🧘 Discomforts of Pregnancy & Hyperemesis
What is normal, what is not, and the fixes that actually work — plus where morning sickness stops being morning sickness.
✅ Normal changes that look alarming
- Blood volume rises about 50% → dilutional “physiologic anemia”
- Heart rate rises 10–15 bpm; blood pressure dips in the second trimester then returns
- Shortness of breath as the uterus lifts the diaphragm
- Constipation and reflux — progesterone slows smooth muscle
- Mild dependent edema of feet and ankles
- Nasal stuffiness, nosebleeds, bleeding gums — increased vascularity
- Chloasma, linea nigra, striae — pigmentation changes
Edema of the FACE and HANDS is not normal. That is preeclampsia until proven otherwise.
🧘 The fixes that work
| Complaint | Why | What actually helps |
|---|---|---|
| Morning sickness | hCG, first trimester | Dry crackers before rising; small frequent meals; avoid an empty stomach |
| Heartburn | Relaxed sphincter + pressure | Small meals, stay upright after eating, avoid spicy and fatty food |
| Constipation | Slowed motility + iron | Fiber, fluids, walking. No stimulant laxatives |
| Leg cramps | Circulation, calcium | Dorsiflex the foot — do not point the toes |
| Backache | Shifted center of gravity | Pelvic tilt exercises, low heels, side-lying with a pillow between the knees |
| Varicosities / hemorrhoids | Venous pressure | Elevate legs, avoid crossing legs, side-lying, support hose |
| Supine hypotension | Uterus on the vena cava | Turn to the left side |
| Urinary frequency | Uterine pressure | Normal in 1st and 3rd trimester. Do not restrict fluids |
Dorsiflexion for leg cramps and left side for supine hypotension are two of the most frequently asked comfort measures. Both are free and immediate.
🏃 Exercises that prepare the body for birth
These are taught in prenatal class and they come up on exams, because each one has a specific target and students mix them up. None of them is about fitness or losing weight.
| Exercise | What it does | How it is taught |
|---|---|---|
| Squatting | Stretches and strengthens the perineal muscles and the pelvic floor, and widens the pelvic outlet for the second stage | About 15 minutes a day. Feet flat and apart, hold onto a chair or a partner for balance, sink down with the back straight |
| Kegel exercises | Strengthens the pelvic floor — less leaking now, better recovery afterwards | Squeeze as if stopping urine, hold about 10 seconds, release. Several sets a day, any position, nobody can tell |
| Pelvic tilt (angry cat) | Relieves low back ache from the shifted center of gravity | On hands and knees, arch the back up, then release. Can also be done standing against a wall |
| Tailor sitting | Stretches the inner thigh and groin, and improves flexibility for delivery positions | Sit cross-legged on the floor, back straight |
| Walking and swimming | General conditioning, circulation, sleep, constipation | Most days, at a pace where she can still hold a conversation |
🚨 The wrong answers this question is built from
- “Squatting tones your abdomen and helps you lose weight faster after delivery.” — wrong twice over. It targets the perineum, not the abdomen, and weight loss is never the goal of a prenatal exercise.
- “It will reduce lower back pain during labor.” — that is the pelvic tilt, not squatting.
- “Three times a week improves your overall fitness.” — too vague, wrong frequency, and again the wrong purpose.
Squatting = perineal muscles, about 15 minutes daily. Hold that pairing and the whole item falls out.
⚠️ When exercise has to stop
Tell her to stop and call: vaginal bleeding, leaking fluid, contractions, dizziness, chest pain, calf pain or swelling, headache, or decreased fetal movement.
- No lying flat on the back after the first trimester — vena cava again
- No contact sports, no scuba diving, nothing with a fall risk
- Do not get overheated — no hot tubs, no saunas
- Drink water; relaxin loosens the joints, so do not stretch to the very end of the range
🚨 Hyperemesis gravidarum
This is not morning sickness. It is persistent vomiting causing:
- Weight loss over 5% of pre-pregnancy weight
- Dehydration — dry mucous membranes, poor turgor, concentrated urine
- Ketonuria — the body is burning fat for fuel
- Electrolyte imbalance — often hypokalemia and metabolic alkalosis from losing gastric acid
It needs IV fluids and often admission - not dietary advice.
🩺 Management
- Daily weights and strict input and output — the objective measures of progress
- Quiet environment; remove strong smells, including food trays and perfume
- Sit upright for 45 minutes after eating
- Monitor for thiamine deficiency with prolonged vomiting
It is associated with molar pregnancy and multiple gestation — both produce very high hCG. An ultrasound is part of the workup.
Also linked with ambivalence about the pregnancy, so ask gently about how she is feeling about it. Emotional support is part of the treatment, not an add-on.
🎯 NCLEX traps
- Face and hand edema is abnormal; ankle edema is not
- Dorsiflex for leg cramps
- Left side for supine hypotension
- Do not restrict fluids for urinary frequency
- Hyperemesis = weight loss, ketones, IV fluids, not crackers