How to cope with pregnancy fatigue

Amanda Smith felt completely drained throughout both of her pregnancies. “Even before I knew I was pregnant, I would come home after work and take a two-hour nap in the afternoon for no good reason that I could think of,” recalls the Toronto mom of three, who works as an elementary school teacher. “Anything more than a normal workday was too much,” she says. “I couldn’t even pick up the mail.” Turns out, Smith was pregnant with twins. A few years later, when she was pregnant with her third baby, she was also taking care of her twin girls, who were three at the time. “I was carrying very large, and I was exhausted,” Smith says. “It was so physical. My mind also started shutting down. I was leaving my purse everywhere.”

It’s normal to feel tired even if you’re not showing yet. According to Alix Bacon, president of the Midwives Association of British Columbia, most women experience fatigue during pregnancy, but how depleted you feel, and at which stage, varies. “We’re looking at a complex hormonal cocktail, and one pregnancy can differ from the next, and the experience can differ from woman to woman.” In the first trimester, says Bacon, “you’ve got a lot of progesterone on board,” which decreases blood pressure and blood sugar, leading to tiredness. There’s also increased blood flow to your kidneys, which means frequent trips to the bathroom in the middle of the night. By the third trimester, you’re carrying around extra weight and finding a comfortable sleeping position feels impossible.

There are some other medical reasons you might be feeling sluggish, too, like anemia (low iron) or thyroid disease. It’s standard to check for these conditions in prenatal blood work, but if you’re feeling especially worn out, be sure to bring it up with your doctor or midwife, who may want to rerun some tests. Women with low iron may need to take an iron supplement. A hypothyroidism diagnosis—which means your thyroid is underactive—is common during pregnancy and is treated with daily medication.

With run-of-the-mill pregnancy exhaustion, the only way to feel better is to go easy on yourself and get more rest, even though others might not know you’re expecting yet. “Be honest with yourself about your commitments and where you can scale back,” says Bacon. Save time and energy by cooking and freezing meals or working from home more often. Jon Barrett, an OB/GYN at Sunnybrook Health Sciences Centre in Toronto, suggests talking to your employer about a shorter workday or adjusting your tasks so you’re able to sit down more.

For many pregnant women, fatigue is also due to having trouble sleeping or falling back to sleep after a bathroom trip. “Part of that is because pregnancy is such a big life change that you just start thinking about things. Or your baby is having a party in your belly,” says Bacon.

According to Eileen Sloan, a psychiatrist at the Toronto Sleep Institute who has researched sleep disorders in pregnancy, 30 percent of women report sleep issues while pregnant. Good habits—like going to bed at the same time every night and turning off screens an hour before bedtime—may help. Also, make sure you’re not napping too late in the day. “Napping after work at 6 p.m., when your body is gearing up for the evening, causes confusion,” says Sloan.

When the exhaustion seemed unbearable, a few things helped Smith manage. She and her husband splurged on a meal-delivery service two days a week.The prescription anti-nausea drug Diclectin allowed her to get some sleep (a possible side effect is drowsiness), and she scheduled plenty of relaxing prenatal massages.

Read more: Pregnancy brain: It's not all in your head Your second pregnancy: What you need to know