What to expect when you're expecting (11 page)

Goose bumps?
Well, not really, but early in pregnancy you may notice an increase and enlargement in the tiny bumps on the areola (called Montgomery’s tubercles)—bumps you may have never noticed before. They’ll resemble goose bumps but are actually glands that produce oils to lubricate your nipples and areolas—lubrication that’ll certainly be welcome when your baby starts sucking on your nipples if you’re nursing. Another sign your body is planning ahead.

Spotting.
Some (but certainly not all) women experience spotting when the embryo implants in the uterus. Such so-called implantation bleeding will likely arrive earlier than your expected monthly flow (usually around five to ten days after conception) and will probably appear light to medium pink in color (rarely red, like a period).

Urinary frequency.
Has the toilet become your seat of choice lately? Appearing on the pregnancy scene fairly early (usually about two to three weeks after conception) may be the need to pee with frightening frequency. Curious why? See
page 135
for all the reasons.

Fatigue
. Extreme fatigue. Make that exhaustion. Complete lack of energy. Super sluggishness. Whatever you call it, it’s a drag—literally. And as your body starts cranking up that baby-making machine, it’ll only get more draining. See
page 127
for reasons why.

Nausea
. Here’s another reason why you might want to consider moving into the bathroom, at least until the first trimester is finished. Nausea and vomiting—aka morning sickness (if only it were limited to the morning)—can strike a newly pregnant woman fairly soon after conception, though it’s more likely to begin around week 6. For a host of reasons why, see
page 130
.

Smell sensitivity
. Since a heightened sense of smell is one of the first changes some newly pregnant women report, pregnancy might be in the air if your sniffer’s suddenly more sensitive—and easily offended.

Bloating
. Feeling like a walking flotation device? That bloated feeling can creep up (and out) on you very early in a pregnancy—though it may be difficult to differentiate between a preperiod bloat and a pregnancy bloat. It’s too soon to attribute any swelling to your baby’s growth, but you can chalk it up to those hormones again.

Rising temperature
. Basal body temperature, that is. If you’ve been tracking your
first morning temperature with a special basal body thermometer, you might notice that your basal body temperature rises around one degree when you conceive and continues to stay elevated throughout your pregnancy. Though not a foolproof sign (there are other reasons why you may notice a rise in temperature), it could give you advance notice of big—though still very little—news.

Missed period.
It might be stating the obvious, but if you’ve missed a period (especially if your periods generally run like clockwork), you may already be suspecting pregnancy—even before a pregnancy test confirms it.

“How can I find out for sure whether I’m pregnant or not?”

Aside from that most remarkable of diagnostic tools, a woman’s intuition (some women “feel” they’re pregnant within moments of conception), modern medical science is still your best bet when it comes to diagnosing a pregnancy accurately. Luckily, these days there are many ways to find out for sure that you’ve got a baby on board:

The home pregnancy test.
It’s as easy as one-two-pee, and you can do it all in the privacy and comfort of your own bathroom. Home pregnancy tests (HPTs) are not only quick and accurate, but you can even start using some brands before you’ve missed your period (though accuracy will get better as you get closer to P-day).

All HPTs measure urinary levels of human chorionic gonadotropin (hCG), a (developing) placenta-produced hormone of pregnancy. HCG finds its way into your bloodstream and urine almost immediately after an embryo begins implanting in the uterus, between 6 and 12 days after fertilization. As soon as hCG can be detected in your urine, you can (theoretically) get a positive reading. But there is a limit to how soon these HPTs can work—they’re sensitive, but not always that sensitive. One week after conception there’s hCG in your urine, but it’s not enough for the HPT to pick up—which means that if you test seven days before your expected period, you’re likely to get a false negative even if you’re pregnant.

Just can’t wait to pee on that stick? Some tests promise 60 percent accuracy four days before your expected period. Not a betting woman? Wait until the day your period is expected, and you’ll have about a 90 percent chance of netting the correct result. Test a week later, and the accuracy rate jumps to 97 percent. Whenever you decide to take the testing plunge, the good news is that false positives are much less common than false negatives—which means that if your test is positive, you can be, too. The other good news: Because HPTs provide a very accurate diagnosis very early in pregnancy—earlier than you would probably consider consulting a physician or midwife—they can give you the opportunity to start taking optimum care of yourself within days of conception. Still, medical follow-up to the test is essential. If the result is positive, have it confirmed by a blood test and a complete prenatal checkup.

The blood test.
The more sophisticated blood pregnancy test can detect pregnancy with virtually 100 percent accuracy as early as one week after conception (barring lab error), using just a few drops of blood. It can also help date the pregnancy by measuring the exact amount of hCG in the blood, since hCG values change as pregnancy progresses (see
page 140
for more on hCG levels).
Many practitioners order both a urine and a blood test to be doubly certain of the diagnosis.

The medical exam.
Though a medical exam can be performed to confirm the diagnosis of a pregnancy, with today’s accurate HPTs and blood tests, the medical exam—which looks for physical signs of pregnancy such as enlargement of the uterus, color changes in the vagina and cervix, and a change in the texture of the cervix—is almost beside the point. Still, getting that first exam and beginning regular prenatal care isn’t (see
page 19
).

“When I took a home pregnancy test, it showed a really faint line. Am I pregnant?”

The only way a pregnancy test can give you a positive result is if your body has a detectable level of hCG running through it (or in this case, through your urine). And the only way that your body can have hCG running through it is if you’re pregnant. Which means that if your test is showing a line, no matter how faint it is—you’re pregnant.

Just why you’re getting a faint line instead of that loud-and-clear line you were hoping for has a lot to do with the type of test you’ve used (some are much more sensitive than others) and how far along you are in your pregnancy (levels of hCG rise each day, so if you test early, there’s only a little hCG to tap into).

To figure out just how sensitive your pregnancy test is, check out the packaging. Look for the milli-international units per liter (mIU/L) measurement, which will tell you the sensitivity of the test. The lower the number, the better (20 mIU/L will tell you you’re pregnant sooner than a test with a 50 mIU/L sensitivity). Not surprisingly, the more expensive tests usually have greater sensitivity.

Testing for the Irregular

So your cycles don’t exactly run on schedule? That’ll make scheduling your testing date a lot trickier. After all, how can you test on the day that your period’s expected if you’re never sure when that day will come? Your best testing strategy if your periods are irregular is to wait the number of days equal to the longest cycle you’ve had in the last six months—and then test. If the result is negative and you still haven’t gotten your period, repeat the test after a week (or after a few days if you just can’t wait).

Keep in mind, too, that the further along in your pregnancy you are, the higher your levels of hCG. If you’re testing very early on in your pregnancy (as in a few days before your expected period or even a few days after your expected period), there might not be enough hCG in your system yet to generate a no-doubt-about-it line. Give it a couple of days, test again, and you’ll be sure to see a line that’ll erase your doubts once and for all.

“My first pregnancy test came back positive, but a few days later I took another one and it came back negative. And then I got my period. What’s going on?”

It sounds like you may have experienced a chemical pregnancy, a pregnancy that ends practically before it even
begins. In a chemical pregnancy, the egg is fertilized and begins to implant in the uterus, but for some reason it never completes implantation. Instead of turning into a viable pregnancy, it ends in a period. Though experts estimate that up to 70 percent of all conceptions are chemical, the vast majority of women who experience one don’t even realize they’ve conceived (certainly in the days before home pregnancy tests, women didn’t have a clue they were pregnant until much later). Often, a very early positive pregnancy test and then a late period (a few days to a week late) are the only signs of a chemical pregnancy, so if there’s a downside to early home pregnancy testing, you’ve definitely experienced it.

Medically, a chemical pregnancy is more like a cycle in which a pregnancy never occurred than a true miscarriage. Emotionally, for women like you who tested early and got a positive result, it can be a very different story. Though it’s not technically a pregnancy loss, the loss of the promise of a pregnancy can also be upsetting for both you and your spouse. Reading the information on coping with a pregnancy loss on
page 576
can help you with your emotions. And keep in mind the fact that conception did occur once for you means that it’ll more than likely occur again soon, and with the happier end result of a healthy pregnancy.

If You’re Not Pregnant …

If your pregnancy test is negative this time, but you’d very much like to become pregnant soon, start making the most of the preconception period by taking the steps outlined in
Chapter 1
. Good preconception preparation will help ensure the best possible pregnancy outcome when you do conceive.

“I feel as if I’m pregnant, but the three tests I took came back negative. What should I do?”

If you’re experiencing the symptoms of early pregnancy and feel, test or no test—or even three tests—that you’re pregnant, act as though you are (by taking prenatal vitamins, avoiding alcoholic beverages, quitting smoking, eating well, and so on. until you find out definitely otherwise. Pregnancy tests aren’t infallible, especially when they’re taken very early. You may well know your own body better than a pee-on-a-stick test does. To find out if your hunch is more accurate than the tests, wait a week and then try again—your pregnancy might just be too early to call. Or ask your practitioner for a blood test, which is more sensitive to hCG than a urine test is.

It is possible, of course, to experience all of the signs and symptoms of early pregnancy and not be pregnant. After all, none of them alone—or even in combination—is absolute proof positive of pregnancy. If the tests continue to be negative but you still haven’t gotten your period, be sure to check with your practitioner to rule out other biological causes of your symptoms. If those are ruled out as well, it’s possible that your symptoms may have emotional roots. Sometimes, the mind can have a surprisingly powerful influence on the body, even generating pregnancy symptoms when there’s no pregnancy, just a strong yearning for one (or fear of one).

Testing Smart

The home pregnancy test is probably the simplest test you’ll ever take (you won’t have to study for it—but you should read the package directions and follow them to get the most accurate results). The following tips may seem obvious, but in the excitement of the moment (Will I be? Won’t I be?), you might forget a couple of things:

Depending on the brand, you’ll either hold the test stick in your stream of urine for a few seconds or collect your urine in a cup and then dip the stick into it. Most tests prefer you use midstream urine because there’s less chance of contamination that way: Urinate for a second or two, stop, hold it, and then put either the stick or the cup in position to catch the rest of the stream.

If you’ll need to wait for the results, place the sample on a flat surface away from heat and in a place where it won’t be disturbed. Read the test after the recommended waiting period; not waiting long enough—or waiting too long—can affect the result.