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What's Going on in Your Body: Common Aches and Pains

Expect some physical reactions to kick in as your body begins to accommodate the new life that's rapidly taking shape within you. More than one newly pregnant woman has remarked, "It's as if my body is running on autopilot, with someone else telling me when to eat and when to sleep." In the first trimester, the most common side effects include the following.

Pregnancy sickness (nausea). The familiar term "morning sickness" is losing favor because, as any sufferer knows, nausea and vomiting have no time limits. (The name stems from the fact that, for many women, symptoms are worst upon waking.) No two cases are alike. Some women feel little worse than a come-and-go upset stomach and never throw up, while others are left sprinting to the toilet
all day long. Still others wish they could retch but can't. If you're lucky, you may be able to identify which smells or tastes set you off, and avoid them. But you may also get ill without a clear-cut trigger. The precise cause of this common malady, which affects most pregnant women to some degree, remains one of the great medical mysteries.

Nausea tends to be worsened by a woman's eating habits--more specifically, by her not eating. Many expectant mothers unwittingly fall into a vicious cycle of cutting back on how often or how much they eat because they feel nauseous, which then perpetuates or even worsens the sickness.

What doesn't cause pregnancy sickness is emotional stress, though stress can exacerbate its severity; being in poor physical shape; difficulty adjusting mentally to motherhood; or an unvoiced displeasure with being pregnant.

The best coping advice is to find ways to take control of this potentially overwhelming condition. Graze on small amounts of foods you can tolerate throughout the day to ward off the extreme nausea that an empty stomach can bring on. It's less important that you eat plentifully, or even especially nutritiously, during the first trimester, than it is to keep something in your stomach to stay as healthy as possible, while avoiding substances that could endanger the developing embryo. The fetus requires very few nutrients at first. Follow your instincts. If the smell of dog food turns your stomach, get someone else to feed the dog. If sitting in a dim room or sleeping alone seems to help, do so. If you can tolerate only bland pasta, stick with noodles. Don't worry if you wind up losing a little weight in the first 2 or 3 months; total weight gain is rarely more than a few pounds in the first trimester, regardless of one's degree of pregnancy sickness.

Comfort yourself, too, with the knowledge that smell and taste aversions may be actually protecting your developing baby. Your sense of smell, for example, sharpens in the first trimester, helping steer you from spoiled dairy products or smoky rooms. (It returns to normal in mid-pregnancy before worsening by the ninth month.) What's more, feeling nauseous should actually reassure you that the pregnancy is proceeding normally. Your baby, by the way, doesn't notice a thing.

More pregnancy-sickness tips:

         Quit eating three big preplanned meals in favor of day-long mini-meals; even snacking as often as once an hour can make a big difference. Bland snacks that work well for some women include rice cakes, pretzels, cold cereal (such as Cheerios or Rice Chex), and saltine crackers.
         To circumvent morning nausea, don't go hungry at night. Have half a sandwich and a glass of milk before you retire, or make middle-of-the-night refrigerator raids for light snacks.
         Drink lots of fluids to avoid dehydration. Cold juice, milk, or lemonade may appeal more than warm or hot beverages.
                
Don't forget other sources of liquids: popsicles (look for brands made of 100 percent juice), frozen juice or sorbet, Jell-O, frozen grapes or melon balls, bouillon.
        
When you're not chewing food, try hard candy or peppermints to prevent irritating stomach acids from building up (as they do on an empty stomach).
        
Nibble crackers, cereal, or cheese before you get out of bed and wait 15 to 20 minutes before standing up.
        
Try the fresh lemon cure: sniff a wedge or suck one, either plain or sprinkled with salt.
        
Keep a window open or a fan running at night, since stale air can worsen nausea.
        
Quit cooking. Order take-out or hand the spatula and apron to your partner. (Restaurants, with their many odors, may not appeal.)
        
Switch to unscented soaps, detergents, and lotions.
        
Skip perfume.
        
Beware herbal medicines (such as gingerroot) purported to quell nausea; they may work, but they are potentially toxic and unstudied in terms of birth defects.
        
Try an acupressure wristband designed for seasickness, available at boating stores or pharmacies.
        
Sleep!


Never take motion-sickness pills or any other medications for nausea without your doctor's okay. Get medical help if you can't keep anything down for several days or if you lose weight rapidly. This can lead to a severe dehydration known as hyperemesis gravidarum, which sometimes requires hospitalization. A combination of antinausea drugs and intravenous fluids may be needed to combat the dehydration and restore your body's chemical balance. These are safe for the fetus, who will also be monitored carefully.




What's Going on in Your Head: Conflicting Thoughts

Being pregnant, you may feel as thrilled as if you've won the lottery, and rightfully so. But even the sunniest mamas have their gray moments. With every facet of your life about to change, it's only logical that your mind should feel as transformed as your body. Often pregnant women are expected to wear a happy face, despite morning sickness, worries about the baby's health, and fears of their own
possible inadequacies. There's an unwritten expectation that if you say anything negative about how you're feeling, you must be a bad mother. Or that negative vibes can somehow penetrate the uterus and depress your unborn baby. Don't believe it.

The truth is, you'll probably be stirring a crazy soup of emotions for the next 9 months. Part of the reason is biological: fluctuating estrogen and progesterone fuel some of pregnancy's infamous mood swings. Moreover, your psyche (and your partner's) need time to adjust to the profound changes taking place. Your relationship to your partner, your parents, your own body, and possibly to your job, friends, and older children or stepchildren are all teetering on the brink of change. Don't let anyone intimate that pregnancy is no big deal or nothing to get worked up about.

The first weeks can be especially intense. The reality of the pregnancy is still sinking in, for one thing. There's a strange "unrealness" about the delay between when the home test dipstick first turns pink or blue and when you get tangible confirmation of the baby's presence in the form of an ultrasound image, a heartbeat, or a swift kick to the ribs. Especially if you haven't broadcast the news yet, the time of not-yet-showing, not-yet-telling can be an exquisite private trip--or a maddening wait.

If the pregnancy was unplanned, you may need extra time to absorb the shock. Often women whose pregnancies were a surprise find they embrace the idea quickly, while mothers-to-be who planned the event suddenly find themselves out-of-sorts. Everyone--and every day--is different.




More Ways to Feel Good

Aside from reassuring yourself that you're not crazy or alone, there are a few practical steps you can take right now:


To help make the baby seem more real, flip through the miraculous photographs of first-trimester fetal development like those found in Lennart Nilsson's classic book, A Child Is Born.

Read ahead in pregnancy guides like this one to arm yourself with full knowledge about the enormity of these 9 months.

Start a pregnancy journal in which you record your thoughts and actions. It can be as simple as a factual record of your prenatal visits or as easy as a tape-recorded monologue.

Buddy up with another woman who's at your same stage of pregnancy. It might be a coworker or neighbor you never had much in common with before--but rest assured, you do now.

Join an on-line support group for women who are delivering the same month as you.

Make a point to do something nice for yourself every day--give yourself a foot massage, buy fresh flowers, reread a favorite book, order take-out, nap.

Go with the flow. Learn to let new experiences and setbacks roll off your back with less resistance than you might have allowed in the past. Change is a constant in pregnancy; nothing stays exactly the same, so get used to it.

Avoid the Pregnant Pollyanna trap--thinking you must act grateful and grin all the time. So much of pregnancy is magical, even spiritual. But it can also be uncomfortable and worrisome. Allow yourself to be real about it.





Checkups and Tests: Good Advice: Getting the Most Out of Checkups

"I looked forward to my appointment for a month, and then I was in and out in five minutes." Don't leave your checkups with that common lament. Here's how to feel better about your visits:


Between appointments, jot down questions that occur to you on a sheet of paper kept in some handy place, like your purse or the refrigerator door. Bring it with you.

Speak up. Your caregiver's not a mind-reader and may not know what's bugging you just by looking at your physical stats.

Consider nothing too small ("There's this twitch in my side") or too embarrassing ("I think I've got hemorrhoids") to mention.

Bring evidence. Show your doctor the labels of vitamins, herb teas, or medications whose safety you're doubting.

Don't tolerate a doctor who won't give you complete answers, show reasonable compassion, or bestow his or her full attention. After all, that's what you're paying for.

Question anything you're told--it's your right.

At the same time, be open-minded. State preferences, rather than make demands. And listen. Your provider has gone through a lot more pregnancies than you have.