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First Trimester Survival Guide: Midwives Answers Your Biggest Questions · Meaningful Medicine with Novant Health

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Melanie Cole, MS (Host): Welcome to Meaningful Medicine, a Novant
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Health podcast, bringing you access to leading doctors who answer your
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questions they wish you would ask.
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From routine care to rare conditions, our physicians offer tips to navigate medical
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decisions and build a healthier future.
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I'm Melanie Cole.
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And we have a panel for you today with Mistee Formica and Kara Simpson.
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They're both certified nurse midwives with Novant Health, and they are here to
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give a first trimester survival guide, Midwives Answer Your Biggest Questions.
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Thank you both so much for joining us today.
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And Mistee, I'd like to start with you.
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Why is the first trimester such an important time for both mom and baby?
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Mistee Formica: Yeah.
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Well, so because the first trimester, of course, everybody wants to have that
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perfect pregnancy and perfect baby, but a lot of what happens happens to you
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before you ever know you're pregnant, and those are the biggest impacts.
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And so, actually, first trimester, I like to say, is just a continuing of
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keeping yourself healthy and being the best person you can be for the pregnancy
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and for your developing baby, because a lot of all that stuff is going to happen
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before we ever you see us in the office.
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And so, our goal is to keep you really healthy on the front end
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before we ever see you in the first trimester so that we don't have
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to address those kind of things.
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But it is utmost important that people come in pregnancy as healthy as they
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can be so that whenever we do encounter problems or medication use or, you
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know, substance use, if you went out drinking with the girls, is it okay?
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Those things are the question that really burn in your mind, and our goal
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is to keep you as healthy as can be on the front end before we get there.
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Because you're not going to know for two weeks you're pregnant, you're technically
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not pregnant, according to our numbers.
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Melanie Cole, MS: Well, thank you for that.
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I couldn't agree more.
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So Kara, what are some of the biggest misconceptions that you've heard
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in your career about that first trimester, about that early pregnancy?
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Kara Simpson: A lot of people come in concerned that they don't have the
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symptoms that they read about online or in Google, in all the books, in the chats,
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and they're really concerned about that.
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So, there are people who come in and say, "I don't even know that I'm pregnant.
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Nothing feels different.
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Am I okay?"
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And the answer is yes.
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It's okay if you don't have morning sick like your cousin or your mom did.
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It's okay if you don't have the food aversions and you're eating normally.
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It's okay if your activity levels haven't tanked.
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Every pregnancy is different.
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Every mom is different.
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Every baby is different.
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So, that's one of the big things that people come in and ask about the first
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trimester that they're concerned about.
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Melanie Cole, MS: Well, I would love to do a lightning round with
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both of you on some of the most common first trimester questions.
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I mean, I remember when I was pregnant with my first one many years ago,
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all the things that went through my mind in that first trimester.
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It's really such an exciting time.
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It can be slightly terrifying as well.
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So Mistee, when should a woman schedule her first prenatal appointment?
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Mistee Formica: Ideally, we want you to have tracked your cycles and keeping
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up on the front end, staying nice and healthy like we had mentioned earlier.
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But ideally, we want to get an early dating and a confirmation
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on your pregnancy if possible.
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So, the best time to do that is somewhere around eight to 10 weeks.
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Each practice is a little bit different in exactly when they want people to come in.
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But yeah, it's not very long into pregnancy and you're already out of
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the first trimester, and that's a lot of the exposure and stuff that you
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been exposed to before ever seeing us.
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And so, ideally, eight to 10 weeks, we can do lots of education early on, but
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it's really kind of prepping up for
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pre-pregnancy situation and having the environment primed and ready to go.
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And then, you get to have what I like to say, the hurry up and
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wait as baby grows, and that's the hardest part for a lot of moms.
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Melanie Cole, MS: Well, it certainly is.
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You know, you get a little antsy as it starts going on.
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But in that first trimester, it does seem kind of slow.
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Kara, what happens at that first visit with a midwife?
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Kara Simpson: So that first visit, we typically orient you to the practice,
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kind of talk about your options as far as who you can see in your pregnancy.
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For our practice specifically, we have midwives, we have physicians,
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we have nurse practitioners, and physicians assistants.
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So, you have a vast variety of who you'd like to see.
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So, we also do a lot of education on that first visit.
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We talk about activity.
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We talk about what's safe to eat.
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We talk about safe medications.
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We talk to you about your next visit, which is typically your initial
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prenatal visit, and that's when we do a lot of our prenatal labs.
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We talk about the options for genetic testing, for carrier screening.
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There's a lot of information at that first visit.
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So, it's a good idea to bring a notepad or bring a phone where you can take notes.
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And you can also come armed with questions.
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We love to answer all the questions that you have.
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And just know that throughout pregnancy there will be a lot of education.
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There'll be a lot of times to revisit a lot of the things that we discuss.
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So, you don't have to come armed with all the questions, especially,
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you know, your first visit.
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We don't have to talk about delivery.
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We don't have to talk about postpartum.
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We have time for that.
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So, we just want you to come in, be prepared to kind of give us your
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health history, we'll go through that at length, and then talk about what
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your pregnancy's going to look like.
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Melanie Cole, MS: So Kara, sticking with you for a minute, how often will
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a woman come and see you throughout her pregnancy and that first trimester?
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Kara Simpson: Yeah.
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So surprisingly, we don't see you a ton at the front end of pregnancy.
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We see you every four weeks up until you're 28 weeks.
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At that point, that's when we do the glucose testing, that's when we
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do your third trimester labs, and you start coming every two weeks.
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And at 36 weeks, we see you every week until that sweet baby arrives.
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So, it can be a little bit scary for people to see us once a month, you
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know, just because you're unsure.
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You're not feeling things, you don't feel perceptions of movement.
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Just know that if there are any concerns, you can always
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come in between your visits.
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You don't have to wait four weeks, especially if you have concerns.
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Melanie Cole, MS: Oh, that's really good to know.
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Mistee, let's talk about those symptoms, because the early pregnancy symptoms,
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you know, they always say the second trimester you kind of feel a little freer.
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But what are some of those symptoms that you see in women that seem
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to be the most noticeable for the woman going through them?
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Mistee Formica: Okay.
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So, the most noticeable symptoms, I think for, of course, anybody is just because
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of the rapid onset of hormonal changes and the ability to have access to information,
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it's like had Kara had said, if you're not feeling it, something's not right.
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But some women feel great in early pregnancy.
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Normal kind of signs and symptoms are being tired, so a little extra fatigue.
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Tasting and smelling things differently.
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I like to tell my moms that your body is now in overhyper protection
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mode, and it wants you to eat good things and will turn you away from
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things that you probably shouldn't be.
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So, your taste and your smell's going to change.
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Your body's going to change, and that can happen very, very quickly.
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You may have to pee a lot or not pee at all.
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There's all the kind of things that can go for anything.
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Discharge is another very common complaint in early pregnancy that people get
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really worried about, but that's your vagina in overdrive, trying to keep that
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environment just perfect for pregnancy.
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And so, on the flip side is you get discharge.
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And so, … a lot of the things you look for have a really good
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background in the reason that they're happening, but they're all very normal.
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And to have them or not to have them are both actually very normal.
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Melanie Cole, MS: What about morning sickness, Mistee?
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When does that usually start and how long does it last?
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What are we supposed to be doing about it?
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Mistee Formica: As Kara said, that first visit, you know, when we give you
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all that information, I love to always give my moms the what we call a kind
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of the green light information, right?
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Because that's what everybody's afraid of.
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But there are lots of kind of over-the-counter herbal remedies, ginger
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tea, peppermints, things like that.
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Every woman's pregnancy is very different.
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I've had a lot of women tell me with their girls, this happened.
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With their boys, this happened.
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With multiple, something else happens.
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So, it all can be very different for every pregnancy, not just every woman,
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but every pregnancy for the same woman.
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But there are things that are natural, like the ginger.
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There's B6 and Unisom, which is an over-the-counter supplement that
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people have been taking now for years.
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And then, there are kind of the bigger guns that you have to come to
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us to get, and hopefully will pass as we get into the second trimester.
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Most moms, it will improve by around 15 weeks.
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But that's a long time to have food aversions and nausea and not want to
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eat or drink when your body is trying to tell you it needs to eat and drink
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healthy and a lot of different new things.
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So, the nausea is a big one.
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And we have all the options and different stages of how can we fix it
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for you, from everything from carrying some candy to some really interesting
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infusion therapy if we have to.
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We do have access to other things.
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Melanie Cole, MS: Well, it is nice to know that there's those things out there.
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And I will agree with you, mint, chewing on mint leaves, ginger tea, a lot
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of those things can definitely help.
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And there are some interesting myths about boys versus girls and
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who makes you the most nauseous.
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And so, that's always interesting to think about.
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And Kara, is spotting normal?
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Mistee mentioned discharge, but spotting is a little bit different
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and can be rather frightening.
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Is this normal?
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And when really is it important to call the provider?
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Kara Simpson: Spotting in pregnancy can be very normal, but it also can be abnormal.
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Anytime you're bleeding in pregnancy, we want to hear from you, even if you're
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just like, "Oh, it's just a couple drops," just because we want to make sure it's
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nothing that you need to be evaluated for.
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So, some things to keep in mind if you do notice spotting,
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the color of the spotting.
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If it's bright red, if it's just light pink when you wipe,
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if it's accompanied by pain.
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Those are things that we want to know.
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You can always call the office just to make sure you don't need
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to come in and see a provider.
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Also things to be aware of, spotting can just be something
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that happens just because.
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It could also be caused by intercourse.
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There are different reasons to spot.
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Some people have what's called a subchorionic hematoma or a
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subchorionic hemorrhage, which can make you spot in pregnancy.
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So, there are lots of factors to consider when you notice spotting, but we always
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want to hear from you when it happens.
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Melanie Cole, MS: Mistee, what other symptoms should really never be ignored?
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And as Kara said, it's always good to call your provider with any
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questions, but what are some of the other symptoms that you like to tell
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women about and say, "You know what?
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Don't ignore that.
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Call us"?
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Mistee Formica: You know, it's one of those things.
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Enough people have, I like to say, unfortunately, stories circulate
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when they are not the greatest.
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And so, you don't hear things when things are—you get the bigger
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story when things turn out poorly.
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But there are some go-tos.
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If you are dizzy with movement, if you're not able to eat and drink for
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more than, I usually say 48 to 72 hours, and you're so sick you can't
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hold anything down, you're getting in some kind of risky territory there.
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If you've got crazy fever that you shouldn't have, you can get kidney
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infections, things like that, discharge, all of that really plays a lot
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into how are as a pregnant person.
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But it can also threaten the pregnancy as well, and those are the ones
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you want to be really aware of.
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A lot of things can be treated in pregnancy very safely, but
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if they go unnoticed, that's where you get into trouble.
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And so, it's always kind of the big ones.
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Like if you have a new reaction to like an iodine allergy or a seafood allergy
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and you're just for the first time really eating it in pregnancy, then it becomes
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how do we safely, you know, treat that?
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Or is this part of the normal cold and flu season?
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We're coming into cold and flu season.
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You know, what is safe to take?
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What is not safe?
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But high fevers, not feeling great, just kind of take the average person.
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And for pregnancy, I always like to say it's almost 10 times worse for
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the pregnant person, not only because you're pregnant, but because everybody's
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going to have two cents of, "Oh, you should do this, you shouldn't do that."
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And, you know, some of the symptoms are still the same.
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Unfortunately or fortunately, I don't know which way you phrase
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that, because of medical technology, we have moms that are a lot sicker
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getting pregnant, and that changes the landscape of pregnancy altogether.
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And so, the conversations you would have never had with somebody who
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possibly 20 years ago wouldn't have been getting pregnant can now get
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pregnant, and you're just dealing with a different human altogether.
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And so, for some of those, we have to be kind of medical, you know,
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detectives and reach out to our colleagues and things like that.
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So if you're ever worried, go to the ER, go call your doctor,
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come in for a work and visit.
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Let us see you.
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Let us put our hands on you.
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Let us see, is this normal?
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You know, where are you at in that kind of spectrum.
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Kara Simpson: Within Novant Health, we actually have OB urgent care facilities.
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One of our offices, one of our satellite offices actually turns into
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an OB urgent care in the evening.
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So from 5:00 to 9:00 PM during the week and 9:00 AM to 9:00
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PM on the weekends, that gives patients another access to care.
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And you don't have to sit at the emergency room for hours and hours on end.
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You're able to get in a little more quickly.
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Most of them have ultrasound and lab capability.
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And it's really convenient, especially if you can't make it in
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during our office hours to see us.
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Melanie Cole, MS: That is great.
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I'm so glad that you pointed that out, Kara, because, you know, the thought of
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going to the emergency room and sitting there for hours is never fun for anybody.
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So, thank you both for telling us about those options.
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And it's reassuring for women to hear that you guys are there for them.
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Now, I'd like to ask you both to offer some really practical advice
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for first-time moms in that first trimester, which can be so exciting.
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So Kara, what is one piece of advice that you give nearly every patient
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for the first time if they're a first-time mom in that first trimester?
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Kara Simpson: Yeah.
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Try to stay present.
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Try to enjoy your pregnancy.
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there are a lot of unknowns, especially until you're able to
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feel that first little flutter.
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Just try to stay present in the pregnancy.
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Sometimes anxiety can overcome us, and it's normal to be anxious,
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especially if it's your first time.
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But what we don't want is for you to be so anxious that you're constantly
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looking at the bad and what could happen, even if it doesn't happen.
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And then, you look back on your pregnancy, and you realize you weren't there at all.
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You weren't there to enjoy the moments or really take it all in
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for the experience that it is.
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So, definitely stay present.
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Melanie Cole, MS: So, that's really great advice.
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Mistee, what questions should moms be asking their providers when
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they often forget these things?
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You mentioned making a list, which is such a great idea, but what do you want them
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asking you the first time they meet you?
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Mistee Formica: I want them to ask for the information.
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Because in the world we live in, there is a lot of resources where people
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are not getting correct information.
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And it's not hard to reach out.
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And Novant has a fabulous myChart apps, and we have great triage nurses.
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Ask.
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It is better to come from one of us that know and can give you good, reliable
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information from good sources so that you can make an informed decision about
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what's happening to you and your body, and is this actually something for you?
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But if you kind of depend on the world right now, it's not the
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greatest environment, and the information's not always correct.
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So, just ask the questions.
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Don't think, "This is not the one I shouldn't have asked," or, "What
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if I would have said something?"
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This is a miraculous process, but you only kind of shoot yourself
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in the foot if you don't ask and you have bad, bad information.
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And all our goal is a healthy mom and a healthy baby.
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How we get there doesn't matter in the end.
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Melanie Cole, MS: Yeah, that's true.
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And with all the misinformation, it's so nice to have you both
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that people can ask questions.
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And bringing those lists really help, ladies.
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So, I want to give you each a chance for a final thought.
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Mistee, starting with you, if you could leave every expectant
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mom with one message about that first trimester and how exciting
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pregnancy can be, what would it be?
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Mistee Formica: I think to really just
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trust the process, which is a hard place to begin for so many women.
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But trust the process.
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Trust that your body's going to do the right thing, and that if anything
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does go wrong, if you get sick, if you get the flu, if you have a
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miscarriage, it's not your fault.
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You do the best you can for you, and we'll help you get the rest of the way.
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And don't take on the world.
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Do what you can.
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You know?
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I like to go back to what I call the mommy mode.
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Make sure you're eating, you're drinking, you're sleeping.
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We got to take care of you, too.
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And I think that is utmost important in the first trimester, because
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they're so focused on everything else.
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They forget about that.
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It's like we got to take care of you first.
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Kara Simpson: I would say to the new family, the expecting person
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that's going to be here for us to know that we're always here for you.
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We have many offices within our specific practice that give many
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people the opportunity to be cared for in their communities, to be cared
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for in places that are local to them.
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We have a variety of providers with different personalities, but our bottom
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line is to care for you and your family, to make you feel comfortable, to make
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you feel heard, advocated for, cared for.
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And that extends into our urgent care, where we have a different
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set of providers to care for you, and also into our hospital where
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we deliver these sweet babies.
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So, overall, I just want to say that we're here for you.
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We're here to care for you.
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We're ready, we're excited, and we can't wait to take this journey with you.
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Melanie Cole, MS: Beautifully said.
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And you're both lovely, and I can hear the passion for what
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you do and the compassion.
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Your patients, I am sure, just love working with both of you.
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So, thank you so much for joining us today.
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And to find a physician, you can visit novanthealth.org.
19:55
And for more health and wellness information from our experts,
19:59
visit healthyheadlines.org.
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That concludes this episode of Meaningful Medicine, a podcast from
20:05
the specialists at Novant Health.
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I'm Melanie Cole.