Pregnancy is a time of excitement and anticipation, as most mothers to be will say. It’s also a time when the woman is full of questions, many of them, unfortunately, based on myth and superstition.
In fact, once pregnant a woman is quickly inundated with a long list – a few dos and several don’ts that are assumed will guide the new mother and help her sustain her pregnancy to full term.
Sometimes, these instructions come from her mother, who received them from her mother before her. Other times, they come from her in-laws, well-meaning friends, or even colleagues. Interestingly and only too often, such instructions include a pregnant woman must not fall down to prevent miscarriage.
Such situations are frequently seen in movies where a woman falls down a flight of stairs, ends up in the hospital, and eventually (and usually dramatically) loses her baby. But are situations like this only true in movies?
Pregnant women, like every other person, are not expected to fall. Dr Olusoji Jagun, consultant obstetrician and gynaecologist at the Olabisi Onabanjo University Teaching Hospitals (OOUTH), Sagamu, Ogun State stated that fall in pregnancy should be avoided although it does happen.
Dr Jagun said, “A fall is a common thing in pregnancy because of the softening of the joints due to the effect of pregnancy hormones, specifically the hormone relaxin. That is why they are told not to wear high heeled shoes. If they fall, they can easily have a fracture.”
Dr Jagun added that in some pregnant women, a drop in their blood sugar level can also cause a fall.
“A woman who is not eating very well or eating irrationally can develop low blood sugar and just fall down. People will assume she just faints, not knowing that it is because of low sugar level. That is why we encourage the woman to eat at least five times a day,” he added.
Pregnancy hormones can also make the feet unsteady, Relaxin is produced by the body to relax the ligaments in the pelvis and to soften and widen the cervix (mouth of the womb) in preparation for delivery. By doing so, the joints will be looser, balance will be uncertain, and the chances of falling will be greater.
Jagun added that in some pregnant women, a drop in their blood sugar level can also cause a fall.
Even though doctors advise women on inevitable instability during pregnancy due to loosening of joints, studies have shown that one in 10 will fall two or more times over the nine months period of pregnancy.
Now, falls during pregnancy are a major public health issue and a common cause of injury in women during pregnancy. In 2014, experts in Enugu found that 32.5 per cent of women had fallen at least once during the index pregnancy.
The study published in the Nigerian Journal of Clinical Practice said most of these falls occurred during the third trimester.
The experts had looked at the prevalence and risk factors associated with falls during pregnancy in 332 consecutive pregnant women brought in during labour for delivery at the University of Nigeria Teaching Hospital Enugu, between 1st May and 31st December 2012.
They found women younger than 30 years had a two-fold risk of falling during pregnancy compared to others. Similarly, women taller than 160 cm had a significantly higher risk of falling during pregnancy than shorter women.
Furthermore, those with their first pregnancy had an almost threefold risk of falling during pregnancy compared with others who had babies before.
Sadly, as much as 18.5 per cent and 13.0 per cent of the women who reported falling during pregnancy required hospital admission and sustained injury, respectively.
Furthermore, the women who were admitted had restricted movement for at least two days with possible impact on the psychological and social wellbeing of the affected women.
A cross-sectional cohort survey of 1,175 women in five public health facilities in Ado–Ekiti indicated also that one-quarter (25 per cent) of the respondents had a fall during pregnancy.
The high incidence of falls, they said, was even more worrisome because about 10 per cent of these women fell at least thrice during pregnancy, with associated complications.
Mothers who fell during pregnancy were significantly older, who previously had a baby, and with unintended/unwanted pregnancies than those who did not fall.
This 2019 study in The Scientific World Journal said most of the reported falls occurred in the third trimester, with about 10 per cent of the women falling at least thrice during the course of the pregnancy.
More than half of the reported falls occurred while engaging in household chores and carrying a child/object with compromised visibility of the feet and floor.
Some of these falls were associated with slippery floors, wearing inappropriate shoes, poor lighting, hurrying, having obstructed views, and using insufficient safety measures such as holding on to stair handrails.
What is more, some fell because they were shoved/struck mistakenly or deliberately, including during intimate partner violence.
The researchers reported contractions of the womb/abdominal pain being the commonest fall-related complications. Others include vaginal bleeding, ruptured placental membranes and broken or sprained bone in an expectant mother.
But do all falls give rise to complications? Can it lead to miscarriage or stillbirth? It depends largely on the stage of the pregnancy. The body is designed to protect the developing baby during pregnancy.
The wall of the womb is thick and made up of strong muscles that help to keep the baby safe. The amniotic fluid also serves as a cushion. During the early weeks of pregnancy, the womb is tucked behind the pelvic bone. So, minor falls during early pregnancy are typically not of concern.
However, falls during the late second trimester and early third trimester might be harmful to both the mother and the unborn baby, especially if there is a direct blow to the abdomen.
According to Dr Jagun, “contractions or abdominal pains as well as the loss of amniotic fluid can occur just as the placenta could be separated from the inner wall of the womb, resulting in the woman bleeding excessively and requiring to be transfused.
“Also the passage of the baby’s blood cells into the blood circulation of the mother can occur, and so the possibility of the baby to die immediately.”
Dr Jagun, therefore, asked that after a fall, women should report to the hospital to assess the likely harm, particularly if in the second or third trimester.
Irrespective of the source of the blow or injury, he said every effort should be made to prevent injury to the abdominal region during pregnancy.
The good news is that risks of a fall can be reduced with a few simple steps:
- Wear shoes that are flat, rubber-soled and not lose shoes.
- Go more slowly. Avoid sudden movements and just slow down, in general.
- Avoid twisting and turning. Avoid shortcuts to grabbing things and try not to hurry. This will help maintain balance.
- Be careful when carrying children, walking on unlevel surfaces or when performing any activity that obstructs your view.
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