Pain in pregnancy

Discomfort and sometimes pain are a common features of pregnancy. It is just the degree that will differ from one person to the next and also, from one pregnancy to another.

The causes are quite often directly related to the pregnancy. These may include an over-exuberant fetus, pressure effects from the fetal head or limbs, and over-distension of the abdomen because of a large fluid volume, a big baby or both. There are several others, as we shall see shortly.

Other causes of pain in pregnancy are only indirectly related or even incidental. The attending doctor needs to be able to distinguish between the miscellaneous pregnancy-related discomforts and pathological causes of pain, which may require specific remedial action. It is after this that all forms converge under a common denominator, that of pain, hence requiring relief.

Modes of pain relief during the course of pregnancy are limited and in many cases not as effective as the expectant mother would wish. However, establishing the cause of her discomfort or pain and confirming the absence of any underlying serious illness does go some way in enabling the mother-to-be to cope.

Sometimes, the pain is so severe as to prompt induction of labor. This is uncommon. This decision should never be taken lightly, not least because it has a tendency of assuming a slippery-slope phenomenon. Induction of labor, especially if remote from term, can be a protracted affair and psychologically and physically traumatic. The success of the procedure is also far from being a foregone conclusion and may very well lead towards a caesarean section.

The various aspects of pain in pregnancy are discussed here.

‘Physiological’ pain in pregnancy

A majority of cases of mild and moderate abdominal pain in pregnancy are described as "physiological". This means that they are a result of the changes brought about by the growing pregnancy. The expectant mother needs to give her doctor a good and precise history and description of the pain. This will help the doctor to distinguish between physiological pain and pain resulting from an underlying disease requiring specific remedial action.

Causes of physiological pain in pregnancy

This diagnosis of physiological pain is made by exclusion.

It is important that conditions such as urinary tract infection, kidney stone, and appendicitis or pregnancy complications (such as placental abruption) are excluded. Once this is established, then the pain may be caused by:

· Stretching of ligaments

· Braxton Hicks contractions

· Heartburn

· Constipation

· Mild torsion of the uterus.

· We shall expand on these below.

It is important that the mother does not try to make the diagnosis herself. If she has any pain, it is imperative that she consults her doctor to verify the symptoms. It could be dangerous to ignore any symptoms, however mild they may seem to her.