Finding Calm for the Expectant Mom

Chapter 1

Am I Crazy, or Am I Just Pregnant?

You're pregnant! Most people are probably telling you "Congratulations!" "How exciting!" "How thrilling!" You may feel thrilled and excited but likely also worried, nauseated, and a whole host of other physical and emotional symptoms-some of which you expected, but others of which, I assume, caught you by surprise. You are probably also coming to realize that being pregnant carries with it responsibilities and expectations-maybe more than you anticipated. Of course, you want to do whatever is in your power to ensure the health and well-being of your baby. But some of those expectations can weigh heavily on you, and it may be a surprise how physically and psychologically challenging pregnancy can be.

No one really talks about how most pregnancies are not spent being blissfully happy or symptom-free. In fact, you've probably heard it a million times: Pregnant women glow. They are so radiant, so breathtakingly gorgeous, so bursting with feminine allure and blooming loveliness that the media can't help but shout about it. And shout they do. When celebrities are pregnant, they seem to sail through the nine months without morning sickness or significant weight gain and are back in their skinny jeans before you know it. And oh, how they glow!

I could fill this book with the claims people make about the glow of pregnancy. It is an idea that is entrenched in our pregnancy mythology. It is something we all want to believe; wouldn't it be wonderful to be radiant for nine months? Except for one thing: It's simply not true. The "glow" of pregnancy is a complete myth. Sure, some of us shine a bit when we're expecting a baby. But to expect to glow for forty weeks is unrealistic. (Listen to what Jessica Simpson had to say about this: "People always say that pregnant women have a glow. And I say it's because you're sweating to death.") The reality of pregnancy is not so glittery or glamorous. The normal physical and emotional symptoms of pregnancy-especially in the first trimester-are often the polar opposite of "glowing."

I'll tell you a story that illustrates this perfectly. As the founder and director of a unique health-care organization, the Domar Centers for Mind/Body Health, I work alongside a staff of integrative care providers-psychologists, acupuncturists, nutritionists, yoga teachers, and others-to help patients tend to their physical and emotional health. We provide a wide range of services, including the Mind/Body Program for Infertility, which teaches relaxation strategies and stress-management skills while offering support for women who are struggling to conceive.

At the beginning and the end of each ten-week program, each patient completes an assessment designed to measure symptoms of depression. We use it to compare depression symptoms in it our patients at the start and the end of our programs. Almost always, we discover that women feel far less depressed at the conclusion of our programs. Well, this is the case for nearly every woman who participates in our programs-with one exception: newly pregnant women. When they take the questionnaire, their scores for depressive symptoms are often off the charts.

The interesting thing is, they don't score high on the depression scale because women in their first trimester all feel depressed about being pregnant. On the contrary, they are thrilled about it. So why do they score so high on depressive symptoms? Well, when you compare some of the most common symptoms of pregnancy with symptoms of depression, you really can't tell the difference between the two. And we're talking about the normal symptoms of pregnancy.

Pregnancy    Depression

Worry about the future    Worry about the future

Loss of energy    Loss of energy

Changes in sleeping patterns    Changes in sleeping patterns

Changes in appetite    Changes in appetite

Difficulty concentrating    Difficulty concentrating

Tiredness or fatigue    Tiredness or fatigue

Loss of interest in sex    Loss of interest in sex

It comes down to this: The physical and emotional symptoms of the first trimester can be so similar to those of depression that it's hard to find a newly pregnant woman who doesn't appear at least somewhat depressed. Or at least feel yucky. Even if she is eagerly looking forward to being a mother, she can be sad, anxious, or worried about her pregnancy or impending motherhood.

Then, on top of it all, pregnant women often feel guilty because they don't feel fabulous. Or they feel guilty because they do. And they feel guilty if they voice a complaint about being pregnant-especially if they have worked hard to become pregnant. If others put a positive spin on pregnancy, they feel badly if they don't match their enthusiasm. Or, if others put a negative spin on pregnancy, it's easy to go down the negative rabbit hole and be upset by horror stories or see any of their own symptoms or feelings as largely negative. Or they can feel completely confused because they are trying to balance the challenges of physical symptoms with the happiness they are feeling or, conversely, feel perfectly fine physically but strangely ambivalent about having a baby. Pregnancy emotions can range from giddy one moment to depleted the next.

Tess, mom of an eight-month-old, expresses what many women feel: "The first trimester was a mix of emotions. My husband and I were on the fence about having kids, so it was a little scary that I was pregnant. At around six or eight weeks, I thought, 'This is a terrible idea,' but at the same time I was really happy . . . and anxious, scared, and excited. Everything I could be feeling-I did! By the second trimester, people were telling me 'don't be stressed,' but trying not to be stressed is so stressful!"

Feeling anxious, moody, and exhausted during pregnancy is normal. So is not feeling anxious, moody, and exhausted. There is no one right way to feel. But the fantasy of contentedly rubbing our growing bellies is only partially true. You can in fact be maternal to the max while simultaneously resenting how nauseated and tired you are feeling. Feeling happy and overwhelmed at the same time is the definition of a normal pregnancy.

Normal Pregnancy Perspectives

"I'm not in it to be pregnant; I'm in it for the baby!"

"I am surprised by how much I loved being pregnant. I loved it."

"No one told me it would be this uncomfortable."

"I don't want to be pregnant again, but I enjoyed giving birth."

"I was a little sad that the pregnancy was over."

Surprising Symptoms

During pregnancy-especially the first months-you are far more likely to be gagging than glowing. In fact, it's common to feel all kinds of surprising physical and emotional symptoms. Even if you are totally thrilled to be pregnant, you're likely to start your nine-month journey experiencing uncomfortable symptoms, including fatigue, nausea, breast tenderness, bloating, insomnia, gassiness, and aversions to certain odors. And until it happens to you-until you start feeling the physical and emotional effects of pregnancy-you simply can't imagine what it feels like, even if you've watched friends and family members go through it. Many of my patients, in anticipation of getting pregnant, read all sorts of well-meaning but unrealistic books and blogs about pregnancy. Many of these portray picture-perfect pregnancies. After all, who wants to read about vomiting and hemorrhoids? Swelling and sleeplessness? Because of the unrealistic portrayal of pregnancy, I find myself having the same conversation week after week. A pregnant patient comes in, feeling guilty about not feeling great; I reassure her that her feelings are totally normal, which of course then makes her ask me why I didn't warn her how hard it can be to be pregnant. I didn't, because, for one thing, it's impossible to predict how anyone will feel during her pregnancy. Additionally, telling someone who really wants to conceive that pregnancy can pose challenges she hasn't even thought about doesn't seem like the best course of action. Besides, some women do feel fabulous for nine months (and for those of us who didn't, we can survive quite nicely without hearing how wonderful those women's pregnancies were, thank you very much!).

In subsequent chapters, I'm going to give you lots of advice on how to put all these conflicted feelings in perspective, how to cope with them, and how to lower their effect on you. But for now, let's take a look at the symptoms that commonly occur when you're expecting.

Frustrating Fatigue

Fatigue and pregnancy go hand in hand. In fact, fatigue is frequently the first pregnancy symptom that women notice. (The other common first is breast tenderness.) Pregnancy fatigue is unlike other kinds of fatigue; it makes you feel heavy and exhausted, not so much tired, but just burned out. It brings about a bone-deep weariness that has many women in bed, fast asleep, by 8:00 p.m.

Pregnancy fatigue seems insurmountable. Wake up from a two-hour nap, and rather than feeling refreshed, you want to roll over for another two hours. Sit down to read a book or watch television, and within seconds you're zonked out. Just the thought of lying down can make your eyelids heavy.

What causes this? The most likely culprits are the hormonal changes of pregnancy. Hormone levels boomerang during pregnancy, especially in the first few months. Another contributor is the fact that other pregnancy symptoms-for example, having to urinate more frequently-can interfere with your ability to get a good night's sleep. After all, it's hard to start the day feeling fabulous when you were up several times during the night to pee.

Stress and anxiety contribute to feelings of fatigue as well. Even low levels of stress or anxiety wear on you, increasing fatigue levels and making you feel less energetic. They also affect your ability to get the rest you need. Studies show that stress and anxiety have an effect on our ability to fall asleep, to stay asleep, and to wake up feeling refreshed. You need to remember that even positive things can make us feel stressed, and we all tend to feel stress when we are experiencing change. Some of the most stressful events in our lives are positive, such as getting married, buying a house, getting promoted, and of course having a baby. So even the happiest pregnant woman, if she is honest, might acknowledge some feelings of stress in the course of her nine months of expecting.

Fatigue can have an incredibly demoralizing effect on pregnant women-especially if you're young, healthy, and active. Many women have never felt this kind of fatigue before, unless they've had a bout of the flu. Active women I have worked with are shocked when they completely lose interest in their morning swim or their evening run, discovering that the climb up the stairs to bed at night is the only exercise they crave. And even when your doctor tells you that what you're feeling is normal, it's hard to imagine that it really is. It's also depressing to think that you'll be feeling so worn out for months and that you may have to give up your active lifestyle. One of my patients told me after her baby was born that she would have been better off taking her three-month maternity leave during the first trimester, when the brain fog of fatigue made her feel that she was completely ineffective at work. Too bad we can't all have two maternity leaves per baby.

The good news about pregnancy fatigue is that for most women it lets up during the second trimester (what I call the whirling dervish phase; you get your energy back, which is good because this is a great time to start getting ready for the baby), and although it can return during trimester three, it's usually not as bad as it was during those initial weeks. But as with most pregnancy symptoms, you can't always count on your body following the "typical" schedule. For some women, fatigue can last for a full forty weeks, while others find pregnancy brings with it a constant energy high.

Exhaustion would just descend on Carrie in the first trimester. She says, "I had extreme fatigue. I would hit a wall and need to sleep immediately. I didn't drive during that time, because I would be so overcome." Later in her pregnancy, Carrie would take naps when tired, but she wasn't hit with the same bone-crushing fatigue that got her in the first trimester.

Impish Insomnia

With all that fatigue, it might seem counterintuitive that most pregnant women experience insomnia. After all, when you are exhausted, sleep should come easily. Unfortunately, this isn't the case during pregnancy. Insomnia is one of the most frequently reported symptoms during pregnancy but also one of the least talked about. Getting up in the night to pee does not usually result in falling back to sleep immediately, because your mind tends to take over and you find yourself lying in bed, thinking and worrying and planning. Many of my patients find this so frustrating. They are exhausted and they crave sleep, but they lie in bed and worry that they aren't sleeping. There are many ways to learn how to sleep better during pregnancy, however, and we devote a chunk of chapter 5 to specific non-medication solutions. The main thing to focus on is to recognize that most pregnant women have problems getting a good night's sleep but there are ways to overcome your insomnia.

Anne was able to nap when she was tired, but when she was about seven months pregnant, she and her partner were in the process of buying a new home. This had her worrying about house issues as well as baby ones. "I would wake up at 3:00 a.m. and not be able to go back to sleep. I'd start thinking about questions and would Google them on my iPad. I'd go from link to link to link and get caught up in a whirlwind of things I probably didn't want to read about. I also couldn't get totally comfortable in bed. I had a wishbone pregnancy pillow (among others); my husband had a sliver of the bed, and the rest of it was pillows and me. Some days, I'd wake up early in the morning and just start thinking, then I'd fall back to sleep around 5:00 or 6:00. It's a good thing I could switch my work schedule to go in later, or I don't know how I would have managed with not being able to sleep and working."

Nasty Nausea

Next up on the pregnancy symptom hit parade is nausea. Personally, I refuse to refer to this noxious ordeal as "morning sickness" because I had it during both my pregnancies, and believe me, I wish it only transpired in the morning. Unfortunately, it can come on at any time of day (or all day). The low point of my second pregnancy? When my four-year-old realized that she could count the number of times I vomited. As in, "Guess what, Daddy? Mommy threw up seven times!"

Nausea occurs most often in early pregnancy, although for an unfortunate few it lingers longer. Typically, it disappears after the first trimester, when your body starts to get used to your hormone levels zigzagging all over the place. Some women have only occasional feelings of nausea. But others get extremely nauseated, with waves of discomfort accompanied by vomiting.