Updated: Tuesday, March 27, 2007
Pregnancy and Medical School
Looking back at the many conversations I've had with classmates, residents, and attendings, I've realized that we all put a lot of focus on dealing with the stresses that come with taking care of babies and raising children. We all obsess about our post-delivery schedules, planning to have children during a lighter part of our training. The trouble with that is that we end up stacking all the tough scheduling up front before the baby arrives, forgetting one crucial thing: the pregnancy. Depending on what your role is, you'll either be pregnant, or be supporting someone who is pregnant (which is also no small task). A decent amount of thought should go into planning the timing of the pregnancy since it can either be easy or difficult, and everything in between. And the experience can differ greatly between children too. Some women coast through the 9 months barely feeling any different in terms of nausea and energy level, while others are placed on iv fluids or bed rest for months because of hyperemesis gravidarum or preeclampsia. It's hard to predict what you'll be like, and so the scheduling is pretty important. I'm not really sure what the best way to plan out those 9 months is, but I'd try to keep the first and last trimesters light and flexible since those are the least predictable in terms of how you'll be feeling (and in case you deliver early).
My personal experience with pregnancy was pretty similar for both kids. The worst parts occurred in a bimodal fashion - between weeks 6 and 15 and after week 30. Nausea, then physical strain. The rest of the pregnancy was fine, but there were other things I worried about (there always seems to be something to worry about). I worried about whether the baby was growing normally, whether I was gaining too much or too little weight, whether I was eating the right variety of food - pretty much what all pregnant women worry about. I also thought about appropriate organogenesis, teratogen exposure, and the myriad of congenital diseases that could affect my child. It wasn't easy going to pathology lab and seeing tiny little tetralogy of Fallot hearts, or opening up my developmental biology book and seeing photos of hydrops fetalis and anencephaly.
I'm a pretty healthy individual who, fortunately, doesn't get sick much. And when I do, it's never really that bad. So, the pregnancy-related nausea really hit me hard. "Morning sickness" is really not an accurate statement, in my opinion. The nausea was there 24/7. I didn't even really throw up that much (probably a single digit number), but the nausea - oh, it was awful. I'd feel like throwing up throughout the whole day, which was much, much worse than just throwing up. And it wasn't really tied to any particular food or odor, though anything with a strong scent did not help at all. It was terrible. I'd carry around a couple of Zip-Loc bags with paper towels, a toothbrush and toothpaste in case I needed to throw up. When I went out, I'd keep an eye open for every bathroom and trash can in the vicinity. Strangely, food made the nausea better (which was the opposite of any previous experiences I had in the past). I'd keep crackers and gum with me all the time. Nothing really tasted good, and nothing really helped that much either. I was pretty miserable.
The other thing that I wasn't aware of regarding the pregnancy was how tired I'd end up feeling during the first trimester. I was wiped out. I've never had mono before, but I imagine it would be a lot like how I felt when I was pregnant. It was tough, since no one really knew I was pregnant (we had not planned to tell everyone until the end of the first trimester), and I certainly didn't look pregnant, but I felt pretty crummy. I was exhausted. I'd sleep every spare moment I had. During the first pregnancy, I'd go to class, come home and sleep for 4 hours, have dinner, and go right back to sleep and not wake up until the next morning. I was literally sleeping about 18 hours and day and still feeling tired. That feeling didn't ease up until the middle of the second trimester. And, since I was choosing to avoid caffeine at that time, I couldn't tank up on coffee to stay awake either. Studying late into the night was nearly impossible. With my second pregnancy, I happened to be on my general surgery rotation, and that was pretty difficult as well. Early mornings, long hours, and all that running around made it hard to eat regularly, and I remember thinking "If I can just make it through this rotation without throwing up on a patient (or worse, in the OR), I'll consider this a successful clerkship."
The second trimester was great - I hardly even felt pregnant at all, except for my growing belly. With the first pregnancy, my belly wasn't noticeable until month 6, so I enjoyed a longer time of feeling normal size. With the second pregnancy, I started showing around month 4 (probably because my abdominal muscles had been stretched out once before) and felt cumbersome for a longer period of time. But in general, the second trimester is a great time to enjoy the pregnancy, shop for baby stuff, and also get some work done before the final stretch.
During the third trimester, I didn't really feel sick or nauseated, but I certainly felt cumbersome and tired. It was hard getting in and out of the car, and I felt clumsy a lot as well. With my first child, I was still going to class, and it was hard carrying around my books. I ended up buying a rolling backpack to lug around my huge Robbins pathology textbook and my computer. I felt a bit dorky but it really helped a lot. With my second child, I was on outpatient pediatrics, which was pretty nice considering I could usually sit down and there wasn't a lot of running around or heavy lifting. It was tough to get good sleep because I had to get up to use the bathroom twice each night, and I could pretty much only sleep on my left side. Sleeping on my back made it tough to breathe, and apparently, you're supposed to avoid sleeping on your right side (pressure on the inferior vena cava).
Looking back, I'm not sure if either situation was better than the other. Both times were difficult, but bearable. With the second pregnancy, I reassured myself that we were not planning on having any more children, so at least the nausea and unpleasantness was a finite situation. I also missed eating sushi, other fish, soft cheeses and having that occasional frappucino (I'm not much of a coffee drinker to begin with, but I started to miss it while I was pregnant). I don't really drink alcohol either, but can imagine that people would miss that too. I'm definitely not one of those women who love being pregnant. I enjoyed knowing what the pregnancy was bringing, but the actual experience was definitely tough at times and I am glad I don't have to worry about that anymore.
