Maggie McKay (Host): Pregnancy is one of those life experiences that nobody can really prepare you for. You can read books, take classes, ask your friends advice and watch videos, but there are some things that nobody tells you about. That's where our guest today comes in. Gynecologist, Dr. Rebecca Eddinger, she'll fill us in on things no one warns you about pregnancy.

Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad, everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. Thanks for listening. I'm Maggie McKay.

Thank you so much for joining us, Dr. Eddinger. I have to say I thought I was overprepared for our baby to arrive. But once he did, so much of what I learned went out the window and I was shocked at how much I did not know. So, thank you for helping us to understand some things women will go through during these nine months.

Dr Rebecca Eddinger: You're welcome. It's my pleasure to be on the podcast. I am an OB/GYN at Valley, but I'm also a mom, so the discomforts of pregnancy are not only something I see professionally, but many I've lived as well, so I get it. Pregnancy's not always a glowing experience, but hopefully I can shed a little light on some of the reasons why we have these discomforts during pregnancy and what we can do to alleviate them.

Maggie McKay (Host): Great. Well, let's start with what are some of the more common uncomfortable body changes women experience during pregnancy?

Dr Rebecca Eddinger: I think one of the big things that patients complain about and experience is changes with the GI tract, constipation, heartburn, those are some big ones that we see.

Maggie McKay (Host): And do you have any suggestions for finding comfort or trying to prevent that?

Dr Rebecca Eddinger: So for constipation, this is when you're having difficulty passing stools or really infrequent bowel movements. It really can happen throughout the pregnancy and it has a lot to do with, early in pregnancy, the high levels of progesterone that really slow down digestion. Later in pregnancy, it could be related to iron supplements that you've been recommended to take or, even during the third trimester, it could just be from the weight of the uterus contributing to the problem, putting pressure on your rectum.

So, my biggest suggestion for constipation is, for starters, making sure that you're drinking plenty of fluids. Definitely increase your water intake during pregnancy. You should aim for eight to 12 cups of water a day, or at least 64 ounces. You also could add some prune juice, that can help with the constipation. And then, look into your diet. Make sure that it's high in fiber. You want fruits, vegetables, beans, whole grain breads. And then some over the counter things that, you know, I would suggest and your doctor would likely suggest as well would be some fiber supplements such as metamucil. But those really do rely on good water intake, so you have to make sure you're increasing your fluids. Additionally, over-the-counter, you could do stool softeners like Colace, those are safe in pregnancy. And then, if you needed to turn to like a bowel stimulant or a laxative, something like a MiraLax would be a gentle option that you could do in pregnancy.

Maggie McKay (Host): That's so good to note because I think a lot of women who are pregnant don't want to take anything, even like Tylenol or Advil just to be on the safe side because of their baby.

Dr Rebecca Eddinger: Of course, a lot of these are safe to do because they're not actually absorbed by the GI tract. They're working on pulling water into the system. So, these are considered safe to take in pregnancy and may be really helpful for the discomforts. The other thing really to do is just try and get out and walk and exercise because that really can help move the GI tract along as well.

Maggie McKay (Host): Is pregnancy carpal tunnel a real thing?

Dr Rebecca Eddinger: So, carpal tunnel is a real thing. It has to do with the increased swelling that you experience in pregnancy, even in those tiny spaces that you can't really see. It's putting pressure on the nerves, so that compresses the tiny nerves that are running through your wrist and moms experience that as numbness or tingling in their hands. It makes it hard to do fine motor activities. Sometimes moms tell me they have trouble even gripping the dishes to comfortably clean, but it's not worrisome and it will generally go away after birth. The biggest thing you could do is wear wrist splints to try and help avoid any excess compression on the nerves, but that's not necessarily comfortable either. So, sometimes it's just a waiting game until you're postpartum to see if there's improvement.

Maggie McKay (Host): It's so unfair. It's like, come on, we're pregnant. Isn't that enough? Now, we have to wear wrist guards?

Dr Rebecca Eddinger: Exactly.

Maggie McKay (Host): There's always something, right? Dr. Eddinger, what can be done for our skin, like acne, dryness, itchiness, pigmentation when we're pregnant?

Dr Rebecca Eddinger: Yeah, that's a big one for patients. First of all, I guess when it comes to the pigmentation issues, your body's producing more melanin, which means certain areas of your skin are going to appear darker. Patients might notice like darkening of their nipples or the areola or that dark line that runs from their belly button down to the pubic hair. Usually within a few months after delivery, that skin pigmentation is going to return to normal, but that can be a little bit concerning for patients, but there's really nothing to do about it.

The other one that patients might notice is the dark patches on their cheeks, nose, forehead that we call melasma. That can be made worse by sun exposure, so it is important to try and limit your direct sunlight exposure and wear hats. And again, that usually will fade a few months after delivery.

Maggie McKay (Host): That's good news. What about acne?

Dr Rebecca Eddinger: So, acne's also common. And if you're already prone to acne, it could be worse during pregnancy. So, I really recommend patients just try and wash their face twice a day with mild cleanser. And you can use over-the-counter acne treatments because there's really very little systemic absorption of these. So, you could use products that have a topical benzoyl peroxide, azelaic acid, salicylic acids and topical glycolic acids. But I would caution you if you were previously on a prescription acne medications, topical retinoids, oral antibiotics, those should really be avoided in pregnancy.

Maggie McKay (Host): And I know some women have amazing hair due to those prenatal vitamins during pregnancy, but other people lose their hair during pregnancy. So, what is the story on that? Some people have hair growing in places they never thought it could.

Dr Rebecca Eddinger: Right. Again, a big bonus of pregnancy, like you said, is your hair often will feel thicker, and it falls out less by the second trimester because of the increased estrogens in pregnancy. So, your hair tends to stay in this growing phase longer than usual during pregnancy, so it feels great. But unfortunately, postpartum, all of those shifts in hormones means a lot of your hair will go back into the resting phase at the same time. So, you'll feel like you're losing much more hair than you'd normally do. You'll see more in your brush, around the drains, probably about four months postpartum. Most people will notice by one year postpartum, that their hair growth patterns are really returning to normal, and there's not too much you can do about it. I would say look around, all the new moms will have those little baby hairs that frame their face. It's just a cute reminder that you're postpartum.

Maggie McKay (Host): Right. And some people take prenatal vitamins even though they're not going to be pregnant for their hair. Is that a good idea?

Dr Rebecca Eddinger: There's really no harm in doing that. I think, if you're of reproductive age, taking a prenatal vitamin could only be helpful.

Maggie McKay (Host): Okay. And what are some of the lesser known body changes that women experience? You touched on a few earlier, but there are so many.

Dr Rebecca Eddinger: I think some of the things in the first trimester that patients might notice, aside from a lot of women will talk about, sometimes you'll notice excess saliva. And that has to do with the hormones of pregnancy too. It can also contribute to like a bitter taste in your mouth and might make the nausea worse. Not much you can do about it. You could try sucking on ice or brushing your teeth more often, but it's just an unusual symptom of pregnancy. But it often eases after the first trimester.

Another thing that can concern patients with their mouth sometimes is bleeding gums. You might notice that your gums are more sensitive when you're brushing or flossing and you might see more blood when you're spitting, and that's from the hormones that make your gums more sensitive to the bacteria, so just continue to brush and floss. You could try using like a softer toothbrush, but also keep up with dental cleanings during pregnancy as usual.

Maggie McKay (Host): And Dr. Eddinger, we have to talk about breasts because that's a big part of pregnancy. Should we buy nursing bras when we're pregnant? And will our breasts and nipples return to normal after pregnancy? Because after breastfeeding, it's a whole new world.

Dr Rebecca Eddinger: So yes, even early in pregnancy, your breasts will start to swell and it might go up a whole cup size before you even are ready to start telling people that you're pregnant. There's fat buildup, there's increased milk glands that lead to the change in size. And this is a good reason enough to switch to a maternity or nursing bra. They have more coverage. They often have wider straps that are more adjustable. They even make extenders that you could buy to put like an extra row of hooks to your regular bras. Just check Amazon, they have everything. So, that's something that you could certainly look into.

Another thing that might concern patients as you get further along in the pregnancy is you could start to leak a little bit of like that thick, yellow fluid, the colostrum that we typically see after delivery. And it's normal to have some leaking during the pregnancy, but it's also normal if you don't leak. It doesn't mean you're not going to be able to breastfeed, but that can be a little surprising for patients when they see it before the baby's here.

Maggie McKay (Host): So after pregnancy, generally, do your breasts go back to normal?

Dr Rebecca Eddinger: So, it depends. As far as the size and the appearance, maybe a little bit different, especially depending on your time breastfeeding. You also might notice that the areola have grown a little bit larger in size during pregnancy and that tends to go back to normal. But they might stay a shade darker than what you remember.

Maggie McKay (Host): Dr. Eddinger, when it comes to sweating, I always thought that was just reserved for menopause. But now, I hear that maybe that's part of pregnancy as well?

Dr Rebecca Eddinger: It is. As much hormone changes as women are experiencing postmenopausal, pregnant women are experiencing hormone changes too, and that can contribute to hot flashes, excess sweating, feeling super hot when everyone around you feels just fine. It also has a lot to do with the increased metabolism in pregnancy, so you're generating more heat just as you're burning more calories. So, all I can say is try to wear loose clothing and drink water, have fans nearby, and I guess that's one of the only benefits of being pregnant in a New Jersey winter.

Maggie McKay (Host): You don't want to be pregnant in Southern California, trust me, or the desert, you know, Palm Springs, whatever. What is pregnancy-related rhinitis?

Dr Rebecca Eddinger: So, this has to do with swelling in the mucus membranes in your nose. The hormones of pregnancy cause this to happen. It can make your nose dry out and bleed more easily as well. So, a lot of pregnant women feel like they constantly have a stuffy nose or even a runny nose. If it's feeling dry, saline drops are probably the best thing to do. Or if it's the skin around the edges, try some petroleum jelly to help with the dryness. And you may want to consider having a humidifier in your bedroom just to moisten the air a little bit.

Maggie McKay (Host): That's a good idea. So if I lose my sense of smell, will it come back after the baby's born?

Dr Rebecca Eddinger: it will improve after delivery. This does happen sometimes just from the stuffiness and the hormone changes, especially later in the pregnancy, but you will get your smell back.

Maggie McKay (Host): How do I know when to call my doctor?

Dr Rebecca Eddinger: So, as far as these common pregnancy discomforts, don't hesitate to ask about them at your regular OB visits. There's a good chance we're going to tell you it's normal, but we also may be able to ask more questions and see if it sounds like something beyond the normal pregnancy discomforts. But I would say if you're between visits and there's something that seems unusual, especially if it's pain that's not relieved by Tylenol or changing positions, or if there's anything like abdominal cramping, bleeding, et cetera, don't hesitate to call your doctor. In general, the practices will have an OB nurse at least that can help you figure out if you need to be seen urgently or put you through to a doctor or midwife that can help answer your questions.

Maggie McKay (Host): I have to tell you, Dr. Eddinger, when I was pregnant, the bible of pregnancy was What To Expect When You're Expecting. And I have to tell you, I just learned more today in this conversation with you than maybe in half of that book. It was helpful for sure. But like we said, the topic of this conversation has been things people never tell you, and pretty much everything you said I never knew. So, thank you so much for sharing your knowledge. Is there anything you would like people listening to take away from this?

Dr Rebecca Eddinger: I think just that pregnancy can be a very exciting time, but there's a lot going on between the ultrasounds and the baby showers and it can be really uncomfortable. So, know that you're not alone. Pregnant women are experiencing this, and your OB is there to help guide you through this, so don't hesitate to ask.

I will say a good resource for somebody who wants some more information would be the book called Your Pregnancy and Childbirth Month to Month. It's a great resource that's written by OB/GYNs. And it's what I would recommend if somebody wants more detailed information about the changes their body's going through.

Maggie McKay (Host): That's great to know. Dr. Eddinger, thank you so much for all this useful information. I'm sure you're going to help a lot of expectant mothers when they listen to this. We appreciate you.

Dr Rebecca Eddinger: Thank you.

Maggie McKay (Host): For more information about obstetrics and gynecology at Valley, please visit valleyhealth.com/obgyn or call 1-800-VALLEY1, 1-800-825-5391 to schedule an appointment. If you found this podcast helpful, please share it on your socials and check out our entire podcast library for topics of interest to you.

Thanks for listening to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-291-6090 or email valleypodcast@valleyhealth.com. I'm Maggie McKay. Be well.