Pregnancy showed me… fill in the blank. Shege. Pepper.

How many times have you heard those words, or said them yourself, hand on your back, side-eyeing the woman who once told you pregnancy would glow? I have heard them in different languages, dialects, and cultures, and the meaning never really changes. Like it or not, pregnancy will humble you.

As a birth worker, it keeps me humble too. No two pregnancies are the same. I say it all the time: never trust a baby; your baby is in charge.

I am a consultant obstetrician and gynaecologist, and I have caught, delivered, assisted or cheered on the birth of thousands of babies. For every birth, there are a hundred more women whose paths have crossed mine: in antenatal clinic, in triage, in the emergency department, and once on a plane, where a baby who could not decide between Ghanaian and Nigerian jollof arrived mid-air and settled the matter by being born thirty-five thousand feet over Cotonou.

Pregnancy is beautiful. It is also full of surprises, and after almost two decades in this work, some of them still surprise me. When I sat down to write this, I asked the women around me one question. What is one surprising thing you experienced during your pregnancy? Close to a hundred answers came rolling in.

Pink lips. A nose that swelled like it had its own pregnancy. The life-or-death need to crunch ice like sweets. Darkened nipples, armpits and groin. A love affair with the smell of hot tar on the road. Random floods of saliva. A helpless new devotion to nonsense TV. Bread and jam cravings in a woman who hated bread and jam. An aching jaw.

Teeth that changed colour, new moles, new hair in ungodly places. Stronger body odour. Sudden aversion to the things she loved most, like coffee. Restless legs, and pain down one leg so fierce she could not walk or sleep without a support band. Ankles that swelled and vanished for nine months. Feet that grew a whole shoe size. Piles.

Headaches paracetamol would not touch. Leaking urine. Vivid, strange dreams. Anxiety and intrusive thoughts, before the baby and after. A surge in sex drive in the third trimester. And tiredness that swallowed whole days: one woman slept twenty-three hours, woke for one, then slept another ten.

Funny. Humbling. And every one of them, in its own way, possibly normal. Some I recognised instantly. A few made me sad. One or two I had never heard of in my life. All of them made me marvel at what women carry, quietly, without complaint.

The truth is that people are scared of pregnant women. Pregnancy is not an illness, but its ordinary symptoms can be genuinely debilitating. Pregnant women are routinely excluded from clinical trials, so we know far less than we should about what is safe and what works. So clinicians are cautious about anything that might touch the baby. Women are left to put up with symptoms that wreck their quality of life.

Fear, underinvestment and the normalisation of women’s pain add up to a paradoxical silent neglect. Paradoxical, because pregnancy raises your status: pregnancies are treasured, women handled like eggs. Yet the same pregnancy invalidates her. It’s just pregnancy. We all went through it. Why are you complaining? At least you’re pregnant. How did you get here in the first place? Women are not offered the nuance of being happy to be pregnant and deeply unhappy with what it is doing to them. Saying so is heard as complaining, ungrateful, weak. I wonder if this is why women reach my clinic so late.

Now read that pregnancy symptom list again, because here is the whole point of this article.

Buried inside the weird and the wonderful are a few signs that are not so wonderful. The ice. The painful leg. The leaking. The dark thoughts. We laugh them off, we normalise them, we pass them down with a shrug and “na so e be.” And in doing so, we sometimes miss the body waving a small red flag. The danger is rarely the strangeness. More often, the danger is the familiarity.

So here are the ones I want you, and your husband, your aunty, your sister and your brother, to learn by heart. Not to frighten you. To free you.

While you are carrying: get seen today, not tomorrow

Your baby goes quiet

Reduced fetal movement may be the first sign your baby is in distress. Babies have their own rhythms, and there is no magic number of kicks. But if your baby is moving less than is usual for them, do not reach for something sugary and wait it out. That old advice costs time we cannot afford to lose. Contact your hospital or maternity unit the same day, and let them assess your baby’s wellbeing. Trusting that instinct is not being dramatic. It is being a mother.

Swelling that comes on suddenly, especially in your face

Puffy feet after a hot day in traffic is normal. But swelling that appears fast, in your face and hands, with a headache that will not shift, blurred vision or flashing lights, or pain high on the right side of your tummy, can be pre-eclampsia: dangerously high blood pressure in pregnancy. It remains one of the leading reasons women in Nigeria die in childbirth. Get your blood pressure and urine checked the same day.

One leg that is hot, swollen, and tender. Or sudden breathlessness

This is the one too few of us are warned about. Pregnancy, and the weeks just after birth, make our blood more likely to clot. A clot in the leg, a deep vein thrombosis (DVT), usually shows as one calf that is swollen, warm, red, and painful, different from the everyday aches and shooting nerve pains so many women get. A clot that travels to the lungs, a pulmonary embolism (PE), can leave you suddenly breathless, your chest tight, your heart galloping for no reason. Do not file this under “I am just tired and heavy.” Treat it as an emergency and get to hospital.

A craving to crunch ice, morning, noon, and night

It made the funny list, but chewing ice or other non-food things can be your body telling you your iron is low. The scientific name for this is pica. Why does that matter so much? Because going into birth anaemic, your reserves already running on empty, leaves you with far less in the tank if you bleed afterwards. And bleeding after birth, postpartum haemorrhage, is still the single biggest reason Nigerian women lose their lives in childbirth. Here is the good news, and it is genuinely good: anaemia is found with a simple blood test and treated with iron. So eat your dark green vegetables (efo riro, ugu, bitter leaf), pair them with something rich in vitamin C like orange, pepper, or tomato, because it helps your body absorb the iron. Take the iron your doctor gives you even when it quarrels with your stomach. Get your blood checked. One red flag, one very simple answer.

A change in your discharge, or a fever

Never ignore vaginal discharge with a new colour, a new smell, a sudden gush of fluid, or simply feeling unwell and feverish. This can signal infection, or your waters leaking early. Both warrant checking, not waiting.

After the baby comes

Leaking urine: This is called incontinence. It affects roughly one in three of us, even after a caesarean birth. We have been taught to laugh it off and live with it for the rest of our lives. Don’t. Pelvic floor exercises help enormously, and if you can find a pelvic floor physiotherapist, they can change your life. This is not the unavoidable tax of motherhood.

A sadness that will not lift: Up to eight in ten women feel the baby blues in the first days: weepy, low mood, raw, undone by a nappy advert. That usually passes within about two weeks. But if the sadness, the anxiety, the intrusive thoughts, the sense of not coping or not bonding with your baby stay longer than that, that is postnatal depression. It is common, it is treatable, and it is not a judgement on you as a mother. In our culture, we expect a new mother to be glowing and grateful, and that silence is dangerous. Say it out loud to someone you trust and to a health worker. You are allowed to need help.

When you go to visit a new mother, ask about her, not just the baby. How are you eating? How are you sleeping? Who is holding you?

The long game: what pregnancy is trying to tell you

Here is what I most want you to leave with. Pregnancy is a stress test for the body you will live in at age fifty.

If you had pre-eclampsia, your risk of high blood pressure and heart disease in later life is around two to four times higher, so those are numbers worth watching from now. If you had pregnancy (gestational) diabetes, up to half of women go on to develop type 2 diabetes within ten years. And if you simply have not felt like yourself since the baby, know that it can take women years to find their new normal. We call that matrescence: the profound physical, emotional, psychological and social transformation of becoming a mother. For some, it now overlaps with perimenopause (when hormones fluctuate and periods become unpredictable, often with hot flushes, poor sleep and low mood), because we are having our babies later. So ask, without apology, about your periods, your sleep, your moods, your pelvic floor, your sex drive.

None of these numbers is a sentence. They are a head start. A window, opened early, to protect the woman you will be in twenty years. Your fifty-year-old self will thank you. So will your children, and yes, your husband too.

My prayer is that your pregnancy does not show you shege. But if pregnancy is going to humble us, let it teach us too. 

Let the weird and the wonderful make us laugh, and let the not-so-wonderful make us act.

So, tell me. What is the weirdest pregnancy symptom you have heard of, or survived? Let’s talk about it. Because it is in these conversations, honest, ours, and free of shame, that we keep our mothers, our sisters, and our long-awaited babies alive and thriving.

Dr Isioma Okolo is a Consultant Obstetrician & Gynaecologist, Harvard-trained global public health researcher, and women’s health writer. She writes about the intersection of medicine, women’s lives, and the social systems that shape health across Africa and the diaspora.