PREFACE: You may have already perused my 1st trimester post, so let me preface this one the same way I did with that one – I am not a medical professional. I am, however, armed with a lot of research and (now) a team of doctors that welcome questions. I encourage everyone to be their own health advocate, but for those who have an under-researched and poorly known condition like POTS, it’s truly vital to be self-informed. Please use this post to supplement your self-education, but take nothing as gospel.
My 20-week anatomy scan appointment with my high risk doctor landed on the same week that the states of Maryland and Virginia shut down. I had just returned from an annual family weekend trip with my mom, sister, and female cousins, a weekend that had been bogged down with the news reports of sports cancellations and new policies pinging our phones every few minutes. When each of us left our homes scattered across the Eastern Seaboard, there was a flu-like sickness that was popping up here and there. We were washing our hands like crazy, but the US was deep in denial. When we returned home just three and a half days later, the country was facing a pandemic and my state was shuttering it’s borders.
Shocked, M and I started reading up on what was happening. He was directed to start working from home, and my doctors contacted me to tell me to stay home as much as possible, and that M would not be allowed at any more of my appointments.
Suddenly, being pregnant in this world became a very lonely experience.
Perhaps that’s why it’s taken such a long time for me to write this post (I’m deep in my third trimester now, five weeks from my due date). Physically, my second trimester was a breeze. My nausea waned around week 16, and fatigue wasn’t so bad either. I had some significant lower back and hip pain, which I discovered was because my SI was out of alignment, but overall, I felt pretty good, physically.
Emotionally, I was battling the reality of losing a lot of experiences we would never get back. Sharing ultrasounds with M, baby showers, having my parents help set up our nursery, going to baby stores to pick things out for the registry. Making friends at birth classes and prenatal yoga. Meanwhile, watching the world fight it out over whether or not individuals like me, with a messed up autonomic system (which controls your blood flow, breathing, sweating, etc.) and thus immunocompromised, were worth an economic crash or not. And on top of all of it, fighting with my doctors over what was more important – managing my POTS, or managing my weight gain.
There were sleepless nights. There were mood swings that I’m not entirely confident were exclusive to the hormones.
I hope – I sincerely hope – that this pandemic won’t be a factor for anyone who is reading this and trying to find some peace and information for navigating their pregnancy with POTS. If it is, I am so sorry. And please, stay home. Wear a mask when you have to go out. Inform yourself and arm yourself. Be your own advocate for your health. It’s terrifying to me that so many people with dysautonomia are so under informed with how their body operates.
PAIN
Anyway. Around 16 weeks, I started having round ligament pain, hip pain, and lower back pain. My cousin, a skilled personal trainer who owns a physical therapy clinic, helped me understand that the back and hip pain was SI pain, and that my SI was out of alignment, making me overcompensate my weight distribution when I walked, and causing muscle strain and pain on my joints, which were already elastic due to the pregnancy. She gave me some exercises to do a couple of times a day with the help of M, and within a couple weeks, I was feeling better. If you experience a consistent ache in your lower back above your pelvis, it’s likely not POTS related, and you should see a chiropractor or physical therapist to get realigned. Or, if there’s a pandemic on, you can try this YouTube video. I also played with several different pillow configurations while I was sleeping (I’ve been using this one) until I found one that supported my back, hips, shoulders, and growing belly. The idea that you should just “deal” with hip and back pain when you’re pregnant “because that’s just how it is” is a bunch of hooey. You don’t have to be miserable just because you’re pregnant. Take control, and try some stuff.
For the round ligament pain, I got a belly support band to wear on my daily walks, but it honestly didn’t help me much. Hydration, proper pillow support of my lower back (think lumbar pillows) and belly (I’m a side sleeper) did more, as well as just moving more conscientiously and slower.
EXERCISE
At 19 weeks, I was going to the gym two or three times a week, spending 20-30 minutes on an upright bike, and doing light weight (up to 15 lb dumbbells) strength training. Halfway through my 19th week, I was laying flat on my back doing chest presses, and tried to roll over to do some side leg lefts, when my lower back just SCREAMED at me. This was before the pandemic began, so I was home alone. The previous week, a midwife at my now former OB office had told me that around 20-22 weeks, your belly gets enough extra weight that lying flat on your back puts too much pressure on a vein in your lower back, and could cut off oxygen supply to the placenta, thus the baby. She theorized that with POTS and the already compromised blood supply, this may happen sooner rather than later. She said that my body “would tell me when it’s time to stop laying flat on my back.” Well. This was it. I started using an exercise ball instead of lying on my yoga mat, which worked okay for another 4-6 weeks.
As the weeks progressed, and my belly grew, I began to struggle with exercising. I couldn’t go to the gym anymore, as they were closed. So I was settling for two 30-40 minute walks a day, and my every other day yoga and strength routine. I felt my energy levels dipping, but I was worried about managing my weight. I pushed through, and started taking two rest days a week rather than one. Then, one evening walk, around 26 weeks, the world started to spin when M and I were about a block from the house. I was hot, sweltering, and a headache came on very suddenly. I was out of breath, and my legs were getting wobbly. We made it back to the house, where M got me an ice pack for my neck, we propped my feet up on a mountain of pillows, and I sipped icy electrolytes. My blood pressure had dipped to 84/46. This would happen once more before my appointment with my brand new doctor.
When I asked her about it, and told her about my exercise routine, and how it was making me dizzy and I was worried about my POTS symptoms, I expected her to tell me to suck it up. I’d already been fat shamed pretty relentlessly by my previous OB, and some small part of me believed that it wouldn’t change with a new doctor.
Thankfully, I was wrong.
“If it makes you feel dizzy, stop doing it.” She told me which exercises to cut from my routine (basically all of them that require lower body weight movement, like squats and lunges), and at my next appointment two weeks later, when I was beginning my third trimester, and I told her I was still getting dizzy even with arm and back movements, so I stopped strength-training, she said “Good!”
The cardiologist she lined me up with said the same thing. “Your body will tell you what it needs right now. Listen to it.”
If you have POTS, you’ve already spent a while trying to learn what your body is telling you. If you’re pregnant, you need to be doing that and then err on the side of caution. Move, yes, that’s important. But now is not the time to over do it and challenge your body.
“I’m less concerned about your strength and more interested in your stamina. I would like for you to walk for about thirty minutes a day, if you can.” My OB explained that birth is a marathon, and that walking and keeping up cardiovascular health is much more important than lifting weights. My cardiologist agreed.
“But if you don’t feel good, then rest.”
DIET & CRAVINGS
ALL I WANT IS JUNK FOOD.
Thankfully, my cravings are still mild. Now that I’m supposed to be eating an extra 100-200 calories a day, I don’t really limit myself as much as I normally would. I’m letting myself have low sugar frozen yogurt or the occasional 1/2 of a bagel a time or two per week. According to my food tracker, I’m still burning calories like crazy, and I’m still netting 400 calories south of where I’m supposed to be. (I use MyFitnessPal, and I just have it set to gain 1/2 pound per week to track the appropriate calorie and nutrient intake – roughly. Truthfully, these trackers are so fluid, it shouldn’t be used as a rock hard defining line of where you should be, but it’s nice to have a rough guideline.). BUT both high risk and OB say baby is right on track for weight gain – so whatever I’m doing, keep at it.
What I am eating a lot of is plain yogurt and oatmeal. Digestion has been a battle since before I got pregnant, and it hasn’t improved. Additionally, there are other bits that are challenged right now that could use the probiotic assistance. If you catch my drift. I’m also drinking kombucha a time or two per week, or getting a serving or so of kim chi (try these tacos!) and/ or sauerkraut. Find what you like, make it a part of your routine. My banana bread is a life-saver for me, and I make some at least once a month.
If you’re anything like me, at this point, you’re tired, and indulging a little here or there is not going to be the end all for you or baby – just don’t go overboard. ESPECIALLY with the high carb, high sugar stuff. We both know that’s just going to cause a sugar high – sugar crash – POTS attack. Nobody is interested in that.
Do you have POTS and are navigating your way through a healthy pregnancy? What’s helping you manage your symptoms?
