Pregnancy, like most things in life, rarely goes exactly as planned. For many of my patients, any fantasy they had of a charming “pickles and ice cream” pregnancy goes off the rails once they experience their first major pregnancy symptom: morning sickness. They come to my office with a look of confusion – there is nothing “morning” about their “sickness.” They expected a few morning heaves (which, in imagination, had seemed almost quaint), but had no idea they were signing up for “all day vomit fests.” Once I explain that, yes, morning sickness is indeed a misnomer, I let them know that there may be a few other unpleasant surprises along their gestational journey. Here are a few I try to prepare them for:
There’s ‘I’ve worked all week’ tired. There’s ‘jet lag after a transatlantic flight’ tired. And then there’s the mother of all tired: ‘first trimester of pregnancy tired’. That tiny 2 cm fetus sucks the energy out of you and can make you feel like you ran marathon every day. It’s common for women in their first trimester to sleep 10-12 hours at night and still feel like they need a nap the next day. There’s not a lot you can do to treat the fatigue other than take your vitamins, drink lots of water, and rest when you can. Be patient, though, your energy does return in the second trimester.
Varicose Veins of the Vulva
We’ve all seen the blue road maps of varicose veins on our grandmother’s calves, and most of us are aware that they might show up on our own calves as a side effect of pregnancy. But what most women don’t realize is that you can get varicose veins in other places during pregnancy, including the vulva. Varicose veins of the vulva look like ropy purple lumps. The vulvar veins often swell throughout the day and can cause the vulva to increase 2-3 times their normal size. The good news is that they do not interfere with delivery (even when they are huge) and they usually get better postpartum; the bad news is they can be hard to treat during pregnancy. My patients have had the best results with compression underwear during the day and then applying ice packs to the vulva in the evening. Frozen peas make a good ice pack or you can make your own frozen gel by freezing Dawn Ultra Dishsoap (no perfumes) in a Ziplock bag. This works well because you can reuse it and mold it to the shape you need.
Your cervix (the bottom portion of your uterus) sits at the top of your vagina and produces the majority of your vaginal fluid (discharge). In pregnancy, the blood flow to your uterus and cervix is increased by 3 fold. Your cervix is very sensitive to hormonal changes of pregnancy. This combination can cause the cervix to produce significantly more discharge in pregnancy. In some cases the discharge is so copious that women need to wear a pad. The increased moisture of the discharge can predispose women to yeast and bacterial infection in pregnancy, so sometimes it can be confusing if the discharge is normal or a sign of infection. Normal discharge of pregnancy should not be associated with pain, itching, burning or odor. If you are concerned, you can have your doctor check to make sure everything is healthy.
As if your swollen, achy belly and constant peeing didn’t make resting hard enough, leg cramps can sometimes lead to miserable sleepless nights during the seemingly endless third trimester. To soothe your calf spasms, stay hydrated, massage your legs, and stretch before bed. You may also want to try eating banana before bed or taking a magnesium supplement to relax your muscles.
New Pregnancy Means New Symptoms
A patient, on her sixth pregnancy, came in recently with a concern that something was wrong. She was experiencing nausea, fatigue, breast tenderness, and heartburn. I ran some tests and told her that she was normal and these were common pregnancy symptoms. She shook her head in denial, informing me that she had never had these symptoms were her other pregnancies. I took a step back and broke the news to her that her luck had run out.
Much like your children themselves, your pregnancies can be extremely different. While having a low-risk pregnancy the first time around does improve your chances of having a healthy pregnancy the next time as well, it does not guarantee that your pregnancy symptom will stay the same.
Most women, whether their pregnancy side effects were just mildly annoying or a source of constant misery, usually forget all the aches, pains, and veins once they see their little one for the first time. If you are having a pregnancy full of unpleasant surprises, talk to your doctor about your symptoms – and hang in there, I promise the end reward is worth it.