The Phenomenon of Pregnancy Fatigue

Recently, one of my patients walked into my office at a much slower pace than she is used to, and with a look on her face of being concerned about an issue she is ready to bring up in our upcoming conversation. She was two weeks away from her planned delivery, a common occurrence with patients whose pregnancies are at risk for a given complication. Doctor, she said, I am ready to have this baby right now, I am at the end of my tolerance for all this discomfort and fatigue that I have been enduring lately. I am tired for the greater part of my days! 

I responded to her by carefully listening and acknowledging how many of my other patients at about the same point of their pregnancies report similar experiences. Then I continued reminding her how much our prior delivery plan took into consideration the level of maturation of her baby who needs to remain in utero for the remaining two weeks before we may offer medical intervention as necessary to induce her labor. As we reiterated the rationale for waiting for fetal maturity to occur and kept our focus on the delivery of a healthy and mature infant, ready to successfully adjust to the extrauterine environment at birth, she progressively regained her strength as she also received confirmation about her normal clinical parameters of health and the reassuring status of her unborn baby at that time. At the end of our visit, she expressed her willingness to remain patient as her delivery day is fast approaching at this point.

The pregnancy experience is generally received by the mothers-to-be with a variety of feelings and reactions, from excitement to apprehension, to fear and exhaustion. The first trimester of a pregnancy is crucial from the standpoint of early fetal development. But it is also the time for the natural adaptation of the woman to the hormonal and physical changes associated with the growth of the fetus, the placenta, and the amniotic fluid.

The changes associated with pregnancy are progressive and may develop slowly enough to allow for maternal adaptation to the gravid state at first. Often, these symptoms emanate from the gastrointestinal system such as nausea and vomiting or the respiratory system in the form of changes to her breathing pattern. Along with symptoms of general weakness, physical fatigue may be associated with a mental component that must be identified and addressed early to prevent its progression to a more serious illness.

The second trimester’s appearance of the “pregnancy bump” is the midline bulge of the woman’s lower abdomen due to the enlarging uterus and its content. Emerging from the pelvic cavity, the uterus pushes forward the lower abdominal wall. This new reality is well received by the mother-to-be and her partner as it reaffirms the presence of the developing fetus. A progressively larger and more muscular fetus can at times move so strongly that the wall of the uterus and of the mother’s abdomen can no longer hide some of the fetal movements that take place throughout the days and nights. Some of these movements, but not all, are perceived by the mother and can be felt by a palpating hand or seen by observation of the maternal abdomen. A first-time pregnant woman is expected to recognize these fetal movements by the twentieth week of the pregnancy while in subsequent pregnancies the perception of movements may occur as early as the fourteenth week.

The pregnant woman lives this experience with great excitement and is ready to endure the changes, the discomfort, and sometimes the health risks that may be associated with her status. The required patience and tolerance that the condition imposes are only matched by the reward represented by a healthy offspring which someday will be born, and she and her family will welcome, cherish and train to later become a responsible member of society.

There comes a time when the fetus has reached a point of readiness to live safely outside of the uterus. Centuries of experience taught us that from the thirty-seventh week of gestation, under normal conditions, a human fetus begins the term of his/her intrauterine life, and spontaneous labor may be an acceptable natural event. This is easier to welcome when the age of the pregnancy is well known from early prenatal evaluation, especially based on an ultrasonographic study, let’s say before the thirteenth week of the pregnancy. During the last three months of a pregnancy, a variety of symptoms may be due to the mechanical burden imposed by the enlarged uterus with its eight-to-fourteen-pound content, the physical changes imposed on the woman’s respiratory, digestive, circulatory, and musculoskeletal systems. This often translates into the inability to fall asleep, enjoy a meal, walk comfortably, or perform usual tasks that an average healthy person may take for granted.

At this point, the expectant woman reaches a time when her autonomy, limited by the presence of the developing fetus in utero for thirty-five to forty weeks, becomes an asset she is no longer ready to trade when the purpose of her sacrifice- waiting for the fetus to be mature- is no longer there. At this point, the pregnant woman may express her impatience in many ways such as: “I am done, please help me deliver this child”, or ‘I am ready to evict this tenant” and so on…

The practitioners who care for pregnant women in search of delivery near the end of their pregnancies must balance the respect for their autonomy against the safety of medical interventions aimed at satisfying their requests. The potential risks to the mother and her fetus must be taken into consideration. In response to a pregnant woman whose behavior suggests the signs of pregnancy fatigue, clinicians must weigh the risks and benefits of any medical interventions toward delivery of the baby to ensure that the safety of both, the mother, and her baby, is not compromised.

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