The majority of the permanent adverse effects of pregnancy are only caused because women do not take sufficient care of themselves during pregnancy or do not report abnormal symptoms to their medical advisers at the earliest available opportunity.
This chapter details some possible permanent effects of what would be considered by many people a normal pregnancy. At first sight this is a long and tragic list but in fact most effects can be avoided.
The control of weight gain during pregnancy has been stressed throughout this book. The weight gain associated with pregnancy alone is 18 lb. and any weight gain in excess of this is caused in the majority of instances by the deposition of fat and subsequent retention of fluid. Retention of excess water is a very unusual phenomenon in a woman who has not already gained an excessive amount of weight. Excessive weight gain leads not only to problems during pregnancy itself but also to tiredness, lassitude and other minor difficulties after delivery.
It used to be said that every woman was allowed to gain one stone per baby. What a tragic comment. Any woman who has gained an excessive amount of weight in pregnancy and who finds herself to be overweight after delivery and puerperium should go on a reducing diet as soon as possible so that she returns to her original weight, regardless of whether she is breast-feeding or not. Many women who have gained extra weight argue that they will go on a diet when they have finished breast-feeding, but after 6 or 9 months they have become so used to the extra weight that they no longer have the desire to lose it or the determination to adhere to a diet. It is quite possible to continue satisfactory breast-feeding while gradually losing weight. A crash diet during breast-feeding is not recommended. Tablets or injections intended to make people lose weight are never advisable and are most definitely contra-indicated during breast-feeding.
Anaemia may be a permanent effect of pregnancy only if it started during the antenatal period or if there was excessive bleeding at delivery or shortly afterwards. Any woman who becomes anaemic during pregnancy is treated; if she loses too much blood following delivery this is corrected by a blood transfusion or by giving her extra iron. Apart from some rare diseases, therefore, there is no reason why anaemia should persist after the completion of the puerperium, and to ensure against it mothers should continue taking their iron pills for at least 3 months after delivery. If a woman considers she is anaemic she should report to her doctor for a blood test. In any event a blood test is nearly always taken at the postnatal clinic and any tendency to anaemia treated. One of the hazards of not attending the postnatal clinic is that such a tendency may never be discovered and will develop without treatment.
Constipation is a relatively common symptom during pregnancy. A large number of women suffer from mild constipation before pregnancy and when they become pregnant this gets worse so that they resort to purgatives of ever-increasing strength. This is entirely unnecessary. The control of the bowels during pregnancy should be dealt with as far as possible by the adjustment of diet and fluid intake and if purgatives are required they should be used sparingly as is necessary to open the bowels regularly once a day. As soon as a woman returns to her normal life and diet her bowels should return to normal. If she has developed the habit of taking a purgative during her pregnancy she must stop as soon as possible or she may find that she has to continue taking it for an indefinite period, or occasionally for the remainder of her life.
Pregnancy does not have any adverse effect on the skin except in women whose skin is normally dry and becomes excessively so during pregnancy. They must take special care to keep their skin well oiled throughout pregnancy and it will then return to normal afterwards. A certain coarseness may develop in the skin of women who gain an excessive amount of weight and do not lose it soon after delivery. Intertrigo, an inflammation in skin creases which occurs in women who are overweight, may be permanently present in those who fail to lose weight.
Quite a high percentage of women complain that their hair becomes unmanageable during pregnancy and occasionally thinner, more brittle and tends to break easily. Providing it is carefully looked after during pregnancy it will return to normal afterwards.
The care of the teeth during pregnancy depends on the care of the gums and oral hygiene. Any dental caries that starts during pregnancy will progress afterwards until it has been satisfactorily treated. Gingivitis should be treated in pregnancy. It causes the gums to recede away from the teeth so that even after delivery the tender and vulnerable part of the tooth is exposed to the ordinary bacteria in the mouth.
Stretch marks may occur on the breasts in early pregnancy as a result of rapid breast enlargement. On the rest of the body, however, stretch marks are the direct result of excess weight gain or of excessive uterine enlargement caused by the presence of too much water or a twin pregnancy. Once they have appeared they will never completely disappear. The marks on the breasts become pale quite quickly after delivery and almost invisible after several months. The marks on the abdomen and thighs, however, take much longer to disappear and always remain as silvery, thin tissue-paper like scars. Once a stretch mark has occurred nothing further can be done about it although, if the abdomen has been particularly stretched by multiple pregnancy or excessive fluid, plastic repair can help.
There is always a tendency for varicose veins to appear during pregnancy. They tend to disappear quite rapidly after delivery. During each subsequent pregnancy, however, the varicose veins gradually become worse and, each time, it takes the legs longer to return to normal, until eventually permanent varicosities remain. Although improvement may well continue for as long as 6 months any varicose veins still present i month after delivery are unlikely to disappear completely. Permanent varicose veins can be treated either by injections or by surgical removal.
Piles or Haemorrhoids
Piles or haemorrhoids may develop during pregnancy but are far more likely to occur at the time of delivery. They may cause a great deal of pain or discomfort for the first few days of the puerperium. Piles usually settle down quite quickly after delivery but, rather like varicose veins, they tend to become worse with each subsequent pregnancy until eventually they become permanent. If the symptoms arc still present at the time of the visit to the postnatal clinic they should be discussed with the doctor. Treatment for persistent piles is not usually advised until several months after delivery when they can usually be corrected by a simple injection.
The breasts become larger and heavier during pregnancy and require more support since they do not contain any muscle tissue and, once allowed to sag or stretch, there is nothing that can be done to make them return to their former shape. Adequate support, therefore, throughout pregnancy and lactation is absolutely essential.
A great deal of argument rages concerning the effect of breastfeeding on the shape, texture and size of the breasts. While it is certainly true that some women can breast-feed their babies without any subsequent effect on their breasts, the majority do find that it results in permanent alteration in the shape and size of the breasts themselves.
The pigmentation that appears on the areola of the breasts at about the 14th week of pregnancy is usually permanent, unlike pigmentation that occurs elsewhere on the body during pregnancy.
If too much standing and tiredness are avoided and sensible shoes worn during pregnancy, there will be no permanent effect on the feet. The ligaments become softer during pregnancy and if the feet are not satisfactorily supported the arches may flatten with resulting foot strain, aching feet and eventually flat feet.
It is very difficult to maintain good posture throughout an entire pregnancy and unless particular care is taken to regain normal posture after delivery and to perform postnatal exercises, backache and other associated symptoms may eventually develop.
The bladder is particularly vulnerable during pregnancy, and after delivery some women suffer from its inadequate control or actual lack of control resulting in leakage of urine on coughing, sneezing or on exercise. Frequency of micturition gradually subsides over a few days or a few weeks. Weakness or lack of control can only be restored by the religious performance of postnatal exercises, especially those that involve the muscles of the pelvic floor.
If stitches have been inserted in the perineum they will be sore for a few days after delivery and the perineum will be tender for several weeks. Normally the discomfort gradually disappears but occasionally small areas of tenderness persist. These symptoms may make postnatal exercises uncomfortable so that they are not performed properly and the muscles do not return to normal. Weakness of the muscles of the perineum can have an effect on sexual intercourse. Any discomfort should be mentioned to the doctor at the postnatal clinic.
After delivery the cervix resumes its normal shape but it is invariably a little larger and the canal slightly wider. The external cervical os, which before pregnancy was circular, becomes oval across the cervical entrance. This may be the only sign that a woman has had a baby when there have been no stitches or stretch marks.
Approximately 75 per cent of all pregnant women develop ulcers or erosions on the cervix and these are the main cause of the vaginal discharge which is normally present throughout pregnancy. About 50 per cent heal spontaneously. An internal examination is performed at the postnatal clinic to take both a cancer test from the cervix and to ensure that any erosions have healed. These occasionally become infected and the simple inflammation persists after delivery causing a continuous yellowish, sometimes offensive, vaginal dis-charge. If this happens then the cervical erosion ought to be treated. Although a persistent cervical erosion may not cause any symptoms, the doctor may decide that it is unlikely to heal on its own and should be treated.
After a pregnancy the uterus is slightly larger even when completely involuted. This cannot be noticed but it does allow more room for an intrauterine contraceptive device which is therefore less likely to cause bleeding or pain in a woman who has had a baby than in one who has not.
Most doctors maintain that every uterus becomes mildly infected at the time of delivery but in a few instances the body is unable to deal with the infection and the uterus remains tender and bleeding continues after delivery for rather longer than usual. The lochia will be redder than normal and the first period heavier than usual. Occasionally periods continue to be heavy and prolonged over several months. The doctor should be consulted about these symptoms.
After having a baby a woman’s menstrual pattern changes. The cycle usually becomes more regular. The pattern of the menstrual flow may change and the number of days may be different but the total loss should be about the same. A girl who suffered from the classic spasmodic type of pain on the first day of her period will find that this does not occur after she has had a baby. Unfortunately a few women do develop a slightly different kind of period pain after pregnancy.