Pregnancy, in real life, isn't defined by the picture portrayed by Bollywood in our minds. The changes happening in your body while pregnant go way beyond vomiting and tamarind- craving, which, unfortunately, are the only things women are prepared for!
The human body is indeed a miracle of nature. Each and every organ system undergoes changes when a woman is pregnant, to accommodate comfortably, another human being growing within her.
You may not physically experience all of these changes even though they're happening within you. Moreover, not every woman may experience every symptom in the list! Remember that you're unique. Just because your sister or best friend went through something during her pregnancy does not necessarily mean that it has to happen to you too!
What are the commonest symptoms you may experience?
* A missed period:
For a woman usually getting her menses like clockwork on the precise date of the month, a missed period may indicate pregnancy.
An increasing number of women these days are faced with irregular periods, hence it may be difficult for them to predict if they've really missed their period. In such a scenario, a positive urine pregnancy test may help to clinch the diagnosis of pregnancy.
Is it possible that you don't miss a period and can still be pregnant?
Very very rarely, but yes, it is known to happen. Sometimes, when the embryo makes its way into the uterus and burrows into the endometrium, or the lining inside the uterus, the woman may experience some bleeding or spotting called 'implantation bleeding', which she may mistake for her period. This may lead to the perception of not missing your period but still being pregnant.
* A positive urine pregnancy test (UPT):
A urine pregnancy test is based on the premise of the pregnancy hormone, or beta human chorionic hormone (beta hCG) which is excreted in the urine of a pregnant woman.
Traditionally, the UPT is done on the morning sample of urine, because it was initially believed that since you don't empty your bladder overnight, the first sample of urine in the morning is more concentrated and has a greater chance of showing a positive value than the ones voided later. However, the present day test kits available are highly sensitive to even low values of beta hCG in the urine, and can show a positive test even when checked later in the day.
The UPT generally turns positive when checked around a week after your missed period. If you check it too early, it may show a negative result even if you are pregnant, because the values of beta hCG in your urine are not significantly high yet.
How do you do a urine pregnancy test?
Add two drops of urine to the well on the test strip and wait for five minutes.
There are two markers on the test strip. 'C' stands for control, and 'T' stands for test. The test strip is so designed that it reacts to the beta hCG, if present in the sample put on it and changes colour to pink. The control line shows you the intensity of the colour that indicates a positive. Thus, two dark pink lines denote a positive and one dark pink line denotes a negative.
There are instances when you get a dark pink line on the control point and a light pink line on the test point. This is what we usually term as a 'weak positive'. There could be a few reasons for this, the commonest being that it is a very early pregnancy, and the beta hCG in your urine hasn't yet reached a significantly high value to appear as positive on the UPT strip. Sometimes it could be an error, and sometimes if you keep the strip for very long, you can see the test line growing darker even if the test is negative. Hence, it is important to interpret the results of the UPT within 5 minutes. However, if you do get a weak positive result on the UPT strip, please consult your doctor. The next step they would advise is to do a beta hCG test on your blood sample, which would detect even the slightest positive, even if the values are very low.
* Morning sickness:
Here comes the classical Bollywood 'Main maa banane wali hoon' symptom!
hCG and progesterone are usually the hormones that cause a woman to feel nauseated in the first trimester of pregnancy. The severity of this symptom may vary with each individual. A few lucky women breeze through the entire duration of pregnancy without a single episode of vomiting, whereas quite a few develop food aversions, inability to tolerate any food orally, severely reduced appetite, which may even lead to weight loss in the first three months of pregnancy. Women with twins or triplets usually have a more severe degree of nausea and vomiting, because of the obvious reason of the pregnancy hormones being at a higher level in the body as compared to a singleton pregnancy.
Your doctor may prescribe certain oral medications which you can safely take, should you develop nausea or vomiting. Sometimes a few of these tablets may cause you to feel sleepy through the day, hence we recommend that you take them only when required.
In the event of very severe vomiting wherein the woman is unable to tolerate any food orally, she may need to be admitted and given intravenous fluids and medications to avoid dehydration.
Classically, this symptom reduces in intensity and severity after the woman crosses 12 weeks of pregnancy, even though there may be a few exceptions.
* Frequency of urination:
Anatomically, the uterus is sandwiched between the urinary bladder in the front and the rectum, i.e. the pouch that holds your stools, behind. Hence, when the uterus starts increasing in size due to pregnancy, it may exert pressure on these two organs, leading most commonly to frequency of urination. Some women may even experience a sense of incomplete voiding, and may need to go back to urinate very soon after the previous washroom visit.
Sometimes you may even experience a change in your bowel habits.
This symptom also gets better once you cross the twelfth week of pregnancy, and can recur during the last trimester once the baby's head starts exerting pressure on the urinary bladder once again.
* Vague aches and pains, tiredness:
It commonly occurs in pregnancy that you feel dull and easily tired even after performing a routine activity that you may be very well used to. You may also experience a stretching pain in your lower belly. That may be due to the increased blood flow to your uterus and other pelvic organs owing to pregnancy. However, any lower abdominal pains are to be taken seriously and informed to your doctor, unless they reassure you that the pain is indeed due to pelvic pressure and stretching of your ligaments due to the growing uterus.
With advancing pregnancy, your posture changes, and the point of weight- bearing in your spine changes too. Ultimately, you may have backache. It may be relieved by rest, correct posture and a few back exercises as advised by the doctor.
Another change you may experience in the later months of pregnancy is swelling in your feet. The pregnant uterus sits on the veins responsible for carrying blood from your legs back to your heart for oxygenation and pumping. This leads to congestion and something that we term as a 'dependent oedema'. This swelling classically worsens after sitting with your legs hanging down, or prolonged standing at the end of a working day, and is relieved on rest. However, swelling on your legs needs to be brought to the attention of your doctor, as it may be an early sign of raised BP.
In the later months of pregnancy, we recommend that you lie sideways when you go to bed, to relieve the pressure off the veins.
* Breast changes:
With pregnancy, your body starts preparing your breasts to feed the baby once it is born. Your breasts may start feeling heavier, and may swell up in size. The brassiere you're used to may start feeling uncomfortably tight. Your nipples may become larger and more prominent, and the areola, i.e. the dark brown circle of skin around your nipple may also enlarge in size and become darker. You may also see some small round painless pimple- like projections along the border of the areola. These are called Montgomery's tubercles and are a normal breast change in pregnancy.
Sometimes you may also experience a sticky, whitish or watery discharge from your nipples in pregnancy- it is nothing to be alarmed about, but do not try and squeeze it out. We usually suggest avoiding breast and nipple stimulation in pregnancy, since the same hormone 'oxytocin', which is responsible for milk expression, is also responsible for labour pains.
* Weight gain, the 'baby bump':
A pregnant woman may not start gaining weight immediately after the pregnancy is confirmed. In fact, a few women may also lose weight in the first trimester on account of reduced appetite, nausea and vomiting.
A baby bump too, is not evident until the second trimester. Upto 12 weeks of pregnancy, the uterus is within the pelvis, i.e. lies inside the bony cage around the area of your hips. Once the pregnancy crosses the 12 week milestone, the uterus gradually starts to grow above the pelvic bone and become more visible in the lower belly as a bump. Before that, whatever you may see is just belly fat! To assess the size of the pregnant uterus till that time, the doctor may have to perform an internal examination 'per vaginum' (PV) in which he/she may insert two fingers into your vagina and assess the size of your uterus with the other hand pressing your lower abdomen.
A few women may not have a very protuberant baby bump. It depends on the tone of your abdominal wall muscles, the size of the baby, and also the position of the baby within you. Shorter women, those carrying twins, women with lax abdominal muscles or larger sized babies may have a bigger baby bump. Hence, the growth of your baby is not dependent on how apparent your baby bump is, contrary to popular belief. Your doctor would check the size and advise serial ultrasound examinations to be able to comment on the growth.
* Skin changes:
Stretch marks are more evident in leaner women with a good skin tone over the belly. Your skin comprises of collagen fibres. As your belly expands due to the growing uterus, these collagen fibres get stretched and damaged, which leads to stretch marks. You may notice similar marks on the skin of people who put on or lost weight suddenly.
You may also see a vertical dark line running along the centre of your abdomen past your belly button.
Pregnancy may even lead to pigmentation over your skin, which may lead to you appearing a few tones darker than usual. Some women may experience darkening over the cheek bones and root of the nose. Acne, or pimples over the face, back and upper arms is also a common complaint which may be attributed to the pregnancy.
A few women may also experience hair fall. Your hair may lose its lustre.
Do not fret over the lack of the so- called 'pregnancy glow' if you're afflicted with any of the above. Being a mother does not imply being conventionally good- looking, fitting into fashionable clothes and having a clear skin and photogenic body. It is more about accepting and coming to terms with the fact that your body would be undergoing irrevocable changes. But given that you have another human being growing inside you, I would say that you're still the most beautiful and gifted woman ever, and that you should be confident and love yourself even more than before!
* Changes happening inside you- the other organ systems:
The human body is a marvel of nature. In order to accomodate the baby, its growth and yet not cause too much strain on your body, there are a lot of changes which start happening within each and every organ system. Your blood volume expands in size, your heart pumps more effectively, your blood pressure drops by a few millimeters, the muscle sphincters in your digestive system relax- and a lot more goes on within you without even making the change obvious. Your metabolism changes- your baby now needs a constant supply of glucose for its growth. If you're a diabetic, you may notice that your blood sugars drop in the initial few months of pregnancy, which later reverses and you may then require a higher dose of medications. You do not need to worry about these changes, unless, of course, you have any pre-existing diseases, which you must share with your doctor so that he/ she would be able to analyse how pregnancy would affect your disease, and how the disease may affect the pregnancy- and take the necessary measures to ensure that you and the baby sail through all the three trimesters with minimal worries!
* Perception of the baby's movements:
You may not be able to feel the baby's movements even as late as the fifth month of pregnancy. Usually, a woman pregnant for the first time may be able to perceive fetal movements as early as the 18th week of pregnancy, and if it's your second or third baby, you may even feel then a couple of weeks earlier.
However, do not fret even if you're a bit late in beginning to feel the movements- each woman's perception may vary based on several factors.
We do not recommend counting the baby's movements till 28-30 weeks of pregnancy.
* Feeling of 'tightening' or the Braxton Hicks contractions:
You may occasionally feel your tummy hardening through the pregnancy. The difference between labour pains and Braxton Hicks contractions is that they are essentially painless, infrequent and do not progressively increase in severity and frequency.
Moreover, if your doctor performs an internal examination, they would find that your cervix hasn't yet started to open up with Braxton Hicks contractions. However, it is always prudent to get checked by a professional to ascertain that the hardening of your belly you feel is indeed due to Braxton Hicks contractions and not labour pains.
Pregnancy is an experience in itself. It is essential to be prepared for this journey by knowing what's right, and not just hearsay and rumours. Remember, never hesitate to get your doubts clarified by your doctor- no matter how silly they may seem. Sometimes, the silliest of mistakes can be the most troublesome! And most importantly, love yourself, and embrace the changes in your mind and body that pregnancy brings with it- that is the secret to a healthy, happy motherhood!
The writer is a dynamic, highly approachable obstetrician, gynaecologist and infertility specialist practicing in Pune.
