Common Discomforts During the Second and Third Trimester

Second and Third Trimester Discomforts

The Second and Third Trimester

Heartburn

Causes

• Relaxation of the cardiac sphincter;
• Decreased GI Motility;
• Increased production of progesterone; and
• Gastric displacement

Interventions

• Encourage the woman to eat small, frequent meals spaced throughout the day;
• Caution her to avoid fatty and fried foods and caffeine products;
• Suggest that she remain upright for at least 1 hour after eating; and
• Encourage her to check with her health care provider before using an over-the-counter antacid.

Constipation

Causes

• Oral iron supplements;
• Displacement of the intestines caused by the fetus; and
• Bowel sluggishness caused by increases progesterone and steroid metabolism.

Interventions

• Encourage the woman to engage in moderate daily exercise;
• Advise the increased intake of fluids and foods high in fiber;
• Urge the woman to maintain regular elimination patterns and avoid ignoring the urge to defecate; and
• Caution the woman to avoid the use of mineral oil, which can deplete her level of fat-soluble vitamins.

Hemorrhoids

Causes

• Pressure on the pelvic veins by the enlarging uterus, which interferes with venous circulation; and
• Increased pressure secondary to constipation.

Interventions

• Describe ways to avoid constipation;
• Caution the woman against prolonged standing and wearing constrictive clothing;
• Suggest the use of a topical ointment or anesthetic if allowed;
• Encourage the use of witch hazel compresses;
• Teach the woman how to perform sitz baths or apply warm soaks; and
• Encourage the woman to lie on her left side with her feet slightly elevated.

Backache

Causes

• Postural adjustments of pregnancy secondary to curvature of the lumbosacral vertebrae that increases with uterine enlargement.

Interventions

• Teach the woman  how to use proper body mechanics;
• Encourage the woman to maintain good posture;
• Suggest that she wear low to mid heel shoes;
• Recommend that the woman walk with her pelvis tilted forward;
• Advise the woman to apply local heat to the back if necessary;
• Suggest sleeping on a firmer mattress or using a board under the current mattress to add firmness; and
• Teach the woman how to do pelvic rocking or tilting exercises.

Leg Cramps

Causes

• Pressure from the enlarging uterus;
• Poor blood circulation;
• Fatigue; and
• Balance in the calcium-phosphorus ratio

Interventions

• If necessary, assist the woman with measures to alter calcium and phophorus intake;
• Encourage frequent rest periods with the elgs slightly elevated;
• Encourage her to wear warm clothing; and
• Teach her what to do during a leg cramps by pulling the toes upward the leg while pressing down on the knee.

Shortness of Breath

Causes

• Pressure of the uterus on the diaphram

Interventions

• Encourage the woman to maintain proper posture, especially when standing;
• Suggest that the woman use semi-Fowleer's position when sleeping and use additional pillows for support; and
• Encourage a balance of activity and rest.

Ankle Edema

Causes

• Poor venous return from the lower extremities; aggravated by prolonged sitting or standing and by warm weather; and
• Fluid retention

Interventions

• Recommend that the woman lie on her side in bed to enhance glomerular filtration rate of the kidneys;
• Encourage the woman to avoid wearing tight, constrictive clothing;
• Advise her to elevate her legs during the rest periods;
• Urge her to dorsiflex her feet when standing or sitting for prolonged periods; and
• Suggest that she get up and move every 1 to 2 hours when sitting for long periods.