How is it possible that the world population is over seven billion, yet most of what we think we know about pregnancy we either learned from played-out sitcoms or children’s books talking about how every life is a “miracle?”
If you didn’t know that the subject was pregnancy and overheard a doctor describing all the things that can and do happen to a mother’s body over the course of her baby’s development, you would likely believe you had stumbled across a new Stephen King audiobook, or crashed a brainstorming session for some kind of body horror film. The details of human gestation and birth are grim to the point that, if they were more widely known and understood, it is likely that the prophylactic market would dry up overnight as celibacy became the new normal.
The evolution of human female anatomy to require menstruation already put women in a rare and unfortunate club; other than primates, it’s just bats and the elephant shrew that have this contentious relationship with the moon. But it turns out that this is only the first of many Cronenberg-esque twists, just waiting to blindside mothers as they struggle through journey of pregnancy.
Unlike so many other obliging diseases, you don’t develop immunity to pregnancy after your first exposure; you just go into remission, vulnerable to a new bout at any time. And if the gift of life is supposed to be the payoff for nine months of hardship, bad news: many of the effects of pregnancy never really go away.
You’ll want to sit down before continuing, because the truth is, pregnancy is really less a beautiful miracle of life and more like a horrible plague, unmatched by almost any disease known to science.
10. Thinning of the Blood-Brain Barrier
In humans, the brain is sort of like an impenetrable fortress. An intricate network of blood vessels insulates the brain from the rest of the body, ensuring that essential nutrients (like oxygen) are able to pass through, but that just about everything else gets blocked (to get an idea of what a breach of this system looks like, consult someone with multiple sclerosis; and that’s just from having extra white blood cells enter the brain). This zealous security system is known as the blood-brain barrier (BBB).
Scientists have spent lifetimes trying to find ways to get medicine to penetrate this barrier to ensure life-saving treatments can be delivered to the whole body, preventing the return of cancer, as well as management of neurodegenerative disorders without having to perform literal brain surgery just to get medication where it is needed.
Warning labels chiding expectant mothers to avoid eating, drinking, self-medicating, or generally putting anything into their bodies other than happy thoughts and classical music are usually focused on how the developing fetus does not yet have its own operational BBB to keep toxins out of its young brain. Considering how active this system is in healthy humans, it makes sense that almost everything that enters the bloodstream is potentially toxic to the unborn. This is also why the Zika virus is such a catastrophic threat to the population: it can appear quite mild in healthy adults, but cause permanent developmental harm in fetuses.
We now know that this relationship is not one-way. During pregnancy, this system stops working normally in the mother’s brain as well.
In order to help the developing fetus get all the materials it needs, it appears the mother’s body compromises its own BBB, making it more permeable and thus vulnerable to the intrusion of non-essential components in the blood. Most of the time, the BBB still manages to get the job done. But recent research has shown that fetal DNA can migrate into the mother’s brain, and then remain there indefinitely, even following birth. This phenomenon, known as microchimerism, may be harmless, but in other cases may be responsible for the development of any number of conditions and autoimmune diseases later on in the mother’s life. Given its name (literally: tiny chimera), scientists are clearly inclined to believe the latter.
It does not appear to matter how long a pregnancy lasts, or whether it comes to term or is terminated early; since a fetus is really just a bundle of DNA and rapidly dividing cells, it is capable of infiltrating the mother’s BBB any old time and planting foreign DNA in her brain like a time bomb. Because these genetic sleeper agents can be activated at any time following pregnancy, it is difficult to screen for them or accurately predict what effect they might have later on.
Of course, even if we could, the BBB’s return to normal operations following pregnancy means it would be all but impossible to treat the microchimera with anything less invasive than brain surgery.
9. Permanent Hormonal Disruption
No self-respecting sitcom can resist the comedic goldmine that is the emotional pregnant woman. From the absent-minded bouts of “pregnancy brain” to wild fluctuations in temperament, the hormonal roller coaster of pregnancy is ripe for laugh tracks and bumbling, exasperated spouses.
In real life, personality changes resulting from hormonal disruption during pregnancy last a little longer than 20 minutes plus commercial breaks.
First, the upshot: studies suggest that women who have experienced pregnancy tend to possess superior memories and better overall mental organization than those who have not. This appears to be related to the boost in brain-developing stem cells from the developing fetus; as baby brains grow, they can lend a little extra neuroplasticity to the mother’s brain too. Neuroplasticity is the trainability of the brain, which makes it easier to change habits, learn skills, or adopt foreign languages, and normally peters out in adulthood.
Unfortunately, they make up for this gentle surge in brain power with an increased predisposition to neurodegenerative conditions like Alzheimer’s. Even more confounding, this neurological restructuring can impact the mother’s entire nervous system, changing the way her body responds to medication and especially hormonal therapy. This is particularly relevant when women enter menopause, the girls-only, reverse-puberty spectacular, for which hormone therapy has become a popular compensatory method.
Not only does hormone replacement during menopause make it a less taxing experience, it can help women mitigate bone loss and even uterine cancer. That is, if their bodies haven’t been too compromised by the hormonal fireworks that accompanied their pregnancy.
It is really more of a Faustian bargain than a divine transformation that turns women into mothers: they gain some extra brain power in the short-term, sure; down the road, though, their ability to respond to medication or remember their own names can disappear.
8. Chronic Pain
Modern society, with its endless variety of desk jobs, daily commutes, and binge-worthy television shows, has already given us plenty of ways to develop chronic back problems. Pregnancy takes all of these hazards and mechanisms for the slow degeneration of posture, and crams them into a crippling nine month window.
Of course, it is hardly surprising that the sudden weight-gain and changing physique that accompanies the later weeks of pregnancy can put a bit of a strain on the spine. What is surprising to many new mothers is that all these bodily changes don’t immediately–or sometimes ever–fully correct following the pregnancy.
Obviously, pregnant women are frequently identifiable by the round “bump” in their abdomens beneath which the fetus is growing. Less visible is the cascade of other physical changes taking place to accommodate this clump of new cells.
A particular hormone, helpfully called relaxin, plays a major role in helping the mother’s body prepare to give birth. As the name suggests, relaxin works by getting ligaments and tissues in the body to loosen, stretch, and otherwise relax. In the correct doses, relaxin helps the pelvis and cervix gain some elasticity, so that the baby can pass through without getting stuck, causing damage, or being damaged on its way out.
The effects of relaxin are seldom so concentrated and precise, however; this is why pregnant women also find their feet painfully swelling and contorting, making it hard to walk or wear shoes. This stretching and loosening can also cause the muscles and tissues of the back to slowly slip out of place and change shape. Expectant mothers compensate for all this by changing posture, adopting a new waddling gait, and training their bodies to accept this as the new normal.
Once all this relaxin dissipates and the pregnancy is over, women’s bodies have a hard time going back to their original shape, and have developed a new muscular memory that prevents them from simply standing up straight and walking with their original stride. That is assuming, of course, that their bodies generated the ideal amount of relaxin in the first place. Too much, and all this sagging, slouching, and shuffling can be even more pronounced during pregnancy, and even longer lasting afterward. Too little, and the entire pregnancy will be accompanied by severe pain as the body struggles to maintain its original shape.
7. Skin Problems
All that relaxin is still no match for the sudden abdominal swelling that makes pregnant women look pregnant. Naturally, that means stretch marks are all but guaranteed; they are difficult to prevent, and impossible to completely eliminate–no matter what the cosmetic company is trying to sell you.
While this is a fairly well-known feature of pregnancy, it is far from the only ill-effect likely to show up in the skin.
It is fun to say that pregnant women have a glow about them; it certainly fits the nonsensical narrative of the magic of maternity. In reality, they are more likely exhibiting chloasma, a sudden activation of melanin in the skin exposed to sunlight, making freckles and moles appear darker, and causing brownish blotches appear, especially on the face. It occurs in as many as three-quarters of all pregnancies, earning it the nickname, “the mask of pregnancy.” Although it is supposed to be temporary, it doesn’t always go away quickly. The beauty industry is happy to accommodate, of course, with all manner of chemical peels and laser treatments that do more harm than good in resolving chloasma.
Absent this change of complexion, women can still look forward to a healthy crop of skin tags, pimply, rice-like growths of excess flesh that may or may not die off after the pregnancy, and will definitely bleed profusely and possibly scar should they be cut or shaved off once they emerge.
Then there is always the chance of pruritic urticarial papules and plaques of pregnancy, also known as PUPPs and pregnancy rash. Unlike most of these side-effects, PUPPs doesn’t have many physical attributes other than itchiness, but routinely alarms women with its appearance. Of course, that fear may have to do with the fact that PUPPs can also disguise the incidence of other more serious skin conditions, ranging from a viral infection to scabies.
PUPPs is such a common condition that doctors generally identify it by sight, rather than testing. This makes it a great instigator for hypochondria among pregnant women, as well as a solid crotch-punch to their self-esteem.
6. Metabolic Disruption
Another hallmark of pregnancy is the double-threat of morning sickness and intense, spontaneous food cravings (or, in some cases, pseudo-food cravings).
These only scratch the surface of the metabolic disruption that afflicts women over the course of their term, and beyond.
While more than 90 percent of pregnant women will experience some degree of morning sickness, in some cases that persistent nausea is actually hyperemesis gravidarum: vomiting so intense and relentless that patients begin to lose weight, dehydrate, and potentially die. It is less common in the developing world, although it remains fatal elsewhere, and is often slow to be diagnosed because it is easy (at first, anyway) to mistake for routine morning sickness.
Even among healthy women, it is possible to develop gestational diabetes, which is exactly what it sounds like: diabetes that develops during pregnancy, creating a cascade of health problems for the mother and her fetus, and putting both at a permanently elevated risk of developing Type II diabetes later on. Gestational diabetes typically diminishes after the pregnancy, but it frequently will lead to a chronic disruption in the woman’s glucose metabolism, not always to the point that it can be diagnosed as diabetes, but significant enough to require medical treatment and dietary management.
Then there is preeclampsia. This condition seems simple on the surface: hypertension, or high blood-pressure, accompanying or following pregnancy. While doctors have been aware of it for nearly two centuries, they still can’t quite figure out what causes it. It seems to correlate with gestational diabetes, for example, but it has also been linked to insufficient vitamin D and sunlight exposure. Of course, too much exposure also tends to spur chloasma, but preeclampsia is more than a passing cosmetic concern.
Hypertension is not particularly healthy for mother or infant to begin with, but along with the elevated blood pressure comes a concentration of proteins in the blood stream. The blood-brain barrier, you may recall, is meant to filter proteins out before blood reaches the brain, but given the hiccups in BBB function during pregnancy, this doesn’t alway work correctly. Preeclampsia can thus graduate to full eclampsia, which is characterized by violent seizures and is very often deadly.
Alternatively, the telltale protein in the blood and hypertension may not manifest, and the preeclampsia will instead rear its head in the form of HELLP syndrome, which entails: Hemolysis (the red blood cells begin to break down), Elevated Liver enzymes, and Low Platelet count (the blood won’t clot properly). This all starts out like pretty much every other symptom of pregnancy: fatigue, nausea, aches and pains, which makes it hard to identify. It can escalate to a bleeding disorder–especially deadly when it isn’t caught before delivery–or else turn into full eclampsia.
Perplexingly, risk factors for major metabolic complications include pretty much everything: it being the woman’s first pregnancy, as well as it being the woman’s second or greater pregnancy; a history of eating disorders like anorexia, as well as obesity. As with all things to with pregnancy, there is a precise happy medium that no one can quite pin down, and everything else falls into “extreme” territory and becomes a threat to the mother.
5. Sleep Cycles Destroyed
People around the world are pretty sleep-deprived to begin with, but growing evidence indicates that women tend to get less sleep than men. Even without adding children or pregnancy to the picture, women’s elevated levels of estrogen, and the cyclical hormonal fluctuations that accompany their menstrual cycles mean that their circadian rhythms are under constant bombardment.
All of the aforementioned complications and features of pregnancy–the metabolic changes, the constant pain, the hormonal fireworks (which make it harder for women to mitigate their urge to pee, especially when they are trying to sleep)–combine to put a good night’s rest on a nine-month hiatus.
Finally having the child at home doesn’t help matters much, as the irregular feeding, pooping, and crying cycles of the newborn–along with some residual hormones tapdancing on the mother’s nerves–ensure that sleep, much like tomorrow, is always a day away.
Pregnancy and motherhood constantly blur the line between insomnia and outright sleep-deprivation, and even for women in otherwise perfect health, this becomes a risk factor for every other pregnancy complication, as well as mood disorders, accidental injury, and death.
4. Potty Problems
There is really no nice way to say it–which is probably why so much of the time, nobody says anything, and the new mother finds out the hard way:
No matter how the mother delivers–naturally, or by C-section–she is going to have some poop issues.
Caesarean surgery (C-section) is a procedure in which the baby is removed from the mother’s abdomen, rather than delivered naturally. It has become the most common form of major surgery in the world, due to the fact that more than a third of all births in the United States are via C-section. It is also completely unnecessary a great deal of the time, yet mothers frequently capitulate under the persistent pressure to elect to have the surgery.
Although c-sections are meant to be a pathway to avoid high-risk pregnancies and deliveries, bypassing vaginal delivery entirely, they still often lead to some form of incontinence: that is, mom no longer has any choice in when or where her bladder evacuates. In the case of C-section deliveries, though, there is a risk of laceration of the internal organs, including various parts of the digestive tract, as well as the bladder, uterus, and all the reproductive organs (obviously, that’s what C-sections are for–as a complication, this type of laceration is unintentional beyond what is required for delivery).
Doing it the old fashioned way, of course, involves a lot of straining and pelvic tension, which invariably results in the mother clearing out her bowels and uterus right at the same time. Precisely because almost all vaginal deliveries involve pooping, it generally gets no attention: the medical staff are ready to scoop the telltale turd right out of the way to clear the landing zone for the newborn, and the mother so preoccupied that she very likely won’t notice that it happened.
She likely will notice in the weeks following delivery, however, when she finds herself strapping on a diaper to manage persistent incontinence. That’s right: it isn’t just babies who need diapers. Alternatively, all the straining and trauma (surgical as well as natural) that accompanies either type of delivery can also cause the sphincter to go on strike, and constipation to set in after childbirth. Depending on the severity, this can be remedied by something as innocuous as prune juice and high-fiber cereals, or the more sporting suppository laxative.
But mother’s is not the only fecal event in the aptly named delivery room.
Although still fed via umbilical cord and not able to “poop” in the full sense of the word, it is possible for the fetus to evacuate its own developing digestive system while still in the womb. These fetal feces–known as meconium–are released into the amniotic fluid suspended inside the uterus. Because the fetus does not take its first breath until after it has exited its mother, it can be at risk for meconium aspiration, literally choking on its own poop before it is even born. Stress experienced by the pregnant mother can stimulate a fetus to pass meconium–anything from excessive exertion to extreme shock. Since vaginal delivery pretty well meets both definitions, it is common for meconium to be discharged during birth, which while unpleasant, puts the fetus at lower risk of aspiration.
3. Emotional Trauma
Clearly, pregnancy and childbirth is a pretty extreme experience–the impact of which is not aided in the least by the tendency for most cultures to “yada yada yada” their way from conception to the intangible, life-altering joy of parenthood. Besides glossing over the less attractive details of the whole process, it sets up some extremely misguided expectations in people going through pregnancy.
As many as one out of every four known pregnancies ends in miscarriage, also known as spontaneous abortion. Causes range from obvious lifestyle issues (drug use, diet) to previously unknown problems with the mother’s reproductive system, to immune system responses terminating the gestation of the young embryo.
If the emphasis on “known” pregnancies seems odd, try to appreciate that a small yet measurable proportion of women manage to carry a fetus all the way to delivery without recognizing that they are pregnant. Accounting for all of these unknown pregnancies, the rate of miscarriage is estimated to be as high as one in three. All these statistics distinguish miscarriages from stillbirths, which are essentially when the same problems terminate a pregnancy after 20 or more weeks of gestation. Measured separately, this accounts for another 26,000 births per year in the U.S. alone, a rate which has remained stable for more than a decade.
The identities of women and girls around the world can be extremely caught up in maternity and the joy (or obligation) to bear children. As such, miscarriage can be a source of pronounced personal shame, trauma, and depression.
Healthy mothers who successfully delivery live, resilient babies are still at risk for developing postpartum depression, a serious condition whose name is well know, but whose nature is poorly understood. Postpartum disorders can manifest as anxiety and obsessive compulsive behaviors, often revolving around the safety and welfare of the newborn. It can also take shape as a more typical form of depression, involving extreme sadness, a sense of isolation, hopelessness, and general despondency. Again, because an idealized expectation for maternity can dominate women’s identities, postpartum symptoms can involve extreme guilt, a sense of failure, or a fear that somehow, you are not fulfilling your role as a mother.
Postpartum depression is not entirely the result of socialization. Ongoing research is exploring the role of genetic factors in causing the disorder, in the hopes of providing better treatment to suffering mothers.
Roughly 10 percent of all women will experience post-traumatic stress disorder (PTSD) at some point in their lives, and research indicates that women who go through pregnancy are at an elevated, lifelong risk of experiencing or exacerbating symptoms of PTSD. This can result in all manner of complications during and after pregnancy, afflicting both mother and child. There is also strong evidence indicating that extreme trauma can be imprinted on DNA and passed from mother to child; survivors of the Holocaust and the 9/11 attacks have been shown to have transmitted a genetic imprint of their experiences to their children.
2. Obstetric Trauma
Whatever your opinion of trigger warnings, consider this a final opportunity to avoid learning things you cannot unlearn.
All scatalogic discourse aside, human childbirth is a messy process, equally as likely to traumatize mothers physically as emotionally.
Although the physiological and historical reasons are unclear, the bottom line is that humans have evolved to have larger heads, without females evolving large enough pelvic bones to accommodate them. Put differently: babies’ heads are generally too big to fit through their mothers’ birth canals.
In some cases, these relative differences are so extreme, there is truly no alternative to C-section delivery. For everyone else, that means a long, slow, painful delivery–more than nine hours on average–that will likely result in one of two typical forms of obstetric trauma.
First: vaginal tearing. The sheer pressure of gigantic baby head against tiny vaginal opening can’t go on without one side giving way, and that side is almost always the strip of skin (perineal area) connecting the vagina with the anus. First-time mothers have a 95 percent chance of at least some tearing occurring during delivery.
Sometimes, of course, the blunt force of the baby’s battering ram cranium isn’t enough to break through. That is when your friendly obstetrician-gynecologist will slice open your vagina manually, a procedure known as episiotomy, which surgically lacerates the perineal skin and lets the newborn slip through the tattered genital curtain.
The alternative (or unavoidable side-effect, unfortunately) to all the heaving and hemorrhaging of natural delivery is injury to the mother’s coccyx. Although this is often described as a fracturing or bruising of the tailbone, it is effectively more like a dislocation caused by the infant on its way out.
As might be expected, the subsequent recovery period frequently entails incontinence (and more diapers) as well as a loss of sexual desire. It only takes a few weeks for most perineal lacerations (incidental or manual) to heal, although some require stitching to hold them together until the skin can grow back together.
Last but not least, there is pelvic organ prolapse.
Imagine wearing a latex glove, then trying to remove it. About half the time, you will find the glove sticks to your hand and turns at least partially inside-out when you yank it off.
Now imagine that your hand is a baby, and the glove is a vagina.
That is, one finger of that glove is a vagina; the others are, potentially, the bladder, uterus, rectum, or intestines. And they may not all come flopping out right when you remove your hand/baby; any of them could emerge from the stretched out opening at any time, even 20 years after the initial delivery.
As you might expect, historical records of this occurring are as old as humanity itself, yet general awareness of it is very low. Because it makes for such an uncomfortable subject of conversation, experts expect that the actual rate of occurrence is much higher than the rate of reporting–which is already more than 50 percent of all mothers.
1. Momnesia
How many diseases have the ability to make you forget how terrible they were, so that you are driven to go out and get it again? Well, that is the genius and horror that is human reproduction: after it tears up mothers from the inside out, in ways both visible and invisible, it sets off one final coup de grace of hormonal chain reactions to cover its tracks.
Actually, some evidence suggests that short-term memory loss is a feature of even the earlier stages of pregnancy–hence the phrase, “pregnancy brain” or “baby brain” in reference to lapses of memory associated with pregnancy.
Other literature refers to a “halo effect,” which is when mothers over time begin to recall the pain of delivery less, and the joys of motherhood, thrill of seeing their newborn, or other positive features of childbirth more. It is debated whether this is a result of hormonal events following delivery, or simply a cognitive fallacy expressed in the context of maternity. This is part of the reason breast-feeding and other maternal bonding activities are encouraged, though: they can help trigger the release of hormones associated with happiness, socialization, and the formation of relationships.
There is other evidence that memory problems can be a side effect of postpartum depression, although this is not strictly limited to memories of the pain of delivery.
Whatever the specific cause, studies have repeatedly shown that for a majority of mothers, individual ratings of memories of the pain of childbirth go down over time. It is as though experiencing some sort of biological Stockholm Syndrome that makes them talk about how grateful they are to have given birth, rather than the more honest, “Yup, this melon-headed ankle-biter split me like firewood coming out.”