Pregnancy, Pregnancy Problems

Urine Infections in Pregnancy

Burning, stinging, smelly urine? Yeah, pregnancy is all about the glamour! Unfortunately, women are more likely to get urine infections when they are pregnant. Find out more about what causes them, what you can do to prevent them and what treatments are available.

woman wc sign

Why urine infections are common in pregnancy

During pregnancy, you have many different hormones at different levels in your body. These hormones help your body to nurture and develop your baby. They also help prepare your body for birth. One of the hormones involved is called Relaxin. This hormone is brilliant at relaxing (yes, really) the small vessels in your body. These vessels might be blood vessels or the tubes which carry your urine from your kidneys to your bladder or from your bladder to the exit! Relaxed blood vessels make it easier to send more blood flow to the baby to help them grow. Relaxed tubes for urine make it easier for bacteria to enter these tubes and cause urine infections. You can also find more information on the effects of Relaxin in my article on pelvic pain in pregnancy.

How do I know if I have a urine infection?

urine pain

The symptoms of urine infections include:

pain when passing urine;

smelly urine;

cloudy urine;

lower back pain on one or both sides of your back;

feeling generally unwell;

and needing to pass urine urgently but only passing small amounts when you do.

That last one can simply be because your baby is bouncing about on your bladder and making you think it’s full. However, if you have any of the symptoms of a urine infection, you should get a urine sample checked by your midwife or doctor. You can also have a urine infection without any symptoms, which is why your midwife checks your urine sample at every appointment just in case.

When the midwife checks your urine, she is looking for things like proteins, nitrites and leucocytes. Proteins can show up because the bacteria are made of proteins, nitrites because some bacteria produce these, and leucocytes because your body is producing them to fight off the infection.

Treatment for urine infections in pregnancy

The standard treatment for a urine infection is antibiotics. You will be asked to provide a urine sample which will be sent to the hospital laboratory. They will check which antibiotics work best to kill the bacteria. However, you can be started on antibiotics before the results come back, as there are general groups of antibiotics we can start with. The doctor will contact you within a couple of days if we need to change the antibiotics or if your sample actually showed that you have no infection.

It is important to complete the whole course of the antibiotics and to provide a sample at the end of the antibiotics to confirm that the infection has gone. Untreated urine infections can occasionally spread up into your kidneys and make you very ill, even possibly needing hospital care, so please ask for help if you think you have an infection.

Ways to prevent urine infections

toilet roll

So how can you reduce your risk of a urine infection, even if you do have that troublesome Relaxin hormone floating around your body?

  • Good Hygiene.
    • Make sure that you are keeping clean. When you go to the loo, wipe from front to back. You can even get wet wipes to use after you’ve used the toilet just to keep everything fresher.
    • Change any pad or liners regularly. You do tend to have a heavier discharge during pregnancy, so you may be using liners or pads to keep your underwear clean. Just remember to keep changing these if they become wet or soiled.
  • Keep drinking
    • Drinking plenty of fluids is really important. It keeps you and baby hydrated, which regulates your own and the baby’s heartbeats. It also means that you are passing urine a lot. This might be inconvenient but passing lots of urine means you are flushing out any nasties before they can start an infection.
  • Good sexual health
    • Mother told you to wee after sex and she was right. Any sexual intercourse can introduce bacteria into the area, some of which might want to set up shop and cause you an infection. By passing urine, then perhaps using a wet wipe or two, you are going to help flush them out of the area before they do.

Other things to consider

Some women find out during their pregnancy that they have a bacteria called Group B Strep in their urine or around their vagina. If it is in the urine it should be treated as usual but this bacteria can also impact upon your labour, birth and baby. I will be writing another post on Group B Strep and will link to it as soon as I have, but in the meantime, here is the link to the Royal College of Obstetricians and Gynaecologists patient information on Group B Strep.

 

Urine infections

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New Mum, Newborn Care

The Newborn Blood Spot Test

One of the first medical tests your newborn baby has is the heel prick test. It is also called the blood spot test and forms part of the UK national screening programme. Further information on the programme can be found here.

You may have heard stories from other parents about how upsetting they and their baby found the test. It does involve a small cut on the baby’s foot but I don’t believe it has to be distressing for parents or baby. In fact, I always aim to cause as little discomfort as possible. I warn parents that the baby is likely to be more upset about getting naked to be weighed that they are about getting the test done.

Baby's foot

What is the Blood Spot Test for?

The blood spot test collects a small amount of blood and checks it for 9 different health conditions.

Some of these conditions are metabolic. This means that the baby may be born unable to digest a certain protein or fat. If the baby’s diet included it, the undigested protein or fat would build up to levels in their body which would cause them harm. However, if we find out that the baby has that condition we can give them a diet without the particular protein or fat and the baby is absolutely fine.

The other conditions we look for are:

  • Cystic Fibrosis, a condition which causes problems in our lungs and digestive systems. The baby may need physiotherapy and medications
  • Sickle Cell or Thalassemia, a condition where blood cells have an unusual shape. It is more common in families with African ancestors.
  • Hypothyroidism, which is where the baby’s thyroid doesn’t produce enough of the hormone thyroxine. The baby may need medication.

How to help reduce baby’s distress

Crying baby

So how can I promise that your baby will be more distressed by the weighing that follows the heel prick test than by the test itself?

Well, in order to collect the right amount of blood, we need the foot to have a good blood supply. Have you noticed that your baby always has cold hands and feet? This is very normal and important as the baby is keeping most of its blood in the important areas of its brain and chest. This means that normally we would have to press quite hard and wait for ages to collect the right amount of blood from the baby’s foot. It’s this drawn out pressure and holding of the foot that causes the most distress.

The key to reducing distress is warm feet.

I always ask parents to put socks on their baby before I visit. Sometimes that means they do it in the middle of the night. I also ask them to put lots (more than 2 or 3) of pairs of socks on the baby, as well as booties, as well as wrapping them in a cosy blanket. No kidding! Sometimes the baby’s feet look twice their size, but I’d rather that for a short time so the baby doesn’t find the test upsetting, than that the baby looks fashionable!

If for some reason the baby’s feet are still cold, or if the parents have forgotten to put on any or enough socks, we still have options to warm the feet up.

My next action is to ask you for a mug or jug or bowl filled with really really warm water. I don’t want lukewarm water. I want the kind of water that turns your fingers red when you put them into it. You should be able to put your fingers into it, though, not find them burning!

The reason your fingers turn red is because the blood flows into them to cool them down. So yes, my plan is to put the baby’s foot into the water until it turns red. Their first experience of paddling! After about a minute of paddling in good warm water, I find that the babies’ feet don’t need lots of pressure to provide enough blood. It also flows quickly so that the test is over quickly too.

Other things you can do to help

Baby being cuddled

Cuddle your baby during the test. They already know you and your scent and your voice. Being held by you is always going to calm them more than if the midwife holds them.

Hold them in an upright position. Gravity will help with the blood flow to their foot. This means that cuddling them across your chest won’t be as effective as holding them over your shoulder or sitting them up in your lap so their feet dangle down over the side of your legs.

Speak gently and soothingly to them. A calm soothing sound such as ‘shush’ or ‘sssshhhh’ can really comfort a baby in distress.

Feed the baby or provide a pacifier for them to suck. Sucking is always a comforting experience for babies. Letting them feed will also keep them close to you which will help keep them calm.

Results of the Blood Spot Test

The results of the test are usually sent out in the post to you if everything is ok. It can take up to eight weeks for these results to arrive. If you still haven’t heard anything, ask your health visitor.

Any abnormal or unexpected results are followed up quickly by professionals. The midwife may return to repeat the test and collect extra blood for further checks. You may be asked to attend the children’s department of your local hospital for further tests. The Health Visitor may come to discuss the results with you or may give you details of a specialist nurse who can talk you through the results in more detail.

The conditions we check for can be found in more detail on the NHS website here, or in the screening booklet your midwife gave you at the beginning of your pregnancy.

Please be reassured that the conditions we are looking for are very rare and entirely manageable. You shouldn’t be overly anxious about the health of your baby if he or she is feeding well and behaving normally. If you do have any concerns about your baby’s health please speak to a health professional as soon as possible.

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