk of maternal haemorrhage after the delivery.