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6 Surprises in the First Trimester

6 Surprises in the First Trimester

Here are six of the first surprises you'll discover during the first trimester, from morning sickness to lower back pain.

This past spring, as the only physician in the ER, I delivered a family’s healthy, beautiful baby right there in the critical care room. I’ve spent the past 13 years learning to evaluate pregnant women, performing ultrasounds on babies in utero and finding that little fetal heart rate. I figured I’d know exactly how to feel and what to do when I got pregnant

Makes sense, right?

Turns out, while I could tell you the “Cardinal Movements of Labor” (the medical term for the positions of the baby’s head as it passes through the birth canal), I was the same as every other new mom-to-be when it came to the… let’s call them  “Cardinal Moments” of pregnancy. 

After a few confused and surprised moments (and some humble pie--which, given my cravings, I would have eaten as well), I decided to put all that medical training to good use--for me and for you. What good was all that studying if I couldn’t use it to educate myself--and my friends--about their own pregnancies? So, over the next few weeks I'll share with you some of my own confusion about unexpected (and expected) symptoms, baby growth and all those tests you may get in my new mini blog, What Medical School Didn't Teach Me About Being Pregnant. Then I'll pull in some of the best doctors I know to help us all figure this out. I first turned to Shana Dowell, MD, an OB-GYN and Assistant Professor, Vanderbilt Center for Women's Health at Northcrest and a mother of two herself. 

“We all have a vision about how it’s going to be and it’s never that way,” Dr. Dowell told me. “Successful women like to be in control, and pregnancy and childbirth and motherhood is one long, never-ending lesson about not having control.” What a relief to learn that the feeling is universal! So, here’s to nine months of surprises--both the joyous and the icky--because we are embarking on an entirely new journey together. Here are six of the first surprises that hit me:

1. You may have morning sickness. Then again, you may not. Instead, you may have a host of other gastrointestinal issues. Acid reflux, constipation, flatulence--yes, pregnancy truly is glamorous! The good news is there are a bevvy of over-the-counter (OTC) medications that you can safely take to address these problems. You don’t need to suffer in silence (or, if your complaint is flatulence, the embarrassing opposite). I wouldn’t recommend that you take any OTCs on your own; first speak to your OB-GYN. If nothing helps, ask to be referred to a gastroenterologist. Other tips from Dr. Dowell: “For morning sickness, eat frequent small meals, stay hydrated, eat first thing in the morning, and try ginger tea, candies or other foods with ginger. There are lots of prescription medications that your doctor may prescribe: diclectin, Phenergan, Reglan, Zofran, and even a Zofran pump.”

2. You will get advice -- lots of advice. Did you think that because I’m a physician fewer people would give me pregnancy advice? Um… no. No matter what, that bump is a metaphorical sign soliciting advice from EVERYONE. Your mom. Your mother-in-law. Your well-meaning friends. Your not-so-well-meaning friends. The lady who makes your coffee at Starbucks. It’s enough to make your head spin. I loved Dr. Dowell’s suggestion: “Listen to your body and trust yourself. Find one or two people who you admire as mothers and get advice from them. Otherwise, I always felt like people were telling me twelve different things. You only end up confused!” Everyone has their own way for dealing with pregnancy and planning for a child, and most of us are just trying to figure out the best way we know how. So remind yourself: You are doing your best. You are going to be a great mom. Then block out the endless chatter.

3. Your pre-pregnancy weight is just as important (if not more so) as the weight you gain. Did you know that in the 1930s, pregnant women in the U.S. were advised to gain only 15 pounds? From the research I’ve found two conclusions: (1) it’s important to stay within the “healthy” ranges of weight gain (although you shouldn’t stress if you’re not following the guidelines week-to-week) and  (2) the most important factor, according to some studies, is the mother’s BMI pre-pregnancy. All the more reason to try to get in shape before you get pregnant. For those who start at a healthy weight, it shouldn’t be a reason to lose total control of your eating, but at the same time, don’t let the growth and weight charts drive you crazy if your doctor thinks your weight is healthy!

4. Your back will hurt, sometimes in strange places. Changes in muscle and ligament stiffness, fluid retention and the imbalanced weight gain in the front of your body can all contribute to back pain. Ideally, focus on core and back exercises during your first trimester to strengthen and prepare for the months ahead.  Is your back already aching? Studies have shown that back exercises, support belts and walking can all help ease the pain. Water therapy and acupuncture may also provide some relief. If your back is still sore, make the ultimate fashion sacrifice. Put away your heels and your flats (yes, those adorable ballet slippers)--and choose low-heeled shoes with good arch support. Also, sleep on your side (ideally on your left side, as your uterus enlarges), with pillows between your knees for support. And don’t forget massage! Now’s the time to enlist your partner to give you their best backrub ever.

5. You will panic. You just ate the most wonderful flatbread pizza with escarole and Camembert cheese. Then you hear in the news that escarole has been linked to an E. coli outbreak and Camembert with Russian flesh-eating bacteria! (Don’t worry--I made that up). Panic sets in as you wonder what you’ve just done to your baby. Even the most logical, intelligent and calm women (read: YOU) can and will feel this way--it’s that instinctive mother-bear mentality. Dr. Dowell says that when she panicked about anything during her pregnancy her husband would joke, “I don’t know, why don’t you ask an OB-GYN?” It’s a good reminder that even a doctor specializing in the care of pregnant women still worried during her own pregnancy, and it’s totally natural. I’ve had friends who stuck to every rule in the book during their pregnancy, while others worked overnight shifts in the ER (fueled by lots of coffee) up until their last week. And guess what? They both had beautiful little babies. 

6. You will feel joy, fear, and…joy.  The first few times you feel a kick, you’ll question if it’s gas. Then, you’ll know. And no amount of reading, preparation or medical degrees will ever prepare you for that wonder. So here’s to the little kicks and the great mom that you’re going to be.

Medically reviewed in June 2019.

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