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Key takeaways

• Breathlessness is a common and normal symptom in pregnancy.
• It usually starts gradually and is not painful or sudden.
• Always mention breathlessness to your midwife or doctor.
• Seek urgent help for severe symptoms like chest pain or sudden onset.

What causes breathlessness in pregnancy?

Feeling out of breath is a common experience during pregnancy. This is also called shortness of breath or breathlessness.

It is normal to feel this way sometimes. This is especially true as your baby grows bigger.

Several physiological changes contribute to this:

• Hormonal changes stimulate the respiratory center in your brain. An increase in progesterone, in particular, makes you breathe more frequently and deeply.
• As your uterus expands, it pushes up on your diaphragm. This reduces the space for your lungs to fully expand.
• Additionally, your body's blood volume increases. This requires your heart to work harder to pump more blood, which can also lead to a feeling of breathlessness.

What normal breathlessness feels like

Shortness of breath often starts gradually in early pregnancy or the second trimester. It is usually noticed after 27 weeks. It should not be painful or come on suddenly.

You should not have other symptoms like wheezing or a cough with normal breathlessness. This sensation may happen as your body adapts to the growing baby and the extra weight you are carrying. Breathlessness might be more noticeable if you are carrying twins or more babies.

When to seek help for breathlessness

It is normal to feel breathless sometimes during pregnancy. However, some symptoms mean you should seek medical advice. Always mention any breathlessness to your midwife or doctor at your next appointment.

When to contact your midwife or doctor

Contact your doctor or midwife straight away if you are feeling out of breath and have any of these symptoms:

• Signs of anaemia – such as tiredness or palpitations, which could indicate low iron levels in your blood.
• Breathlessness when resting – this includes when sitting or standing still.
• Worsening breathlessness – if it has just started or has become much worse during your third trimester.
• Difficulty lying flat – you feel you need to sit or stand up to breathe properly.
• Unable to sleep lying down – you feel you cannot lie in bed at night and need to sit upright to sleep.
• Swelling in both legs, feet, or ankles – which could indicate a more serious underlying condition.
• New respiratory symptoms – such as coughing or wheezing, especially if the cough is new or worsening. This could suggest a respiratory infection.
• Increased tiredness – you feel more tired than usual and lack energy for daily tasks.
• Difficulty finishing sentences – because you are breathless.
• Sudden onset of breathlessness – as this is not typical for normal pregnancy breathlessness and requires immediate assessment.

When to call 999 or go to Accident and Emergency (A&E)

Call 999 or go to Accident and Emergency if you have breathlessness along with any of these symptoms:

• Severe breathlessness – with gasping or choking.
• Chest pain – especially if it does not go away.
• Tight or heavy chest feeling – which could be a sign of a cardiac issue or pulmonary embolism.
• Pain when breathing deeply or coughing – as this can indicate a problem with your lungs or pleura.
• Pain that spreads – to your arms, back, or neck.
• Changes in skin colour – lips or skin turn very pale, blue, or grey. On Black or Brown skin, changes can be easier to see on the palms of the hands.
• Feeling faint or dizzy – or if you pass out.
• Heart palpitations – your heart feels like it is beating too fast or not beating normally.
• Coughing up blood – which is a serious symptom and requires urgent medical attention.
• Swelling in one leg – especially with throbbing pain, warmth, or redness. This could be a sign of a blood clot in a deep vein (deep vein thrombosis, or DVT).

Tips for managing shortness of breath

While breathlessness is common, there are ways to help manage it and make yourself more comfortable:

• Improve your posture – Sitting or standing up straight can give your lungs more room to expand. Avoid slouching.
• Adjust sleeping positions – Try sleeping propped up with extra pillows or in a semi-reclined position. Sleeping on your side can also be helpful.
• Pace yourself – Avoid rushing activities. Break tasks into smaller steps and take breaks when needed.
• Stay calm – Anxiety can worsen breathlessness. Try relaxation techniques or mindfulness.
• Wear loose clothing – Tight clothing around your chest or abdomen can restrict breathing.

Breathing exercises for relief

Pursed-lip breathing can help keep airways open longer:

1. Breathe in slowly through your nose for two counts.
2. Purse your lips as if to whistle.
3. Breathe out slowly through your mouth for four counts.

Diaphragmatic breathing, also known as belly breathing, helps use your diaphragm more efficiently:

1. Place one hand on your chest.
2. Place the other hand on your belly.
3. Breathe in slowly through your nose.
4. Feel your belly rise.
5. Breathe out slowly through pursed lips.
6. Feel your belly fall.