What I wish they would tell you about having babies - Part 1

by Dr. Sarah Shimanek, PT, DPT, WCS, PRPC

Oh my goodness, where to start?! There are so many things I wish OBGYNs and other birth providers would tell you about having babies; from what to expect from your body during pregnancy, how to prepare for birth, how to minimize complications during delivery, what’s normal after birth, how to help your body heal postpartum, and when to seek extra help for recovery. Whew, that’s a long list! So, let’s just start with that first one and go from there. Today, we’ll talk about body changes during pregnancy.

So, we all know that when we get pregnant, our bodies change, right? And depending on who we’ve talked to or what we’ve read, we may know about things like stretch marks, hair loss, increased foot size (IKR?!), and maybe even about changes to your pelvis, but maybe not.

As a physical therapist, what I care most about aren’t the aesthetic parts of this, like stretch marks, hair loss, or foot size, though I know those are important to you. But the hair usually grows back, stretch marks have been rebranded into “tiger stripes,” and at the end of the day you can buy new shoes. I had my own journey through these things, and I know they’re still annoying. I had those little short hairs that grew back for years after I had my son and stuck out everywhere, and I had several pairs of shoes I had to throw out because they didn’t fit anymore.

But what’s more important to me, and I think what you’ll also agree is important to you if you think about it, are the changes that affect our ability to do the things we want or need to do. For example, as your belly grows, it’s normal for your abs to start to separate in the middle. All this means is that the connective tissue that joins your abs together will get wider. Sometimes this also stays around after pregnancy, which is called Diastasis Recti Abdominus, and we’ll talk more about that when we talk about things to look for postpartum. But during pregnancy, this is normal and just part of the process. As your belly gets really big, this means your abdominal muscles can’t support you as well as they did before. This can lead to back pain, hip pain, or sacroiliac (SI) joint pain, or it can just make it harder to do stuff. Maybe it’s just harder to get in and out of bed, or maybe you can’t do your job anymore because you can’t bend and lift. Maybe you have a toddler you can’t lift or run around after. Maybe you can’t clean your house or stand a long time to cook dinner. These are the things that really affect your life. Of course, if it’s really affecting your life, you should call a physical therapist.

So, we all know your belly grows during pregnancy (duh!), but what else is different? Well, a big one are the changes that happen as your hormones change. There are a lot of hormones affected by pregnancy. One of the ones we seem to hear the most about is relaxin. This peaks during the first trimester and remains elevated until a few days after delivery. It is a popular culprit for the increased laxity experienced by most pregnant women. If you’re not familiar with this, pregnant women’s joints move more than they did before pregnancy, which is one of the factors that can contribute to back, hip, or pelvic pain, as well as the weakness we talked about earlier. While relaxin is part of the reason these things happen, there are other hormones implicated as well. Estrogen increases up to 30 times its normal level during pregnancy, and is also implicated in the relaxing of ligaments. Estrogen levels increase the most dramatically during the first trimester, but continue to increase throughout pregnancy, and then drop dramatically afterward. Cortisol and progesterone also follow this pattern, both of which have also been implicated in the increased ligament laxity.

Increased progesterone is also responsible for constipation, swelling, possible hemorrhoids or varicose veins. The stretch marks can be attributed to both the increased estrogen and increased cortisol. Interestingly, for people with autoimmune disorders, this increased cortisol also has such a suppressive effect on the immune system, that many individuals experience a decrease in symptoms. Before I got pregnant, I had problems with interstitial cystitis, which is considered by many to be an autoimmune disorder, and I went to this very unhelpful urologist who basically told me my problems weren’t that bad, and that when I got pregnant they would go away. While this was not helpful advice, it did prove to be accurate, as my symptoms did improve with pregnancy. I have cortisol to thank for that.

So, now that our endocrinology lecture is over (though trust me, I could have gone into wayyy more detail, lol), why does this all matter and what can we do about it?? I mean, we can’t control these hormone changes, and they’re necessary for pregnancy anyway, right? Well, yes, that’s right. However, there ARE things you can do to minimize how this affects your life. We’re going to talk about five of them: mindset, exercise, nutrition, sleep, and stress management.

The first thing you can do is to relax and know that in general, these changes are normal, and most of it will get better after pregnancy. I know it’s antithetical advice, but again, try to stay calm and accept some of this as inevitable. That said, DON’T let it interfere with your life more than it needs to. Take care of yourself and get help when you need it.

That brings us to the second thing, and that’s to keep exercising or, if you don’t have a regular exercise routine - start exercising. This is of course only with the blessing of your doctor or midwife, and only if you don’t have medical complications or are at risk preterm labor. That said, more and more research has come out saying exercise is not only safe during pregnancy, but should be encouraged. The old advice used to be that you can continue doing any exercises you were doing before pregnancy, but shouldn’t start anything new. But that’s hogwash (yes, I said hogwash), and research supports that. Though they probably didn’t use the term hogwash in the studies. Instead, the more current advice is that it’s still perfectly safe to continue any exercise that doesn’t include a high risk of falling or sustaining heavy injury, and it’s also safe to start a new exercise, as long as you take it slow — which is something you should always do when starting a new exercise program, anyway.

Good types of exercise to do while pregnant are things that focus on core and pelvic stability, as that’s what you need to both avoid pain and to prepare for labor. Pilates and yoga are both good examples. You don’t need a pregnancy-specific class. Just tell an instructor that you’re pregnant so they can help you modify if needed. And if you’re doing something on your own, just avoid being on your back after the first trimester. It’s also a great time to start a walking program. Additionally, you can consult a physical therapist that specializes in pregnancy to help you develop an appropriate exercise program.

The third thing is one you probably don’t want to hear, but it’s healthy eating. I know this is a struggle. I remember wanting to eat all the cake when I was pregnant with my daughter. No, really. I actually bought a whole cake from Costco just for myself. And I wanted fried chicken strips so badly with my son (and I was vegetarian). But the unfortunate truth is, the things we eat do have an effect on our body, particularly when it comes to our hormones. This is true outside of pregnancy as well, of course. But during pregnancy, so many of the changes we see that affect our lives are due to hormones, so it can really help to eat a generally healthy diet where we avoid inflammatory triggers, particularly sugar and maybe dairy or gluten.

This doesn’t mean we have to be perfect, but you want to shoot for plenty of veggies, some fruits, moderate amounts of whole grains, and plenty of lean protein and healthy fats. Your plate for most meals should be half veggies, 1/4 protein, and 1/4 whole grains (unless you are on a diet that limits carbs), with added healthy fats like olive oil, avocado, olives, and/or nuts. Those added fats can really make a difference in cravings for things you shouldn’t be eating — like an entire sheet cake (or was that just me?). Make sure to include plenty of sources of iron as well, such as lentils, spinach, tofu, chickpeas, white beans, and lean meats. Cooking in a cast iron pan can also increase iron intake. Good healthy snacks would be fruit and nuts, maybe a little cheese if you don’t have a problem with dairy. For more on what you should eat to regulate hormones during pregnancy, consult a dietician or well trained nutritionist that specializes in pregnancy and birth.

Another important thing to focus on is sleep. Sleep patterns change during pregnancy, with a decrease in deep sleep and more awakenings during sleep. My unofficial theory is that at least part of this is due to the crazy dreams you have when you’re pregnant, though it’s actually probably the poor sleep that leads to the vivid dreams, rather than the other way around. Increased progesterone is actually thought to be responsible for these more vivid dreams, and it’s likely the increase in vivid dreams is because of more time spent in REM sleep (lighter sleep where you do your dreaming) and less time in deep sleep. But I feel like the dreams themselves can be a cause of poor sleep. I still remember a dream I had when I was pregnant with my daughter where I dreamt that a huge tidal wave was coming in November. My daughter was due in November. It wasn’t too hard to figure out what my subconscious was going for, but I did wake up terrified. It’s hard to sleep well after that.

Since you’re likely going to be stuck with some decrease in sleep quality, you may have to increase sleep quantity as a way to battle fatigue. Try to arrange your schedule so that you can get to bed earlier, wake later, and/or include naps during the day. Sometimes we are made to feel weak for these choices, but it’s important to do these things to take care of ourselves and acknowledge that we really do have a true physiological need for more sleep due to these hormonal changes. Make it a priority. Reduce or eliminate caffeine consumption, especially after noon. Avoid drinking too much water before bed so you wake less often at night. Avoid screens for at least 30 minutes before bed. Try meditating before bed (more on this later). And if needed, talk to your OB about sleep supplements that may be okay during pregnancy.

The last step in managing the effects of changing hormones on your body during pregnancy is to manage stress and anxiety. We can’t eliminate stress. But we can prioritize the things that make us happy and help us to deal with our daily stresses. Maybe this is exercise, maybe it’s walking or yoga, maybe it’s music, drawing, or painting. Think about things you love to do and make time for them. We can get so focused on preparing for the baby that we forget about ourselves. It’s good practice to start taking care of ourselves before the baby comes, as it’s important to prioritize ourselves afterward too.

Guided meditations are also great resources for calming stresses. There are several apps for this including Insight Timer, Headspace, Calm, etc. You can also find thousands of meditations on YouTube. Though they’re more popular for preparing for intervention-free vaginal birth, think about incorporating hypnobirthing meditations, even if that’s not your thing. Hypnobabies has several audio tracks to help prepare for birth (they actually do have a c-section one!), and to reduce fears around pregnancy and delivery. Find them here: https://www.hypnobabies-store.com/product-category/pregnancy-tracks/. Hypnobirthing International also has some great tracks you can download. I used her rainbow relaxation track daily during the second half of my pregnancy with both my kids and found it very helpful: https://hypnobirthing.com/retail-shop/

Yes, pregnancy is magical and special, but also really weird. There are a lot of strange things that happen to your body, but cool stuff too. I mean, you’re growing a freaking human. There’s nothing cooler than that. Just take care of yourself, remembering those five things: mindset, exercise, nutrition, sleep, and stress management. And call a PT if you have pain. Pain is not normal and needs to be dealt with. Especially if it’s affecting your ability to live your life.