If you're a woman in your late 20s/early 30s, you've no doubt hit, or started to hit the stage of life when your Instagram explore page is full of baby bumps and pregnancy announcements.
Like sands through the hourglass, so go the stranger's sonograms of our lives. Whether you want them or not, once the constant feed of engagement pics and wedding posts cease, prepare for a lifetime of baby/toddler/teen photos that you are under every obligation to at least smash that like on, and every once in awhile leave a comment somewhere in the vein of "aww." And the awws are usually deserved, babies are cute (they biologically have to be!) Hell, it might even be enough to convince you that procreation is a good idea.
But as we all already know, social media and especially Instagram, is a giant lie. Pregnancy isn't all sun-dappled bump photos and frosted baby shower cakes. So what really happens to your body should you decide to play host to a foreign organism for nine months? I talked to Batya Grundland, a maternity care lead and family physician to find out the physical reality of pregnancy.
VICE: So to start, what kind of major life changes should you make before you even start trying to have a baby? In terms of like drinking, and smoking?
Batya Grundland: If you're thinking about having a baby, you would want to start on folic acid or a prenatal vitamin. All prenatal vitamins have 1 mg of folic acid in them, so that's easy. That would be number one. And number two you do want to, as you alluded to, certainly reduce your drinking if you were trying to get pregnant.
Well, what does that mean? Like, what does reduce mean?
So, the trick is there's no real guidelines, I mean other than regular low risk adult drinking guidelines which for women, is 10 drinks spread throughout the week. The problem is that most women don't know they're pregnant the minute they get pregnant. If you were actively trying to get pregnant, you probably actually at that point want to abstain from alcohol because you don't want the impacts of alcohol to happen in the very early stages of pregnancy if you can avoid it, in that period when you may not realize you are pregnant. I would say that recreational drug use and smoking we obviously recommend reducing and avoiding if possible, in general because there are general health effects for people even when you're not pregnant.
But sometimes people need pregnancy as motivation to make those lifestyle changes. Whatever changes you can make prior to getting pregnant are obviously desirable. Because both of those behaviors, recreational drug use and smoking, can have impacts on the fetus even from the early stages. Having said that, if someone is engaging in those behaviors and gets pregnant, there are mechanisms for harm reduction and reducing the impact that it would have on the baby. So we certainly wouldn't recommend terminating a pregnancy if you smoked a joint before you knew you were pregnant.
So, in terms of like, the physical changes that happen, maybe we could just kind of go into trimester by trimester? Like, just that first three months, I think that the myth is that you'll throw up a lot when you feel nauseous but other than that, it's kinda chill.
Yeah, no. The first trimester is actually often the hardest trimester of pregnancy. So, as you mentioned, many women struggle with nausea and some women struggle with profuse vomiting during the first trimester. We do have medications and things to help manage that so most of the time, that's sufficient but those medications are actually a little bit sedating. So, it's not a perfect fit.
Even for women who don't have bad nausea or vomiting, many women feel profound fatigue in the first trimester. And remember for most women, they aren't really telling too many people that they're pregnant in the first trimester. They don't look pregnant in the first trimester so you're still trying to carry on your daily activity with this profound fatigue. So that is a huge change that many women struggle with. The other things that you might notice right away in the first trimester are significant breast tenderness and already some growth in your breasts. The tenderness can actually be quite uncomfortable and again that happens in the first trimester.
Some women will get some irregular spotting as well and sometimes that can be normal and sometimes that can be the sign of a concern. So that could be something that you'd wanna talk to your medical provider about. I guess the other thing that happens in the first trimester, since we're having kind of a frank conversation, is for most women, their bodies do start to change. They start to get a little more bloated and they get a little softer in the mid section, they may already start getting lower abdominal pains but they don't at all look pregnant. Again, they're often not telling people that they are pregnant. So that's often something women are really struggling with is that they don't feel the same. They can feel that their bodies are changing but it's not a huge difference yet, right?
What about mentally in the first three months? Are you still operating on all cylinders?
No, well, you're exhausted. Right? Most women are exhausted. So, I would say it's the exhaustion more than the other mental stuff. At that point, it all kind of runs into it. So you kind of finish your day at work and all you can do is sleep. If you can get through a day of work without a nap.
OK, so then moving into the next three months.
So the next three months, the second trimester, that is usually a much better time for women in their pregnancy in terms of the physical symptoms of pregnancy. Usually by the second trimester, after the nausea and vomiting settles down, you might still be fatigued in that you're not quite at your baseline but you're able to get through the day and you're still able to enjoy a little bit of social time in the evening.
Towards the end, there are things like the development of lower back pain, or chest pain, or reflux (so a little bit of heartburn) that can worsen. The other thing actually, I didn't mention for the first trimester and this is across both trimesters is some women notice more shortness of breath with basic activities that they previously would have been able to do without question. So, climbing a flight of stairs, or walking briskly. In the second trimester this can get exacerbated because as the uterus grows, it can start to compress the lungs a little bit. That's the other thing that people start to notice in their second trimester but usually the second trimester is actually a pretty good time.
What about weight gain?
Weight gain is obviously something that will happen. The target for weight gain in pregnancy varies a little bit based upon women's baseline BMI. So for a woman of an average BMI prior to pregnancy, the expected weight gain throughout the pregnancy is between 25 to 35 pounds. How that happens in an individual woman's bodies will vary tremendously. So, if you are someone who's vomiting like crazy in the first trimester, they may actually lose weight in their first trimester and then gain it later. Other women, the only way they can manage their nausea is by eating simple carbohydrates all day so they tend to gain a lot in their first trimester and it kinda settles out as time goes on.
What about stretch marks? Do they show up now?
They can start to show up towards the end of the second trimester and then into the third trimester.
Going back to that mental change, what's happening for your brain right now?
Yeah, the fatigue tends to improve in the second trimester but it's true. Usually throughout the pregnancy and certainly in the second and third trimester, there's a subjective phenomenon of what we call "pregnancy brain" where you're just not quite as sharp. I don't think I've got a good physiological explanation for why that happens but it's certainly a described phenomenon that women will notice and talk about and complain about. Thankfully for most people, it doesn't get to a point where it significantly affects their ability to do day-to-day activities. It's more like simple, you know, word-finding difficulty, getting a name here or there, getting a little less efficient than you might be normally. That's usually how it manifests.
The popular narrative is really like, "oh, it's the most beautiful time and you feel amazing" and some women are starting to speak out against that. Is there an average experience? What do you tell women who don't feel that way?
So, there's no average. Some women have like a really good pregnancy experience where they do love being pregnant. Then there are women who have terrible experiences and we don't know what predicts these things. We have women who are vomiting throughout their pregnancies, we have women who are in pain throughout their pregnancy. We have women who just don't feel right throughout their pregnancy. But no one, very few people go out and write and brag about that. That's just not what people are gonna get out there because no one wants to say you know, how terrible their pregnancy was and how they're wondering if they really made the right decision doing this whole thing. No one's gonna talk about that but it is absolutely a normal experience.
OK, so you're rounding the bases of the final three months, is this when things irreparably change forever?
Some of the things that you can expect as you progress through the pregnancy—first, more muscular aches and pains. So my joke is, it's like a glimpse into your life with osteoarthritis 20 years down the road. It's kinda like that. There's like a bit of stiffness, everything kinda hurts or can hurt. Common areas for people to have pain are their lower back, and women get chest wall pain just because everything is expanding to make room for the baby, so lots of joint pains and aches are really, really common. Often by the third trimester, sleep is really disturbed because it's hard to get comfortable. That's a common thing. If it hasn't happened already, I didn't mention this and this can happen through the trimesters is changes with your urinary pattern. So urinary frequency, urgency and certainly as you get along, certain things like incontinence especially if you cough or sneeze, you've got a baby sitting on your bladder. So that's certainly something and that's often something that's very difficult for women, especially younger women dealing with this. You mentioned earlier, stretchmarks, not everyone gets stretch marks but certainly if you will get them, they usually pop out by the third trimester.
Do you know why some people get them and some people don't?
Can you prevent them?
Not really. There's a lot of luck of the draw stuff when it comes to pregnancy. So yeah, there's aches and pains, stretch marks, pressure on the bladder. Other skin changes—this can happen. Some women will notice a darkening of their skin in general actually where they kind of walk around looking a bit tanned throughout their pregnancy. Certainly as it goes later into the pregnancy, some women will get individual marks that are dark. There's a line that can go down the middle of the abdomen and often become present during a pregnancy and get darker. Usually the biggest change in the third trimester is really around the mobility and general comfort. If you had heartburn, it's likely to get worse in your third trimester. If you are short of breath, it's likely to get worse in the third trimester because the baby's compressing more. Ankle swelling is another thing—so it's quite normal to have swelling of your lower limbs, especially if it's symmetrical and bilateral, that's really normal. To have both ankles swelling up is really normal and an unpleasant part of pregnancy.
What about the actual birth?
Most people's context for their birth experience is what we see on TV which is someone's water breaking dramatically, someone rushing like crazy to a hospital and five minutes later, there is a baby and it's a normal vaginal birth. That is actually never how it happens. The first thing to understand is that there are different stages of labor. There's early labor which is where you are starting to have contractions and you are starting to feel uncomfortable but they are not strong enough or regular enough that you are admitted to the hospital. Some women just experience little things here and there and they don't know what to make of it. Other women can be in that process where they are actually uncomfortable with contractions for a couple of days prior them to being regular when we can admit them to the hospital and continue on with their labor. You can actually have labor for a while at home and like you can imagine, it's really uncomfortable. You're pretty exhausted by the time you're sitting in the hospital.
Once you are in what we call 'active labor,' which is where you are having regular, strong contractions that are changing your cervix to the point where you'll actually be able to birth the baby, for the average, for most first babies, women's cervixes change at one centimeter an hour. You usually hopefully are admitted around three to four centimeters and we want to get you to ten. Textbook first baby birth, once you're admitted to the hospital, is at least six hours. Of course not all women progress at that rate, some women are slower, other women are faster. But that's kind of average. If that's not going well, there are things that sometimes your medical provider will need to do to help augment the labor and help encourage it to move faster just so the baby can tolerate the labor and the mom can tolerate the labor.
The next stage of labor is from the time that you're ten centimeters to when you actually have the baby and push the baby out and again, that is not like it's three pushes and the baby comes out. It would be considered completely normal for a woman in her first pregnancy to have to potentially push for two hours to actually birth the baby. Despite the beautiful, vaginal births you see on TV, the vast majority of women do tear as part of that delivery, not with a cut, just naturally tear their pelvic floor. There are other scenarios. You can have what's called an assisted vaginal delivery where we need to use a vacuum or force to help get the baby out vaginally. For those interventions, often we do need to control the tear because there is a risk of a worse tear and that's when we might do the episiotomy and obviously those can be—it's certainly not what you envision on television.
The third mechanism that people do tend to know about is the possibility of a cesarian section which is an abdominal surgery to get the baby out and there are a number of times where that can happen. It can happen despite all interventions, the woman is not dilating, the labor is not progressing, and keeping the labor going is no longer safe.
The other myth perpetuated by popular culture is that you have it and then you're home and you're walking around and you're just like this amazing creature. I mean, if you've had major surgery or an episiotomy, there's recovery, right?
Well even if you've had a normal vaginal delivery, I think the biggest message for this postpartum period is that there are two patients. The new baby that needs to be cared for and fed and taken care of and who isn't sleeping consistently, and the primary caregiver for that person is going through their own significant physical and emotional recovery. So it's a very tricky time in that sense. It is not the bliss that you see on TV.
What's the physicality of that time?
The first thing is most women will bleed postpartum and most women will bleed four to six weeks. The first couple days are just a heavy period and then eventually it should taper off into spotting but you may be bleeding for up to six weeks. Often women will have pelvic pain if they had a vaginal delivery. Some women more than others but their usually is a feeling of fullness and discomfort in the pelvic region. Some women will have pain with urination for quite a while. I mean we obviously repair the tears but there's still, you know, for lack of a better term, scratches and things like that can be very easily irritated. So peeing can be quite uncomfortable for the early postpartum days.
Some women actually struggle with regaining urination independently. This is a very, very small proportion of women but it does exist. Essentially the urination does come back but it can take a while and some women actually have to be sent home with a catheter in place.
On the flip side, with bowel movements, the process of labor slows down your bowels so many women will have pain with the initial bowel movement and they will be constipated for the initial postpartum period as things recover. For women who have had a cesarian section, obviously there can be pain around the wound. So lots of soreness and pain potentially. There's of course normal wound pain and concerning wound pain but often it's just normal and they have to avoid heavy-lifting, they have to walk very carefully, stairs can be difficult.
One of the other things that I always love telling people about that happens in the postpartum period that no one tells you about is night sweats. So what happens is women often are retaining some food throughout their pregnancy and they need some IV fluids during their labor so they're getting a whole bunch of fluids as part of their pregnancy and then that ankle swelling that happens in the third trimester, before it gets better, it gets worse. So it's not like you have a baby and all of the sudden there's no swelling. Usually, the 48-72 hours after you give birth, your ankles actually look worse and your legs can look quite swollen. And then eventually that tends to improve over the next couple of weeks but as all of that is improving, part of what is happening is your body having night sweats to get right of that extra fluid. So that's something that often freaks women out 'cause they are awake in the middle of the night having to peel off layers of clothes as if they're having a hot flash but it's actually normal.
For women who are trying to breastfeed, which we often encourage, that is a whole other change that's happening. So you're trying to teach your baby how to breastfeed and that often takes some time. Women can get some cracked nipples and it can be very painful. As the milk comes in, which is usually two to three days postpartum, women can get quite engorged in their breasts which again, can be quite painful and uncomfortable. So lot's of breast pain and fullness. Some, a small subset of women, that pain and fullness will lead to a blocked duct which is more painful and a portion of those women will develop an infection of that duct called mastitis. That's obviously very painful and you actually feel unwell and that's because that's an infection that needs to be treated.
What about the shape and size of your breasts? Do they change?
Oh yeah. I mean for all women, they will change because most women will produce milk, whether you choose to breastfeed or not so they get larger, they get more engorged and fuller. The other thing that happens is that they will change with feeding, they are not constant through the day. So if you feed the baby, they will get smaller and softer and then when it's time for the next feeding, they will get larger and more fuller. For many women it won't be to the same extent but the change maintains through the period of breastfeeding. Even for many women after they stop breastfeeding, their breasts are not what they were before.
What about your vagina?
If you've had a vaginal delivery obviously that whole area has been stretched out and you've been pushing and even within your pregnancy, your pelvic floor muscles have been stretched and weakened so the more vaginal deliveries you have, the vagina can become more stretched out. You are at risk for things like incontinence, especially with coughing and sneezing.
Why don't more people have this conversation more often in the public sphere? Why not prepare women for what really happens so they don't feel wrong when they feel bad?
You're right, I don't know why we don't talk about that part of it. Maybe it's because we don't want to scare women off? For everything that I've said, most of this is for actually a relatively short-lived period of your life. You're really looking at the nine months of pregnancy, the postpartum period. Some women transition through those things very easily, some women struggle. But if you enjoy parenthood, I don't know if you forget about all of this happening but the parenthood, which is a lifetime commitment, is worth it.
Follow Amil on Twitter, she never posts baby photos.