Fig. 41.—Elevated Sims’ position to relieve varicose veins of the vulva. (By courtesy of The Maternity Centre Association.)
Hemorrhoids are virtually varicose veins which protrude from the rectum, but, unlike those in the legs, are extremely painful. As it is the straining incident to constipation that causes these engorged veins to prolapse, this condition constitutes one more reason for preventing constipation. A pregnant woman whose bowels move freely every day rarely has hemorrhoids.
Should hemorrhoids appear, the first step is to have them gently pushed back into the rectum. The patient can usually do this for herself, quite satisfactorily, after lubricating her fingers with vaseline or cold cream. Lying down, with the hips elevated on a pillow; the application of an ice bag, cold cloths or witch-hazel compresses to the anus will almost always give relief. When the condition is severe, the physician may prescribe medicated ointments, lotions or suppositories, but operation is seldom resorted to during pregnancy, for fear of bringing on labor prematurely. Sometimes the hemorrhoids are worse during the first few days after labor, but as a rule they disappear with the removal of the cause, which in this case is pressure made by the enlarged uterus.
Cramps in the legs, numbness or tingling may be caused by the pressure of the large, heavy uterus upon nerve trunks supplying the lower extremities. The recumbent position; applying heat and rubbing the painful areas will often give comfort.
Shortness of breath is sometimes very troublesome toward the end of pregnancy, and, as may be easily seen, is due to the upward, and not downward pressure of the uterus. For this reason it is aggravated by the patient’s lying down and relieved by her sitting up or being well propped up on pillows, or a back rest.
Vaginal discharge. The normal vaginal discharge is greatly increased during the latter months of pregnancy, as was pointed out in Chapter V, so that ordinarily the moderately profuse yellowish or white discharge at this time has no particular significance. Its existence should be noted, however, and brought to the doctor’s attention, for a very profuse discharge is likely to be regarded as a possible evidence of gonorrhea. For this reason a smear is usually made, when the discharge is excessive, to establish or eliminate this diagnosis; if it is positive, it indicates the necessity for treatment to safeguard both mother and baby.
As the normal vaginal discharge has antiseptic properties, it should not be removed by douches, which many patients are eager to take; but if it is irritating and causes itching or burning the patient may be made entirely comfortable by avoiding the use of soap and by bathing the vulva with a solution of sodium bicarbonate or with olive oil.
Itching of the skin is a fairly common discomfort, and is possibly a result of irritating material being excreted by the skin glands and deposited upon the surface of the body. The local irritation usually may be allayed, if not very severe, by bathing the uncomfortable areas with a solution of sodium bicarbonate, or a lotion consisting of a pint of lime-water, half an ounce of glycerine and thirty drops of carbolic acid. It is a good plan, also, for the patient to increase the amount of fluids which she is taking, in order to promote the activity of the skin, kidneys and bowels, and thus dilute the material that may be responsible for the itching and increase its elimination through all channels. In other words the itching may be due to a mild toxemia.
Some women complain of discomfort caused by the stretching of the skin over the enlarged abdomen, which becomes so tense it feels as though it might tear apart. There is a very old and widely current belief that this sensation may be relieved by rubbing the abdomen with some kind of an oil or ointment. And, moreover, that such oiling will not only increase the elasticity of the superficial layers of the skin, but the deeper layers as well, and that by this means striæ may be prevented. There seems to be little foundation for the fear that the skin will tear, or belief in the efficacy of the oiling, but if a woman fancies that she is safer and more comfortable after oiling her abdomen, there is certainly no reason why she should not do so.