No one knows how the body changes during pregnancy better than me, an obstetrician/gynecologist who went through it for the first time while finishing up my residency. The first and last trimesters are the most challenging. But, there are many signs and symptoms associated with pregnancy like morning sickness, frequent urination, breathlessness, swelling of face, hands, and feet, round ligament pain, and lower back pain. And, I had them all. These outwardly physical changes to your body are the most noticeable to others in the third trimester, but there are many complicated processes that your body undergoes from the very beginning, inside and out. Get ready for motherhood. It grows on you.
During pregnancy, everything grows bigger. The uterus grows massively from a tiny pear shape to the size and shape of a watermelon. Lungs expand, and the chest cavity widens. Your blood volume doubles and the heart pumps faster. In fact, every seven minutes, all of the blood circulation will pass through the uterine arteries. Babies are demanding. And, it starts in the womb. Your body needs fuel and lots and lots of water to complete the baby making process. Water is also crucial to prevent constipation and dizziness, but the increased urge to urinate even in the first trimester makes drinking water a constant balancing act.
So, let's start with the most obvious physical changes. But first, you should know that all of your bodily changes, physically, mentally, emotionally, and chemically are because of the HORMONES produced by the pregnancy. The three hormones to blame are estrogen, progesterone, and HCG.
1. Breasts Enlarge
The breasts grow, expand, droop, sweat, tingle, and leak. Growth goes on throughout all of the trimesters and is often the very first sign that a woman is pregnant, even before a missed period. Nipple sensitivity starts early on which stresses your lingerie budget. I had the hardest time finding a bra where a seam did not cross the nipple. Seams are unusual today. But I remember the bra fabric decades ago felt like burlap compared to current ones that are heavenly. Honestly, you may never fit into the same bra size again. To some women, that is a good thing. Others are miserable with chafing, worsening neck, and shoulder pain. Find and buy a good bra, one specifically designed for the growing, sensitive breasts. Nipple pads and creams may help sore or cracked nipples.
2. Belly Grows
From the moment you suspect you are pregnant, your abdomen starts sticking out and your pants will not zip or fasten. It's infuriating. It's a good sign though because it means the hormones of the early pregnancy are strong, and those are needed to make it to the second trimester when most women start 'showing' their baby bump. The worst thing about the expanding belly is the round ligament (groin) pain especially when you make a sudden movement or the baby kicks. Sometimes the pain shoots into the vagina. To avoid round ligament pain, pregnant women need to walk and move slower. One more zing from the round ligament and I was cured of my hurried gait. Nowadays, there are support garments that keep the enlarged uterus from triggering that dreaded pain.
3. Back Pain
One weird thing is that the back starts aching long before the belly protrudes, but it gets even worse in the third trimester. It's mostly lower back pain that can be relieved with a good support garment. The hormones of pregnancy can make your pelvis loose which leads to a strange feeling of missing a step. For me, it lasted for a year or so after pregnancy. In extreme cases, the muscles of the belly called the rectus abdominis separate from each other in the mid-line leading to what is called diastasis recti. It requires surgery to repair. It is best to prevent it by exercising, strengthening your lower back and belly muscles, or wearing a support garment. Gaining too much weight is a huge risk factor for developing both stretch marks and diastasis recti.
4. Stomach/Bowel Changes
From the first trimester onward, the gastrointestinal (GI) tract acts up. It starts with nausea and vomiting and ends with hemorrhoids. Although I never vomited, I wanted to. This low-grade nausea lasted until about 16 weeks, but everyone is different. The best way to deal with nausea is either with diet changes (non-greasy, non-spicy, and bland is best) or with 'sea bands' that people use for motion sickness. Make sure they are sized right. They are painful if they are too tight. Excessive vomiting can lead to dehydration, medications, or hospitalization. Some lucky moms-to-be never feel sick. My nausea made me eat more which made my weight an issue. It is crucial to eat appropriately and not gain too much weight. The recommendations vary, but more than 30 pounds is putting you at risk for pregnancy complications and physical problems later. Small, frequent meals are best to prevent wide glucose fluctuations which trigger cravings and binge eating.
And gas and constipation were the worst. Even with drinking loads of water, I still had chronic constipation. And this led to one big, fat, throbbing hemorrhoid! So if this happens to you, get on a stool softener like docusate, STAT.
5. Complexion Changes
I was among the unlucky. My complexion got worse until I reached the third trimester. The acne was everywhere, nothing like I had as a teenager. Hormones are continually rising throughout the majority of the pregnancy, and this causes oil production to increase causing acne. The best remedy is to wash your face (morning and evening) with a warm, soapy cloth, once to remove the outer layer of cells, and then a second time for a deeper cleansing. Do not rub vigorously or use hot water. Pat the area dry and apply an anti-acne cream. It can be all-natural or a benzoyl peroxide lotion. Some women notice an improved complexion which is probably due to genetics or luck. Prenatal vitamins (and HORMONES) may have a role in improved finger nail growth and hair luster.
Stretch marks occur when the collagen and elastin break down due to rapid or excess stretching of the belly. Not everyone gets them. Some stretch marks are red, and some are shiny, but a lighter shade of your skin tone. It is best to prevent stretch marks by not gaining too much weight, but genetics are important, too. There are postpartum therapies like fractional lasers that are non-ablative, meaning it does not harm the outer layers but delivers energy to stimulate elastin growth. It works best on newer and red stretch marks. Stretch marks do fade over time but rarely disappear completely. The best news about pregnancy is that it is a temporary condition and the bodily changes revert to normal over the course of a year after childbirth.
Kim Langdon M.D.
Retired and Rested OB/GYN after 19 years