Physical and Emotional Changes in the Pregnant Woman
Pregnancy is generally divided into three trimesters, or three periods of 3 months each, for purposes of discussion. This is done because most women experience the same general changes during each trimester.
During pregnancy, two kinds of development go on at once—the physical changes in the mother-to-be and the physical changes in the fetus. Along with the physical changes the woman experiences, some emotional changes take place. You and your partner can use these changes as opportunities to grow, to expand your awareness of yourselves and of each other, to deepen your sense of responsibility, and to become aware of what millions of other parents-to-be have experienced.
The first trimester of pregnancy is the first 3 calendar months, or through the fourteenth week of gestation. You will experience many physical and emotional changes during this time, although most of the physical changes will be more noticeable to you than to anyone else.
The major physical changes that women experience during the first trimester include the following:
For many women, a missed menstrual period is the first sign of pregnancy. Other women continue to have very light periods for the first 2 to 3 months. This lack of a regular period is due to the high levels of estrogen and progesterone that the body produces to maintain the uterine lining that nourishes the developing embryo. Many women spot slightly on the day the ovum attaches itself to the uterine wall. This is not menstrual bleeding; rather, it is called implantation bleeding.
By the time the fetus is 12 weeks old, the placenta, or afterbirth, has formed. The uterus has grown to the size of a grapefruit, with its top reaching to just above the pubic bone. The cervix has already begun softening.
The vagina has begun thickening and softening because of the increase in maternal hormones. It has also turned blue to violet in color as a result of the increased blood supply to the area. Vaginal secretions have become more noticeable and will increase in amount as the pregnancy progresses.
A tingling or prickling sensation is often felt in the breasts during the early weeks of pregnancy. This is because the blood supply is increasing and the milk-secreting glands are growing. After a few weeks or months, the tingling or prickling will disappear, but the breasts will usually continue to enlarge until the third trimester.
Around the eighth week, veins may become visible under the skin, and small round elevated areas appear on the areola, the dark area surrounding the nipple. These elevated areas are the Montgomery glands, which secrete oil to help keep the nipples soft and pliable in preparation for breastfeeding.
Many women experience an increased need to urinate during the first trimester because the enlarging uterus is pressing on the bladder. This need usually eases during the second trimester, as the uterus rises out of the pelvis. Even though it means more trips to the bathroom, you should drink plenty of fluids to maintain good kidney function and to provide the water necessary to metabolize the protein you eat.
About half of all pregnant women feel nauseated and may vomit during early pregnancy, and sometimes also in later pregnancy. This condition is called morning sickness, although it can occur at any time during the day. Morning sickness is attributed to an increase in hormone levels, a lack of vitamin B6, and/or low blood sugar. Eating foods high in B vitamins and consuming small high-protein meals throughout the day usually help this condition. (For a further discussion of morning sickness, see “First Trimester” on this page.)
In addition to nausea, some women also have trouble with indigestion and heartburn. The hormones relaxin and progesterone relax the smooth muscles in the body, including the sphincter at the top of the stomach, which keeps food in the stomach. Progesterone is also responsible for relaxing the intestines somewhat, thereby slowing digestion and making constipation more likely. Eating a diet high in fiber (fresh fruits and vegetables, and whole grains), drinking plenty of fluids, and exercising regularly help to minimize constipation. For some additional heartburn preventatives and remedies to try, jump to “Heartburn Fighters“.
The hormones of pregnancy can affect your skin either positively or negatively. Many women experience the glow of pregnancy, and their skin radiance. Others are not so fortunate and develop acne. Continue to eat a good diet and drink plenty of water. Wash your face two or three times a day with a gentle cleanser and apply moisturizer to dry areas.
Avoid the temptation to pick at or squeeze the blemishes. This will only increase the likelihood of infection and scarring. Choose makeup that does not clog the pores or try to limit the time you wear it. Wash the applicators or purchase new blush brushes or powder “puffs”. If the acne is severe, you may need to see a dermatologist. Make sure that he knows you are pregnant. Two common medications used for acne, Accutane and Retin A, should not be used during pregnancy.
Pregnancy brings changes to every system in the body, and these changes require a great deal of physical and emotional energy. Proper rest is extremely important for an expectant mother. You should not feel guilty about resting during the day or about going to bed early. You need rest for your body to adjust to pregnancy.
See Figure 2.13 for an illustration of the woman’s body at the end of the first trimester.
Many expectant mothers spend the first trimester accepting the fact that they are pregnant and coming to terms with the implications. This is true for other family members as well. You may find yourself drawing inward and focusing on the changes in your body and on your fears and dreams. You may feel increasingly vulnerable to danger and may also fear miscarriage.
Even when the pregnancy is wanted, expectant parents usually have many questions: Can we afford a child? How will our lifestyle change? Will you have jealousy problems with our other children? The woman may wonder: Will I quit work? Both parents-to-be may feel a sense of panic at the additional responsibilities. Ambivalent feelings toward the pregnancy are very common in the early months. These feelings are not bad or wrong. By acknowledging and talking about them, you and your partner may find yourselves better able to cope with them and to accept the pregnancy. Facing your doubts and fears about pregnancy aids in emotional growth.
Many couples enjoy more sexual activity during this time of adjustment, while other couples may desire less sex. (For a discussion of sexual intimacy during the first trimester, see “Sexual Relations During Pregnancy“.) You and your partner should talk to each other openly about your feelings to prevent pent-up fears from damaging your relationship.
By the end of this first trimester, you may find that you have begun to sort out and examine your feelings toward your own parents. Think about how you will be different from or similar to them. Among the other feelings you may experience during the first trimester are excitement, increased creativity, and increased sensuality. You may feel “special” during this time.
Mood swings sometimes become more extreme during pregnancy. You may find yourself laughing or crying over insignificant things. This problem is related to the increasing levels of hormones. Researchers believe that these hormones do not cause the moods, but probably increase the intensity of the feelings. Some evidence has shown that expectant mothers feel more anxiety if the baby is a boy, but the reason for this is unknown.
Women experiencing a second or later pregnancy often find that they are less preoccupied with the pregnancy than they were with their first. The major adjustment to parenthood seems to come with a first pregnancy. With later pregnancies, women have less time available and feel less of a need to ponder the meaning of each physical change.
The second trimester of pregnancy is the middle 3 months, or from the fifteenth through the twenty-eight week of gestation. This trimester is often the most enjoyable of the three. Your initial period of adjustment has passed, and fatigue and nausea are usually less of a problem. It is during this time that your pregnancy becomes obvious to the other people, and you may frequently be the center of attention. Your body, though larger, is not cumbersome, and you should find it fairly easy to move around.
The major physical changes that women experience during the second trimester include the following:
The uterus begins to expand out of the pelvis and into the abdominal cavity by the fourteenth week. By the twentieth week, which is midway through the second trimester, the uterus is usually at the level of the navel.
A woman pregnant for the first time usually begins to feel the movements of the fetus at about 16 to 18 weeks. Women who have already borne at least one child often feel these movements earlier. When the movements are first perceived, the fetus is about 7 inches long and weighs less than 1 pound. The woman may also feel mild uterine contractions, called Braxton-Hicks contractions.
The tissues of the vagina continue to soften and become more elastic, preparing for the baby’s passage at birth.
Hormones cause the cartilage to soften and widen to provide additional mobility and relaxation in the pelvic joints. This allows a large baby to pass through more easily.
Colostrum, a clear yellow fluid that precedes mature breast milk, is often present by 16 weeks.
By the end of the second trimester, the blood volume has increased by 40 to 60 percent and the heart has begun pumping more blood per beat. Edema (swelling) is common because of the increased blood volume, the pressure from the enlarging uterus, and the increase in estrogen. The fluid will tend to pool in your feet and hands when you stand for long periods.
Resting on your side will improve your circulation and will help to relieve the edema. Increasing your protein intake will also help to decrease the swelling. If the swelling is sudden and involves the face, you should notify your doctor, since this may be a sign of pregnancy-induced hypertension. (For a discussion of this condition, see “Pregnancy-Induced Hypertension“.)
The Linea Nigra
The linea nigra is a dark line that extends from the navel to the pubic hairline. It is common and is attributed to the hormonal activity of pregnancy. It fades after delivery, although it may continue to be visible.
Many women develop at least some stretch marks, or striae gravidarum, during pregnancy. Stretch marks appear when the connective tissue of the skin is stretched to the point of rupture. They are red or pink lines and may appear on the abdomen, thighs, or breasts. After delivery, they fade to white. Many women find that massaging oil or lotion into the vulnerable areas prevents stretch marks, although heredity seems to be a more important factor.
Mask of Pregnancy
Some women develop the mask of pregnancy, which consists of dark blotches on the face. This pigmentation is believed to result from increased levels of melanocyte stimulating hormone (MSH). Production of MSH drops after pregnancy, with the mask of pregnancy usually disappearing. Deficiency of folic acid, a B vitamin, may also be a cause. Your prenatal vitamins should include folic acid to meet your increased requirement.
See Figure 2.14 for an illustration of the woman’s body at the end of the second trimester.
Most women find the second trimester to be a more positive experience than the first, as they are now beginning to feel the movements of the life within them. Most husbands by now have accepted the existence of the pregnancy and are as excited as the woman about the movements of the baby. During this trimester, men frequently also become more aware of their wife’s growing dependence on them.
As the pregnancy progresses, the woman may feel more vulnerable and may need her mate’s attention more. She may want him to become more involved with the pregnancy and the baby. In addition, she may become overly concerned for her husband’s safety.
Meanwhile, the husband may share the woman’s interest in the pregnancy, or he may feel an increased creative interest in his work or hobby. He may gain weight or show other symptoms of pregnancy. These are all ways in which expectant mothers and fathers deal with the stresses and changes that are occurring. It is important for both partners to be aware of and to talk about their feelings, especially when friction arises between them.
A woman’s dreams may become very real during this trimester and are sometimes disturbing. Dreams are a way of bringing fears to consciousness, where they can be dealt with more easily. Dreaming about misfortune to the baby or to herself, or about giving birth to animals is common. If a woman refuses to acknowledge her fears, she may suffer increasing anxiety.
The third trimester of pregnancy is the last 3 months, or from the twenty-ninth through the fortieth week of gestation. It is a time of preparing for the birth, physically, mentally, and emotionally.
The major physical changes that women experience during the third trimester include the following:
Toward the end of pregnancy, the uterus reaches the breastbone, or sternum, and measures about 11 by 14 inches. Lightening occurs from 1 to 6 weeks before delivery. This means that the baby’s head settles downward into the pelvis and may engage in the pelvic inlet.
Braxton-Hicks contractions become stronger and more apparent as the time for delivery approaches. (For a discussion of false labor, see “Warm-Up Signs of Labor“.) The cervix becomes softer during the last few weeks and may begin to thin out and open up a little in preparation for labor. The woman may feel a sharp pain in the groin if she moves suddenly. This pain is caused by a spasm in or stretching of the round ligaments. These ligaments are a main support of the uterus and extend into the groin area on both sides.
As the pregnancy nears its end, more mucus is passed vaginally in preparation for the baby’s passage. The vaginal swelling also increases at this time and may result in discomfort during sexual intercourse. (For a discussion of sexual intimacy during the third trimester, see “Sexual Relations During Pregnancy“.)
The growing uterus puts pressure on the stomach and intestines, pushing them up and back. Heartburn, a burning sensation felt in the chest, may occur. This is caused by the escape of gastric contents into the esophagus as a result of the relaxation of the sphincter at the top of the stomach. Problems with constipation may continue.
Shortness of breath is common because the uterus is pushing up to the diaphragm. This improves after lightening. Many women also experience nasal congestion and may even have nosebleeds.
Some women experience a change in vision, possibly requiring new glasses or preventing them from wearing their contacts. Report any change in vision to your caregiver, since it may be the result of gestational diabetes, pregnancy-induced hypertension, or another serious problem.
Varicose veins may develop in the legs, vulva, or rectum (hemorrhoids). Varicose veins are caused by the increased pelvic pressure exerted by the uterus and growing fetus, as well as by the decrease in blood returned from the lower body and limbs. They usually diminish after delivery.
The need to urinate usually increases, especially after lightening occurs. This is caused by the pressure of the baby on the bladder.
Carrying around the extra weight causes fatigue to return during the last trimester.
- Eat frequent small meals.
- Avoid spicy or fried foods.
- Eat a small amount of yogurt before meals.
- Drink milk or eat ice cream.
- Chew gums.
- Never overfill your stomach with foods or liquids.
- Take an antacid as recommended by your caregiver.
- Try papaya enzyme with meals.
- Do not lie down after eating.
- Sleep with your head elevated.
- Avoid bending at the waist.
See Figure 2.15 for an illustration of the woman’s body at the end of the third trimester.
During the third trimester, most women focus more and more on the baby, and on labor and delivery. Both parents-to-be find that the search for the perfect name has become an important pastime. They also spend time preparing an area in the house for the baby. Almost all women by now have accepted that they are pregnant and are able to differentiate their babies as real people, separate from themselves.
Time during the third trimester seems endless. Many women count on their due date to bring the end of their discomfort and may be very discouraged if go a week or more beyond.
Because of their large size, some women experience a drop in self-esteem during this trimester. They need the people around them, especially their husbands, to reassure them that they are still attractive.
You can use your preoccupation with labor and delivery to your advantage this time. Gather as much information about the birth experience as possible. Read books, take classes, and talk to new mothers. However, avoid people who repeatedly attempt to discourage you from taking prepared childbirth classes or who dwell on negative birth experiences. You need to keep a confident, relaxed attitude toward the upcoming event. Do not avoid your fears. Do not avoid your fears, but at the same time, do not allow negative thinking to dominate you. Your chances for a positive birth experience are to a great extent determined based on your attitude. Fear and anxiety create negative experiences.