What symptoms should never be ignored in pregnancy?

Discovering you are expecting a baby can be both exciting and daunting time for any woman. It is only natural to worry a bit throughout your pregnancy – it’s a new and sometimes nail-biting journey; every woman hopes for an uncomplicated pregnancy and a healthy baby nine months later. Expectant mums can be reassured that for most pregnancies, that is what happens.

However, our recent survey found that a large proportion of mothers did not feel they had risks explained to them in preparation for childbirth. With this in mind, and as part of our campaign to focus on the challenges faced by mums, we wanted to highlight for mums out there some symptoms that all expectant mothers should be aware of during pregnancy, as they may indicate something more concerning is going on.

Janet Edwards, a midwife of over 30 years, has worked both as a community midwife and managed a busy labour ward. Alongside her role she was a supervisor of midwives for 12 years. 

Janet sets out below some of the symptoms mums should look out for. While there are a number of possible causes of these symptoms, any mother experiencing them should contact their local maternity unit where a midwife will be able to give appropriate advice. This will usually involve attendance at the Day Assessment Unit or Triage within the local hospital maternity unit. 

“If you are fit and healthy with no underlying health conditions you will be cared for by midwives with no need to see a doctor at all during your pregnancy, birth or postnatal period. Midwives are highly trained to provide this care and to recognise when it necessary to refer you to your GP or the obstetrician at the hospital. This is usually when your pregnancy or labour fall outside the remit of normality. For example raised blood pressure, diabetes, concerns about your baby’s growth or movements. Your midwife will listen to all your concerns and reassure and advise you appropriately. Unfortunately, there are occasions when the mother does not feel listened to, or simply does not get on with her midwife.” 

Symptoms to be aware of

Vaginal bleeding

Vaginal bleeding during pregnancy is abnormal and, therefore, always needs to be investigated. In early pregnancy you can contact your midwife or GP who may refer you to the Early Pregnancy Assessment Unit. 

Some women will experience very slight blood loss during pregnancy, known as ‘spotting’ following sexual intercourse which can range from light pink to brown. Beyond 12 weeks, if you are rhesus negative blood group, you will need an injection of anti D; a requirement for all rhesus negative mothers where there is a risk of the blood from a potentially rhesus positive fetus mixing with the mothers rhesus negative blood. This also applies to rhesus negative women who have had a blow to the abdomen. 

If in doubt you need to contact your midwife or GP or the Day Assessment Unit at the hospital. If bleeding is excessive you need to contact the Day Assessment Unit/triage and get there as a matter of urgency. You may require an ambulance which they may arrange for you. 

Abdominal pain

Many women during pregnancy will experience abdominal ‘stitch-like pain’ associated with stretching ligaments as the womb/uterus gets bigger with the growing fetus. However when abdominal pain becomes intense, persistent or feels like ‘period’ pain, it must be investigated. 

Pain may be nothing to worry about, but it could be something more serious like premature labour, bleeding from the placenta/afterbirth, or the placenta starting to separate from the lining of the womb/uterus. 

If the pain is intense and/or persistent you will need to contact the Day Assessment unit/triage. 

Severe headache

Most women will experience headaches during pregnancy. However, if the headache becomes persistent and will not go with paracetamol it should be investigated. 

The headache may be associated with some visual disturbances such as ’floaters’ or blurred vision. It may also be associated with generalised swelling/puffiness to the face, hands, legs and feet. This may be nothing to worry about, but a condition known as preeclampsia needs to be excluded. This is done by checking the blood pressure and testing the urine. It may also be required to take some blood tests which will determine whether preeclampsia has, or is developing. If you have these symptoms do contact the Day Assessment Unit/triage. 

Itching all over

Many women will experience some slight ‘itching’ during pregnancy. However, if it specifically affects the palms of the hands and feet it needs to be investigated. It could be a serious condition which affects your liver and in turn can affect your baby. Your community midwife should refer you or you can phone the Day Assessment Unit/triage.

Feeling your baby move less

Most women will feel their baby move by 18-20 weeks. These movements will increase and reach a peak by 32 weeks. For those who do not feel any movements before 24 weeks you may require an ultrasound scan. From 24 weeks most women will feel their baby move everyday. Before 28 weeks the community midwife will listen to the heart rate with hand held listening device known as a sonicaid. It is important for women to be aware of their baby’s movements everyday. Fetal movements should be consistent until birth.

If a reduction or sudden alteration in movements is perceived it is important to contact the Day assessment unit or Triage without delay. It is inadequate to be advised to drink cold water or advised that fetal movements slow down towards the end of pregnancy. The advice should be to attend for a period of continuous fetal monitoring, known as a CTG, to confirm fetal wellbeing. Whilst most babies are absolutely fine, if concerns persist an ultrasound scan will be performed.

Fetal growth

Your midwife will measure your abdomen with a tape measure every 2-3 weeks from 24-28 weeks gestation. She may plot these measurements on a specific growth chart. Whilst the measurements can be subjective, if the measurements do not increase or reduce from previous, you will be referred for a scan to confirm adequate fetal growth and fluid levels surrounding your baby.  

If your baby is measuring large for dates, the midwife will arrange for a glucose tolerance test to exclude diabetes which is associated with an increased risk of shoulder dystocia whereby the shoulders of the fetus can get stuck during the birth. Midwives and obstetricians are highly trained to deal with this obstetric emergency. If your baby shows excessive growth towards the end of pregnancy, the midwife may refer you for a scan or to the obstetrician to discuss birth options. However, it is possible the obstetrician will advise a vaginal birth in the absence of diabetes.

Sepsis

If you feel unwell and have a high temperature, rapid heart rate, some breathlessness, are feeling nauseous or are having diarrhoea, it is vital you get seen straight away. Do not wait to see your GP. Contact the Day Assessment Unit/triage who should advise you to attend as a matter of urgency for investigation. This will hopefully exclude any infection that may have got into your blood stream. 

If you start leaking fluid

Contact the Day Assessment Unit/triage you may be advised to attend for assessment. However, if your baby is moving normally and the colour of the fluid is clear there will be no urgency for you to attend. If your membranes have ruptured you will be vulnerable to infection so it should be advised to monitor your temperature regularly during waking hours. . 

It may be useful for you to have a digital thermometer from the start of your pregnancy. 

After the birth

You may wish to discuss your birth experience before leaving hospital. This should be facilitated. The Trust may have a ‘Birth After thoughts’ service which will provide you with an opportunity to discuss your birth experience.  

Before you leave the hospital the midwife will give you a list of serious illnesses to look out for in you and your baby. These should be discussed with you to ensure you fully understand the information given to you. It will be reiterated again by the community midwife when you receive your first home visit which will usually be within 24 hours. It is important to read this information so as to be aware of any potential problems. 

In some cases women think they should wait until the midwife is due to see them at home the following day. If you have concerns during the night about you or your baby you can phone the maternity unit and speak to a midwife who should give you the correct advice. If you feel your concerns have not been heard and you remain significantly worried about you or your baby, the only option would be to go to A&E. 

We frequently see women who have expressed concerns about their baby who is sleepy and not feeding. Again, do not wait until the next day to get advice. If your baby is jaundiced, sleepy and not feeding this would be even more concerning and requires investigation. 

If you have any of the concerns mentioned above it is essential that you report them to the Day Assessment Unit/triage or the Labour ward where you will speak to a midwife. There may be occasions where you can speak to the community midwife, however if you experience any of the above, the quickest way to get advice or reassurance is via the Day Assessment Unit/triage or labour ward. 

What you can do if you don’t feel you are being listened to

A large proportion of my role as a clinical negligence solicitor is spent representing mothers who have been injured during childbirth.

Many of the mothers I represent have said that they didn’t feel their concerns were taken seriously, and in fact they were reassured that everything was fine and normal. This is borne out in our recent survey where just over 17% of mums we surveyed stated that they did not feel concerns about their mental before and/or after the birth of their child were listened to.

Mums I have worked with often talk about feeling guilty that they didn’t do more, but what can a mum do if they feel they are not being listened to about concerns they are raising during pregnancy? Janet suggests the following:

“If you feel at any time you are unhappy with your care, some trusts will have a PMA (Professional Midwifery Advocate) whose primary role is to support midwives to support women. The PMA may have the additional role of supporting women directly with concerns regarding their care. Alternatively a Supervisor of midwives should be available 24/7 via the local Trust switchboard. Each SOM is accountable to the LSAMO (Local Supervising Authority midwifery officer) and not the Trust. Whilst the SoM will support the midwife in her clinical practice, the SoM will also listen and advocate on your concerns regarding the care you have received. This could include your choice of birth or any shortfalls in care you feel you have received.    

However if your Trust does not have this service, it may be required to contact the Head/ Director of Midwifery. 

If you are unhappy with your midwife, you can also contact the appropriate midwifery manager eg hospital or community via switchboard at your local hospital and discuss your concerns. It may be necessary to change to another midwife which can be arranged. 

Failing this, you can send a complaint letter to the Legal Services department within the hospital who will initiate an investigation and determine whether lessons can be learnt from your experience.”