I’VE NEVER GIVEN BIRTH – BUT I’VE DONE MY SHARE OF ‘PARENTING’
In communities like the one I grew up in, nannies are a rarity, but a ‘village’ of neighbors and relatives can be counted on to pitch in with child care.
At 27, I’ve never given birth and I’ve never been pregnant. But I like to joke that I have “children.” I didn’t intend to spend my preteen and teenage years helping to raise several of my neighbors’ children. But somehow, children always found me.
My first baby was J, whose mother moved into the apartment next to ours when I was in elementary school in Ridgewood, Queens. I helped her clean her apartment some Saturdays, and she’d help me bake brownies. We watched ’90s telenovelas together – it was J’s mother, and not my own, who explained the plotline of “La Usurpadora” to me.
When I was 11 she told my family that she was pregnant. My mom explained that the situation behind our neighbor’s pregnancy was complicated, and that she would need our support. So I looked at sonograms, helped her carry heavy bags, and painted the baby’s room. My siblings and I pitched in to organize and set up the baby shower. And right after J was born, I slept on my neighbor’s couch, getting up at 2 a.m. to help fix his bottle and feed him. I almost fell asleep at school that first week, but I liked helping out. J was tiny and warm and he smelled like milk, and I loved sitting in my neighbor’s living room, rocking him to sleep. I used to wonder what kind of job he’d want in the future, if he’d look like his mom, or if he’d be tall.
My neighbor fainted when she went into labor and broke her leg, so she was put on bed rest to help her recover. During this period, she struggled with severe mood swings. I didn’t know what postpartum depression was at the time; all I knew was that after someone had a baby, they became sad and tired and would sometimes wear the same house dress for over a week.
I couldn’t comfort my neighbor like her relatives or my mom could, and I certainly couldn’t understand why having a baby seemed to have made her so stressed out and unhappy. But I could help her care for her son. I was excited to finally meet J. I talked to him while I changed his diapers, I marveled at how tiny his toes were, and I practically cried when he started trying to gurgle responses to my questions.
I was there when J started learning how to walk and talk, and I was there when he started drawing recognizable pictures of things like airplanes and cars. I pushed J in his stroller while I followed his mom around grocery shopping, at doctors’ appointments, and on beach trips. My house name, Anga, was one of the first names J learned to pronounce. When he learned to read, J and I would help each other pick picture books. J liked anything to do with airplanes and animals so I always made sure to help him find those in the piles of books his mom had in her bedroom closet. I’d walk him to activities when his mom couldn’t and, as my parents often babysat J too, he was around pretty often.
But his early grade-school years were hard. J had trouble behaving, and I often had to mediate between him and his mother. I was still just a high schooler myself, but J and his mom had always felt like family. I wanted to do anything I could to make sure they would be O.K., even though I was really frustrated with his behavior, too.
“I don’t want to do laundry,” I remember him yelling at his mom. “I’m not going to the laundromat.”
I handed him his sneakers and walked with him to the laundromat. He complained and cried the whole time but I just kept handing him clothing to sort. Some days he’d refuse to get ready for school, or to leave the front steps of our building. My parents and I would help get J to school, convince him to do some chores, and talk to him about listening to his mom.
When I was in college, I’d drop J off at summer camp before heading to my summer class or summer job. On days when I was too busy to drop J off, a family friend whose daughters attended the same camp would take him. But his mom would tell me that he’d cry whenever I wasn’t there.
“The other girls are nice too, walking with them isn’t so bad,” I told him.
“Yeah, but I want to walk with you, not them,” he said.
J eventually started getting help for some of his behavioral issues, which made hanging out with him and his mom easier. As he transitioned into middle school, I didn’t have to watch him as often, but we’d go for walks sometimes and we’d hang out on my old block and talk about comic books and fan fiction.
I think of J as my “first baby,” but he wasn’t the only one. After I started high school, my nephews were born, and I graduated from one kid to a set of three. Whenever I felt overwhelmed, I’d remember what I did with J and it helped me through my auntie shifts with diaper explosions, middle-of-the-night bottles of milk, and the terrible twos. I’d take my nephews to the park, help watch them when my brother and sister-in-law ran errands, and I’d get them to finally go to sleep by telling bedtime story after bedtime story.
As I started meeting more people outside my community, I learned that affluent people didn’t always rely on neighbors and relatives and would hire nannies or babysitters. Most people from working-class communities don’t have nannies. But they have people like me.
Around that time, I learned that my mom had also helped care for her nieces and nephews, and the children of close friends, before having her own kids. My dad, who grew up as the middle child of 13 on a mountainside in Puerto Rico, practically raised his last two siblings. His older sister was taken out of school to help raise him. My maternal grandmother helped raise a lot of my mom’s younger cousins. She also helped raise me, and I helped take care of her for a while after she had a stroke when I was in high school. I’ve just carried on the tradition of “adopting” kids and and keeping them safe.
When I finally moved out of my parents’ home, I made sure to find an apartment in the same neighborhood so that I could still visit my nephews and still stop by to visit J and his mom. My nephews are in middle school now and tell me about their crushes and the teachers they like. They come over to my apartment and we sing Bad Bunny lyrics, make snacks, or go hang out on their front steps.
J is a teen now. He’s taller than me, really tan, and has a headful of beautiful curly hair. He likes video games and anime T-shirts.
“Were you my main babysitter?” he asked me a few months ago. “I remember seeing you around all the time.”
We were both sitting on my bed hanging out and catching up.
“I was always there,” I reminded him. I had missed seeing him around thanks to my crazy schedule when I was freelancing and working two jobs.
J watched the Fourth of July fireworks from our rooftop with me and my family this year. We talked about anime series that we both liked, and he told me about school and asked me about freelancing. We compared classic series and he nagged me about not finishing season three of “Attack on Titan.” We walked around after the fireworks and looked at stupid memes on his phone. It felt like hanging around a much younger brother again.
“How’s high school?” I asked him.
He rolled his eyes and then laughed.
“It’s not so bad actually.”
“At least it doesn’t suck as much as middle school,” I told him.
He asked to hang out again, and I told him I’d shoot him a text and that we’d go get lunch soon. We’ve messaged a few times, and if I go for too long without hearing from him, I reach out again or stop by to visit J and his mom. I’m proud that J is growing up and learning how to be comfortable with himself. And I like to think that hearing him out and doing my best to be patient helped him grow up to be the teenager he is today.
I’m still part of J’s village. And he’s part of mine.
Though your body might be ready to return to sex after a
miscarriage, are you?
How soon can you have sex after experiencing a pregnancy loss?
It’s a common question among women of childbearing age, considering that up to
20 percent of pregnancies result in miscarriage and approximately 1 in 100 in stillbirth. There’s not a standard — or
straightforward — answer. Generally, physicians counsel patients to wait until
they feel ready. But readiness for a woman and her partner can depend on a
number of physical, and emotional, factors.
“From a medical
and practical perspective, the primary thing is to ensure that the pregnancy
has passed completely, the cervix has closed, and that there isn’t an increased
risk of causing infection in the uterus,” explained Zev Williams, M.D., Ph.D.,
chief of the division of reproductive endocrinology and infertility and an
associate professor of obstetrics and gynecology at Columbia University Irving
Medical Center. “The timing for this depends on how far along the pregnancy was
at the time of the loss and how quickly the woman’s body recovers.”
romantic readiness is another question altogether.
roadblocks are a big factor: Women may feel reluctant to engage in sexual
intimacy while still grieving their loss. Miscarriage can also change a woman’s
relationship with her body, and what sex represents to a couple might shift. If
this seems hard to understand, it is: I am a psychologist specializing in women’s
reproductive and maternal mental health, and I didn’t fully comprehend how
complex returning to sex could be until I experienced a second trimester miscarriage
firsthand. Then I understood all too well: There’s no one-size-fits-all answer.
“There are no
guidelines with regard to telling patients what to expect about returning to
sex after miscarriage. Routinely, we don’t discuss sex after loss unless patients
bring it up,” said Jessica Schneider, M.D., an ob-gyn at Cedars Sinai Medical
Center in Los Angeles. “There’s research about how safe it is to get pregnant
again after a loss, but not about sexual function or satisfaction.” And the
fact is, sexual function and satisfaction can, and do, change.
I talked to
several women about their experiences around sex after pregnancy loss to find
out how they approached returning to intimacy. (The women preferred their last
names not be used due to privacy concerns.)
Some women, like
Ash, 36, felt ready to have sex right away. After experiencing a stillbirth,
she turned to sex for healing. “It was a way to feel powerful in my body,” she
said. “I felt like my body had failed me, and sex was a way to get that back.”
There was one caveat though: She didn’t want to risk another pregnancy. “It
felt better to engage in sexual acts that couldn’t result in one.”
Trying to get
pregnant again is a sensitive topic medically and emotionally. The World Health
Organization’s official stance is to wait six months before attempting another
pregnancy. Recent research, however, suggests that having
sex sooner doesn’t have a negative effect on future pregnancies and could actually help success rates.
“The doctor told
us to wait until we were comfortable,” said Maria, 26, who has had four
miscarriages. “It was nerve-wracking to return to sex. I think because I was
terrified of getting pregnant again and losing it or not getting pregnant
again. It was challenging mentally.”
self-blame can enter the bedroom after pregnancy loss and create trouble where
there previously was none. Hanan, 27, thought she was ready to have sex again
immediately after a stillbirth, though her doctor told her to wait six weeks.
She said she felt arousal and the desire to have sex, and engaged with her
husband in everything other than penetrative sex, while waiting for medical
clearance. But the first time they had intercourse, she wasn’t prepared for her
emotional reaction. “I cried so much after the first time. I felt very guilty,”
she said. “My body wanted to, but my brain didn’t. It felt selfish and immoral
— like I should have been celibate while grieving.”
are especially challenging for women who are actively trying to conceive again.
“I did not want to initiate sex after my loss, but at the same time, I did want
to get pregnant again,” said Maggie, 32. “My vagina became a constant reminder
of the loss.”
Some women said
they resented their bodies for a perceived failure. “After my miscarriage, I
couldn’t be with anyone for over a year,” Zachi, 27, told me. “The fact that my
body failed impacted the way I felt sexually afterward. I carried the baby
emotionally, long after physically.”
While a 2015
survey found that 47 percent of respondents who had experienced a miscarriage reported feeling guilty about it — and
nearly three-quarters thought their actions may have caused it — the reality is
that chromosomal abnormalities are the explanation in about 60 percent of
miscarriages. Pregnancy loss cannot be prevented.
If you’ve been
trying to conceive for a long time, sex following a pregnancy loss can become
especially fraught — even unappealing.
“After my first
miscarriage, we only had sex to conceive. It started to feel like a task,” said
Gina, 30, who has experienced infant loss and two miscarriages. “That mentality
compounded after my second miscarriage and killed all sexual desire for me.”
Sonali, 33, who
has lost four pregnancies, had difficulty returning to the very place she got
pregnant. “Sex with your other half in the bed where you conceived the babies
you lost is so triggering,” she said.
thinking about where I’d be in my pregnancy now; how I wouldn’t be able to have
sex in this position,” Maria said. “It makes me feel guilty to feel great, when
I should be seven months pregnant and uncomfortable.”
can have unintended positive impacts on a woman’s sexuality, too. Zachi said
that she is more assertive in her sex life because of her miscarriage. “I have
to listen to my body now,” she said. “It becomes painful not to. I am a lot
more sure in what I want.” A miscarriage ultimately brought Maggie and her
husband closer together, she said. “During the loss, I felt like I was on an
island,” she remembered. “The first time my husband and I had penetrative sex,
I cried from relief, because I felt so re-connected to him.”
enjoying sex again is really about one thing — personal readiness — which is
what I tell my patients. It’s O.K. to feel grief and sexual desire
simultaneously. “Moving on” is not a prerequisite for pleasure.
I had a miscarriage in between my two girls. I went in for an
ultrasound at around seven weeks, and there was no heartbeat. My period is so
irregular that I had to wait two additional weeks to confirm that the pregnancy
was not progressing properly. My obstetrician couldn’t definitively date the
pregnancy because he couldn’t definitively date the ovulation, so I trudged to
multiple radiologists for multiple disappointing ultrasounds over 14 days.
I expected to feel sad during this painful two-week wait, and
after — and I absolutely did. A guttural sadness that would take months to
What I didn’t anticipate was that I would feel a lot of other
things, and that the emotional ground would continue to shift under my feet. I
felt relief when I was able to take a new job right around when I would have
been due to give birth; I knew I wouldn’t have been able to take it had I
carried that pregnancy to term. Then I felt guilty about feeling relieved. I
felt anger — spiky and random, popping up unexpectedly and without apparent
trigger. And most appalling to me was the envy I felt toward women who were
pregnant, successfully. An acquaintance of mine was due around when I would
have been, and I could not stand to be around her during her pregnancy. When
she tried to make plans, I made excuses.
a myriad of responses to loss, said Julia Bueno, a psychotherapist and the
author of “The Brink of Being: Talking About Miscarriage.” “There may
well not be any grief,” Bueno said, and the grief some women feel is
“exquisitely nuanced, powerful and profound.” If the miscarriage is in the
first trimester, it may also be hidden, Bueno said, because you don’t always
look pregnant to the outside world, and it’s not customary to reveal a
pregnancy until you’re past 12 weeks.
of pregnant women may also feel a range of emotions. As technology allows us to
know we’re pregnant just after a missed period, it allows partners to become
bonded to babies far earlier than they might have been in previous generations.
There’s a case study in Bueno’s book about a woman who miscarried twice, whose
husband was grieving deeply. “He bought the pregnancy test. He saw that test
emerge — he was drawn into it,” Bueno said. He was already forging a
relationship with the baby that he had to mourn, too.
five years after my loss, I don’t think about the miscarriage much anymore. I
was lucky to have a second child, which is what I desperately wanted, and that
helped me. But lots of families still feel complicated grief even after having
additional children. Bueno lost twin girls, Florence and Matilda, at 22 weeks,
and she had three miscarriages as well. She went on to have two boys, and for
her, “the nourishment and joy runs alongside the grief.” Bueno told me about an
oral history she had read from a woman with nine children. That woman had a
miscarriage, too, and though she was in her 80s at the time of the oral
history, she still felt the loss acutely despite her sizable brood.
you know someone who has experienced a loss, Bueno said, “err on the side of
compassionate curiosity.” This could mean saying you’re sorry for a loss, and
then asking something open-ended, like, “Tell me what it meant to you,” as it
allows for the many kinds of emotion someone might feel. Be prepared for any
response — a woman may not want to talk about it at all, or she may want to
talk about the gory viscera. I recall making extremely dark jokes about what
came out of me in the aftermath. Those physical side effects, “that stuff needs
to be talked about,” Bueno said. Otherwise we run the risk of women feeling
“icky and shameful and abnormal” about what they’ve experienced.
need to make cultural space for every single kind of reaction to loss — there
will always be a gamut of responses. And sharing these stories is a good place
The vast majority of parents are less satisfied with their marriages after they have kids than they were before.
Mothers in heterosexual relationships report the lowest levels of marital satisfaction, mostly because they tend to take on more “second shift” work — housework and child care — than their partners do.
Listing and dividing household tasks (including child care) make both partners feel a greater sense of fairness, though those tasks do not have to be divided 50/50.
Maintaining a sexual connection is also important — and reestablishing that connection takes time postpartum.
The lowest point of my marriage was probably when I was excessively pregnant with our second daughter. It was 90 degrees outside every day, and I had blown past my due date with no signs of labor. I had trouble falling asleep but had finally drifted off one night when my husband came home from a work event and woke me up. I had a brief and fleeting desire to bludgeon him with a bedside lamp.
I’m not alone: The majorityof studies on marital satisfaction suggest that couples are less happy after they become parents, though the degree and length of unhappiness is more of an open question. Deeply unpleasant thoughts about your spouse will probably flit through your mind at some point during your child’s first year, mostly because of the extreme exhaustion infants create in their parents (there’s a reason extreme sleep deprivation is considered torture).
I spoke to three experts — including a New York Times-bestselling author, a sociologist and a relationship-focused psychotherapist — about how to keep relations as positive as possible during your transition to parenthood. All the experts I spoke with said that taking a transparent, proactive approach to dividing household work — including child care — was the number one way to keep the rage-beast of new parenthood at bay.
WHAT TO DO
Don’t be surprised if you’re not happy.
Though it’s normal for satisfaction to
decline in any relationship over time, research performed within the past decade suggests
that new mothers may be most vulnerable to that dip. Sociologists theorize
that, in heterosexual relationships, mothers are more unhappy with their
marriages after they have children because they tend to take on more “second
shift” work — child care and housework — and begin to feel that their
relationships are no longer fair. Surveys have shown that
whether they work or not, mothers are doing more child care
than fathers are.
Take the same amount of parental leave as your partner (if you can).
If at all possible, make sure both partners are taking identical amounts of leave. Jennifer Senior, an Op-Ed columnist at The New York Times and author of the bestselling “All Joy and No Fun: The Paradox of Modern Parenthood,” said that imbalance in leave-taking can set the stage for an imbalance of caretaking that can last for years. The parent who takes less leave has less experience soothing the baby. So the parent who takes more leave — almost always the biological mother — becomes the default “baby whisperer,” because she has more experience. It’s hard to get out of that pattern once you’re in it. In countries where parents tend to take equal amounts of leave, like in Canada or Sweden, marital satisfaction rates are higher. The unfairness extends even to sleep: Past research has found that working mothers in America are significantly more likely to get up during the night with a sick or wakeful child than working fathers are — and sleep is more equal in countries with more egalitarian policies in place.
Manage your expectations.
“Take the image of the ideal parent and throw it in the garbage,” said Dr. Leah Ruppanner, Ph.D., a sociologist at the University of Melbourne who specializes in family and gender. She gives this advice especially to mothers, because there are much more aggressive cultural expectations about what a good mother is supposed to be. According to the Pew Research Center, the majority of Americans still believe that women do a better job caring for new babies than men do (only 1 percent of Americans think men do a better job), and almost 80 percent believe women face a lot of pressure to be an involved parent.
Make a list of tasks, and divide them fairly.
Senior suggested that parents should list all of their household tasks, including child care, and divide them in a way that seems fair — not equitable. For example: If one partner works 15 hours more a week than the other partner, then they will probably be doing fewer hours of house- and child-related work. But all the experts we spoke with agreed that ad hoc arrangements led to the most strife (and, in hetero couples, usually leave the mom feeling shafted). Merely making the list provides a way for parents to work through all of the potential pain points.
Get granular with your list.
The writer Alix Kates Shulman created a “Marriage Agreement” with her husband when she had children, so that household responsibilities would be distributed fairly. She wrote about it in 1970, and her list gets very specific: “Transportation: Getting children to and from lessons, doctors, dentists, friends’ houses, park, parties, movies, library, etc. Making appointments. Parts occurring between 3:00 and 6:30 p.m. fall to wife. Husband does all weekend transportation and pickups after 6.” Senior said you should get as granular as possible when you’re listing and dividing chores — the more specific you get, the less resentment will fester.
Don’t be a maternal gatekeeper.
Some mothers believe themselves to be the superior parent, and engage in what sociologists refer to as “maternal gatekeeping” — they mediate their spouses’ interactions with their children. Practically speaking it often means nitpicking: “Why are you swaddling Ruby that way?”; “Jasper doesn’t like his bottle so cold.” If mothers want child care to be divided fairly, they have to let fathers do things their own way, even if it’s not your way (if the child is truly in danger, that’s another story — you should always intervene in that case). “You’re letting them learn how to respond to the kids,” Ruppanner said. “They learn how to do it. It’s not astrophysics.”
Ruppanner suggested that if a parent is really struggling not to meddle, they should physically leave the house when their spouse is on duty — go for a run, take a nap, give yourself some personal time.
Redefine your sex life.
Having a child is a “complete reorganization of the structure of your life,” said Esther Perel, M.A., L.M.F.T., a psychotherapist and author of the book “Mating inCaptivity: Unlocking Erotic Intelligence” — and that includes your sex life. Many biological parents are given the go-ahead to have sex six weeks postpartum, but that’s because “at six weeks you can be penetrated without tearing,” Perel said — and that doesn’t mean you’re ready for it physically or psychologically. Perel added that it could take as long as a year before you’re ready to have penetrative sex — so don’t be discouraged if you’re feeling uneasy at six weeks. It takes time to re-establish the rhythm and get used to a changed body and a restructured life.
Parents who gave birth need time to recover, and nursing parents may experience vaginal dryness because of lowered estrogen levels. About 90 percent of mothers resume sex within six months of birth, though 83 percent are experiencing sexual issues three months postpartum, and 64 percent are still experiencing issues at six months. Perel encouraged parents to “broaden their erotic interests” outside of penetrative sex and experiment with new erogenous zones. Continuing to connect sexually is important for keeping those hostile feelings at bay, for both parents. “On the long list of what your kids need, making sure the couple remains intimately connected remains very high,” Perel said. “There’s nothing holding a family together except the contentment of the couple.”
Jennifer Senior, author of “All Joy and No Fun: The Paradox of Modern Parenthood,” July 24, 2018
Dr. Leah Ruppanner, Ph.D., associate professor and co-director of The Policy Labat the University of Melbourne, July 25, 2018
Esther Perel, M.A., L.M.F.T., author of “Mating inCaptivity: Unlocking Erotic Intelligence” Aug. 3, 2018
A lot of parenting
questions boil down to: Is this a thing, or is something wrong? We’re doing an
occasional series explaining why certain things seem to happen to your kid (or
to your body or to your relationships) as your child grows. This week, we’re talking
about prenatal and postpartum night sweats.
For this week’s edition, I put
out a call on Twitter for questions about your
weird prenatal and postpartum symptoms — and, wow, did you all deliver. In a beautiful and bizarre
outpouring, you told us about painful carpal tunnel, constipation, thyroid
malfunctions, excess drool, itchy nipples, strange divots in your thighs and
shins that won’t go away, cured aversions to cilantro … the list goes on,
because the human body is a magical, horrible wonderland. I tallied the responses, and by my extremely unscientific calculations,
night sweats seemed to be the most common unexplained symptom from our
respondents (e.g., “I
had to sleep on a beach towel because of all the sweat and the milk leaking”). So that’s what I’m
delving into today.
Q: Are pregnant and postpartum
night sweats really a thing?
A: Waking up with a soaking nightgown during or
after pregnancy is common. In a study of about 430 women published in 2013, for instance, researchers
found that35 percent reported nocturnal hot flashes while they were pregnant, and 29 percent reported them postpartum.
In pregnant women, night sweats peaked during week 30, while in postpartum
women, they peaked during the second week after birth.
Why it’s happening is a little more complicated,
so we asked four ob-gyns and a researcher who has studied night sweats about
what might be going on in your body, and what you can do about it.
Why are pregnant women so damn
The short answer is, we don’t know for sure,
because there’s a lack of systematic research on the topic (more on that in a
bit). But it probably has to do with their ever-shifting hormones.
During pregnancy, there’s a huge rise in the
levels of progesterone and estrogen. Once you give birth, the levels of those
hormones fall off a cliff.
Rebecca Thurston, Ph.D., a professor of psychiatry and director of the
women’s biobehavioral health program at the University of Pittsburgh who
studies night sweats and hot flashes, said that nocturnal hot flashes in
pregnancy seem to mirror hot flashes in menopause, and that those hormonal fluctuations might
play a role. (Several of the experts I
spoke with said that prenatal and postpartum night sweats were a rehearsal for
menopause … yay?)
Do all pregnant women get hot flashes?
No. While every person who has given birth
experiences these hormonal fluctuations, not all of them get night sweats, and
we still don’t fully understand the underlying physiology as to why this might
be, said Dr. Thurston. More than just hormones are
probably causing the hot flashes, and they don’t just happen at night.
The hormonal shifts are part of a complex set of
changes that happen during pregnancy, said Dr. Jen Gunter, M.D., an ob-gyn, frequent New York Times contributor and author of “The
Vagina Bible.” (Dr. Gunter said she remembered sweating so much at night when
she was pregnant with triplets that she’d think, “my bed is a swimming pool.”)
“There’s an increase in body temperature, and there’s changes in the blood
vessels — they dilate more and increase blood flow to the skin,” said Dr.
Gunter. So some women may find that they’re more sweaty in general, not just at
According to what little research has been done,
African-American women and women with depressive symptoms are more likely to
report night sweats during pregnancy and the postpartum period. Women with high
pre-pregnancy B.M.I.s were also more likely to have night sweats during
pregnancy but not necessarily postpartum.
First, report your night sweats to your doctor
or midwife, said Dr. Dara Matseoane-Peterssen, M.D., chief of general
obstetrics and gynecology at New York-Presbyterian Allen Hospital. If you’re
experiencing other symptoms along with night sweats, such as a fever or a
racing pulse, that may be a sign of a more serious problem, such as an
infection or a thyroid issue.
If your sweats aren’t a sign of something more
serious, exercising can be an effective
first line of attack — whether you’re pregnant or not. Dr. Julie Chor, M.D., an assistant
professor of obstetrics and gynecology at the University of Chicago, said there’s some evidence
that women who exercise are less likely to experience nighttime hot flashes
than women who don’t. While experts aren’t sure why this may be, exercising during and after your pregnancy is beneficial to your health in general, so you might as well try it
(as long as you’re following safe exercising guidelines).
Focusing on creating an optimal sleep
environment can help you avoid creating a veritable saltwater marsh in your
bed, too. If your household and energy bill can tolerate it, set your bedroom’s
temperature to around 65 degrees at night, said Dr. Thurston. Dr. Colleen
Denny, M.D., assistant clinical professor in the department of obstetrics and
gynecology at N.Y.U. School of Medicine, also suggested keeping cool water and a cold compress by your bed, and
dressing in layers so you can take them off as the night, and your sweating,
As a fellow night sweater during pregnancy, my
personal suggestion is to keep a second set of night clothes by your bedside so
that you can make a quick change out of your wet pajamas in the middle of the
night without groping around in the dark.
Why don’t we know more about night
“There are major gaps in knowledge about women’s health and women’s bodies,” said Dr. Thurston. Women
overall have been less likely to be represented in clinical trials, because researchers have
historically been men. And pregnant women in particular are “severely underrepresented,” in part because of fear of
harm to their fetuses. Many of the experts I spoke with mentioned that we’re
just starting to care about the health of the mother, and not just the health
of the fetus, as vital to the overall health of the pregnancy.
But there is also a lack of study on the
day-to-day experiences of women, said Dr. Gunter. Something like night sweats
could just be a “nuisance” symptom — which is to say, uncomfortable but
ultimately not harmful. But these sorts of symptoms could also be associated
with better or worse pregnancy outcomes, and “we don’t know because they
haven’t been studied,” Dr. Gunter said. In preparation for our interview, Dr.
Gunter scanned her copy of the latest edition of a 1,400-page medical text
book, and there were just two lines about sweating, referred to as “increased
cutaneous blood flow” — she couldn’t even find the word “sweating” in the index.
Dr. Thurston emphasized the importance of
reporting these kinds of symptoms to your midwives or doctors, not just to rule
out serious problems, but also to add to the body of knowledge that exists on
women’s health. “The more we know about these symptoms in the medical
community, the more we can generate research around them,” she said.
Exercising during pregnancy is generally
safe and can reduce the risk for several conditions including excessive weight
gain, gestational diabetes and preeclampsia.
Always consult with your doctor before
starting any exercise routine, since certain conditions can make it more
Doctors recommend about 30 minutes of
exercise a day — or 150 minutes a week — but no more than 45 minutes per day,
which can increase your risk of overheating and dehydration.
Aerobic exercise, including jogging, is safe
during pregnancy, but you should be able to carry on a conversation while
active. Start slowly if you rarely exercised before pregnancy or are obese.
Avoid inherently risky activities, such as
scuba or sky diving, contact sports, horseback riding, gymnastics or downhill
skiing. Hot yoga and hot pilates are also unadvisable since they can increase
body temperature too much and endanger the fetus.
If you notice warning signs of early labor
or pregnancy complications, such as vaginal bleeding, breathing problems, or
painful contractions, stop and contact your doctor.
Both times I’ve been pregnant, I’ve felt conflicted about
exercise. On the one hand, I was often tired and nauseous; napping felt way
more appealing than sweating. On the other hand, I wanted to do what was best
for my baby and ward off extra pregnancy pounds. So I began hunting for the
perfect prenatal workout. I tried what felt like everything — elliptical
machines, yoga, power walking and even weightlifting, which elicited a number
of concerned comments from gym-goers to “take it easy.”
According to Dr. Margie Davenport, Ph.D., director of the
Program for Pregnancy and Postpartum Health at the University of Alberta in
Canada, the belief that it’s dangerous to exercise during pregnancy is common —
but it’s wrong. “We recommend beginning exercise or continuing to exercise as
soon as you become pregnant,” she said. In most uncomplicated pregnancies,
exercise is safe and tied to a reduced risk for many complications including
excessive weight gain, gestational diabetes, preeclampsia, back pain and depression. For
anyone worried about the safety of exercise during pregnancy, like those judgey
gym-goers, Dr. Davenport and her colleagues recently published a systematic review in the British Journal
of Sports Medicine, which analyzed 46 studies, and concluded that prenatal
exercise does not increase the risk of miscarriage or death of the fetus.
The research I consulted, along with the obstetrician and
maternal-fetal medicine specialist I talked with for this guide, agreed with
Dr. Davenport: In most circumstances, exercise is good for both mom and baby,
although there are important things to keep in mind.
WHAT TO DO
the differences between safe and unsafe exercise
Most of the time, exercising during
pregnancy is safe, but nevertheless “it’s really important that women speak
with their health care provider to see if they have any contraindications, or
medical reasons that they shouldn’t,” Dr. Davenport said.
According to the American College of
Obstetricians and Gynecologists, women with certain health conditions —
including certain heart or lung diseases, cervical issues, pregnancy with
multiples, persistent bleeding during the second or third trimester, preeclampsia
or anemia — shouldn’t exercise while pregnant at all.
ACOG’s guidelines also
note that if you have certain conditions or habits, such as heavy smoking, high
blood pressure, overactive thyroid or are morbidly obese or underweight,
consult with your doctor before exercising, because the benefits of exercise
may not outweigh the potential risks.
how exercise can help you
Exercising during pregnancy isn’t just about
keeping off extra pounds (although it also does that). According to a recent review published in the British Journal
of Sports Medicine, pregnant women who exercised in various ways had about a 40
percent reduced risk for gestational diabetes, gestational hypertension and
preeclampsia. Studies also suggest that women who exercise during pregnancy
are less likely to
become depressed and develop less severe low back and pelvic pain.
Regular exercise can help with labor and post-delivery recovery, too, by reducing the odds of having an
instrument-assisted delivery — a delivery in which forceps or a vacuum
device is used — and lowering the risk for
urinary incontinence after birth.
precautions before and during exercise — and avoid risky types
To reduce the chance of developing low blood
sugar, you should eat before exercising, said Dr. Raul Artal, M.D., a professor
and chairman emeritus of the department of obstetrics, gynecology and women’s
health at the St. Louis University School of Medicine. Smoothies, fruits, nuts
or whole-grain crackers are good choices. Drink water to stay hydrated, too,
and don’t exercise outdoors at temperatures above 90 degrees. That’s because
heat stress in the first trimester, such as from saunas and hot tubs, has
been linked with birth defects of the brain,
nervous system or spinal cord. According to recent research, though,
exercising when it’s not really hot out does not increase core body temperature
enough to cause problems. In fact, research suggests that exercising during
pregnancy is linked with a reduced risk for neural tube defects.
ACOG recommends that pregnant women avoid
the following activities, which could pose health risks:
Contact sports such as ice hockey, boxing,
soccer and basketball
Activities with a high risk of falling, such
as downhill skiing, water skiing, surfing, off-road cycling, gymnastics and
Hot yoga or hot pilates
you can do regularly
“Oftentimes, women think that exercise means
going to a gym, and it doesn’t,” said Dr. Diana Ramos, M.D., M.P.H., an
obstetrician and medical director for reproductive health at the Los Angeles
Public Health Department. “It’s as simple as walking.”
Other activities ACOG recommends include
swimming, stationary cycling, yoga, pilates and low-impact aerobics such as
jogging and pool aerobics. What’s most important is that you choose an activity
that you’ll be able to do regularly. My favorite prenatal workout ended up
being one I did in my basement —
where I was conveniently shielded from intrusive bystanders and just a few
steps away from the essential re-fueling station (aka my kitchen).
ACOG’s guidelines recommend
that pregnant women exercise for 150 minutes a week, or about 30 minutes a day,
five days a week. They caution against exercising for more than 45 minutes at a
time because doing so can increase the risk for low blood sugar, which can make
you lightheaded or dizzy. If you didn’t exercise much before you got pregnant,
or you are obese, it’s O.K. to start with as little as 10 minutes of activity a
day and “build it up at a rate that is going to be sustainable,” Dr. Davenport
said. Dr. Davenport also pointed out that some activity is better than none at
all — exercising for fewer than 150 minutes a week still provides some
Aerobic exercise, such as jogging, is safe
for women who were active before they got pregnant. Guidelines recommend that
women be able to pass the “talk test,” meaning they can carry on a conversation
while exercising. More intense exercise may also be O.K., but Dr. Gregory
Davies, M.D., a professor and chair of the Division of Maternal-Fetal Medicine
at Queen’s University in Canada, pointed out that very little research has been
done to address this question. “Most, if not all, our knowledge about safety
and pregnancy benefits is based on research protocols that reflected moderate
exercise, at most,” he said. The same goes for strength training, so if you’re
going to lift weights, don’t overdo it. A 2015 trialfound that pregnant women can safely lift
10 pounds or less, but studies haven’t evaluated the safety of heavier
that your body is changing
During pregnancy, a woman’s joints become
more relaxed, so it’s important not to overstretch, Dr. Davenport said. It’s
also wise to avoid activities that require jumping or quick directional
changes, which can stress the joints, too. Balance becomes less stable after
the first trimester, which is why it’s also important to avoid activities that
require careful balance, such as skiing. To stay safe, invest in supportive
shoes — don’t go for your daily walk in flip-flops — because “you really need
the right support for your feet,” Dr. Ramos said.
ACOG also suggests avoiding exercises that
require you to lie on your back during pregnancy. Doing so can restrict blood
flow to the heart, which might also restrict blood flow to the fetus. Usually,
if this happens, you will feel light-headed and nauseous, Dr. Davenport said,
which you can take as a sign to sit up.
WHEN TO WORRY
According to ACOG, women who experience any warning signs while
exercising such as vaginal bleeding, regular painful contractions, amniotic
fluid leakage, difficulty breathing, dizziness, headache, chest pain, muscle
weakness, or calf pain or swelling should stop and contact their health
Dr. Margie Davenport, Ph.D., associate
professor of kinesiology, sport and recreation and director of the Program for
Pregnancy and Postpartum Health at the University of Alberta, Dec. 5, 2018
Dr. Diana Ramos, M.D., M.P.H., medical
director for reproductive health for the Los Angeles Public Health Department,
Dec. 5, 2018
Dr. Raul Artal, M.D., professor and chairman
emeritus of the department of obstetrics, gynecology, and women’s health at the
St. Louis University School of Medicine, Dec. 6, 2018
Dr. Gregory Davies, M.D., professor and
chair of the division of maternal-fetal medicine at Queen’s University in
Canada, Dec. 10, 2018
women are more susceptible to foodborne illness than most people because their
immune systems are weakened.
like salmonella, campylobacter and Toxoplasma gondii can be harmful to a
pregnancy, but experts are particularly concerned about Listeria monocytogenes,
a bacterium that can cause infection that can have devastating
minimize listeria risk, avoid foods most likely to carry it, such as certain
types of processed meats (unless they’ve been thoroughly heated), smoked fish,
soft cheeses and unpasteurized milk and dairy products.
research on moderate alcohol consumption during pregnancy is mixed, experts
have said that abstinence is the safest bet.
your doctor suggests otherwise, you can keep your morning coffee, as long as
you limit yourself to 200 milligrams of caffeine or less per day.
you ate the wrong thing? Don’t stress. Discuss it with your doctor, who can
give you tips on what, if anything, to do next.
WHAT TO DO
Take care with
certain types of processed meats
are dozens of bacteria, viruses and parasites that can linger in foods and
cause illness. Experts are particularly concerned about listeriosis — a
bacterial infection that can cause seemingly mild or even nonexistent symptoms
in pregnant women, but which can be especially dangerous to an unborn baby —
including causing miscarriage, preterm labor or stillbirth.
infections during pregnancy are rare. Between 2009 and 2011, according to the
Centers for Disease Control and Prevention, there were just 227 cases in
pregnant women in the United States. But research suggests that pregnant women
may be up to 20 times more vulnerable to a listeria infection than the rest of
immunity is altered when you’re pregnant, and that makes you more susceptible
to serious consequences of foodborne illness,” said Dr. Zoe Kiefer, M.D.,
M.P.H., an ob-gyn at Beth Israel Deaconess Medical Center in Boston. Nearly
one-quarter of all listeria cases in pregnant women in the United States result
in fetal loss or death of the newborn, according to the C.D.C.
outbreaks tend to occur in certain ready-to-eat meat products such as hot dogs,
sausages, and store-bought, meat-based salads such as those made with chicken
or ham. Cold cuts and deli meats are a common source, too. In fact, on April
17, 2019, the C.D.C. reported that
at least eight hospitalizations and one death were linked to a listeria outbreak
among sliced deli meats and cheeses at several deli counters across four
states. Other outbreaks have been caused by refrigerated pâtés, meat spreads,
smoked seafood, carpaccio, produce like cantaloupe and lettuce, and dairy
products like ice cream and soft cheeses (more on cheese below).
of cutting these high-risk foods from your diet completely, Mary Saucier
Choate, M.S., R.D.N., a food safety field specialist at the University of New
Hampshire Extension, recommended cooking foods that can be eaten hot to an
internal temperature of 165 degrees, or until steaming, since high temperatures
kill the bacteria. A hot open-faced turkey sandwich or a fully cooked hot dog
would do the trick. Or, consider making your own alternatives, such as freshly prepared
salmon salad (made from canned salmon), egg salad or a peanut butter and banana
have said to keep fruits and veggies (with the exception of sprouts; more on
that below), in your diet unless there’s an outbreak. Cooking produce is another
way to minimize potential risk, said Dr. Haley Oliver, Ph.D., an associate
professor of food science at Purdue University.
general, keeping kitchen surfaces clean, thoroughly washing fruits and veggies
and properly storing them (like keeping cut melon refrigerated) can help keep
Be flexible with fish choices
is packed with nutrition and is an important addition to many people’s diets,
especially if you’re expecting. It’s not only high in protein and essential
vitamins and minerals, but supplies healthy omega-3 fatty acids that aid in
your brain and heart health, and in your baby’s brain and retina
doesn’t make fish an all-you-can-eat food when you’re pregnant, though. Most
fish contain some level of mercury, a metal that can cause brain damage as well
as vision and hearing problems for babies exposed in the womb. But certain
types tend to contain more mercury than others. Large, long-living fish like
bigeye tuna, swordfish, shark, king mackerel and orange roughy have the highest
mercury levels and are best avoided.
health agencies recommend that pregnant women eat two to three servings (8 to
12 ounces) of fish per week, including a variety of low-mercury fish including
cod, flounder, salmon, sardines, shrimp or canned light tuna; or one serving
per week of moderate-mercury fish like halibut, snapper or albacore tuna.
There is debate, however, over whether some types of tuna are safe for pregnant women to eat at all. In 2014, Consumer Reports analyzed Food and Drug Administration data and found that while canned light tuna on average was low in mercury, the amount varied greatly from can to can, with some containing unsafe levels of the toxin. Since there’s no way to tell which can is which, or which type of tuna the can contains, the group recommends avoiding all types of tuna while you’re pregnant. Talk with your doctor about the best diet plan for you.
Take care with raw foods
fish known to harbor parasites (such as the anisakiasis worm, which can cause
abdominal pain, nausea, vomiting and diarrhea) are typically frozen before
they’re sold for consumption as sushi in the United States. Freezing can also
halt the growth of bacteria like salmonella, which may be present.
freezing is not foolproof against foodborne illness, explained Dr. Christina A.
Mireles DeWitt, Ph.D., an associate professor of food science and technology at
Oregon State University. And it doesn’t prevent cross contamination. Most
people’s immune systems can handle the temporary G.I. distress resulting from
eating a contaminated food, said Dr. DeWitt, but pregnant women and their
babies are at higher risk for complications (as are young children and the
elderly or immune-compromised), so it’s best to avoid uncooked fish, such as
sushi and raw oysters, when you’re pregnant.
also best to avoid raw or undercooked meat. While most pregnant women are
advised to avoid cleaning their cat’s litter boxes due to the increased risk of
infection from Toxoplasma gondii — a parasite that thrives in cat feces — about
half of the yearly toxoplasmosis infections in the United States result from
eating food. Common sources include undercooked pork, lamb and wild game meat;
as well as raw fruits and vegetables (which could contain infected soil).
the F.D.A.’s “heat chart” for
instructions on how to ensure your meat is fully cooked. And wash your hands
with soap and warm water after touching soil, sand, raw meat, cat
litter or unwashed vegetables. The F.D.A. also recommends thoroughly washing
and, if possible, peeling, fruits and veggies before eating.
Abstain from alcohol
some studies suggest that light-to-moderate drinking — defined as no more than
one drink per day for women — is no big deal during pregnancy, there’s enough
evidence to the contrary for many experts to agree that no amount of alcohol is
safe. A 2013 review of 34
studies, for example, concluded that women who drank up to three drinks per
week throughout their pregnancies were more likely to have children with behavioral
issues like poor impulse control or difficulty interacting with other kids than
women who didn’t drink at all.
during pregnancy has been linked to an increased risk of fetal alcohol spectrum
disorders, such as fetal alcohol syndrome, which can lead to facial
abnormalities, improper growth and intellectual disabilities. A 2018 study published in the journal JAMA
estimated that as many as 5 percent of children in the United States have an
really don’t know what amount is safe,” said Dr. Kiefer. So for now, skip the
Avoid unpasteurized drinks
or the process of heating foods to kill harmful bacteria, has made many foods
safe for pregnant women to consume. But be on the lookout for milks, juices,
dairy and other products that haven’t gone through the process.
unpasteurized milk can harbor germs like listeria, salmonella, campylobacter or
cryptosporidium. In 2014, the American Academy of Pediatrics said that since no
studies have found any benefits of drinking unpasteurized milk, pregnant women
who drink milk and milk products should only consume those that have been
pasteurized. (The same advice goes for infants and children.)
juices sold in the United States are pasteurized, including all that are
shelf-stable. But some refrigerated juices sold at certain types of stores like
high-end chains, local organic juice joints, corner bodegas or farm stands may
not be. If you don’t see a label stating a drink has been pasteurized, ask
whether it has been. If they’re not sure if it has, skip it.
Be choosy about cheeses
with refrigerated meat and unpasteurized dairy products, cheese can harbor
listeria and other pathogens. But unlike the “cook it or skip it”
recommendation for meat products, the advice on cheese isn’t always
general, the softer — and wetter — a cheese gets, the more you have to worry
about pathogens surviving and growing. Bacteria like moisture, said Dr. Dennis
D’Amico, Ph.D., a professor of food microbiology at the University of
Connecticut, so pathogens tend to grow on soft cheeses more quickly than they
grow on harder ones.
you go from a mozzarella with high moisture to something like a cheddar or a
Monterey Jack, the risk is starting to go down,” said Dr. D’Amico. Dry, hard
cheeses such as a traditional Parmigiano or a Pecorino Romano have virtually
zero risk of foodborne illness, said Dr. D’Amico.
cheeses made with unpasteurized milk are by far the riskiest: C.D.C. estimates
suggest they’re as much as 160 times more likely to cause foodborne listeria
infection than soft cheeses made with pasteurized milk. But even pasteurized
soft cheeses are not risk-free: A 2018 C.D.C. report revealed that there
were 12 times more listeria outbreaks linked to pasteurized soft cheeses
between 2007 and 2014 than there were between 1998 and 2006. One such outbreak
in 2015 hospitalized 28 people — six of whom were pregnant. Latin-style
cheeses, like Queso Fresco, have been implicated in more outbreaks than other
the F.D.A. says it’s O.K. for pregnant women to eat soft cheeses made with
pasteurized milk, Dr. D’Amico and other experts have suggested that pregnant
women consider avoiding them to be safe.
If you drink coffee, stick to one cup
of research has linked consumption of coffee and other sources of caffeine to
increased risks for miscarriage, preterm birth and
low birth weight babies. But the research isn’t clear on how much is safe to
consume. Most public health groups, including the American College of
Obstetricians and Gynecologists, agree that limiting caffeine to no more than
200 milligrams per day will not majorly increase such risks.
tell my patients it’s O.K. to have one cup of coffee daily,” said Dr. Kiefer,
no matter your stage of pregnancy.
caffeine content can vary depending on what you drink. At Starbucks, a shot of
espresso has 75 milligrams of caffeine; whereas its Tall-sized brewed coffee
drinks have closer to 190 to 280 milligrams. The English breakfast tea I
ordered at the coffee shop that day probably had around 50 milligrams.
keep in mind that caffeine can pop up in unassuming places, such as in decaf
coffee, colas, iced teas, energy drinks, kombucha and chocolate.
Avoid raw eggs
can carry salmonella, a bacteria that can cause infections resulting in fever,
nausea, vomiting, diarrhea and dehydration. And if you’re infected during
pregnancy, symptoms can be so severe that they may lead to serious
complications for both you and baby.
can’t withstand high heat, so eggs cooked to 160 degrees or more will be safe
to eat. Cook eggs thoroughly until the whites and yolks are firm and no clear
or runny sections remain.
liquid eggs sold in refrigerated cartons are pasteurized and likely won’t have
the potential to make you sick. Pasteurized shell eggs probably can’t make you
sick either, though these are harder to find. Also remember that raw eggs can
be found in seemingly innocuous foods and drinks, too, such as Hollandaise
sauce, Caesar dressing, eggnog, raw cookie dough, aioli, meringue, mousse and
handling raw eggs, wash your hands and disinfect surfaces they’ve touched to
prevent cross contamination.
A.A.P. guidelines have advised pregnant women to avoid eating peanuts — and to
delay introducing them to high-risk children (such as those whose parents have
allergies) until age 3 — so as to prevent peanut allergies in their children.
But as peanut allergies increased despite this advice, and more research
emerged, the A.A.P. rescinded that recommendation in 2008 (and reaffirmed their stance in
some pregnant women still haven’t gotten that memo.
anything, newer research suggests that allergen exposure may reduce food
allergy risk. A 2014 study of
more than 8,000 women and their offspring published in JAMA Pediatrics, for
example, found that moms who ate peanuts and tree nuts (like almonds or
walnuts) five or more times per week during, shortly before or shortly after
their pregnancies had kids who were 69 percent less likely to develop nut
allergies than those whose moms ate them less than once per month.
good news, since nuts are good sources of the protein, healthy fats and
vitamins and minerals that pregnant women need.
raw sprouts — including alfalfa, mung bean, radish and clover—are risky for
pregnant women. “Seeds may become contaminated by bacteria in animal manure in
the field or during the postharvest stage,” said Choate, the food safety field specialist
at the University of New Hampshire Extension. These bacteria can grow to high
levels during sprouting, and are impossible to wash out. To play it safe, ask
for your sandwich with no alfalfa sprouts, and for the bean sprouts to be left
off your pad Thai.
Review the recalls
few days it seems there’s another healthy food we’re told to avoid due to an
outbreak, from romaine lettuce to tahini to sliced melon. To stay on top of the
latest news, sign up to get notified about alerts and recalls from both the
F.D.A. and the Department of Agriculture by email here. You’ll also get an email when the recall
is over, so you won’t unnecessarily need to limit your diet for longer than you
something on the “do not eat” list? Don’t freak out. The chances that one
slip-up will damage your pregnancy are relatively slim, said Dr. Kiefer. “If a
patient calls me and says, ‘I had a ham sandwich,’ I try to reassure them that
they’re probably O.K.”
You do need
to worry, however, if you experience symptoms that could signal actual food
poisoning, such as nausea, vomiting, diarrhea, fever, chills or dizziness; or
any signs of preterm labor such as cramping or bleeding. If you have any of
these symptoms or if you’re unable to keep fluids down for more than a few
hours at a time, call your doctor or head to the E.R. so you can be monitored
for hydration and treated as needed.
that before-you-knew-you-were-pregnant party night, bring it up with your
doctor. While experts have said that no amount of alcohol is safe, one isolated
exposure to alcohol may not cause problems for you or your baby, said Dr.
Kiefer. Talk with your doctor about concerns you have regarding drinking at any
point in pregnancy, especially if you’ve had any significant alcohol intake
since your last period.
Zoe Kiefer, M.D., M.P.H., an ob-gyn at Beth Israel Deaconess Medical Center in
Boston, January 2019
Saucier Choate, M.S., R.D.N., a food safety field specialist at the University
of New Hampshire Extension, January 2019
Christina A. Mireles DeWitt, Ph.D., an associate professor in food science and
technology and director of the Oregon State University Seafood Research and
Education Center, January 2019
Dennis D’Amico, Ph.D., a professor of food microbiology at the University of
Connecticut, January 2019
Haley Oliver, Ph.D., an associate professor of food science at Purdue
University, March 2019
who’ve given birth have postpartum pelvic floor issues that can require
physical therapy. Look out for peeing when you laugh, sneeze or exercise, or
for very frequent urges to pee.
pelvic floor issues isn’t just Kegels (and a lot of people do Kegels wrong).
sex hurts after the first few times, go slow, use lube and try non-intercourse
forms of sex. If it still hurts, see a pelvic floor physical therapist.
If you feel like
something is falling out of your vagina, you may have prolapse. Consult your
doctor for a referral to a pelvic floor physical therapist.
Scar pain is
common after both C-sections and vaginal births even up to a year postpartum.
Scar massage may help.
If your back,
shoulders or hips hurt, make sure you’re carrying your baby and baby gear on
both sides of your body equally, and see a physical therapist.
When I was pregnant, I read four books on pregnancy and two
on childbirth. I read no books on what my body would be like during the first
year postpartum, because I had never heard of any. During that first year, many
people are underinformed about their own bodies, even as they learn vast
amounts about their babies. Many of us are cleared for sex and exercise at six
weeks postpartum, but a body that grew another human can take much longer than
that to heal — and can be permanently changed in some ways.
For this piece, I discussed health in the first postpartum
year with two ob-gyns, a nurse, two physical therapists who specialize in
treating postpartum bodies and two mothers. All the experts said many people
have questions about what is normal, and they recommended calling your
obstetrician, midwife or primary care provider if you’re concerned about
something specific. For many symptoms, a next step will be a referral to a
physical therapist. The experts stressed that you don’t have to live with pain,
discomfort or leaking urine, and that your health is as important as your
WHAT TO DO
Don’t ignore concerning changes.
Peeing a little
when you sneeze, laugh or exercise is such a classic postpartum symptom that
many assume it can’t be fixed. Not so. It’s called stress incontinence, and
it’s a symptom of a problem with your pelvic floor, a set of muscles that
stretch, bowl-shaped, between the tailbone and the pubic bone. Urge
incontinence, in which you feel the need to urinate very frequently, feel you
have a very small bladder or feel you can’t hold it, is also due to pelvic
floor muscle stress.
If you have any
kind of incontinence, a good first step is a referral to a physical therapist
who specializes in pelvic floor issues. “Being pregnant puts stress on your
pelvic muscles” because of the weight of the fetus, said Dr. Tamika Auguste, an
ob-gyn at MedStar Washington Hospital Center in Washington, D.C. Vaginal
delivery or a C-section can further stress your pelvic floor, especially if the
C-section was unplanned and occurred after some amount of labor. “Oftentimes
women don’t always recognize immediately how much of a toll that still took on
their vaginal canal and pelvic floor,” said Alison Colussi, D.P.T., a physical
therapist specializing in pelvic health. Muscles that stretch during delivery
can either remain too loose or over-tighten in response.
Do pelvic floor exercises — but not just Kegels.
When you think
pelvic floor, you probably think Kegel exercises — in which you contract your
pelvic floor muscles. But Kegels are not always helpful, and they’re hard to
learn how to do properly on your own, Colussi said, so it’s best to visit a
physical therapist if possible. Some women’s pelvic floors are overly tight,
“in a constant state of mini-Kegel,” as Colussi puts it, which Kegels would
only exacerbate. Even when pelvic floor muscles are weak and need strengthening,
“the focus is much more on finding the full range of motion of those muscles,
which includes both relax and contract,” Colussi said.
part is hard. I tried to do it while on the phone with Colussi. “I’m not
entirely sure if they’re relaxed or not,” I told her. “Am I actually trying to
contract something accidentally?” She laughed. “I hear that 10,000 times a
day,” she said.
said, patients come in looking for an exercise to do for 10 minutes every day.
“But the question is not what’s a good exercise,” she said. It’s more about how
people move in every one of their daily activities, from getting out of bed to
picking up mashed fruit off the floor to lifting babies out of their cribs.
The proper way to pick up that
mashed fruit or a baby in a car seat is to squat down, keeping your center of
gravity over your hips and not tilting forward. Then exhale, engage your abs and
straighten up using your leg muscles, not your back.
Don’t put up with painful sex.
It’s common to
feel discomfort or pain the first few times you have penetrative sex after
childbirth, but after that, don’t put up with it. The first step is of course
to go slowly and be gentle with yourself. Often ob-gyns will advise using an
over-the-counter lubrication product, because breastfeeding suppresses estrogen
production, and estrogen produces lubrication, explained Dr. Alison Stuebe,
associate professor of obstetrics and gynecology and chair of the taskforce
that wrote the newest American College of Obstetricians and Gynecologists guidelines for postpartum care.
But lube is just a beginning, our experts all agreed.
In addition to
dryness, pain during sex can be caused by pelvic floor dysfunction, other tight
or stretched muscles or scar pain from a tear or episiotomy during a vaginal
birth. Sex can hurt for patients who’ve had C-sections as well, because both
C-sections and the process of pregnancy can stretch or tighten muscles. Ask
your obstetric care provider for a referral to pelvic floor physical therapy.
Dr. Stuebe also
directs patients to “The Parents’ Guide to Doing It,”
an episode of “The Longest Shortest Time” podcast with sex advice columnist Dan
Savage as a guest. Savage discusses types of sex other than penetration.
Unfortunately, some women experience pain with any kind of sex, usually from
increased nerve sensitivity, said Colussi.
Seek help if you feel pressure in your vagina.
Some women come
to Colussi saying they feel pressure in their vagina, like something is
obstructing their bowel movements, “or like a dry tampon is half falling out of
me,” she said. Sensations like these could mean a pelvic organ prolapse, when
an organ (uterus, bladder or urethra) shifts from its original position or
presses against the vaginal wall. “Prolapse is probably the thing women are
least prepared for,” said Colussi.
can be fixed with surgery or alleviated with a pessary (a support in the vagina
to prop up the prolapsing organ), but milder prolapses can be managed just by
lying down more frequently and avoiding high levels of pressure in your
abdomen, Colussi said. “Oftentimes for a woman it feels a lot worse than it
actually is,” she said, but in other cases prolapse can be more severe than it
feels, so it makes sense to see a health care provider. To better manage
pressure levels in your abdomen, don’t bear down when pooping; and exhale
instead of inhaling or holding your breath when you exert yourself. If you find
yourself grunting and then holding your breath when you lift something heavy,
try exhaling instead.
Ask your doctor about scar pain.
If you feel pain
in your C-section scar or scar from a tear or episiotomy, see your medical
provider. A doctor may recommend scar massage or scar mobility treatments from
a postpartum physical therapist. However, be aware, scientific data on the
effectiveness of scar massage is limited because it has barely been studied,
Dr. Stuebe said. A 2011 paper concluded that scar massage is “anecdotally effective”
but found that surgical scar massage of any kind had only been studied in a
tiny sample size of 30 patients. Scar pain is common. A year after giving
birth, a study found, 18
percent of women who had C-sections still had pain at the incision site, and 10
percent of women who had vaginal births still felt pain in the vagina or
perineum (the area between the vagina and the anus).
Learn to carry your baby on both sides.
Carrying a baby,
lifting a baby and holding a baby while breastfeeding are hard physical work,
especially for women who were pregnant. Your posture and movement habits change
during pregnancy from carrying around extra weight in new places, and your body
also produces the hormones relaxin and progesterone, which loosen your
ligaments and joints.
design doesn’t help. “Car seats and cribs have changed drastically” in recent
years, said Colussi. They’re carefully designed for infant safety, but not for
parent ergonomic safety. Infant or “bucket” car seats are heavy, and usually
parents carry them in their nondominant arm, causing muscle imbalances. She
recommends that parents practice early and often carrying their babies on both
sides equally. “Cribs are hard because the rails can’t go up and down anymore,”
she said. Colussi recommends that parents, especially shorter ones, place a
step aerobics stepper next to the crib.
If pain persists
after making these changes, physical therapy is a good idea.
Use proper form for sitting up.
If you feel a
gap in your abdominal muscles, you may have diastasis recti, in which all the
layers of the abdominal muscles, the rectus abdominus, separate in the middle.
This happens normally during the latter part of pregnancy to make room for the
growing uterus, but if it persists at your six-week postpartum checkup, ask
your provider, who may refer you to a physical therapist. To avoid putting too
much pressure on these muscles, avoid crunches or sit-ups, and when you sit up,
don’t sit straight up using just your abdominal muscles: Roll onto your side
first and use your arms.
WHEN TO WORRY
If you have
shortness of breath, pain in your chest or seizures, call 911.
If you have an
incision that does not heal, a temperature above 100.4F, too much bleeding
(soaking one pad per hour or a blood clot the size of an egg or larger), a red
or swollen leg that feels painful or hot, or a headache that does not get
better with medication or is accompanied by vision changes, call your medical
If you had
gestational diabetes, make sure you get screened for diabetes according to your
medical provider’s advice.
If you had high
blood pressure (pre-eclampsia) during
pregnancy, make sure your blood pressure is monitored according to your medical
provider’s advice. (You are still at risk for pre-eclampsia up to six weeks
If you quit or
tapered smoking or other drugs during pregnancy, see your medical provider for
a postpartum support plan. The stresses of life with a baby can lead to
Debra Bingham, Dr.PH.,
R.N., professor of nursing at the University of Maryland and executive director
of the Institute for Perinatal Quality Improvement, Aug. 23, 2018
Tamika Auguste, M.D.,
obstetrician-gynecologist at MedStar Washington Hospital Center, Aug. 27, 2018
Colussi, D.P.T., physical therapist at Physical Therapy Center of Rocky Hill in
Rocky Hill, Conn., Aug. 27, 2018
Alison Stuebe, M.D., M.Sc., associate
professor of obstetrics and gynecology at the University of North Carolina
School of Medicine, Aug. 27, 2018
HOW TO BE A SUPPORTIVE PARTNER DURING PREGNANCY (AND BEYOND)
Numerous studies have shown the benefits of having a partner who is supportive or perceived to be supportive. Conversely, having a partner who is perceived to be unsupportive is a predictor of depression and anxiety both before and after a child’s birth.
Start early. Being a supportive partner begins in the months before delivery, when an expectant mother’s anxiety levels may be rising about giving birth and the changes a baby brings.
Make a plan for your supportive role both during and after the baby’s arrival, but be flexible. There’s no script for how things are going to go.
New research indicates that supporters may need support of their own: They can feel isolated or rejected but question the legitimacy of their experiences.
you’ve watched any movies with birth scenes, you may have noticed that the
partner’s role often fits into one of two categories: He — and it’s always a he
— is a comically inept second fiddle, fainting just when he’s needed most, or
else absent entirely, inhaling a cigar in a nearby pub.
dated archetypes exist for a reason. What actually comprises a supportive
partner has only come into focus in recent years, as fathers and same-sex
partners have become more central to the birth and all that comes after. But
the research is resoundingly clear: A strong mate makes a difference. Having a
supportive partner is good for everyone involved, including the baby.
scientific literature is less clear on what specific strategies best support
pregnant women — it’s tough in a clinical setting to isolate the benefits of,
say, a well-timed hug or a promise to handle 3 a.m. feedings. But the three
researchers I spoke to distilled their studies into some real-world advice.
WHAT TO DO
Connect with each other well before the due date.
This should be
even more of a priority than buying the right stroller. “The focus is so much
on practical needs,” said Dr. Pam Pilkington, Ph.D., a perinatal psychologist who
practices at the Centre for Perinatal Psychology in Melbourne, Australia, and
founder of Partners to Parents, a resource site developed
by a team of researchers and psychologists at Australian Catholic University to
provide guidance for partners. “During pregnancy, people perhaps don’t focus on
the couple relationship, or supporting each other emotionally as much as they
terms, this means talking often and openly about how you’re both feeling —
anxious, excited, uncertain, whatever it is, Dr. Pilkington said — then
validating each other, making sure you both feel heard and accepted. An
example: After a month at home, a new mother might say, “I feel trapped here
all day while you’re at work.” The supportive answer here is not, “I need to
work so we can pay the bills. Why don’t you get your mother to come help?”
Rather, a validating answer would be: “I’m sorry that you’re feeling pinned in
place. It sounds like you’re missing seeing your friends at the office.”
Trying to build
mirroring-and-validating skills during the relative calm before your child’s
arrival will help cement your bond for the challenges to come, Dr. Pilkington
Make your good intentions known.
of service to another is what’s known in scientific vernacular as “offering
social support.” Researchers call it a mysterious force that has tangible
benefits. “There’s a magic about social support,” said Dr. Christine Dunkel
Schetter, Ph.D., a professor of psychology and psychiatry at UCLA who has
studied its effect on stressful situations, including pregnancies. “And the
magic is that when it’s really working in these kinds of situations, it’s about
things that take place between two people. And it’s about what one person says
to the other, or does, that makes them feel better.”
Part of the
magic of social support?Even when an expectant mother merely perceives that
she has a supportive partner, she’s more likely to come through pregnancy happy
and healthy, research shows. Studies have variously found that partner support
is associated with better birth outcomes and lower levels of distress and depression
among both mothers and infants.
But follow-up is
key, too, said Dr. Dunkel Schetter. If you don’t actually come through on a
promise to assume half of the diaper-changing duties, the benefits of perceived
support quickly trail off.
supportive partners will learn that the best kinds of support are nonverbal —
offering a hug during a low emotional ebb. And the support should be offered
unconditionally. “The person giving it can’t say, ‘Now you owe me, you’re
obligated, I’ve done so much for you,’ ” said Dr. Dunkel Schetter.
program developed by the Yale School of Nursing, provides social support
instruction, among other services, in a group setting for women and their
partners; it’s now available in health-care facilities around the United
States. (You can find a nearby location on the website.)
Take a birthing class — but be open-minded when the day arrives.
Classes like the
Bradley Method, which teaches that childbirth can be managed through deep
breathing and the support of a partner or labor coach, can be helpful in making you feel more
prepared, and offering a sense of what to expect. But Dr. Pilkington pointed
out that birth is not the same as being a cast member in a play. The baby
sometimes rewrites the script. Things take unexpected turns, or the mother’s preferences
before going into labor might change 12 hours in. The partner should avoid
rigid thinking about how it was supposed to go, and instead help the mother
roll with whatever’s happening and support her choices along the way, Dr.
Have a plan for the weeks after the baby arrives…
the partner can draw up an action plan in which he or she commits to executing
certain helpful tasks. Maybe it’s late-night feedings if the mother is going to
pump breast milk or your baby is on formula. Maybe it’s a daily break that the
mom can count on, like taking the baby out for a walk so she can nap or take a
bath, said Dr. Pilkington.
… But be flexible.
Planning to do
those 3 a.m. feedings is one thing. The searing exhaustion that kicks in after
four weeks of doing that is another. During your child’s early life, it’s best
to expect some meltdowns. (The baby will cry sometimes, too.) Revisit the plan
anytime based on whatever challenges you might face at each stage of your
baby’s life. It’s O.K. to ask for extra support from friends and family, Dr.
Pilkington said. Both parents can use a break in the first couple of months of
their baby’s life.
Know your role with feeding.
One task the
mother generally handles alone is breastfeeding. But a 2015 studyled by the University of Ontario
Institute of Technology suggested that a partner’s active involvement —learning
how breastfeeding works and providing encouragement — leads to “significant
improvements” in breastfeeding duration. Then think of simple, commonsense ways
to step up: Helping the mother stay hydrated by offering a glass of water,
bringing healthy snacks and providing a comfortable environment, Dr. Pilkington
For parents who
can’t breastfeed or choose not to, Dr. Pilkington says it’s important to
remember they haven’t failed. “How parents feed their infant is a personal
choice that should be based on their specific situation,” she said. If the
mother is pumping, you can help maintain the equipment and offer to bottle-feed
using the milk. Parents feeding their baby with a bottle — whether it’s formula
or breast milk — can split overnight duties, one taking the 9 p.m. to 2 a.m.
shift, the other holding down the 2 a.m. to 7 a.m. slot, for example. Partners
using formula can make sure there are adequate supplies on hand at all times
and know how to mix it. Some formulas can be premixed and stored in the fridge for
up to 24 hours, which could save an exhausted mom from having to drowsily scoop
powder in the small hours of the night.
Expect that your sex life will change — for a while, at least.
This is a
biological imperative, so expect the temperature to be dialed down in the
marital bed post-birth (for a duration that depends on the circumstances of the
delivery; consult a professional). And even after you’re medically cleared,
that doesn’t mean you’ll feel the same or have much energy for sex early on.
Make a point to seek out alternate forms of intimacy, like hand-holding and
cuddling, Dr. Pilkington said. The key, again, is to maintain an emotional
connection and strong lines of communication.
Look for signs of your own stress, and act on them.
psychological effect on partners after a baby’s arrival is mostly a black hole
in the scientific realm. Dr. Pilkington noted that only 19 of the 120 recent
studies around pregnancy touched on outcomes for fathers or partners, and
researchers openly acknowledge the need for more research.
But the few studies that have been done show that fathers can struggle to
navigate this interlude. Dr. Zoe Darwin, Ph.D., a lecturer in maternal health
at the University of Leeds in the U.K. who has conducted some early inquiries in
this area, found that men often feel stressed and detached but want to keep the
spotlight on the mother and child. “The research that we’ve done,” she said,
“found that although some of the men we spoke with felt excluded by maternity
services, and had experienced significant stress in this period, they often
questioned the legitimacy of their experiences and their entitlement to
support.” If you feel yourself struggling, let your partner know, and consult a
WHEN TO WORRY
If you’re struggling with depression or anxiety, you may need more than a hug or the sage words of a parenting class. Seek professional help from a counselor.
Dr. Pam Pilkington, Ph.D., perinatal psychologist who practices at the Centre for Perinatal Psychology in Melbourne, Australia.
Dr. Christine Dunkel Schetter, Ph.D., professor of psychology and psychiatry at UCLA, expert on stress processes in pregnancy
Dr. Zoe Darwin, Ph.D., lecturer in maternal health at the University of Leeds in the U.K. who specializes in mental health and wellbeing during and after pregnancy.
18 BRILLIANT WAYS TO CARE FOR YOUR PREGNANT WIFE OR PARTNER
Pregnancy is, for many women, one of the most emotionally wrought and physically challenging experiences in life. Whether it’s her first or her fourth, the best thing you can do for your pregnant partner is show a little extra compassion during these 40ish weeks.
We’re offering 18 ideas here – all of which we’re confident would be appreciated – but the best thing for you to do is find the expressions of care that feel most genuine to you. Think about your partner as a person; her likes, dislikes, obsessions, and quirks. Many of those will follow her into pregnancy and then well into motherhood.
Showing that you understand and love her will help your partner feel cared for as she wades (or waddles) into the sometimes tumultuous waters of pregnancy.