Should I Call the Doctor

Why am I supposed to keep a written record of my baby’s movements?

I know it’s normal to have some swelling in my feet and ankles, but my hands are so swollen I can’t get my rings off, and my husband says my eyes look puffy.  I have a prenatal appointment in four days, but my husband wants me to call now.

Every once in a while, I feel a sharp pain from my groin up the side of my abdomen.  Is this something I should worry about?

For the past few days, I’ve felt a strong, uncomfortable pressure very low in my abdomen and in my vagina.  My baby isn’t due for three more weeks, but sometimes it feels like she’s pushing hard against my vagina.

My baby is due next week.  I had a pelvic exam yesterday, and the doctor said my cervix was softening and beginning to thin out.  When I arrived home after the exam, I noticed a little blood and mucus on my panties.  It happened again this morning.  Does this mean there’s something wrong with my baby?

I’m just a few days away from my due date, and I noticed some watery discharge in my underwear when I went to the bathroom two hours ago.  I’ve been having mild, painless contractions every 20 minutes or so since then, and I can feel something leaking with each contraction.  My doctor has told me I should go to the hospital if I think the bag of waters has broken, but I can’t tell if this is urine or if my water broke.

     Also See:

                   OB Patient Information: Your in Labor - True or False

                   OB Patient Information: Warning Signs

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Why am I supposed to keep a written record of my baby’s movements?

Fetal movement is an important indicator of fetal health.  Decreased movement can mean your baby is not receiving enough oxygen or nourishment.  You should immediately notify your prenatal caregiver if your baby doesn’t move at least ten times in 2 hours after eating a meal.

Prenatal-care providers usually ask their patients about the baby’s activity level at each visit.  There are several methods for writing down “kick counts,” as these records are often called.  Generally the goal is to be able to count four to six movements in an hour, two or three times a day, or to count at least ten movements in a 2 hour period after eating a meal.

The best time to do kick counts is usually just before or after eating, depending on when your baby is most active.  Most mothers find that it helps to drink a glass of milk or juice before doing a kick count and to rest on their side while doing them.  Some of the situations that can decrease a baby’s movement levels include extreme maternal fatigue or stress, dehydration, poor nutrition, lying on your back to rest or sleep, and standing or walking for prolonged periods.

I know it’s normal to have some swelling in my feet and ankles, but my hands are so swollen I can’t get my rings off, and my husband says my eyes look puffy.  I have a prenatal appointment in four days, but my husband wants me to call now.

Many expectant mothers find that their rings no longer fit their fingers during late pregnancy.  This may be due to weight gain or to fluid retention in the hands.  If the swelling, or edema, in your hands, face or around your eyes doesn’t improve when you change your position, activity or when you move from a hot, humid place to a cool, dry place, call your prenatal caregiver immediately; your blood pressure may be too high.

All healthy pregnant women experience some swelling because they retain extra fluid in their bloodstream and in and between some of the body’s cells.  Blood volume increases 40 to 45 percent during pregnancy. 

The reason your legs, ankles, and feet become swollen is gravity; the veins that return blood from the lower body back to the heart sometimes can’t keep up with the increase in blood volume during pregnancy.  This problem is compounded by the weight of the baby, uterus, placenta, and amniotic fluid, which presses downward on veins as they move blood upward through the pelvic area.  You may notice swelling is worse if you stand, walk, or sit for an extended period of time.

Edema also can occur in your hands if you sleep in a position that places pressure on your arms or if you hold your arms down at your side for some time.

Resting in a reclining position or elevating the affected part of the body usually reduces the swelling.  The type of swelling that is relieved by resting or elevating the affected part of the body is called “dependent edema,” because it depends on the position of your body.  Swelling that does not go away with a change of position is known as “persistent edema.”

You may be able to prevent or reduce swelling by resting on your side for two hours twice a day and drinking eight to ten glasses of liquids.  The best choices are water, milk, juices, and lemonade or limeade.  Avoid coffee, tea, and soft drinks; they cause your body to get rid of too much fluid.  If you enjoy herbal teas, stick to chamomile, cinnamon, mint, or fruit and make certain they contain no caffeine.

Sometimes excess fluid retention isn’t visible, and the only clue is a sudden jump in your weight.  Like persistent edema, this kind of fluid retention can indicate high blood pressure, so your doctor will monitor if you gain more than two pounds a week during your last trimester.  Other signs of high blood pressure that should be reported include persistent or severe headache; a sudden, major decrease in the amount of urine passed; and visual disturbances, such as seeing flashing lights or dark spots, or blurred or narrowed vision.

Every once in a while, I feel a sharp pain from my groin up the side of my abdomen.  Is this something I should worry about?

Occasional, sharp, brief pain in the side of the abdomen is common in late pregnancy.  A spasm or cramp generally causes this pain in one of the round ligaments; two strong cords of fibrous tissue that helps support the uterus.

In a non-pregnant woman the round ligaments are short, because the uterus is small.  During pregnancy the ligaments grow and stretch along the uterus.  As a result they are irritable and may cramp if you make a sudden movement, sit or stand up after lying down, turn at the waist, or even sneeze.  To prevent round-ligament pain, avoid sudden or jerky movements, and move slowly when changing position.  To relieve occasional round-ligament pain, bend slightly at your waist toward the side that hurts.

Although the round ligaments are usually responsible for pain in the side of the abdomen, this pain can be a sign of something more serious, such as placenta abruption (premature detachment of the placenta) or appendicitis.  Call your prenatal caregiver or hospital immediately if the pain persists longer than five minutes or if it is accompanied by one or more of the following symptoms: hardening of the uterus; bloody or watery vaginal discharge; weakness; nausea; dizziness; cold, clammy skin; shoulder pain; or extreme anxiety.

For the past few days, I’ve felt a strong, uncomfortable pressure very low in my abdomen and in my vagina.  My baby isn’t due for three more weeks, but sometimes it feels like she’s pushing hard against my vagina.

Many expectant mothers experience this bothersome sensation during the last trimester.  Although it’s usually normal, you should call your prenatal caregiver or the hospital labor-and-delivery unit if severe pain, vaginal bleeding, watery discharge, or uterine contractions that are five or fewer minutes apart accompany the pressure.

If these warning signs aren’t present, your discomfort is probably the normal result of carrying the increased weight of your baby, uterus, placenta, and amniotic fluid.  The discomfort you feel in your lower abdomen essentially occurs because the baby is pressing down toward your pubic bone, trapping nerves and muscles between the bone and your baby’s head.  The baby also exerts pressure on the veins that move blood out of the pelvis and vagina, and as a result these veins become swollen and congested with blood.  The area may feel tender and sore, as though it’s bruised.

Because your abdominal muscles help support your baby’s weight, your discomfort starts sooner and is worse if a previous pregnancy or excess weight has weakened the muscles.

You can temporarily decrease your discomfort by resting on your side with a small pillow or rolled-up towel positioned between the bed and the baby, or by resting in the knee-chest position.

To get into the knee-chest position, place a large pillow on the floor in front of your body, and assume a kneeling position.  Place your hands and arms on or under the pillow, and keeping your buttocks up, rest your head and chest on the pillow.  Scoot your knees backward or forward until your back is rounded and comfortable.  You can stay in this position for as long as you’re comfortable; even 15 to 20 minutes is fine.  When you’re ready to leave this position, do so slowly, pushing your weight against your hands as you gradually assume a kneeling position.  The knee-chest position may be uncomfortable at first, but with practice many expectant mothers find it both comfortable and relaxing.

To reduce pelvic or vaginal soreness, do frequent Kegel exercises, tightening your vaginal muscles as though you are trying to hold back urine, and then relaxing them.  Try to do at least five Kegels ten times a day.  You also can find some relief by applying a cold compress to the area or soaking in cold water.  And while some women find sexual intercourse uncomfortable when their vagina is sore, others find that orgasm relieves the congestion and soreness.

Your childbirth educator can teach you other ways to reduce discomfort, including exercises such as the pelvic tilt and the buttocks curl.

My baby is due next week.  I had a pelvic exam yesterday, and the doctor said my cervix was softening and beginning to thin out.  When I arrived home after the exam, I noticed a little blood and mucus on my panties.  It happened again this morning.  Does this mean there’s something wrong with my baby?

Since you are within two weeks of your due date and experienced only a small amount of bleeding, there is probably no need for concern.  A “small” amount of bleeding is such that a lightweight panty liner is enough to absorb the blood and you do not need to wear a sanitary pad.  (Do not use a tampon for pregnancy-related bleeding or discharge.)

It’s common to experience a small amount of vaginal bleeding after a pelvic exam near the end of pregnancy.  This usually means that the cervix is thinning and perhaps beginning to dilate.  If the examiner’s fingers touch the cervix, the mucus plug may be disturbed, causing a bloody, mucous discharge.  This is not a cause for alarm.

You’ll experience this same type of discharge when the cervix has thinned and/or dilated enough for the mucous plug to begin oozing out on its own.  This is a normal process that may indicate that labor will begin within the next few days or so.

I’m just a few days away from my due date, and I noticed some watery discharge in my underwear when I went to the bathroom two hours ago.  I’ve been having mild, painless contractions every 20 minutes or so since then, and I can feel something leaking with each contraction.  My doctor has told me I should go to the hospital if I think the bag of waters has broken, but I can’t tell if this is urine or if my water broke.

The bag of waters can break before or during labor.  Some women notice a sudden gush of fluid, while others feel only a persistent trickle.

It’s easy to confuse leaking amniotic fluid with leaking urine, especially in later pregnancy, when most women have problems with bladder control.  To determine which it is, go to the bathroom and empty your bladder, lifting the baby (your abdomen) a bit to let as much urine as possible drain.  Afterward, put on a clean, dry sanitary pad.  If the pad is wet within the next five or ten minutes, try to empty your bladder again, and put on a new pad.  It usually takes 20 minutes or longer for your bladder to have enough urine to leak, so if the second pad gets wet within the next few minutes, your bag of waters is probably leaking.  Also, uterine contractions usually inhibit urination, so leaking that occurs or increases with contractions is probably amniotic fluid.

Since you are near your due date, your doctor or nurse may ask you to wait at home until the contractions become stronger and more frequent or until a specific number of hours have passed.  If your baby hasn’t dropped, or if the leaking fluid is greenish or brownish, you’ll probably be told to go to your doctor’s office or to the hospital immediately.  (A woman less than 37 weeks pregnant should check in with her caregiver immediately if she thinks her water has broken.)

It’s important to follow your prenatal caregiver’s instructions regarding the bag of waters, because once it breaks, you and your baby are more vulnerable to infection.  As with any new or unusual symptom during pregnancy, call you prenatal caregiver if you aren’t sure what to do.

By Sherry L.M. Jiménez, R.N., M.S.N., F.A.C.C.E.

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