During pregnancy, some things are a given – hello BELLY! – and other changes may come as a surprise. Specific anatomic and physiologic changes occur with every pregnancy, however the majority of aches and pains that may accompany these changes are NOT normal and can be addressed or prevented with a little more knowledge and a bit of guidance. The following outline highlights a small portion of the body’s transformation; but it is by no means exhaustive:
Let’s start off here with the proverbial meat n’ potatoes of the physical changes in pregnancy: changes in the MUSCULOSKELETAL SYSTEM. While all of the changes and happenings described below are part of the normal progression of the very natural process of pregnancy, they nonetheless are changes that can be smartly managed to minimize any adverse effect on mom and optimize her physical function during pregnancy AND postpartum! You’ll see some tips sprinkled throughout, but the most important take home here is to be as mindful about taking care of and living in your body during pregnancy as you are about what is going on inside with the growth of your baby(-ies)! Certainly this includes nutrition and sleep, but also includes using good body mechanics when you change positions and lift bags of groceries, and exercising in ways that will help you have the strength for caring for your new baby (and schlepping all their things!) and in ways that generally keep you as strong and functional as possible during the entire pregnancy.
HORMONAL CHANGES are truly part of the deal and there is nothing to do to change that they are occurring. However, the following few points may give you a little more context - primarily that we can’t outright blame hormonal changes for pain in the pelvic joints, but we can lean on them to explain some of the changes in digestion and bowel/bladder habits!
Growing a little person (or persons!) inside your own body is a lot of work! The CARDIOVASCULAR SYSTEM has to step up its game to - quite literally - keep pace! Apart from being aware of these changes, & assuming they remain medically clear to do so, the best thing a pregnant woman can do is to continue to engage in cardiovascular activities. Intensity, duration, and activity type may need to be modified from pre-pregnancy and to be modified further as the pregnancy progresses, but try to find something fun to keep you moving throughout! Swimming, walking, stationary equipment, etc - anything non-impact (no downhill skiing or boxing, for example!). If you are unsure of what to do, it is worth it to meet with a physical therapist or fitness professional who can help!
The growing uterus displaces the heart upward, forward and to the left. Blood volume and flow both increase, with heart rate increasing on average 10-15% (from 72bpm to 80-90bpm). Cardiac output, the amount of blood pumped by the heart with each beat, increases by 40% during pregnancy, though blood pressure decreases slightly until the final month of pregnancy. As the uterus grows, its increased size puts pressure on the veins to the lower body, creating increased pressure and decreasing the rate of venous blood flow. This has the potential to cause edema, hemorrhoids, or varicosities.
You could be convinced that that flight of stairs you climb every day just doubled in steepness and length...but NO, it’s just that the RESPIRATORY SYSTEM is also working a lot harder during pregnancy. Part of this has to do with the body’s need for more oxygen, and part is a very mechanical adjustment to the changing anatomy of a progressing pregnancy. As with other things, continuing to challenge the system through regular and appropriate exercise will make these respiratory changes easier to manage. It is also crucial to essentially undo some of these adaptations postpartum, consciously drawing your breath back into the lower ribs and lower belly and letting your diaphragm move through its normal range of motion - something a 9-month gestation uterus prevents it from doing!! (We’ll talk more about this next week...)
The rib cage is displaced upwards and expands. Shortness of breath on exertion is reported in up to 75% of pregnant women by 31 weeks gestation. Pregnant women breathe more deeply and frequently with 20% increased oxygen consumption.
Back to those hormones...the changes they cause in the GASTROINTESTINAL SYSTEM frequently result in constipation. Boo. Fortunately, we put out a piece last week with great tips on diet and fluid intake to address constipation - all tips that remain valid for pregnancy-related constipation. One key thing, however, for pregnancy-related constipation - it is more important than ever to avoid straining! The pelvic floor and pelvic organs, as well as the abdominal wall, are working harder than normal and are under near-constant stretch and stress. This means that they are more vulnerable to bearing down and straining. And what does vulnerable mean...? It means that it is more likely that the additional stresses they experience could contribute to longer-term problems like pelvic organ prolapse, urinary or bowel incontinence, and loss of muscle function in the abdominal wall.
Intestinal motility decreases secondary to increases in the hormones estrogen and progesterone – leading to increased constipation.
Everyone has heard of the “in the bathroom all the time” pregnant woman stereotype. Frequent urination can truly be a problem for many women but there is treatment available! This should not be ignored and allowed to have a detrimental affect on quality of life! See our previous post and visit Take The Floor PFD for additional information and resources. Certain pregnancy-related changes in the GENITOURINARY SYSTEM contribute to bladder changes in this timeframe.
Though largely determined by genetics, some common changes in the INTEGUMENTARY SYSTEM are minimized by keeping weight gain within your provider’s recommendations and performing resistance exercises that keep muscle tone from diminishing during pregnancy, including the abdominals! Remember, as with cardiovascular exercise, if you aren’t sure what to do, don’t do nothing! Many healthcare and fitness professionals are available and happy to help!
Striae Gravidarum (stretch marks) may affect the skin of the breasts, abdomen, buttocks, and thighs.
While pain or other issues affecting function are not altogether surprising given the extra stress your body is responsible for - pregnancy and childbirth is a monumental and monumentally-physical undertaking after all! - you do not have to dismiss it as part of the deal and passively wait until baby arrives, hoping improvement will come then! Tell your physician if you notice any pain symptoms, particularly if they are affecting your ability to do the things you need to do in daily life, and ask them to point you toward providers who can help! There are often ways to treat, and even prevent dysfunction during pregnancy including: modifying posture and body mechanics, adding specific flexibility and strengthening exercises, and occasional use of external supports (belts and binders).
In conclusion, even this lengthy post doesn’t do adequate justice to the important physical changes experienced during pregnancy, nor to the equally important ways that pregnant women and their providers can proactively engage with and manage these changes! A natural process (yes, pregnancy is!) does not inherently mean we passively let it take it’s course. The collective “we” of culture, moms, healthcare providers are learning more and expecting more of ourselves and our function all the time - as well we should! Let’s work together to keep spreading this message - a message of empowerment for moms, really - that all of us can deal honestly with the physical changes and challenges of pregnancy and childbirth AND rise together to meet these challenges with appropriate education, care and action.