with Dr. Dori Skye Engel, ND
Striking the balance between not being alarmist and bringing up every possible thing that could happen during pregnancy, while providing helpful, supportive information and specific recommendations to help symptom management. There is almost always something that can be done to alleviate your discomfort. Often there is some trial and error involved.
This is not a replacement for medical advice. Please always consult with your practitioner for individual advice.
Symphysis Pubis Disorder (SPD), also known as Lightning Crotch
Does it sound kind of like a strange pregnancy super hero?
While we believe all pregnant people are superheroes, this symptom definitely is not. Think sharp, sudden, stabbing pain in your vagina and pelvis, often accompanied by tenderness, pain and minor swelling in the pubic bone, with possible radiating sensation down the legs, hips or up into the lower back. This condition is the most common cause of pelvic girdle pain during pregnancy and the immediate postpartum period.
What's going on? Your Symphysis Pubis is the joint between the two halves of the front of your pelvic bone. During pregnancy your body produces a hormone called Relaxin, meant to soften and stretch all your ligaments, in order to make room for your expanding uterus, and allow your pelvic bones to stretch enough for a baby to pass through. Sometimes that Relaxin is so effective that the joints become hypermobile to the point of discomfort and pain.
It tends to hurt the most when walking, climbing stairs, turning over in bed, lifting things, getting up from sitting, coughing or sneezing. So basically, everyday movements.
The good news - it is rarely an indicator of anything serious. When your baby's head gets bigger and starts to wedge itself deep in the pelvis, it puts pressure on your pubic bone which causes discomfort.
Recommendations –
1. A thorough assessment and treatment recommendations from a licensed birth body worker who is familiar with SPD can be invaluable. This could be a pelvic floor physiotherapist, an osteopath or a chiropractor. These practitioners will be able to suggest pelvic symmetry exercises, perform a symphysis pubis release adjustment and assess what other structures might be influencing the discomfort.
2. Massage and acupuncture can also be very comforting and effectively alleviate discomfort.
3. Focusing on keeping legs together as much as possible, when rolling over in bed, getting in and out of bed or a car, anything that takes the stress off of the expanding joint is vital. Ice at the end of the day can alleviate discomfort.
4. A pregnancy support belt or pregnancy girdle can also be very helpful to wear everyday to help support the overly flexible joints. Baby Belly Band makes an SPD support belt. Mama Spanx is also a great option for shapewear that helps to support the hips and stabilize the symphysis pubis joint.
Hyperemesis Gravidarum
Also known as 'Morning Sickness' or the 'Pregnancy Pukes'. They all mean the same thing and none of them are any fun.
Facts - Approximately 50% of pregnancies are affected by these symptoms at some stage. Nausea often resolves after the first 12–14 weeks of pregnancy, however it can persist for months (and occasionally for the full length of the pregnancy). This is one of the many things your friendly neighbourhood Naturopathic Doctor can help you with during your pregnancy. In some cases testing may be indicated to assess whether a nutrient deficiency, pathogenic bacteria or hormonal dysregulation may be a factor.
Recommendations -
1. Protein. So much protein. You are building a person out of nothing but a handful of cells and some magic stardust. People are made of protein, your pregnancy protein requirements are huge. Always go for the protein. Nuts by the bed, power bars and meat sticks in your bag and in every pocket are essential. Once you are hit with those pregnancy hunger pains/nausea it is often too late. Stay ahead of the hunger.
2. Ginger is the Queen of all things anti-nausea. A strongly steeped ginger tea, ginger tincture, ginger sucking candies, ginger capsules, any format will do. It is the most potent anti-nausea herb and very safe for all stages of pregnancy.
3. Vitamin B6. Often deficient in mamas with intense nausea (and carpal tunnel syndrome), this vitamin aids your body in processing protein. Vitamin B6 is one of the two main components in the pharmaceutical medication commonly prescribed for Hyperemesis Gravidarum - Diclectin. The other component is a sleep-inducing antihistamine.
4. Acupuncture. Very effective in many cases when done by an experienced practitioner. Bonus - you can address multiple complaints in one session.
5. Electrolytes. Dehydration can exacerbate nausea, and if you are actually vomiting, you are losing fluids, minerals and electrolytes. Some people like a sour lemonade. Homemade or store bought electrolytes (without artificial colours or flavours) can be very helpful.
Round Ligament Pain
Sharp, shooting, stabbing pain in the abdomen. Does not sound like something that should be happening during pregnancy. And yet, it is. No, it is not your baby. No, your baby can't feel it. Yes, there is always something that can be done about it.
What’s going on? The simple stretching of your round ligaments, the ones that support your growing uterus and keep it held up in your body. It's also the sensation of your internal organs rearranging to allow for your ever growing baby. Round ligament pain can affect up to a third of all pregnancies. It can feel like a sudden pulled muscle, either under the abdomen or from the sides and moving down into the pubic area. It's not always symmetrical, sometimes occurring only on one side.
Recommendations -
Stretch - daily stretching is key to keeping your body limber. Prenatal Yoga and Spinning Babies exercises are a great place to start.
Rest - building a baby is hard work, restorative sleep is imperative, yet gets more and more challenging the farther along in your pregnancy you are. Supporting your body with pillows under the knees, under the belly, behind the back, taking the load off of those ligaments can avoid over stretching.
Hydrate - so many good reasons to stay hydrated, pain is just one of them. Your blood volume doubles during pregnancy, this requires substantial fluid. Adequate hydration can reduce stretch marks, alleviate constipation and headaches, prevent hemorrhoids and support proper stretching of ligaments. Fill up your giant water bottle and don't leave home without it.
Bodywork - osteopathic or chiropractic adjustments and/or a great prenatal massage can do wonders for the blossoming pregnant body. These trained professionals may also recommend physio tape which can help support the ligaments.
Pregnancy Support Belt - in some advanced cases a support belt may be indicated to support the belly, hips and pubic bone.
Prenatal Depression
Postpartum Depression deservedly gets plenty of attention, but did you know that more than 10% of all pregnant people may also struggle with depressive symptoms during their pregnancy? This seemingly joyous time of life, when many of your friends and family may be thrilled, glowing and gushing about how incredible and amazing everything is. And yet it is not uncommon to feel apprehensive, fearful, miserable and overall blue.
Additionally the symptoms of depression overlap with the hormonal shifts of pregnancy – fatigue, weight gain, sleep changes, appetite changes, irritability and mood swings. Confusing!
Why are you feeling this way? There are so many potential causes of prenatal depression, it’s important to properly assess for your root cause.
What can you do? There is ALWAYS something that can be done to help. Please reach out, support is available.
Recommendations -
1. Ensure you receive a proper assessment – check for thyroid imbalances, blood sugar dysregulation and nutritional deficiencies – particularly iron, Vitamin D, Vitamin B12, protein and essential fatty acids – these can all be a huge factor in depressive symptoms
2. Move your body, get some sunlight and time in nature – ideally all 3 every day.
3. Talk to someone. Be honest – your partner, your friend, your parent, your sibling, your therapist. An effective support system is vital. If your situation is complicated by a history of pregnancy loss or complicated pregnancy, please reach out, help is always available.
4. Journal – get your thoughts down on paper and out of your head. Just the act of writing can have a profound effect on your mood and outlook. It’s also a fascinating artifact to return to once your baby is born.
5. Supplements – as mentioned above, ensure a thorough assessment. That said, all pregnant people need a significant amount of iron, vitamin D and essential fatty acids every day. You may also benefit from a Probiotic, Vitamin B complex, Adaptogenic herbs, Choline, Phosphatidylserine, and/or St John’s Wort, an herb traditionally used to treat all forms of depression that is safe during pregnancy. Please speak to your Naturopathic Doula for individual recommendations.
6. Eat well – sometimes temporary sensitivities can pop up during pregnancy. Substantial protein and healthy, good quality fats can go a long way towards stabilizing mood.
7. Optimize sleep. Easier said than done, but this is an essential component to a healthy mood.
Ultimately, sleeping, hydrating, eating protein, moving your body and reaching out for help is never wrong. We’re here for you. You got this.
Want to get prepared for pregnancy, birth and postpartum? Grab our free Bump to Baby Checklist! This clear and thorough guide walks you through everything to expect from your first trimester to past your 6 week postpartum check up.
- What tests and screenings will be offered and when
- When to sign up for prenatal education and what types to consider
- Things you should think about that your care provider may not mention
- Links to helpful resources
Dr Dori Skye Engel is a Naturopathic Doctor and Birth Doula practicing in the Toronto area. She is a mama of 3 wild and wacky boys and is an avid traveller. Dr Dori believes strongly in the body’s innate healing ability and works to find the right combination of support to guide her patients in attaining optimum health, vitality, resilience and vibrancy. Through a combination of tools including clinical nutrition, lifestyle counselling, botanical medicine, homeopathy, traditional Chinese medicine, acupuncture and hydrotherapy, she creates personalized treatment protocols for each individual. Dr Dori has a special interest in the Perinatal period of a family’s life; Fertility support, Preconception Care, Pregnancy, Labour & Birth, Postpartum support as well as Babies & Children. Treating the whole person, as well as the whole family, she is honoured to support men & women through further life changes such as menopause, thyroid dysfunction, diabetes, heart disease, skin conditions & all the curveballs life throws. She is certified in Facial Rejuvenation Acupuncture and is a trained Birth Doula. Dr Dori is also the co-host of Beyond Beautiful Birth a Podcast about the messy, intense and powerful and all-encompassing beauty of birth and beyond.