Tips to manage common pregnancy symptoms by trimester

Morgan Michalowski, midwife, with patient

Whether this is your first baby or your newest addition, physical changes during pregnancy can feel tiring, worrisome or even scary at times. The line between harmless discomforts and abnormal warning signs can often be difficult to determine.

Of course, every woman — and every pregnancy — is unique. However, being aware of some of the most common symptoms by trimester could help expectant moms know when to self-soothe or when to call your doctor or midwife.

First trimester: Up to 13 weeks 6 days

Nausea and vomiting

Studies find that up to 85 percent of pregnant women experience nausea and vomiting. Commonly referred to as morning sickness, this unpleasant symptom can actually strike at any time of day. Most medical professionals associate nausea and vomiting with rising levels of the human chorionic gonadotropin hormone (HCG). HCG is produced when a fertilized egg attaches to your uterus and continues to rise through the first trimester, helping to maintain the pregnancy until the placenta can fully take over. The good news is that even though morning sickness can be uncomfortable and distressing, studies indicate that nausea and vomiting may actually be a sign that a fetus is developing healthily. At the same time, if you are one of the few pregnant women who doesn’t experience this symptom — don’t be alarmed. Just consider yourself lucky.

What to do

Try eating small, frequent meals to help manage nausea and vomiting. Other remedies that work for some women include eating ginger, drinking chamomile tea or wearing an anti-nausea wristband.

When to call

If you don’t see improvement, you can ask your doctor or midwife about safe anti-nausea medications. If your symptoms are bad enough that you can’t eat or drink for 24 hours, go to the nearest emergency department immediately.

Fatigue

Don’t be too hard on yourself if you’re unable to keep up with activities the way you did before pregnancy. Hormonal changes — specifically, a rise in progesterone — are likely the cause of fatigue in the first trimester.

What to do

Take naps if possible, and make adequate sleep a top priority. Try to get eight hours of sleep each night. While it may become more challenging later in your pregnancy, most women have little trouble finding comfortable sleep positions in the first trimester. It may also help to wind down with relaxing activities before bed. For example, drinking chamomile tea or reading may help calm you for a good night of rest. Usually by the second trimester, energy levels perk up again.

When to call

Contact your doctor or midwife if no matter how much you sleep, you never feel like you have enough energy to get through the day. Your provider may decide to check your thyroid levels to determine if there is an underlying cause of your fatigue.

Second trimester: 14 weeks 0 days to 27 weeks 6 days

Constipation

During pregnancy, there is no shortage of hormonal changes taking place in your body. Progesterone is a hormone that plays essential roles in pregnancy, as well as conception, menstruation and sex drive. As progesterone levels rise during pregnancy, it’s common to experience slower contractions in your intestines, which can lead to constipation.

What to do

Maximize your hydration by drinking at least 2 liters of water each day. You may consider adding herbs or fruit or drinking sparkling water to make it more appealing. Some foods, such as cucumber and watermelon, carry high water content, making them good options to help increase hydration as well. There are many benefits to staying hydrated in pregnancy. In addition to helping avoid constipation, it can help prevent uterine irritability (mild contractions and cramping) and increase energy.

Increasing fiber in your diet can also help prevent or manage constipation. Good sources of fiber include bananas, oranges, apples, mangos, kale, spinach, beans, legumes and whole grain bread.

Additionally, if you’re taking iron supplements, know that they can increase your risk of constipation. Consider increasing hydration and fiber and starting an over-the-counter stool softener to help reduce or avoid constipation.

When to call

If you’re experiencing constipation, discuss it with your doctor or midwife at your next visit.

Round ligament pain

As your baby grows, your uterus expands and lifts out of your pelvis. Women have two round ligaments — one each on either side of your uterus. As these ligaments stretch to accommodate your growing belly, the pressure can cause sharp, shooting or jabbing pain. Round ligament pain commonly occurs while walking or exercising.

What to do

Yoga, stretching, or working with a chiropractor who specializes in Webster technique can help manage round ligament pain. While these options may work for some women, be sure to get clearance from your doctor or midwife before trying any new activity.

When to call

If you’re experiencing round ligament pain, discuss it with your doctor or midwife at your next visit.

Third trimester: 28 weeks 0 days through labor

Heartburn

According to one old wives’ tale, if a pregnant woman has heartburn, it means she’s carrying a baby with a full head of hair. Truthfully, hormones are the culprit once again. Heartburn occurs because increased progesterone relaxes your stomach valve, allowing acid to back up into your esophagus. Additionally, your rising and expanding uterus places pressure on your stomach, forcing acid into the esophagus.

What to do

Don’t lie down immediately after eating. Allow at least 60 minutes for your food to digest. Also, avoid acidic foods, and eat smaller meals more often throughout the day. For additional relief, you may also consider asking your doctor or midwife about trying papaya enzymes or over-the-counter medications that are safe to take during pregnancy.

When to call

Contact your doctor or midwife immediately if you have any of the following symptoms in addition to persistent heartburn:

  • Nausea and vomiting
  • Headache that doesn’t go away with Tylenol or caffeine
  • Spots before your eyes

Right upper belly pain that feels like heartburn in conjunction with the symptoms listed above could be a sign of preeclampsia.

Braxton Hicks contractions

Braxton Hicks are often painless contractions that you may experience near the end of your pregnancy. But, keep calm. This is simply your uterus’ way of practicing for labor.

What to do

Remember to drink 2 liters of water each day. Your uterus is more likely to contract when you are dehydrated.

When to call

Braxton Hicks are not worrisome unless you have more than four in an hour, and they don’t go away with rest and hydration. If this occurs before you reach 37 weeks, notify your doctor or midwife right away.

Morgan Michalowski, CNM, WHNP, IBCLC

Morgan Michalowski, CNM, WHNP, IBCLC offers evidence-based medical care and lactation support to teens, adolescents and adults throughout their life span. Her focus is on helping clients reach their personal health goals through guided listening, education, and individualized care.

Learn more about Morgan