First Trimester: Everything You Need To Know About The First Trimester

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Our Experts In This Episode


Leslie Ludka is a Certified Nurse-Midwife who graduated from the midwifery program at the Yale University School of Nursing. After a year of providing full scope midwifery care to native Hawaiian and rural community women on the island of Molokai, Leslie returned to Boston, where she spent nine years at Brigham and Women's Hospital, the primary teaching facility for Harvard Medical School. Since leaving that position, Leslie has been self-employed with LML Consulting, providing full-scope clinical midwifery both nationally and internationally. 




Welcome to your Pea in the Podcast, I'm Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy.


This week, we're talking all about the first trimester.


From getting that positive pregnancy test...


"I bought the urine test as I had been doing every month, and I was just thrilled when we got the positive results."


To how you're feeling...


"I definitely noticed I was much more fatigued, I couldn't really stay up past 8, 9PM at the latest. And I started to have some of the queasiness."


We'll talk about your risk of a miscarriage, whether you should have sex -- if you even want to have sex -- when you should tell people and we'll help you pick your doctor or midwife...


"You need to look for someone that you feel can teach you and walk along beside you in this really incredible experience."


We'll talk to a wonderful certified nurse midwife and a mommy-to-be who is going through this with you in this Pea in the Podcast: The First Trimester.


Oh baby, you're having a baby! You're at the beginning of a 40-week journey in which the spark of life begins in you and becomes your baby. It is awe-inspiring and thrilling. If you planned this little one, as Alissia -- who is now 10 weeks pregnant -- did, you've probably already started making changes in your life to give your little one the best possible start.


"The first thing, I started taking my prenatal vitamins, so just knowing that you should be taking that at least a month or two before even trying to get pregnant and then just being more cautious of what I ate also. So just trying to eat a little bit healthier, making sure I was exercising, just trying to be in the best shape I could be kind of beforehand, before the pregnancy, and then obviously trying around the appropriate time, which is around ovulation."


Those prenatal vitamins include folic acid, which will help defend your baby against neural tube defects like spina bifida, and you should take that before you start trying to get pregnant. But sometimes even when you're doing all the right things, it can take a little time to get pregnant.


"Initially, I was really excited and having heard so many of my friends had got pregnant on their first try, I assumed that I, too, would be able to get pregnant on the first try, but when that didn't happen after the first, second, third try then I started to get a little bit nervous. But my husband was very calming and he said, ‘just relax, we're young, we're healthy, it will happen.’ And sure enough, you know, I think even being more relaxed actually maybe that had some affect on us getting pregnant."


Then finally, sweet success for Alissia and her husband.


"I knew that I could do the urine test 4 days before your period was supposed to be due, so exactly at that time I bought the urine test as I had been doing every month, and I was just thrilled when we got the positive result."


Positive result.  Then what? Leslie Ludka is a Certified Nurse-Midwife with a Master's of Science in Nursing.


"When you have a positive pregnancy test, what you should do is you should make sure that you call your healthcare provider and set up an appointment so that you can have a history, a physical exam and necessary lab results, lab tests, and common sense things: you should be eating well, you should be taking good care of yourself, exercising, prenatal vitamins, you want to take really good care of your body to carry a nice healthy pregnancy."


For some of you, those two little lines or that plus sign or even the digital inscription shouting ‘pregnant!’ will be a huge surprise. That's okay. Just get started now making those changes that will help your baby grow strong and healthy. We'll go into more detail on that in a few minutes, but let's start with how you're feeling. If you've just gotten that positive pregnancy test, especially if you're as newly pregnant as Alissia was when she got hers, you might not feel anything at all. That may make you nervous.  Don't be.  You'll feel it soon enough, and you may want to send those symptoms back where they came from. Leslie Ludka runs down some of them for you.


"Pretty typically women will complain of breast tenderness, of fatigue, of some weight gain, headaches, nausea and vomiting, increased urination. A lot of women feel like, ‘oh my goodness I just went in a peed and now I have to pee again and I have to get up in the middle of the night 2 or 3 times to pee.’ It's because the pregnancy is sitting right on top of the bladder so it causes pressure on the bladder, which gives us the sensation that our bladder can't be too full before we really feel like we have to go in and pee."


Mom-to-be Alissia dealt with many of those things.


"The first thing that I noticed was breast tenderness and tingling. That was the first thing, and then slowly they began to grow and I’m kind of small chested to begin with so that was a very obvious change for me. And I was feeling fine for the first 2 weeks. So up until the 6-week mark, that was the only change I noticed. Then around 6 weeks, everything changed and I definitely noticed I was much more fatigued. I couldn't really stay up past 8, 9PM the latest, and I started to have a little bit queasiness. So not like morning sickness when they talk about just in the morning. This is all day feeling nauseous, definitely feeling queasiness and still today."


Ah, the dreaded morning sickness. More than half of you may be dealing with it, but that leaves a lot of you who dodged that bullet. Some people worry this means they will miscarry. It does not. It means you are lucky. I was one of the lucky ones. I never experienced a minute of morning sickness.  Sorry! But since Alissia has, I will let her offer some suggestions on how to deal.


"Well, the first thing that I quickly realized is as soon as I oversleep -- so going to bed at 8 o'clock and then sleeping until 7 in the morning -- actually made it a lot worse, because I wasn't eating for all of those hours.  So now if I wake up in the middle of the night, as I often do to go to the washroom, if I have something to eat then, that definitely helps a little bit. And just basically eating constantly throughout the day, small, usually high-carbohydrate snacks that usually helps. I always have crackers or bagels nearby. The other thing I found was helpful for me was cold food, so like cold grapes or cold watermelon. I also found very soothing for me was fennel, cold fennel kind of sliced up and just snacking on that."


Midwife Leslie Ludka has several other suggestions that may help you if you feel like you want to die.


"If you do experience morning sickness, one of the key things to do about that is start drinking fluids, keep water with you all the time. It is really like liquid gold. Throughout your entire pregnancy water is really like magic, you need to drink as much as you can possibly manage. I recommend to women that they drink at least a liter of water every day in addition to all other fluids that they drink, and it does seem to help with morning sickness."


"Also frequent small meals are very important. You want to be a grazer, not necessarily sit down to a meal with your entire family, just eat half of that meal and save it for a couple of hours later, eat the other half. And scent seems to be something that will trigger morning sickness or the feeling of nausea, because morning sickness is a fallacy; women have that sickness feeling all day and through the evening, and so scent will often trigger that. So if you are the person that’s cooking the meal, you may cook the meal and think 'I am not at all interested in touching that food. It's just awful.’ What I recommend to women is to cut a wedge out of an orange or a lemon or a lime and put that orange or lemon or lime up to your nose and then you’ll smell the citrus, which seems to be enough to take away the other scent so that you don't get the scent of the cooking food or whatever it is that is bothering you, and then you don't necessarily experience that nausea. And a lot people will also recommend ginger, ginger snaps, ginger ale, but fluid is really primary."


Some moms-to-be have trouble holding down their prenatal vitamins when they struggle with morning sickness.


"I will recommend to women that they take children's chewable vitamins during that period of time until their stomach is able to tolerate the regular vitamins."


Your doctor may also say it's okay to skip the prenatals when you are really suffering. Make sure you talk to them about it. In fact, if you are having morning sickness, your doctor really should know.


"It's always a good idea to let your doctor or your midwife know that you are experiencing morning sickness, and if you’re vomiting and you're really not able to keep fluid down and you're feeling like you’re dehydrated, those are really very important times to speak with your healthcare provider about the morning sickness because we don't want people to get dehydrated. If you are losing weight, certainly you should be discussing that with your healthcare provider as well."


You may be surprised by just how tired you are in the first trimester. I was. I don't think anyone ever told me that extreme fatigue could be a symptom of first trimester pregnancy.  It is. It certainly is for Alissia.


"Well, I can tell you today it is about 3 o'clock here and I've already taken 2 naps. On the weekends is when I catch up with my naptime. As a family physician, I have set hours so I’m usually getting up about 6:30 and working until about 5-6PM in the evening. And by about 11 o'clock in the morning, I'm already counting down the hours until I can go take a nap or get some sleep. It actually consumes a lot of my mind, you know, just thinking and planning when my next nap or sleep can be. Unfortunately I'm not able to take a nap at work, but I have heard definitely some of my friends making time and finding ways to sneak in a little nap in the middle of the day. But usually my routine is I get home, have something to eat and as soon as I can, just get into bed."


Luckily this early pregnancy fatigue, which is caused by the huge shifts in hormones, will generally subside after the first trimester...for a while anyway. What you need to do in the meantime is rest when you can. Take those naps.  Enjoy them.


Some of you will worry, even this early on, about the position you sleep in. You're worried about sleeping on your stomach or someone told you you must sleep on your left side.


"There were some studies that were done on women that had high blood pressure in pregnancy, especially toward the end of their pregnancy, and we found that if a woman who had high blood pressure or toxemia or preeclampsia with pregnancy, if she slept on her left side, then the big vessels that run up her back, the vena cava, could be more open and it wouldn't be compressed by the weight of the pregnancy. So we found for those women with problems in their pregnancy of high blood pressure, then we would recommend to them that they try to sleep on their left side because we realize that that will help to lower their blood pressure. Somehow that got translated into all women should sleep on their left side all of the time; women should never sleep on their back; women should never sleep on their stomach. It’s not the case; the case is if you have a normal healthy pregnancy, you can sleep in any position that is comfortable for you. I have many women come into my office in tears and say 'Oh no, this morning I woke up and I was sleeping flat on my back' and it's really not something that she should be concerned about if she is carrying a normal, healthy pregnancy, she can sleep in whatever position is comfortable for her."


Midwife Leslie Ludka stresses if you have complications in your pregnancy and your doctor or midwife tells you to try and sleep in a particular position, please follow their advice.


Okay, sex. It's how you got this way, but how do you feel about it now? You might feel you suddenly have a ravenous sexual appetite and want it all the time.  It is another product of your shifting hormones.  But then again, you might not...


"My experience is that I have absolutely zero interest. I've kind of made that clear, and I keep telling my husband that hopefully by the second trimester there will be some interest back, but for me right now all I can think about is sleeping and when my next nap will be."


Either reaction is perfectly normal and is likely to change during your pregnancy, probably several times. Ask your partner to please be patient.


What else is happening to you? Well, your growing breasts may change in a couple of ways, your nipples may darken and your veins may become more obvious. You may feel PMSy; I did for the entire first trimester. Fun! You may also experience some twinges that feel like cramping and some spotting, don't panic. It's probably normal, but you should report any bleeding at any point in your pregnancy to your doctor or midwife right away. You also may have some more glamorous symptoms like constipation, gas and heartburn.


Okay, so it's time to have your first prenatal appointment. You'll probably schedule it for between 8 and 12-week gestation. How do you pick a doctor or a midwife?


"When you go to your healthcare provider, when you're trying to decide who you are going to go to, you should pick someone that you're very comfortable with that you feel like you connect with that person that that person is going to teach you everything that you need to know about what’s happening to your body, so that as you go through your pregnancy, you have all of the information to make the decisions that you need to make for you because they are your decisions. So you need to look for someone that you feel can teach you and walk along beside you in this really incredible experience."


So interview a few.


"What I usually do is ask the person, and if it is a couple, ask the couple to come in and sit down and we'll talk about everything that they want to talk about and so you need to sit down with someone that you can say ‘okay, what is your philosophy on this and what is your philosophy on that. And what if this happens in my pregnancy and what if that happens in my pregnancy and how available are you going to be to me if I need to come in and see you and I have to spend 40 minutes with you or an hour with you instead of the usual 15 or 20 minutes with you, that sort of thing. What do you think about a birth plan?’ I just think it is very important that people have the experience that they are looking for. Granted, people have to remain flexible because sometimes things don't always go the way that we hope they will go, and in that respect, again, you speak to your healthcare provider, ‘what if this happens or what if that happens how will we handle that’ and to know that if things go off the track off the planned route that that healthcare provider is going to explain everything to you so that even when things go off track, you're the one that’s making the decisions about which way things are going to go with the input of the medical expert."


An open and trusting relationship with your healthcare provider is essential and can make all the difference in how you feel about your pregnancy and birth experience, so if you don't feel completely comfortable with your doctor or midwife get a different one.


When you found a doctor you're wild about, what happens at that first appointment?


"During the first trimester what you'll do is you'll come in and you'll have a complete history, so we want to know that your history and family history and the father of the baby's family history doesn't point toward any possibility of any genetic problems for baby. Then you'll have a complete physical exam so that we can look at your body and we can see that your body is healthy to carry a good healthy pregnancy and then there will be lab results, there will be lab tests that are done. We want to know what your blood type is. We want to know if you have ever been exposed to any infectious diseases. We want to do a pap smear. They are all pretty routine testing. It's pretty routine for most practices across the country that all of the same sort of testing is done. Just again to screen and make sure that everything is looking good and that you have all of the information that you need as you go through this process."


So they'll draw a lot of blood during this first exam, you also may get an ultrasound. If you are after week 5, you may see a beautiful pulse of light that is your baby's tiny heartbeat. That is a great relief for many moms-to-be who have suffered early pregnancy loss because when you see that beating heart, your chances of miscarriage drop. In fact, miscarriage is a concern for almost every pregnant woman, and it is common, between 15 and 20% of all pregnancies end in miscarriage, mostly during the first trimester and often before a woman knows she is pregnant.


"And when you really give some thought to it, the fact that an egg and the sperm can get together and so many things have to connect perfectly, and if they don't connect perfectly in the first trimester often times mother nature will say, ‘gee this pregnancy isn't going to go to a full-term healthy baby so let's stop the pregnancy now.’"


Still, that doesn't make it any easier for the woman who suffers this kind of early loss. And it's the kind of fear of this loss that often drives couples to keep their happy news to themselves for a while. Alissia, at 10 weeks pregnant, hasn't told her family yet.


"Well, in my case, I did have a miscarriage last year, so I think having that experience just makes me a little bit more cautious, because miscarriages are so common, it's just so devastating to have to go around and tell the same people again, that’s what happened to you."


So if you are waiting to tell people until you feel more secure in your pregnancy, there are a few milestones that might make good moments to spread the good news.


"When you see the baby on ultrasound and you see the heartbeat, that's a very good sign. But when your healthcare provider and you actually hear the baby with a doptone or a fetoscope, then the chances of losing that pregnancy drop dramatically, and for most people that is around 12 weeks. And then for most people, they can feel little flutters of the baby moving at about 16 weeks and so some people will wait until then. But, again, it's an individual decision."


Speaking of ultrasound, the first trimester is when you will likely face the decision of whether you want the first of many prenatal screenings that will give you some insight into what is going on with your baby. It's called a nuchal translucency. It assesses your risk for Down Syndrome and some other chromosomal issues, as well as looks for some congenital heart defects. You can get it between 11 and 14 weeks of pregnancy. If you choose to get this test, you'll have a specialized high-resolution ultrasound. The sonographer will measure the amount of fluid behind the fetus's neck. Babies at risk for Down's tend to have a higher amount of fluid there. This test may also be combined with blood work to increase its accuracy.  If your baby is found to be at an increased risk of having Down's or some other issue, you may be offered a more definitive test, the amniocentesis.  We'll talk about that in detail in another podcast.  Whether or not you avail yourself of these prenatal tests is up to you and no one else. Some women have them because they want to be prepared for the possibility of a special needs child, and feel knowing will make them a better parent. Others decline because they feel it will make no difference in how they proceed with their pregnancies; still others want the option of terminating their pregnancies. This, like so many decisions during your pregnancy, is yours and yours alone.


Okay, so we've talked about how you’re feeling, we've been to the doctor, let's talk some more about lifestyle choices you can make so you have a healthy pregnancy and baby. First, you know you have to quit smoking and drinking, right? Some of you for whom this pregnancy is a surprise may be stressed about the choices you made very early in your pregnancy.  Midwife Leslie Ludka says you can give yourself a bit of a break on that.

"Mother nature does this wonderful thing -- when we get pregnant, the egg and the sperm come together and a baby starts to form, and for that first few weeks before we know that we've missed a period, that baby is actually self-sufficient, it is not connected really to the mother's blood stream. So if a mother went to a party and she had a couple of drinks, it isn't necessarily going to affect that pregnancy because that baby is encapsulated for that first period of time as it begins to develop, so I do say to women 'you know, if you did have a couple of drinks when you had not missed your period yet and you didn't really realize that you were pregnant, it isn't something that you really necessarily have to worry too much about.'"


So let that go. There's nothing you can do about it any way. Just start fresh today.


Let's take a look at what you're eating.


"Eating for 2 is not really a good idea because if you’re doing that, you’re going to put on weight that you’re going to eventually have to take off. So it's being sensible, you want to eat really good healthy foods. Stay away from the sweets, the snacky sort of things. And if you’re eating well and you're getting some exercise everyday, your body will gain the weight that it needs to gain in a pregnancy and for most women that’s between 20 and 40 pounds."


And get moving. This is good for you and good for your growing baby.


"If you're a person that has a regular routine of exercise, then you can continue that regular routine of exercise. So if you're a runner, you can continue to run. If you're a tennis player, you can continue to play tennis. What we don't recommend is that someone start some rigorous exercise routine with the pregnancy. That is not a good idea. If you are someone who has always played tennis, then continue to do whatever it is that you have always done. But you really need to let your body be the barometer. If your body says that you're tired, then you need to listen to that and you need to slow down and generally people that are exercising to a great degree are looking for the burn. You are not looking for the burn when you're pregnant; you're just looking for regular exercise. And the two best exercises I've found to recommend to women are walking and swimming."


If you haven't exercised before now, you're not off the hook here. Even you can go for a walk.  You know you can!


"Get up and put on some good supportive walking shoes and walk 10 minutes out of your house and walk 10 minutes back and then you can increase that to 15 minutes out, 15 minutes back, eventually getting up to a half an hour out, a half an hour back. And if you're swinging your arms, listening to maybe some music and getting a good power walk in, you're getting great exercise."


Mom-to-be Alissia is working on both those things.


"Focusing on trying to eat as healthy as I can, lots of fruits, vegetables, increasing my calcium intake, a lot more yogurt and cheese, milk, and getting lots of rest. So just making that a priority and focusing on me. I also started prenatal pilates classes, so I'm hoping as the weeks go on I'll have a bit more energy to do a bit more exercise, but for now that is all I can handle at this time."


But Alissia -- who, by the way, is also a family doctor -- says always remember to be good to yourself.


"Just really focus on taking care of themselves and resting when you need to, eat when you need to.  A lot of people, I think, worry about weight gain, but especially in this first trimester when the only thing that will make you feel a little bit better is food, try to make healthy choices, but not be afraid of how much you are eating. Then it will all balance out in the end. That would be my advice."


Don't push yourself too hard. Your body is working hard to build that baby, and Midwife Leslie Ludka says during the first trimester, some of the most important work is getting done.


"At that point in time, baby is laying down their organs, so all of the organs are starting to form and really by the end of the first trimester, the baby is about an ounce in weight and the baby can make breathing motions, the baby can urinate, the baby can squint or frown or mouth opens and closes, the baby can swallow. It's just amazing."


It is amazing. At the end of the first trimester on ultrasound, your baby will look, well, like a baby -- a baby with a big head, but a beautiful dancing baby! Still, you've got two trimesters to go before you meet that beautiful bean who will soon be kicking you. Alissia says the 30 weeks that remain for her seem like they will last forever.


"Oh, it does, it seems so far away, but at the same time, it is so exciting that, you know, I keep thinking a year from now, we'll hopefully have a new addition to the family and they'll be able to enjoy the experiences we’re having right now. So I'm really looking forward to it."


It is a thrilling journey, enjoy every minute of it, mom. We at Pea in the Podcast will be with you every step of the way.


We hope you've enjoyed this Pea in the Podcast: The First Trimester. Please visit our website for more information about our experts, to find links and transcripts and to register to get tailored week-by-week shows for each week and stage of your pregnancy. It's everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I'm Bonnie Petrie. Thanks for listening.


A Special Thanks To...


Alissia in Toronto for sharing with us her journey through the first trimester.