8 How does a woman know she's pregnant?

8.2 Experiencing the pregnancy

If a woman does find herself pregnant, what can she expect? Pregnancy is a time of enormous physical and emotional changes, and these are often difficult to cope with. To begin with, the physical effects of early pregnancy can be extremely unpleasant. The nausea and vomiting of morning sickness can be very severe, and although in many women the symptoms abate after a while, in others they persist right through the pregnancy. Sickness is thought to be due to the high levels of progestogen circulating in the blood.

Q Where is the progestogen made?

A It is made initially by the corpus luteum.

At later stages, progestogen is made by the placenta, and it is necessary to maintain the pregnancy. Women differ in the degree of morning sickness that they suffer – some do not suffer at all, and in many women the amount they suffer varies with each pregnancy. It is not known whether this is because women produce different amounts of progestogen, or whether they can tolerate different levels of it (or both). Whatever the reason, this does not alter the fact that the woman may feel very ill. During this time she may nonetheless have to function as efficiently as always, while perhaps concealing her condition – for it will not at this stage be obvious to anybody (except perhaps mystics) that she is pregnant.

Other ‘normal’ symptoms of early pregnancy are generally easier to cope with. Sore breasts, again resulting from exuberant hormones, are often no more painful than what the woman may experience every month during her menstrual cycle. An increased appetite, something which, rather perversely, often accompanies morning sickness, is usually easily dealt with. Many symptoms associated with pregnancy, such as raised blood pressure or fuid retention, do not usually occur until later on, when the fetus has grown bigger.

One thing that must be emphasized is that all the changes associated with pregnancy are for the baby's benefit. A normal, healthy woman is well adapted to her diet and lifestyle, so it is likely that she will find any body changes unpleasant. Added to the physical discomfort is often severe emotional upheaval, particularly if it is a first pregnancy. The prospect of fundamental lifestyle changes are sometimes difficult for people to accept. Even when a pregnancy is very much wanted, it is not unusual for women to suffer periods of depression and worry about the future. Part of the worry surrounds practical issues like jobs, housing and money, but most women also worry about the pregnancy itself, and whether the baby will be healthy. As you know, many pregnancies are unsuccessful for the very reason that the embryos are not healthy, and, perhaps mercifully, many abnormal fetuses are spontaneously aborted. However, a small number of babies are born with some kind of abnormality, and this knowledge cannot fail to be a source of worry, especially if there is a family history of disease or if the woman is in her late 30s or older.

In our society, pregnancy is generally very popular with the non-pregnant, particularly in the ‘correct’ social circumstances. But even the most universally welcomed pregnancy is likely to appeal rather more to by-standers than to the mother-to-be herself. The combination of physical effects and deep emotional disturbances can cause uncharacteristic mood swings which may be hard to live with. All this makes pregnancy seem like a case for intensive care (and perhaps contributed to the pervasive view that pregnancy is an illness), but even the worst of pregnancies is only temporary, and this knowledge gives many women cause for cheer, especially if they are looking forward to having their baby. Many women differentiate in their own minds between ‘expecting a baby’ and ‘being pregnant’, and the feelings associated with each can be diametrically opposed. Most women, however, achieve some balance that they can live with, so that although reproduction may not be an entirely pleasurable experience, it is usually not all bad, either. The anticipation, the challenge, the excitement of feeling movements, and generally feeling special are all aspects of pregnancy that most people thoroughly enjoy.