Dyspnea is the medical term for shortness of breath (SOB), sometimes described as “air hunger”. It is an uncomfortable feeling. Shortness of breath can range from mild and temporary to serious and long lasting. It is sometimes difficult to diagnose and treat dyspnea because there can be different causes.
Shortness of breath is a common problem. While it may have a bad connotation it need not always be so. Obstetricians often refer to me pregnant women with SOB. After a detailed clinical examination, ECG and Echocardiogram, if there is no obvious pathology, I label it as “psychological dyspnea” (triggered by undue anxiety generated by an unjustified fear of an untoward pregnancy outcome). In this article, I wish to tell pregnant women troubled with “dyspnea” that, while not remaining indifferent to the complaint, it is important not to panic. They may be suffering from what is called “physiological” dyspnea, which is innocuous.
As pregnancy progresses, a woman may have difficulty catching her breath even after carrying out routine tasks, such as climbing stairs. According to a 2015 study, an estimated 60 to 70 percent of women experience shortness of breath during pregnancy. Doctors often attribute this to the growing uterus pushing upward on the lungs making it difficult to breathe.
While shortness of breath is a common symptom of pregnancy, it is not always possible for a doctor to pinpoint one single cause. It can to be due to a variety of factors, ranging from the growing uterus to changes in the demands on the heart. Some women may notice changes in their breathing almost immediately, while others see differences during the second and third trimesters.
First trimester: A fetus does not have to be very large to cause breathing changes in a pregnant woman. The diaphragm, a muscular band of tissue that separates the heart and lungs from the belly, rises by as much as 4 centimeters during the first trimester of pregnancy. The diaphragm’s movement helps the lungs fill up with air. While the more stoic may not be aware of changes in how deeply they can breathe in, others may notice they cannot take full breaths and begin to complain. Besides changes in the diaphragm, pregnant women often breathe faster due to an increase in the hormone “progesterone”.
Progesterone plays an essential role in the fetus’s development. It is also a respiratory stimulant, meaning it causes a person’s breathing to quicken. While breathing faster does not necessarily cause shortness of breath, some women may report changes in breathing patterns.
Second trimester: The heart working harder during pregnancy may cause shortness of breath. The growing uterus commonly contributes to shortness of breath in the second trimester. However, some changes in the way the heart functions can also cause breathlessness. The amount of blood in a woman’s body increases significantly during pregnancy.
The heart has to pump harder to move this blood through the body and to the placenta. The increased workload on the heart can make a pregnant woman feel short of breath.
Third trimester: During the third trimester, breathing may get easier or more difficult depending largely on the position of the developing baby’s head. Before the baby starts to turn and drop further into the pelvis, the baby’s head may feel as if it is under a rib and pressing on the diaphragm can make it hard to breathe.
How to cope: A pregnancy support belt may help improve posture. Practicing good posture will allow the uterus to move away from the diaphragm as much as possible. Sleeping with pillows supporting the upper back can allow gravity to pull the uterus down and give the lungs more space. Tilting slightly to the left in this position can also help keep the uterus off the aorta, the major artery that moves oxygenated blood through the body.
Practising breathing techniques commonly used in labor, such as Lamaze breathing, may help a pregnant woman ward off dyspnea. Listening to the body and slowing down when needed could help. It is crucial to take breaks and rest if breathing becomes too difficult. In the later stages of pregnancy, a woman may not be able to perform the same level of physical activity as before. If a woman has an underlying medical condition causing SOB, it is essential to follow the doctor’s recommendations about treatment.
When to see a doctor: a) if you develop blue lips, fingers, or toes, heart palpitations or an extremely high heart rate, pain when breathing, or if there’s wheezing. b) If shortness of breath is especially bothersome or if someone experiences it for the first time. The doctor may want to perform imaging tests, such as ECG, blood tests, an echocardiogram, ultrasounds on the legs, to rule pathological causes such as a preexisting or underlying disease of the lung (exacerbation of bronchial asthma and pulmonary embolism) or cardiac illness such as Peripartum cardiomyopathy.
In most cases, mercifully, SOB in pregnancy turns out to be nothing serious and all a doctor needs to do is to reassure the sufferer. The pregnant woman filled with joy ought to remember that, after all, giving birth brings her into the essence of creation, where the human spirit is courageous and bold and the body, a veritable miracle of wisdom.
(Dr. Francisco Colaço is
a seniormost consulting physician)
