A head-to-toe guide to the changes — and what you can do about them.
I was getting out of the shower recently and did something I normally don’t dare do. I took a glance at my body in the mirror. The glance turned into a stare.
My body, once so lithe and lean, looked shockingly like the lumpy, droopy bodies of older women I used to pity smugly in locker rooms. What happened? I thought.
Kids are what happened. Ever since my body endured two pregnancies, childbirth, and nursing, it’s never been quite the same, even now, eight years later. “Creating a baby and giving birth, your body has gone through some remarkable changes,” says Iffath Hoskins, M.D., an obstetrician in Savannah. “Many parts of your body will revert back to normal, but not everything. After kids, your body redefines what normal is.”
In our appearance-obsessed society, that’s not exactly comforting. It’s hard not to grieve the departure from what’s considered attractive.
Of course, some women do manage to accept their body’s changes as badges of honor, and even welcome the excuse to relax their expectations. “Having had kids has given me permission to stop worrying about my body so much,” says Gloria Lee of Austin, Texas, a mom of two, ages 10 and 7. “After all that, I figure I’ve earned the right to wear elastic-top pants and skirts if I want!”
“I’m too old to be Jessica Simpson and (hopefully) too wise to want to be,” says Elena Junes of Santa Fe, New Mexico, the mom of two, ages 8 and 6. “I feel like my body is the sum total of the experiences I have had in my life.”
There’s comfort in knowing we have lots of company in these long-term physical changes. Here, the most common transformations:
Face Almost 25 percent of women have a change in their skin pigmentation, due to hormones while they’re pregnant. Many women complain of blotchy skin after having kids. “It’s the reverse of the ‘mask of pregnancy'” says Jennifer Proud Mearns, a mom of five from Shaker Heights, Ohio. “It’s almost as if the melanin has been zapped from my face in places where it was initially dark.” The sun makes those changes more noticeable, says Marianne O’Donoghue, M.D., associate professor of dermatology at Rush University Medical Center in Chicago. The prevention is daily sunscreen. The cure: a gentle bleaching by a dermatologist.
Teeth, breasts, midsection, and more
Teeth Folklore has it that a tooth is lost for every pregnancy — which would be quite a dramatic price to pay for our beloved children. But there is a factual basis for its origin. Progesterone and estrogen can increase circulation, bringing more blood to the gums, causing swelling and sensitivity to bacteria. “Pregnant women are more prone to gingivitis,” says Kimberly Harms, D.D.S., of River’s Edge Dental Clinic in Farmington, Minnesota. “And any gum disease you have can grow worse during pregnancy.” If not taken care of, pregnancy gingivitis can damage the supporting fibers and bone that hold teeth in place — hence the old wives’ tale. “All the problems can be avoided with meticulous dental hygiene during pregnancy and afterward,” says Harms.
Breasts Laments about post-pregnancy, post-nursing breasts are common (the breasts of 95 percent of women won’t look the same afterward, one expert estimates). They fall into one or both camps: the lessening or the drooping of these prized pieces of real estate. Going down in bra size is thought to be caused by a change in the makeup of the breast. When you get pregnant, the ducts, lobules, and other glandular matter inside spring to life and push aside some of the fatty tissue, according to Natalie Angier, author of Woman: An Intimate Geography. Each breast can gain as much as a pound while working to sustain your baby. Afterward, the milk-producing apparatus shrinks, but, says Angier, “the fat grows lazy and doesn’t reinfiltrate the spaces.” So the breast gets smaller. Drooping breasts can be blamed on overly stretched skin and connective tissue. Nothing can be done to counteract the shrinking breast. But you can lessen any additional sagging during your next pregnancy and in the months after by wearing a good maternity and nursing bra, day and night, to ease the load on ligaments and skin. The nipples don’t escape unchanged, either. During pregnancy, the areola around the nipple darkens due to hormonal changes, and it may stay that way. Some women complain that after nursing their nipples are constantly on alert. They may also become larger after breastfeeding simply because “they’re being pulled out every time you nurse,” says Sumeeta Nanda, M.D., an Oklahoma City obstetrician.
Midsection Of all the things I’ve lost since having babies, I think I miss my waistline the most. One study of the post-pregnancy body used a charming description of this area: “redundant skin.” “This tissue only has so much elasticity, so once stretched past that, it does not completely return,” says Laura Irwin, M.D., an obstetrician and gynecologist and associate professor at the Medical College of Georgia. Also problematic are the abdominal muscles, some of which stretch 50 percent during pregnancy, according to Sylvia Brown, coauthor of The Post-Pregnancy Handbook. After such extreme stretching, the muscles will never again be as strong, she says. This means that it will be next to impossible to have a stomach as toned and flat as it was when your baby was just a glimmer in your eye. Part of the prescription to improve your chances of ever showing your midriff again is not to gain more than the recommended amount of weight during pregnancy and to return to your ideal weight after the baby. Good posture and daily stomach-strengthening exercises can help, too. Women who’ve had c-sections have a special challenge — a scar. “There are several layers in the abdominal wall, and that affects the way the abdomen heals,” says Bruce Flamm, M.D., clinical professor of obstetrics and gynecology at University of California, Irvine. The most common complaint of those who have had c-sections is that their abdomen pooches over their scar and that it’s difficult to get muscle tone back.
Lower back Back problems are expected during pregnancy, but one study found a third of women still reported them three months after delivery. Why? It’s difficult to pinpoint all the factors, but it may start with a hormone called relaxin, which loosens the joints in the pelvis to allow the baby to pass in delivery. “This loosening may change the support structure of the spinal joints,” says Anthony Lisi, a professor at University of Bridgeport College of Chiropratic in Connecticut. Then, after the baby is born and before ligaments have tightened up, you could put more of a strain on your back by lifting and nursing in an awkward position. To help prevent back problems, do abdominal-strengthening exercises, and use leg muscles more than back muscles when picking up things — including children — by bending from the knees, not the hips. Also, make sure not to hunch over when you nurse, which can exacerbate back pain.
Thighs and rear end Treasonously, the female hormones estrogen and progesterone encourage the collection of fat in the thighs, buttocks, upper arms, and breasts, especially during pregnancy. “In evolutionary terms, women who collected more fat were the ones who could keep their babies alive through the winter,” says Mary Vernon, M.D., a bariatric physician in Lawrence, Kansas. This may have made sense for hunters and gatherers, but it’s a brutal anachronism now. Much of the collected padding disappears over time, especially if you breastfeed, since this uses up fat stores. Still, experts estimate that on average a woman retains eight to ten pounds with each pregnancy. “The double whammy of it all is caring for your kids,” says Helen Darling, a mom of two from Austin, Texas. “I can’t find time to exercise now without paying a sitter.” Studies have found that women who gain more than the recommended weight during pregnancy are more likely to retain it. This makes it all the more important next time around to gain a reasonable amount of weight and to continue to exercise during and after pregnancy — even if you can manage nothing more intense than pushing the baby in a stroller.
Feet, body hair, and those pesky stretch marks
Pelvic floor Pelvic floor is a nice term for the “down there” region where so much of the action of childbirth takes place. This area, also called the perineum, can change drastically after vaginal births. Instead of looking like a pencil point, the opening of the cervix will look more like a fish mouth. The vagina will be larger after serving as the interstate for a seven- or eight-pound baby. The clitoris also often remains enlarged after pregnancy, according to Angier. One of the repercussions of all this is incontinence; about 25 percent of postpartum women suffer from it. “The perineum is like a lawn chair. When you have a lot of weight sitting there for a long period of time, it begins to sag in the middle,” says Dr. Irwin. The sagging of muscles leads to less control over the bladder and even the anus. Pregnant women know they should do their Kegel exercises to strengthen the pelvic-floor muscles, and Kegel slackers are punished by slacker muscles. Still, certain factors that are mostly out of a woman’s control may put her at more risk for pelvic-floor damage. They include prolonged pushing during labor, a forceps or vacuum delivery, large babies, and episiotomies.
Feet Fourteen years after the birth of her first child, Tina Moody still has dozens of pairs of shoes that she outgrew by half a size, but refuses to let go of. “No one told me that every shoe in my closet would become too small after my pregnancy,” says Moody, a therapist from Dripping Springs, Texas. Who knows how many pairs of shoes are sold every year to restock postpartum women with exaggerated extremities? According to researchers at the University of Vermont College of Medicine, feet don’t actually get longer or wider during pregnancy. But the volume of the foot increases due to fluids retained by your body — 6.5 extra liters on average, some of which pools at the feet and then sticks around — along with extra fatty tissue.
Spider and varicose veins Months of carrying around the additional load of pregnancy can take its toll on the legs in the form of spider veins, and their uglier cousins, varicose veins. Spider veins, dilated blood vessels, can look like tiny red and blue sunbursts. Varicose veins are larger, dilated veins that may stick up above the skin surface. “Estrogen relaxes the smooth muscles in the veins, which can cause them to dilate,” says Diane Berson, M.D., a Manhattan dermatologist. In addition, blood volume during pregnancy increases by more than a pint, and veins expand to carry the extra blood. The tendency to develop spider and varicose veins is hereditary, and both usually remain after pregnancy. The best preventive step, especially if you have a family history, is to wear support hose during pregnancy, which helps keep blood vessels from stretching out. Also, avoid standing for long stretches, prop your feet up when possible, and exercise to help circulation. Spider veins can be diminished by a dermatologist, who will inject them with a saline solution. The treatment for varicose veins is more complex. Problem veins can be blocked, stripped out, or removed by laser surgery.
Stretch marks Fifty to 90 percent of pregnant women suffer from stretch marks — those squiggly lines that look like so many lightning bolts and are often found on the abdomen, buttocks, thighs, and breasts. Some are reddish and purplish, others become white breaks in the smooth surface of the skin. Brought on by the rapid weight gain and loss during and after pregnancy, stretch marks are caused by a breakdown in the connective tissue of the skin. There’s little that can be done about them, so think of them as mementos of your fertility! Special creams during pregnancy can alleviate the itching that sometimes comes with the stretching, but won’t prevent the marks. Retin A may help fade stretch marks, but you should never use it during pregnancy or while nursing. And laser resurfacing isn’t usually effective, either.
Skin changes Other reminders of your pregnant days that have staying power include the linea negra, the dark line from the pubic area to the sternum that often develops as estrogen and pro-gesterone increase, which may never quite disappear. “You can also see an increase in benign growths during pregnancy,” says Dr. Berson. The most common are skin tags — extra dollops of skin that develop wherever you have folds in the skin, such as underarms and the stomach — and angiomas, which are clusters of blood vessels near the surface of the skin that appear as round red dots. A dermatologist can easily remove skin tags and angiomas.
Body hair About 5 to 8 percent of women have more body hair after pregnancy, showing up in inconvenient places such as the chin and the nipple. “This is because progesterone — one of the two pregnancy hormones — contains some of the male hormone androgen,” says Dr. Hoskins. Fortunately, excess hair can be removed by plucking, shaving, or — more permanently — by electrolysis. Head to toe, these changes of motherhood can be devastating and deflating. The best treatment? Looking at the smudged and smiling faces of your kids, and knowing that you wouldn’t trade anything, not even the bulges, sore back, or bigger feet, for the experience of being a mom.
Jeannie Ralston is a Parenting contributing editor and mother of two boys, Gus, 8, and Jeb, 6.