"I'm so tired!" This is one of the most common refrains of pregnancy. Most women are more tired than usual in pregnancy. During the early months, your body is working hard — pumping out hormones, producing more blood to carry nutrients to the fetus, speeding your heart rate to accommodate the increased blood flow and changing the way you use water, protein, carbohydrates and fat. High progesterone levels actually make you sleepy in a direct way. During the last couple of months of pregnancy, carrying the extra weight of the baby is tiring.

In addition to physical changes, you're dealing with a range of feelings and concerns that may sap your energy and disturb sleep. It's natural to have conflicting feelings about a pregnancy, whether it's planned or unplanned, your first or your fourth. Even if you're overjoyed, you're probably facing added emotional stresses. You may have fears about whether the baby will be healthy, anxiety about how you will adjust to motherhood and concerns about increased expenses. If your job is demanding, you may worry about being able to stay productive throughout pregnancy.

These concerns are normal and natural. It's important to recognize that emotional issues also play a part in how you feel physically.

■ Prevention and self-care for fatigue

Remember that it's normal to feel tired during pregnancy. Fatigue is a sign from your body that you need extra rest. Don't push yourself. Here are some ways to keep fatigue from getting the best of you:

• Rest. Accept the fact that you need extra rest during these nine months, and plan your daily life accordingly. Take naps when you can during the day. At work, finding time to sit back comfortably with your feet up can renew your energy. If you can't nap during the day, maybe you can take one after work or before dinner or your evening activities. If you need to go to bed at 7 p.m. to feel rested, do it. It may help if you avoid drinking fluids for a few hours before bedtime so that you won't have to get up as often during the night to go to the bathroom.

• Avoid taking on extra responsibilities. Cut down on volunteer commitments and social events if they're wearing you out.

• Ask for the support you need. Get your partner or other children to help out as much as possible.

• Exercise regularly. Regular physical activity will increase your energy level. Moderate exercise, such as walking for 30 minutes a day, can help you feel more energized.

• Eat well. Eating a nutritious, balanced diet is more important now than ever. Make sure you're getting enough calories, iron and protein. Fatigue can be aggravated if your diet is short on iron or protein.

■ Medical care for fatigue

No medications for fatigue are safe or effective during pregnancy. Avoid stimulants such as caffeine, which may be harmful in high doses.

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