Why am I so tired?

Pregnant women are often excessively tired in the first and third trimesters, but probably for different reasons. In the first trimester, your body undergoes rapid physiological changes accompanied by high levels of hormones that conspire to exhaust you. Couple this with food aversion or nausea and vomiting, and the result for many women is complete exhaustion.

This tends to get better by the second trimester and then in the third trimester, particularly the last few weeks of pregnancy, exhaustion returns as you sleep less at night and carry around 30 extra pounds during the day. If you have another small baby or two at home already, then the effect is even worse.

What can you do? In the first trimester, work on minimizing the effects of nausea and vomiting of pregnancy. Keep your energy up by eating several small meals or snacks throughout the day and try adding vitamin B6 if you haven’t already. Naps sometimes feel like a good idea, but they often have the opposite effect then what you desire. Napping can interfere with your ability to get good rest at night and create a vicious cycle. Going for a walk for getting some exercise is probably a better idea and will improve your nighttime sleep.

Some women in the first trimester are excessively tired because they have cut caffeine completely out of their diets. Remember, you were still allowed to have up to 350 mg of caffeine today; so don’t feel too badly about having that cup of coffee in the morning or maybe after lunch.

Many pregnant women need to work on maximizing their sleep habits. Make sure you have a dark room, maybe with a noisemaker, like a fan or something else that makes background noise, to minimize interruptions. Try to use your bedroom for sleep only; don’t make a habit of watching TV from your bed or staring at your phone. Women in the third trimester often find every little uncomfortable spring in their mattress with their rounder bellies and hips. Try adding an extra layer of egg crate or a phone topper to your mattress and make sure you have a long pillow that you can hug with your legs.

Also, be sure to empty your bladder right before you go to sleep and if you find that you are awakening to pee several times a night, you might need to restrict water intake for 2-3 hours before going to sleep.

In rare cases, excess fatigue might indicate another problem like a thyroid abnormality or anemia; if you feel like you are more tired than the average pregnant woman, be sure to talk to your doctor.

How can I tell if I’m in labor?

Every pregnant woman at some point in her pregnancy will be given to wonder if she is in labor. Most women have a few false starts. Braxton-Hicks contractions can be confusing and can become frequent and regular, at least for a short time. Women frequently have physiologic discharge or will urinate and wonder if their water is broken. So how can you tell real labor from false labor?

The answer is time. Real labor is progressive in every way, but you won’t be able to see this until some time has passed. If you’re having some regular contractions, the best thing to do is to see what happens over the next two or three hours. If you are really in labor, your contractions will become more frequent (maybe going from every 6 to 7 minutes apart to every 3 to 4 minutes apart), they will last longer (going from, say, 30 seconds in length to 45 or 50 seconds in length), they will become more painful, they will become more regular and predictable, and they will persist. False labor, on the other hand, may seemingly start strong but over two or three hours will lose steam and wane.

If it’s your first baby, you have plenty of time. Labor will likely last many hours and you will have plenty of time to arrive at the hospital. If it’s your fourth baby, then you already know what to expect; if you are reading this anyway, your labor probably won’t last that long and you should head to the hospital a little sooner.

In some cases, your doctor may ask you to come to the hospital a bit earlier; for example, if you’re positive for group B strep, then you will need four hours of IV antibiotic therapy in addition to however long it takes to get to the hospital, get admitted, and get an IV started, before the baby born.

If your water breaks, you should probably head on the hospital. This may be a sign that your labor is already very advanced, since women’s water tends to break at an average of about 8 cm. If your water is broken and you’re not already in labor, then you should still go to the hospital because your labor likely needs to be augmented or induced.

If you have had a previous cesarean delivery, then you should come to the hospital much sooner because you do not want to risk laboring at home. A trial of labor after cesarean is a good idea for most women, but because of the risk of uterine rupture, that trial of labor should happen at the hospital as much as possible.

How can you tell if your water is truly broken? You can’t always tell; but in general, once your water breaks, it keeps coming. Ruptured membranes is not just a small gush or a little bit of spotting; if you think your water has broken, clean up and see if the leakage persists. If it does or you are unsure, you probably need to be examined.

Is my water broken?

You can’t always tell; but in general, once your water breaks, it keeps coming. Ruptured membranes is not just a small gush or a little bit of spotting; if you think your water has broken, clean up and see if the leakage persists. If it does or you are unsure, you probably need to be examined.

Discharge is common in pregnancy but usually never results in more leakage than would fill a small pad or pantiliner. Probably the most common reason why women believe that their water has broken is because they have peed on themselves. Most women cannot believe that they have in fact peed on themselves but in the third trimester, with the baby’s head smashed right against your bladder, this is a common occurrence. If it happens on your bedsheets or in your underwear, you won’t always be able to tell that it is urine by smell or color alone. Amniotic fluid has a unique odor that is like a combination of ejaculate and bleach; that may not be helpful if you’ve never smelled amniotic fluid before, but when you do maybe you’ll recognize it.

When will the doctor check my cervix?

There’s no reason to check your cervix unless you’re having signs of labor, like regular contractions or maybe bleeding or leakage of fluid. If you’re considering an early induction, checking your cervix might help determine how good an idea that might be. If your cervix isn’t ready for labor (already dilated, for example), then an induction might unnecessarily increase your chances of a cesarean delivery.

When can I get induced?

Inductions happen for lots of good reasons – but also some not so good ones. Unless there’s a medical reason to do so, you shouldn’t be induced before 39 weeks. Even at 39 weeks, induction might not be a good idea unless your body is ready for labor. Checking your cervix can help determine this. Otherwise, it might be better to wait until 41 weeks. After 41 weeks, it’s unusual that going any further makes much sense.

Sometimes you might need to be induced much earlier, but it should be because you have a medical problem like high blood pressure or some other complication.

Will I need an episiotomy?

No!

Except in some very rare emergency cases, episiotomies should never be performed. If your doctor performs routine or frequent episiotomies, then he may not be practicing up-to-date medicine. We have known since the mid-1980s that episiotomies are harmful and unnecessary except in a handful of rare emergencies, such as severe shoulder dystocia.

This doesn’t mean that you might not tear, but however badly you might tear an episiotomy would’ve made things worse.

Will I need a cesarean?

We hope not! But some women do, of course.

Cesarean delivery is definitely over-used in the United States. There are some good reasons why a woman might need one:

  • If she’s had a prior “Classical” cesarean delivery (where the incision on the uterus is made higher than normal)
  • If she’s had more than two prior regular (“low transverse”) cesareans
  • If she has placenta previa, where the placenta covers (or is very close to) the cervix or vase previa (where placental blood vessels cover the cervix)
  • If her baby is breech or sideways (and the doctor is unable to turn the baby to be head down)
  • If her baby is unable to tolerate labor (this should be unusual)
  • If her baby is too big (which is more than 5,000 grams or about 11 lbs for a nondiabetic mother or more than 4,500 grams or just under 10 lbs for a diabetic mother)
  • If her labor doesn’t progress or she is unable to push the baby out after sufficient time (most doctors don’t given women enough time for these things)
  • If she has triples or quadruplets
  • If she has active genital herpes or uncontrolled HIV

Those are just about all the reasons. We don’t know for sure, but probably half of all cesareans done are unnecessary. Most of the unnecessary cesareans are related to impatience, and new guidelines from the American College of Obstetricians, will result in significantly fewer cesareans if doctors follow them.

Should I have a water birth?

Probably not.

This is a test question, though. You have to separate out laboring in the water and actually giving birth in water. Most of the known advantages of water birth are actually related to the process of labor in water while the known disadvantages of water birth are associated with giving birth in the water.

For example, the benefits of reduced pain during the first stage of labor (that is, the part leading up to pushing), a shorter first stage of labor, and less need for anesthesia, all occur before the birth itself takes place. At the same time, the reported disadvantages of the water birth all take place during the actual process of delivery, including newborn aspiration, drowning, infections, fatalities, hyponatremia, depressed Apgar scores, and umbilical cord rupture.

So it probably makes the most sense to labor in the water and then get out when it’s time to push and have the baby on dry land.

If you think about it, nature designed the birth process to happen on dry land. One of the benefits of a vaginal delivery over a cesarean delivery is that the baby gets most of the amniotic fluid squeezed out of her lungs while traveling through the birth canal so that her first breath, once delivered, is full of nice, clean air. This doesn’t always happen with a cesarean delivery and consequently babies have higher rates of respiratory problems with cesarean delivery as compared to vaginal delivery. In any event, when a baby is born vaginally underwater, the first inspiration by the baby may be underwater and therefore lead to aspiration of water with subsequent increased risk of infections, drowning, and other respiratory maladaptions.

Keep these things in mind when you read about water births being more natural than land births. In fact, water births are a rather modern invention. Currently, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend against deliveries occurring under water.

Should I VBAC?

If you’ve had a previous cesarean delivery (or two), you may be a candidate for a trial of labor after cesarean (TOLAC). This is a complicated issue. The short answer is that most women with only one prior cesarean delivery should try to VBAC (vaginal birth after cesarean), but you should read more about it here.