Your First Trimester: What to Expect

Your First Trimester Congratulations on your pregnancy!

We know that the beginning of your journey may come with a lot of emotions and questions. We are here for you every step of the way, providing guidance, comprehensive care, and the necessary resources to ensure that you have a healthy pregnancy, delivery, and baby.

What happens during the first trimester?

The first trimester of pregnancy, which spans from conception to about 12 weeks, is when a fertilized egg becomes implanted into your uterus and rapidly evolves into your baby. From the formation of major organs to the emergence of a tiny beating heart, the first trimester sets the foundation for growth and development.

What to expect during your first trimester appointments Your initial visit with a provider will be about 10 to 12 weeks after your positive pregnancy test. During this visit, a due date will be established, and labs and medical history will be reviewed with you. A pelvic exam will also be conducted, and a 20-week ultrasound will be ordered. To make sure you have all the resources you need, we’ll also provide you with educational materials and links to first-trimester videos.

During this visit, prenatal genetic counseling and testing options will also be discussed. Our prenatal genetic counseling and testing can be helpful for families who have a family history of genetic disorders or birth defects, loss during pregnancy or infancy, infertility struggles or medications, pregnancy at 35 or older, or recent chemotherapy or other medicines.

Your first-trimester checklist Here is a checklist of considerations during your first trimester: • Schedule a prenatal appointment • Start focusing on a healthy and balanced diet, and consult your provider for specific dietary recommendations • Discuss exercise options that are safe during pregnancy with your provider and incorporate them into your routine • Begin taking prenatal vitamins containing folic acid, iron, and other essential nutrients as recommended by your provider • Avoid smoking, alcohol, and recreational drug use • Minimize caffeine intake and discuss safe levels with your provider • Evaluate your work environment(s), and if you have concerns about workplace hazards, consult with your provider • Consider investing in comfortable maternity clothes that provide ample support and accommodate your growing bell • Decide when and how you want to share the exciting news with family, friends, and colleagues

Remember that every pregnancy journey is unique, and it is important to consult with your health care provider throughout for personalized guidance and recommendations.

We’re here to help you understand what happens during your pregnancy You may have many questions about your pregnancy journey. We are committed to providing you with comprehensive answers and resources to make you feel as confident and comfortable as possible.

Refer to our Question Guide below for things that you may want to ask your doctor during your appointments.

Question Guide: During your pregnancy: • How and when do I tell my family I’m pregnant?

• Can I continue taking my current medications?

• Which prenatal vitamins and supplements do you recommend?

• Which prenatal screenings do I need?

• Is it safe to exercise?

• Which symptoms are normal, and which aren’t? When should I call you?

• What are some important factors to keep in mind when looking for a pediatrician?

• Is any kind of bleeding normal?

• What medication can I take to manage morning sickness or aches and pains?

Preparing for delivery: • How can I tell the difference between actual labor and Braxton Hicks contractions?

• Can you walk me through what my delivery and labor experience may look like?

• Is it safe to deliver after my due date? How long after my due date can I go?

• Is a C-section or vaginal birth better or safer?

• Can I get an epidural? At which point during labor can I get one and at which point is it too late? Is it painful to administer?

• Who can be in the room with me during delivery?

• How long will we be in the hospital?

• How can I ensure that my birth plan is being followed?

After delivery: • How long after delivery can I get back to my usual daily activities?

• What kind of changes should I expect in my body?

• Are there possible complications I should be aware of once I go home?

• Can we discuss feeding options, such as breastfeeding and formula?

• How often should I follow up with my health care provider after giving birth?

• What should I do if I’m not feeling the emotions I expected to feel after having my baby?

Financial: • What is the cost of care, and what are my options?

Frequently asked questions and answers Care Questions Q: What foods should I avoid?

• Discuss any herbal supplements with your provider before taking them • Avoid any fish caught locally (inland lakes, rivers, and the Great Lakes). We encourage you to eat up to 12 ounces a week of low-mercury fish (e.g., salmon, tilapia), but limit albacore tuna to 6 ounces a week.

You should not consume any raw fish or seafood. You should also avoid swordfish, shark, and tuna streaks, as they are more likely to be high in mercury • Avoid sugary drinks like soda and energy drinks • Avoid unpasteurized dairy products and apple cider • Avoid lunchmeat unless it has been heated before eating • Avoid consuming over 200 milligrams of caffeine per day, which is roughly equivalent to one 12-ounce cup of coffee. However, caffeine can also be found in other sources such as tea, chocolate, and some sodas.

Q: How much weight is safe to gain?

We encourage you to eat a healthy balanced diet with three servings of protein each day. The amount of weight gain that is recommended in pregnancy depends on your health and your body mass index (BMI) before pregnancy.

Your provider will discuss recommended weight gain with you during your first appointment.

Q: Can I go to the dentist?

Yes, it is important for you to continue routine dental care during your pregnancy.

Some things to keep in mind prior to receiving dental care are: • Inform your dentist: Make sure to let your dentist know that you are pregnant and provide them with relevant details about your pregnancy, such as the trimester and any specific concerns you may have • Dental procedures: Routine dental procedures such as cleanings, fillings, and root canals can typically be performed during pregnancy. However, nonemergency appointments, such as elective procedures or cosmetic treatments, should be scheduled 13 weeks after pregnancy • X-rays: If X-rays are being taken, be sure to have a shield placed over your abdomen • Anesthesia and medication: Local anesthesia isvgenerally safe during pregnancy. However, it is important to let your dentist know about your pregnancy so they can choose appropriate anesthetics and medication. Some medications, specifically certain antibiotics and pain relievers, may need to be

avoided during pregnancy. Always talk with your provider and dentist to address any concerns or specific recommendations based on your individual pregnancy.

Q: Where can I sign up for prenatal classes?

You can sign up for prenatal classes at https://www.spectrumhealth.org/healthiercommunities/ pregnancy-and-family-classes Q: What is a certified nurse midwife?

A certified nurse midwife (CNM) is a registered nurse with a graduate education in midwifery. They have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME).

This education includes a university degree as well as hands on clinical training by practicing CNMs. CNMs are collaborative physicians, and we have provider teams in our offices as well as our hospitals.

Q: What does midwifery care mean?

Midwifery care is unique, individualized care. Midwifery services include general health check-ups and physical exams, pregnancy, birth, and postpartum care, well-woman gynecologic care, and treatment of sexually transmitted infections.

Certified nurse midwives can also prescribe medications and offer treatment options. Midwifery offers patient-centered care during labor and delivery, minimizing technological interventions while providing continuous hands-on assistance and guidance during labor and birth. All our midwives are trained to monitor the physical, psychological, and social well-being of the mother throughout pregnancy and beyond. Throughout treatment, midwives will address complications that may require them to partner with an OB-GYN. Q: What is a doula?

A doula is a person trained to provide advice, information, emotional support, and physical comfort to a mother before, during, and just after delivery. We do not have employed doulas. However, please feel free to bring one to your delivery.

Q: What is prenatal genetic testing?

Prenatal genetic testing via non-invasive prenatal test (NIPT) is a very accurate blood test done any time after 10 weeks to screen for too many or not enough copies of certain chromosomes. This test studies fetal DNA (genetic material) in your blood to see if there is anything wrong. Knowing this information can be helpful for you and your provider to better manage your pregnancy.

NIPT is a screening test, meaning that it only tells you whether your baby is more or less at risk for certain conditions and is not a diagnosis. This test cannot detect all genetic changes that could lead to health problems. The decision to have the screening is yours. If you would like more information, ask your provider how you can schedule a free, 15-minute information session with a certified genetic counselor online through various genetics companies.

Q: What is genetic carrier screening?

Genetic carrier screening is a blood test that checks your genes to determine whether you are a carrier of 14 genetic conditions that are advised for screening during childbearing years. You can complete this test while pregnant or before you become pregnant. This test only needs to be completed once. If you screen positive, we recommend that your partner also gets screened to determine a potential pregnancy risk. It is important to remember that no test can detect 100% of genetic carriers. Although the chance is small, even if your test is negative, it is still possible that you could be a carrier. While the decision to have the screening is yours, your provider is here to help provide guidance. If you would like more information, ask your provider how you can schedule a free, 15minute information session with a certified genetic counselor online through various genetics companies.

Q: I was told I need an NST. What is that?

A non-stress test (NST) is non-invasive and involves monitoring the baby’s heart rate using an external monitor. This monitor is placed on your abdomen. The average time of the test is 30 minutes. If you have questions about the purpose of the test, please call our office and speak to one of our nurses.

Q: Is virtual OB-GYN care safe?

If you are eligible to receive virtual care, this means that you will have a combination of in-person and virtual visits. We will provide you with a kit to support virtual visits during your pregnancy. We do ask that you return the kit after your 37-week virtual visit to allow other patients to have the same experience and convenience you had. This kit consists of a blood pressure cuff and fetal Doppler. Whether you are in person or virtual, we are committed to providing you with the most comprehensive care possible.

Insurance Questions Q: What is considered routine prenatal care by most insurances?

Routine prenatal care visits are one of the best ways to promote a healthy pregnancy and receive information to help keep you and your baby healthy. It is important that you attend all your prenatal appointments. Routine prenatal care in your provider’s office includes: • A physical examination • Recording of weight • Blood pressure check • Fetal heart tone check

• Monthly visits up to 28 weeks’ gestation, biweekly visits between 28 and 36 weeks, and weekly visits from 36 weeks until delivery Routine prenatal care does not include: • New problems identified by you or your provider • Management of medications or treatment of conditions not related to your pregnancy Q: What is covered by my insurance during my pregnancy? How much will I have to pay?

Every insurance plan is different. We encourage you to contact your insurance company for coverage details specific to your plan. Prenatal care includes visits directly related to caring for your pregnancy. Conditions treated unrelated to pregnancy, such as colds or sore throats, may result in additional co-pays or charges. Often, routine prenatal lab work and/or ultrasounds are left to your deductible, so although they are covered by insurance, you may still be responsible for charges.

Lifestyle Questions Q: Can I travel?

Many women can travel during their pregnancy. It is important to discuss travel plans with your provider, especially if you have a high-risk pregnancy or history of preterm labor. Some important things to remember about travel are: • If you are traveling by airplane or train, please be sure to check the requirements for pregnant passengers • Long-distance travel (over 1 hour away from the hospital) after 36 weeks of pregnancy should always be discussed with your provider • Always wear your lap and shoulder seat belt. The lap belt should be worn across your hips and under your belly, and the shoulder harness above your belly • If you are traveling long distance, get out of the car every few hours and walk around • Try to avoid high-sodium (salty) foods and drink plenty of water Q: Can I continue to work?

Most women can continue to work throughout their pregnancy. If you are employed where you may be exposed to hazardous materials or chemicals, your employer should have a Material Safety Data Sheet or Right to Know manual available to explain any risks that you could incur through exposure.

Some important things to remember about working are: • Avoid prolonged sitting and standing • Avoid chemical and toxic fumes, and be aware of what is in your workplace • Do not lift more than 25 pounds • Do not climb a ladder, as balance can be affected by your expanding belly • If you work around X-rays, use the proper equipment