The 1st Trimester

Nothing could have prepared me for this.

This twin pregnancy laughed in the face of all the knowledge I thought I had as a midwife.

The side effects of this “magical time” left me annihilated: the nausea, constipation, reflux, back pain, lethargy, depression etc.

Reading about it in a textbook and experiencing it first hand was an incomparable experience. I just wasn’t prepared for these symptoms to wreak such colossal havoc on my body, leaving me feeling imprisoned to this flesh whose only purpose, it now seemed, was to grow babies.

Depression – in the first trimester – I was prepared for though. I had noticed a significant trend amongst women (both patients and friends) who expressed disappointment and sadness due to the fact that they weren’t feeling excited to be pregnant.

This is typically due to a trifecta: the misery of nausea, debilitating lethargy and the power of progesterone (as I’ve spoken about in The Hormonal Chaos).

It is almost impossible to be happy when you feel this way. But, knowing that it is NORMAL can lead to radical acceptance (and can also help you realise that you just need to ride it out and not overanalyse it – the happiness will usually come in the 2nd trimester, don’t worry).

This, of course, is even more complicated in women who have undergone fertility treatments, leaving them depressed that they’re depressed and feeling utterly disappointed that they aren’t excited (especially when they wanted this pregnancy SO much).

Depression (and I emphasise – in the first trimester) is so common, that I was not phased by it when it happened to me.

But, what I wasn’t prepared for was “the Guilt Sandwich” that overwhelmed me those first few months.

The first layer of this unexpected sandwich was my lifelong friend GUILT: I felt SO guilty that I was too sick to work. We had spent a fortune trying to get pregnant, and now I couldn’t go to work, which not only made our finances tighter at home, but also affected my maternity leave. And of course I was stressing about the financial implications of having twins.

On top of guilt was a thick layer of fresh, homemade ANGER: I was so angry that I was debilitated by my pregnancy. I was so angry that my physical suffering was to continue – that I was never going to get a break. I was genuinely shocked by how angry I was; it was not an emotion I was prepared for.

As soon as the anger was spread nice and thick, more GUILT would plonk itself on top:

How could I be so ungrateful?

I felt so guilty for complaining.

This was such an amazing outcome. We were pregnant with twins! What was wrong with me?

I also felt WEAK and PATHETIC. I beat myself up for not being able to work – comparing myself to others who seemed to “suck it up”: A classic example of how we make our life so much worse than it needs to be, and how we are responsible for creating the “hell” that we live in. No one was telling me that I was weak and pathetic, in fact they were saying the opposite, but it was my own internal dialogue that was so incredibly harsh and made my suffering so much worse.

Another emotion that caught me off guard was GRIEF – I thought that once I got pregnant that I would no longer experience grief, but the truth is that I grieved the fact that, once again, I was debilitated by a physical illness and it felt as though I would never have reprieve. And, to be honest, those feelings were not far fetched: I never did get reprieve – for the entire pregnancy.

Every two days my nausea would get worse. With each new ascension of nauseas intensity I would grieve my suffering again – moaning and crying and writhing and weeping.

“I can’t do this,” I would moan to my husband, “this is going to kill me. I won’t survive.”

I would begrudgingly try to adjust to my new level of misery – that is until the next day when the nausea would increase again, leaving me moaning and crying and writhing and weeping.

This cycle repeated itself every second day until my nausea “peaked” at around 12.5 weeks. It was around this time that the smell of my husband became utterly unbearable. I had struggled with his general “smell” from the beginning, but each week it got worse and worse and worse. I would wake up in the middle of the night bemoaning my husband’s suddenly intolerable halitosis (the truth is, he doesn’t really have bad breath, but when I was pregnant it sure felt like it).

I would open the doors and stick my head out into the wintry night, gasping as if I was suffocating.

“DO YOU HAVE TO BREATHE???!!!” I would scream, waking my husband up from his deep sleep, “CAN’T YOU SLEEP WITHOUT BREATHING???!!!!”

It felt as though he was trying to kill me. At around twelve weeks I finally forced him to take holidays (vacation time) and go away for a couple of weeks. I just couldn’t take it anymore.

My poor husband was judged by onlookers.

“How can you leave your wife when she is so sick?” they would comment. How could my husband explain that I was absolutely, undeniably repulsed by him – in fact, I wished he could stay away for longer.

And it wasn’t just him; I was repulsed by EVERYONE and EVERYTHING. I had the occasional visitor but, if I were to be completely candid, I preferred to not have visitors at all because not only was I unable to hold a conversation due to my debilitating misery but the smell of their deodorant alone exponentially increased my nausea.

I also wasn’t prepared for the sheer isolation that pregnancy was going to impose on me. In those first three months I only left the house three times – for doctor’s appointments only.

The cat was my only companion, my only distraction.

It took me a LONG time to accept that isolation (for me) was to go hand in hand with pregnancy.

And, much to my chagrin, the depression was also to linger until the end of my pregnancy. The combination of physical misery, isolation and significant hormonal changes made depression inevitable.

This was heightened by my use of supplemental vaginal pessaries (waxy little capsules of progesterone that yes, go up the vagina). My dose of progesterone also had to be increased as I kept spotting those first few weeks (and would have anxiety-inducing gushes of fresh blood each time I threw up).

As a midwife, I have always felt incredible empathy for women who have bled during their pregnancy. I had always imagined that it would induce terrible anxiety: now that I was experiencing it, it really was as horrible as I had imagined.

This increased dose of progesterone came with other unfortunate side effects – an increase in depression, lethargy and constipation (and I won’t even go into detail about the copious, disgusting, waxy, cottage-cheese-like discharge that resulted from vaginal insertion of these pessaries).

But I will tell you about the constipation (I say this as a disclaimer, so that if you continue reading it will be at your own discretion).

I think it was the lethal combination of dehydration, lack of fibre and progesterone, but one day it escalated into an experience that left me not only traumatised, but begging for mercy from the heavens.

I was living off ginger beer and biscuits/crackers.

I became so dehydrated that I lived with a perpetual headache, cracked lips and cracked skin.

I am sure the dehydration made my nausea worse, but water tasted TOXIC – I just couldn’t stomach it.

Oh, how humbling this was. How many times had I INSISTED that my ladies drink water, and take their vitamins, whether they felt like it or not?

Here I was, COMPLETELY UNABLE to do either of those things.

What a hypocrite I was.

Deep down I knew that if I just FORCED myself to drink water, that perhaps I would feel a tiny bit better – but I just couldn’t do it.

My sunken eyes and grey skin screamed of the need for IV fluids, but I couldn’t bear the thought of exposing myself to not only the smell of the car, but also the horror of the hospital. I felt like I’d rather die at home than leave the house and expose myself to the smells of the outside world.

And of course, severe dehydration = severe constipation.

I had never experienced anything quite like this before.

As a young nurse working in Adults (I have never had to do this in Pediatrics) I had a couple instances where I had to perform – with a poker face hiding my sheer disgust and abhorrence – what’s called a “digital removal” or “digital disimpaction”; meaning you use your finger to try to force the feces out of the rectum. Usually once the main blockage is removed, the rest will continue to flow (sometimes shooting out like a fire hose).

It’s been over a decade since I have had to perform this – and I was hoping I would NEVER have to do it again.

But here I was.

Sitting on the toilet.

Bearing down so hard that my vision got blurry, I felt dizzy, and my heart rate slowed down to a near black-out rate.

I thought I was going to pass out.

It had been several days since I had “passed a stool” or “opened my bowels”.

I’d sit on the toilet for up to an hour, unable to get anything to move. I’d try my hardest not to strain, keeping in mind what the physical therapists said about protecting your pelvic floor, but the most I could achieve was the utterly frustrating “groundhogging” (click here if you really want to know the definition).

No matter what I did – it would slide right back in.

Each day it got progressively worse, until it finally became such an enormous mass that “groundhogging” ceased and I wasn’t sure it could even exit my body. I knew I would have to resort to extreme measures to get it out, but the mere thought of what I needed to do sent my body into convulsions.

I sat on the toilet, my hands shaking in reluctance.

“Please God,” I begged, “if I survive this, I PROMISE to drink more water. I PROMISE to stop eating crackers. Please, please, please help me get through this.”

Never had I uttered such a strange prayer.

But I was desperate. I honestly didn’t think I was going to survive this.

If I wasn’t already nauseas, the mere thought of a “digital removal” would have made me vomit regardless – but this situation, coupled with my severe nausea, felt like a special form of torture.

As I reached back to try to pry the hard mass from my body, I started violently dry heaving.

Since I had already vomited that morning, there was not much coming up, but I had to open up my legs and angle my head in between them to try to aim the stomach acid into the toilet.

The mere act of vomiting causes you to bear down, helping push the feces further out (or – as in labour – a baby).

I used this to my advantage, and used my finger to try to pry the hard pumps out.

This grotesque and disgusting act only made my vomiting worse, which I continued to use to my advantage.

When I reached a point of such painful, burning stretching that I thought it would kill me, the hard lump finally came out, causing such intense relief that I could ALMOST classify it as ecstasy.

Now – bear with me – as disgusting as this may be, it bears resemblance to birth. Because, as a midwife, I was trained to tell women to act as though they were doing “the biggest poo of their lives”.

We encourage them to bear down in the same manner as they do when constipated, as this facilitates efficient pushing.

I have also heard midwives tell women, “All that constipation in pregnancy was to prepare you for childbirth.”

However you look at it, it’s still a traumatizing thing to experience.

Since I, somehow, survived that experience I kept my promise to God (or rather myself, if I were to be honest).

I stopped drinking ginger beer and forced myself to drink more water.

I stopped eating crackers and resorted to cornflakes instead (with almond milk, as that was the only milk I could tolerate).

Eating cornflakes proved to be a perfect remedy, as it helped me consume more fluids and it was also a way to get more vitamins in (as I was still unable to take my prenatal vitamins).

When I studied midwifery I was taught that if women cannot afford, do not have access to, or are unable to take multivitamins – that we should encourage them to consume fortified breads and cereals: that is the best way to get in extra vitamins and minerals.

So that’s what I did.

Cornflakes for breakfast, lunch and dinner.

And, of course, at 0200 am.