What to expect when you're expecting (69 page)

Fetal heartbeat

Size of uterus, by external palpation (feeling from the outside), to see how it correlates to due date

Height of fundus (the top of the uterus)

Hands and feet for swelling, and legs for varicose veins

Questions or problems you want to discuss—have a list ready

“I’ve been terribly constipated for the past few weeks. Is this common?”

Irregularity—that bloated, gassy, clogged-up feeling—is a very regular pregnancy complaint. And there are good reasons why. For one, the high levels of progesterone circulating in your expectant system cause the smooth muscles of the large bowel to relax, making them sluggish—and allowing food to hang around longer in the digestive tract. The upside: There’s added time for nutrients to be absorbed into your bloodstream, allowing more of them to reach your baby. The downside: You end up with what amounts to a waste-product traffic jam, with nothing going anywhere anytime soon. Another reason for the clogged-up works. Your growing uterus puts pressure on the bowel, cramping its normal activity. So much for the process of elimination, at least as you once knew it.

But you don’t have to accept constipation as inevitable just because you’re pregnant. Try these measures to combat your colon congestion (and head off hemorrhoids, a common companion of constipation):

Fight back with fiber.
You—and your colon—need about 25 to 35 grams of fiber daily. No need to actually keep count. Just focus on fiber-rich selections such as fresh fruit and vegetables (raw or lightly cooked, with skin left on when possible); whole-grain cereals and bread. legumes (beans and peas); and dried fruit. Going for the green can also help get things going—look for it not only in the form of green vegetables, but in the juicy, sweet kiwi, a tiny fruit that packs a potent laxative effect. If you’ve never been a big fiber fan, add these foods to your diet gradually or you may find your digestive tract protesting loudly. (But since flatulence is a common complaint of pregnancy as well as a frequent, but usually temporary, side effect of a newly fiber-infused diet, you may find your digestive tract protesting for a while anyway.)

Really plugged up? You can try adding some wheat bran or psyllium to your diet, starting with a sprinkle and working your way up, as needed. Don’t overdo these fiber powerhouses, though; as they move speedily through your system, they can carry away important nutrients before they’ve had the chance to be absorbed.

Another Reason for Being Tired, Moody, and Constipated

Have you been tired, moody, and constipated lately? Welcome to the pregnancy club. Surging gestational hormones, of course, trigger those pesky symptoms in most pregnant women. However, a shortage of another hormone, thyroxine, can mimic these common pregnancy complaints, as well as many others—weight gain, skin problems of all kinds, muscle aches and cramps, a decrease in libido, memory loss, and swelling—especially of the hands and feet. (Another common symptom, an increased sensitivity to cold, is more clear-cut during pregnancy, since expectant moms tend to be warmer rather than chillier.) Consequently, hypothyroidism (a deficiency of the thyroid hormone due to an underactive thyroid gland) may be easy for physicians to miss in an expectant mom. Yet the condition, which affects 1 in 50 women, can have an adverse affect on pregnancy (also wreaking havoc in the postpartum period; see
page 460
), so proper diagnosis and treatment are vital.

Hyperthyroidism (when too much thyroid hormone is produced by an overactive gland) is seen less often in pregnancy, but it can also cause complications if left untreated. Symptoms of hyperthyroidism—many of which may also be hard to distinguish from pregnancy symptoms—include fatigue, insomnia, irritability, warm skin and sensitivity to heat, rapid heartbeat, and weight loss (or trouble gaining weight).

If you have ever been diagnosed with any thyroid problems in the past (even if they have since cleared up) or if you currently take medication for a thyroid condition, be sure to let your practitioner know. Because the body’s need for thyroid hormone fluctuates during pregnancy, it’s possible you may need medication again or need your dose adjusted (see
page 531
).

If you have never been diagnosed with a thyroid condition, but you’re experiencing some or all of the symptoms of hypo- or hyperthyroidism (and especially if you have a family history of thyroid disease), check with your doctor. A simple blood test can determine whether you have a thyroid problem.

Resist the refined.
While high-fiber foods can keep things moving, refined foods can clog things up. So steer clear of the refiner things in life, such as white bread (and other baked goods) and white rice.

Drown your opponent.
Constipation doesn’t stand a chance against an ample fluid intake. Most fluids—particularly water and fruit and vegetable juices—are effective in softening stool and keeping food moving along the digestive tract. Another time-honored way to get things moving: Turn to warm liquids, including that spa staple, hot water and lemon. They’ll help stimulate peristalsis, those intestinal contractions that help you go. Truly tough cases may benefit from that geriatric favorite, prune juice.

When you gotta go, go.
Holding in bowel movements regularly can weaken muscles that control them and lead to constipation. Timing can help avoid this problem. For example, have your high-fiber breakfast a little earlier than usual, so it will have a chance to kick in before you leave the house—instead of when you’re in the car stuck in traffic.

Don’t max out at mealtime.
Big meals can overtax your digestive tract, leading to more congestion. Opt for six mini meals a day over three large ones—you’ll also experience less gas and bloating.

Check your supplements and medications.
Ironically, many of the supplements that do a pregnant body good (prenatal vitamins, calcium, and iron supplements) can also contribute to constipation. Ditto every pregnant woman’s best buddy, antacids. So talk to your practitioner about possible alternatives or adjustments in dosages or, in the case of supplements, switching to a slow-release formula. Also ask your practitioner about magnesium supplements that may help fight constipation

Get some bacteria.
Probiotics (aka “good bacteria”) may stimulate the intestinal bacteria to break down food better, aiding the digestive tract in its efforts to keep things moving. Enjoy probiotics in yogurt and yogurt drinks that contain active cultures. You can also ask your practitioner to recommend a probiotic supplement—in powder form, it can be easily added to smoothies (and it has no taste of its own).

Get some exercise.
An active body encourages active bowels, so fit a brisk walk of about half an hour into your daily routine (some people find even a 10-minute walk works); supplement it with any exercise you enjoy that is safe during pregnancy (see
page 224
).

If your efforts don’t seem to be productive, consult with your practitioner. He or she may prescribe a bulk-forming stool softener for occasional use. Don’t use any laxative (including herbal remedies or castor oil) unless your practitioner specifically recommends it.

“All my pregnant friends seem to have problems with constipation. I don’t—in fact, I’ve remained very regular. Is my system working right?”

From the sound of things, your system couldn’t be working better. Chances are your digestive efficiency is attributable to your lifestyle—one you’ve been enjoying for a long while or one you’ve adopted since you learned you were expecting. Stepped-up consumption of fiber-rich foods and fluids, along with regular exercise, are bound to counteract the natural digestive slowdown of pregnancy and keep things moving smoothly. If this dietary style is new to you, the productivity of your digestive tract may decrease a little (and flatulence, which often temporarily accompanies such dietary changes, may ease up) as your system gets used to the rough stuff, but you will probably continue to be “regular.”

“I’m not at all constipated. In fact, for the last couple of weeks I’ve had loose stools—almost diarrhea. Is this normal?”

When it comes to pregnancy symptoms, normal is often what’s normal for you. And in your case, more frequent, looser stools may be just that. Every body reacts differently to pregnancy hormones—yours may be reacting
by stepping up, not slowing down, on production of bowel movements. It’s also possible that this increased bowel activity is due to a positive change in your diet and exercise habits.

You can try cutting back on bowel-stimulating foods, such as dried fruits, and adding bulking foods (such as bananas) until your stool becomes more firm. To compensate for the fluids you’re losing through loose stools, make sure you’re drinking enough.