“That first pregnancy is a long sea journey to a country where you don’t know the language, where land is in sight for such a long time that after a while it’s just the horizon – and then one day birds wheel over that dark shape and it’s suddenly close, and all you can do is hope like hell that you’ve had the right shots.”
Pregnancy. By the time I was pregnant with my first baby, I was ecstatic to finally be carrying a baby for longer than 8 weeks. I had longed to be in this place for what seemed like forever. What I promptly realized was that I knew a lot about babies, but I knew nothing about being pregnant. No one talked much about this phase. For some reason, I think women avoid this topic altogether. Maybe it is because we forget so quickly how hard being pregnant is, or maybe it is because we don’t want to admit that it isn’t entirely easy.
As thrilled as I was to be pregnant, I also found it very challenging. Now in my second pregnancy, I am quickly remembering the parts that were particularly difficult, and reminding myself so I am not surprised when these issues come up. I want to share what I struggled with for all my female friends, and for all the men who have no idea what we deal with. I am hoping to broaden basic understanding so we all have a little more empathy and compassion for the pregnant women in our lives.
1. Pregnancy forces you to take care of yourself. This is a very hard thing to swallow for those of us who have been conditioned to ignore our needs. Particularly in the first trimester, pregnancy is very tiring, and to my surprise, it elicited an exhaustion that I had never experienced nor expected. In medicine, we learn to beat ourselves and our bodies into submission throughout our career. Eighty-hour work week in residency? Learn to function on less sleep. Busy day in the ER? Don’t eat (save time), and don’t drink very much so you don’t have to go to the bathroom (also save time).
It sounds kind of crazy, but it is exactly how we physicians think. I did not expect pregnancy to be different–meaning I fully anticipated powering through any problems. But it didn’t work that way.
When I got pregnant, for the first time in my life, I could not force myself to do anything. My body needed rest so badly that it did not allow me to press my ‘over-ride’ button, as I had so frequently done in training. It was incredibly frustrating, but also really eye-opening. I actually needed to rest when I was tired. I could no longer wake up at noon after an overnight shift and expect to function. I also needed to eat when I was hungry, if I didn’t I would feel so ill that I couldn’t function at work. My previous tactic of not eating during a busy shift became impossible. The hard and profound lesson I learned was that I had become accustomed to ignoring my body and it’s needs, and that I had abused myself in this way since medical school.
This experience has totally shifted my perspective on how we function and cope as physicians as well as our expectations of our trainees. At this point, I really do not want my students, residents, and fellows to develop my habits or my complete obliviousness to this as a problem. I am embarrassed that it took me getting pregnant to be more aware of my own needs, and subsequently the needs of my team.
In addition, being pregnant as an attending physician was hard enough, but I work and have worked with dozens of women that were pregnant in training, ie residency or fellowship. I am not sure how any of them have done it, with the insane work hours and all the needs of the pregnant body. I have developed so much empathy and respect for my female colleagues as they experience pregnancy. We should all be working toward better conditions for them, as well as giving them a break whenever possible.
2. Pregnancy is really hard, and during this time it is common to develop self-doubt and self-judgement. You are actually growing a tiny human! The thought of this alone is insane. The inability to seemingly do everyday tasks due to exhaustion often creates feelings of inadequacy and self-judgement, with statements like, “what is wrong with me?” I know that I felt as though I wasn’t doing my job as a mom when I was too tired to cook dinner, or when I needed to go to bed really early, letting daily household tasks go undone. In addition, our mood fluctuations can be daunting and overwhelming.
Being unable to fully control or understand our emotional responses creates a feeling of “why do I feel so crazy?” Which can also create more self-judgement as we feel as though no one else is experiencing pregnancy in this way. I cried probably every other day during my first trimester, sometimes it was because my toddler didn’t hug me in the morning, or because my husband forgot to make me coffee. All very insignificant things, that elicited what I felt to be a overreaction in me. In order to help one another through these challenges, I think it is important to share as many stories as possible. If you are talking to a pregnant woman, let her know what you struggled with during this time. The last thing we need to hear is how painless everyone else’s pregnancy has been. What we do need is to be empathized with.
3. Body image issues are alive and real. For me, I had pretty much maintained the same weight during my adult life. I had also worked hard to eat right and exercise frequently. Then came pregnancy. This is a special time, when you are supposed to gain weight, which is good and healthy. Unfortunately, due to long-standing messages about weight gain, this process didn’t feel good and healthy, it felt wrong and inappropriate.
Being pregnant and gaining weight that first time was totally destabilizing to everything I thought about weight and health. Seriously. I know my body and every inch of me. I know exactly how tight my jeans are, and when I need to cut out the chocolate and replace it with an extra hour at the gym. In pregnancy, we are supposed to get big and gain weight and it all happens in a very short period of time.
During my first pregnancy, I realized how obsessed our society is with weight. I also realized there was quite a bit of self-judgment on this topic as well. I scrutinized the amount I gained, compared myself to others, and hoped that I would be able to get ‘my body back.’ I think there is too much unnecessary pressure around weight and pregnancy, and a lot of the pressure is self-induced based on our upbringing in a image-obsessed society. It is important for women to take a deep breath, stop looking at the scale, and realize your body is doing an amazing thing. When I struggle, I remember what my husband tells me, which is ‘Pregnancy is beautiful and feminine. You should not worry about your weight.’ Love that guy.
4. Pregnancy elicits a lot of fear. So much fear. Fear of miscarriage, fear of genetic abnormalities, fear of going into labor early, fear of still-birth, postpartum depression and SIDS. The funny thing is, fearing the inevitable or the uncontrollable, is a waste of time. So instead of sitting in fear, I choose to bask in love for my baby and hope that none of the unfortunate happens.
I also had a deep fear of our quality of life going down. I really love to sleep, and I really like my down time. Someone told me I wouldn’t sleep for weeks after delivery. That was a scary thought. People also were not very encouraging with statements like, “so sorry for you, life is going to change…” Especially when the ones making these comments were people with children! I was afraid that maybe we were making a huge mistake. Maybe we were just supposed to be the really cool aunt and uncle. Not like we could have changed the trajectory, but I was terrified. Then I had a friend who told me, ‘people are going to tell you all this stuff to make you so nervous and afraid, but in reality, it’s the best thing ever.’ Lucky for us, having our son was the best thing ever. Instead of instilling dread in expectant mothers, I have chosen to be encouraging and share my excitement. Isn’t that what we all wanted when we were pregnant?
The thing is in the end, all the fear, moodiness, changes, body issues become inconsequential once the baby is born. Maybe that is why we don’t talk about it as much. My body changed back, but I also became less concerned about whether my jeans were too tight. The emotions stabilized, and the fears slowly subsided. I became better about taking care of myself, and then better at taking care of others as well. I developed a new-found compassion and empathy for other women, other pregnant women, and all of their struggles.
Judgment is unavoidable in society these days. But you can choose to internalize that judgment or not. I remember hearing someone say once, ‘someone else’s judgment is none of your business.’ Which is true, right? Think of a situation where you have judged someone else silently. Aren’t our judgements of others really just fears about ourselves that we project? So stop worrying what others are thinking. It’s actually none of your business because it is really about them, and when push came to shove, they would never want you to know anyway.
Anything else? Is there anything I missed that you think I should have included in my advice?