Pregnancy is a subject that generates a lot of paper. Bookstores and libraries devote not just shelves but entire aisles to it. At your first prenatal visit, your doctor will likely load you down with armfuls of pamphlets that cover every test and trimester. But despite all this information, pregnancy can take any soon-to-be parent by surprise.
What the Doctor May Leave Out
If your doctor hasn't mentioned the following topics during your visits, he or she isn't purposefully omitting the information. More likely, your doctor hasn't brought them up because pregnancy affects women in different ways. For example, some pregnant women experience morning sickness in the morning, some feel it all day, and some never have it. Or your doctor might not mention something because it doesn't have a medical focus — a doctor may not have any more insight into your increasing shoe size than your neighbor does! Also, some women may think questions about breast size or hemorrhoids are too personal or embarrassing to ask their doctors.
Any concerns you have about your or your baby's emotional or physical health, regardless of how unrelated or trivial they may seem, should be discussed with your doctor. He or she has seen many expectant parents, some less worried and some more worried than you, and can reassure you when there is no problem or give you more information when there is one. And if your doctor doesn't take the time to listen to your concerns or doesn't seem to take them seriously, you should feel free to get a second opinion.
Altered States
Pregnancy doesn't just change your body — it affects the rest of you, too.
1. The Nesting Instinct
Many pregnant women experience the nesting instinct, a powerful urge to prepare their home for the baby by cleaning and decorating. Or perhaps you'll want to tackle projects you haven't had time to do, like organizing your garage or closets.
As your due date draws closer, you may find yourself cleaning cupboards or washing walls — things you never would have imagined doing in your ninth month of pregnancy! This desire to prepare your home can be useful because it will give you more time to recover and nurture your baby after the birth. But be careful not to overdo it.
2. Inability to Concentrate
In the first trimester, fatigue and morning sickness can make many women feel worn out and mentally fuzzy. But even well-rested pregnant women may experience an inability to concentrate and periods of forgetfulness. A preoccupation with the baby is partially the cause, as are hormonal changes. Everything — including work, bills, and doctor appointments — may seem less important than the baby and the impending birth. You can combat this forgetfulness by making lists to help you remember dates and appointments.
3. Mood Swings
Premenstrual syndrome and pregnancy are alike in many ways. Your breasts swell and become tender, your hormones fluctuate, and you may feel moody. If you suffer from premenstrual syndrome, you're likely to have more severe mood swings during pregnancy. They can make you go from feeling happy one minute to feeling like crying the next. You may be irrationally angry with your partner one day, then a coworker may inexplicably irritate you the next.
Mood swings are incredibly common during pregnancy, although they tend to occur more frequently in the first trimester and toward the end of the third trimester.
About 10% of pregnant women experience depression during pregnancy. If you have symptoms such as sleep disturbances, changes in eating habits (a complete lack of appetite or an inability to stop eating), and exaggerated mood swings for longer than 2 weeks, you should talk to your doctor.
Unexpected Effects of Pregnancy
4. Bra Size
An increase in breast size is one of the first signs of pregnancy. Breasts usually become swollen and enlarged in the first trimester because of increased levels of the hormones estrogen and progesterone. That growth in the first trimester isn't necessarily the end, either — your breasts can continue to grow throughout your pregnancy!
In addition to the size of your breasts, your bra size may be affected by your rib cage. When you're pregnant, your lung capacity increases so you can take in extra oxygen for yourself and the baby, which may result in a bigger chest size. You may need to replace your bras several times over the course of your pregnancy.
5. Skin
Are your friends saying you have that pregnancy glow? It's only one of many skin changes you may experience during pregnancy due to hormonal changes and the stretching of your skin to accommodate a larger body. Pregnant women experience an increase in blood volume to provide extra blood flow to the uterus and to meet the metabolic needs of the fetus. They also have increased blood flow to their other organs, especially the kidneys. The greater volume brings more blood to the vessels and increases oil gland secretion.
Some women develop brownish or yellowish patches called chloasma, or the "mask of pregnancy," on their faces. And some will notice a dark line on the midline of the lower abdomen, known as the linea nigra (or linea negra), as well as hyperpigmentation (darkening of the skin) of the nipples, external genitalia, and anal region. These are the result of pregnancy hormones, which cause the body to produce more pigment. The body may not produce this increased pigment evenly, however, so the darkened skin may appear as splotches of color. Unfortunately, chloasma can't be prevented, but wearing sunscreen and avoiding UV light can minimize its effects.
Acne is common during pregnancy because the skin's sebaceous glands increase their oil production. And newly formed pimples might not be the only evolving spots on your face or body — moles or freckles that you had prior to pregnancy may become bigger and darker. Even the areola, the area around the nipples, becomes darker. Except for the darkening of the areola, which is usually permanent, these skin changes will likely disappear after you give birth. Many women also experience heat rash, caused by dampness and perspiration, during pregnancy.
In general, pregnancy can be an itchy time for a woman. Skin stretching over the abdomen may cause itchiness and flaking. Your doctor can recommend creams to soothe dry or itchy skin.
6. Hair and Nails
Many women experience changes in hair texture and growth during pregnancy. The hormones secreted by your body will cause your hair to grow faster and fall out less. But these hair changes usually aren't permanent; most women lose a significant amount of hair in the postpartum period or after they stop breastfeeding.
Some women find that they grow hair in unwanted places, such as on the face or belly or around the nipples. Others experience changes in hair texture that make hair drier or oilier. Some women even find their hair changing color.
Nails, like hair, can change noticeably during pregnancy. Extra hormones can make them grow faster and become stronger. Some women, however, find that their nails tend to split and break more easily during pregnancy. Like the changes in hair, nail changes aren't permanent. If your nails split and tear more easily when you're pregnant, keep them trimmed and avoid the chemicals in nail polish and nail polish remover.
7. Shoe Size
Even though you can't fit into any of your prepregnancy clothes, you still have your shoes, right? Maybe — but maybe not. Because of the extra fluid in their pregnant bodies, many women experience swelling in their feet and may even have to start wearing a larger shoe size. Wearing slip-on shoes in a larger size will be more comfortable for many pregnant women, especially in the summer months.
8. Joint Mobility
During pregnancy, your body produces a hormone known as relaxin, which is believed to help prepare the pubic area and the cervix for the birth. The relaxin loosens the ligaments in your body, making you less stable and more prone to injury. It's easy to overstretch or strain yourself, especially the joints in your pelvis, lower back, and knees. When exercising or lifting objects, go slowly and avoid sudden, jerky movements.
9. Varicose Veins, Hemorrhoids, and Constipation
Varicose veins, which are usually found in the legs and genital area, occur when blood pools in veins enlarged by the hormones of pregnancy. Varicose veins often disappear after pregnancy, but you can lessen them by:
- avoiding standing or sitting for long periods of time
- wearing loose-fitting clothing
- wearing support hose
- elevating your feet when you sit
Hemorrhoids — varicose veins in the rectum — frequently occur during pregnancy as well. Because your blood volume has increased and your uterus puts pressure on your pelvis, the veins in your rectum may enlarge into grape-like clusters. Hemorrhoids can be extremely painful, and they may bleed, itch, or sting, especially during or after a bowel movement. Coupled with constipation, another common pregnancy woe, hemorrhoids can make going to the bathroom downright unpleasant.
Constipation is common throughout pregnancy because pregnancy hormones slow the rate of food passing through the gastrointestinal tract. During the later stages of pregnancy, your uterus may push against your large intestine, making it difficult for waste to be eliminated. Constipation can contribute to hemorrhoids because straining may enlarge the veins of the rectum.
The best way to combat constipation and hemorrhoids is to prevent them. Eating a fiber-rich diet, drinking plenty of fluids daily, and exercising regularly can help keep bowel movements regular. Stool softeners (not laxatives) may also help. If you do have hemorrhoids, see your doctor for a cream or ointment that can shrink them.
Birth Day Surprises
10. Things That Will Come Out of Your Body
So you've survived the mood swings and the hemorrhoids, and you think your surprises are over. Guess again — the day you give birth will probably hold the biggest surprises of all.
Only 1 in 10 mothers' water breaks before labor contractions begin. Some women never experience it — a doctor may need to rupture the amniotic sac (if the cervix is already dilated) when they arrive at the hospital. How much water can you expect? For a full-term baby, there are normally about 2.1 to 5.9 cups of amniotic fluid. Some women may feel an intense urge to urinate that leads to a gush of fluid when their waters break. Others may have only a trickling sensation down their leg because the baby's head acts like a stopper to prevent most of the fluid from leaking out. In any case, amniotic fluid is generally sweet-smelling and pale or colorless and is replaced by your body every 3 hours, so don't be surprised if you continue to leak fluid, about a cup an hour, until delivery.
Other unexpected things may come out of your body during labor in addition to your baby, blood, and amniotic fluid. Some women experience nausea and vomiting. Others have diarrhea before or during labor, and flatulence (passing gas) is also common. During the pushing phase of labor, you may lose control of your bladder or bowels. A birth plan can be especially helpful in communicating your wishes to your health care providers about how to handle these and other discomforts of labor and delivery.
Lots of surprises are in store for you once you become pregnant — but none sweeter than the way you'll feel once your newborn is in your arms!
Reviewed by: Steven Dowshen, MD
Date reviewed: June 2008
