What symptoms should I call my provider about during the first trimester?

You should reach out to your provider if you have symptoms such as persistent bleeding, severe illness, high fever, dizziness or an inability to eat or drink for an extended period of time. The midwives emphasize that many conditions can be treated safely during pregnancy, but it is important not to ignore concerning symptoms.

Episode chapters

00:00 Introductions
00:22 Meet the panel: Midwives Mistee Formica and Kara Simpson
00:43 Why is the first trimester such an important time for both mom and baby?
02:10 Common misconceptions about the first trimester
02:55 Lightning round: Common first-trimester questions
03:17 When should you schedule your first prenatal appointment?
04:29 What happens at the first midwife visit?
05:48 How often will you see a provider during pregnancy?
06:37 Common early pregnancy symptoms
08:24 Morning sickness: onset, duration, and remedies
10:23 Spotting in pregnancy: what’s normal and when to call
11:33 What other symptoms should never be ignored?
14:18 OB urgent care options at Novant Health
15:13 Practical advice for first-time moms in the first trimester
15:29 Kara's top advice: Stay present during pregnancy
16:12 What questions should expectant moms ask their providers?
17:44 Final thoughts from Mistee: Trust the process
18:55 Final thoughts from Kara: We're here for you
20:01 Episode wrap and resources

Melanie Cole, MS (Host): Welcome to Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer your questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

I'm Melanie Cole and we have a panel for you today with Mistee Formica and Kara Simpson. They're both certified nurse midwives with Novant Health, and they are here to give a first trimester survival guide, Midwives Answer Your Biggest Questions. Thank you both so much for joining us today and Mistee, I'd like to start with you. Why is the first trimester such an important time for both mom and baby?

Mistee Formica: Yeah. Well, so because the first trimester, of course, everybody wants to have that perfect pregnancy and perfect baby, but a lot of what happens happens to you before you ever know you're pregnant, and those are the biggest impacts and so, actually, first trimester, I like to say, is just a continuing of keeping yourself healthy and being the best person you can be for the pregnancy and for your developing baby, because a lot of all that stuff is going to happen before we ever you see us in the office.

And so, our goal is to keep you really healthy on the front end before we ever see you in the first trimester so that we don't have to address those kind of things. But it is utmost important that people come in pregnancy as healthy as they can be so that whenever we do encounter problems or medication use or, you know, substance use, if you went out drinking with the girls, is it okay? Those things are the question that really burn in your mind, and our goal is to keep you as healthy as can be on the front end before we get there. Because you're not going to know for two weeks you're pregnant, you're technically not pregnant, according to our numbers.

Host: Well, thank you for that. I couldn't agree more. So Kara, what are some of the biggest misconceptions that you've heard in your career about that first trimester, about that early pregnancy?

Kara Simpson: A lot of people come in concerned that they don't have the symptoms that they read about online or in Google, in all the books, in the chats, and they're really concerned about that. So, there are people who come in and say, "I don't even know that I'm pregnant. Nothing feels different. Am I okay?" And the answer is yes. It's okay if you don't have morning sick like your cousin or your mom did. It's okay if you don't have the food aversions and you're eating normally. It's okay if your activity levels haven't tanked. Every pregnancy is different. Every mom is different. Every baby is different. So,

that's one of the big things that people come in and ask about the first trimester that they're concerned about.

Host: Well, I would love to do a lightning round with both of you on some of the most common first trimester questions. I mean, I remember when I was pregnant with my first one many years ago, all the things that went through my mind in that first trimester. It's really such an exciting time. It can be slightly terrifying as well. So Mistee, when should a woman schedule her first prenatal appointment?

Mistee Formica: Ideally, we want you to have tracked your cycles and keeping up on the front end, staying nice and healthy like we had mentioned earlier. But ideally, we want to get an early dating and a confirmation on your pregnancy if possible. So, the best time to do that is somewhere around eight to 10 weeks. Each practice is a little bit different in exactly when they want people to come in.

But yeah, it's not very long into pregnancy and you're already out of the first trimester, and that's a lot of the exposure and stuff that you’ve been exposed to before ever seeing us and so, ideally, eight to 10 weeks, we can do lots of education early on, but it's really kind of prepping up for pre-pregnancy situation and having the environment primed and ready to go and then, you get to have what I like to say, the hurry up and wait as baby grows, and that's the hardest part for a lot of moms.

Host: Well, it certainly is. You know, you get a little antsy as it starts going on. But in that first trimester, it does seem kind of slow. Kara, what happens at that first visit with a midwife?

Kara Simpson: So that first visit, we typically orient you to the practice, kind of talk about your options as far as who you can see in your pregnancy. For our practice specifically, we have midwives, we have physicians, we have nurse practitioners, and physicians assistants. So, you have a vast variety of who you'd like to see.

So, we also do a lot of education on that first visit. We talk about activity. We talk about what's safe to eat. We talk about safe medications. We talk to you about your next visit, which is typically your initial prenatal visit, and that's when we do a lot of our prenatal labs. We talk about the options for genetic testing, for carrier screening. There's a lot of information at that first visit. So, it's a good idea to bring a notepad or bring a phone where you can take notes.

And you can also come armed with questions. We love to answer all the questions that you have and just know that throughout pregnancy there will be a lot of education. There'll be a lot of times to revisit a lot of the things that we discuss. So, you don't have to come armed with all the questions, especially, you know, your first visit. We don't have to talk about delivery. We don't have to talk about postpartum. We have time for that. So, we just want you to come in, be prepared to kind of give us your health history, we'll go through that at length, and then talk about what your pregnancy's going to look like.

Host: So Kara, sticking with you for a minute, how often will a woman come and see you throughout her pregnancy and that first trimester?

Kara Simpson: Yeah. So surprisingly, we don't see you a ton at the front end of pregnancy. We see you every four weeks up until you're 28 weeks. At that point, that's when we do the glucose testing, that's when we do your third trimester labs, and you start coming every two weeks and at 36 weeks, we see you every week until that sweet baby arrives.

So, it can be a little bit scary for people to see us once a month, you know, just because you're unsure. You're not feeling things, you don't feel perceptions of movement. Just know that if there are any concerns, you can always come in between your visits. You don't have to wait four weeks, especially if you have concerns.

Host: Oh, that's really good to know. Mistee, let's talk about those symptoms, because the early pregnancy symptoms, you know, they always say the second trimester you kind of feel a little freer. But what are some of those symptoms that you see in women that seem to be the most noticeable for the woman going through them?

Mistee Formica: Okay. So, the most noticeable symptoms, I think for, of course, anybody is just because of the rapid onset of hormonal changes and the ability to have access to information, it's like Kara had said, if you're not feeling it, something's not right. But some women feel great in early pregnancy.

Normal kind of signs and symptoms are being tired, so a little extra fatigue. Tasting and smelling things differently. I like to tell my moms that your body is now in overhyper protection mode, and it wants you to eat good things and will turn you away from things that you probably shouldn't be. So, your taste and your smell's going to change. Your body's going to change, and that can happen very, very quickly. You may have to pee a lot or not pee at all. There's all the kind of things that can go for anything.

Discharge is another very common complaint in early pregnancy that people get really worried about, but that's your vagina in overdrive, trying to keep that environment just perfect for pregnancy and so, on the flip side is you get discharge and so, a lot of the things you look for have a really good background in the reason that they're happening, but they're all very normal and to have them or not to have them are both actually very normal.

Host: What about morning sickness, Mistee? When does that usually start and how long does it last? What are we supposed to be doing about it?

Mistee Formica: As Kara said, that first visit, you know, when we give you all that information, I love to always give my moms the what we call a kind of the green light information, right? Because that's what everybody's afraid of. But there are lots of kind of over-the-counter herbal remedies, ginger tea, peppermints, things like that.

Every woman's pregnancy is very different. I've had a lot of women tell me with their girls, this happened. With their boys, this happened. With multiple, something else happens. So, it all can be very different for every pregnancy, not just every woman, but every pregnancy for the same woman. But there are things that are natural, like the ginger. There's B6 and Unisom, which is an over-the-counter supplement that people have been taking now for years and then, there are kind of the bigger guns that you have to come to us to get, and hopefully will pass as we get into the second trimester. Most moms, it will improve by around 15 weeks. But that's a long time to have food aversions and nausea and not want to eat or drink when your body is trying to tell you it needs to eat and drink healthy and a lot of different new things.

So, the nausea is a big one and we have all the options and different stages of how can we fix it for you, from everything from carrying some candy to some really interesting infusion therapy if we have to. We do have access to other things.

Host: Well, it is nice to know that there's those things out there and I will agree with you, mint, chewing on mint leaves, ginger tea, a lot of those things can definitely help and there are some interesting myths about boys versus girls and who makes you the most nauseous and so, that's always interesting to think about.

And Kara, is spotting normal? Mistee mentioned discharge, but spotting is a little bit different and can be rather frightening. Is this normal? And when really is it important to call the provider?

Kara Simpson: Spotting in pregnancy can be very normal, but it also can be abnormal. Anytime you're bleeding in pregnancy, we want to hear from you, even if you're just like, "Oh, it's just a couple drops," just because we want to make sure it's nothing that you need to be evaluated for. So, some things to keep in mind if you do notice spotting, the color of the spotting. If it's bright red, if it's just light pink when you wipe, if it's accompanied by pain. Those are things that we want to know. You can always call the office just to make sure you don't need to come in and see a provider.

Also things to be aware of, spotting can just be something that happens just because. It could also be caused by intercourse. There are different reasons to spot. Some people have what's called a subchorionic hematoma or a subchorionic hemorrhage, which can make you spot in pregnancy. So, there are lots of factors to consider when you notice spotting, but we always want to hear from you when it happens.

Host: Mistee, what other symptoms should really never be ignored? And as Kara said, it's always good to call your provider with any questions, but what are some of the other symptoms that you like to tell women about and say, "You know what? Don't ignore that. Call us"?

Mistee Formica: You know, it's one of those things. Enough people have, I like to say, unfortunately, stories circulate when they are not the greatest and so, you don't hear things when things are—you get the bigger story when things turn out poorly. But there are some go-tos. If you are dizzy with movement, if you're not able to eat and drink for more than, I usually say 48 to 72 hours, and you're so sick you can't hold anything down, you're getting in some kind of risky territory there. If you've got crazy fever that you shouldn't have, you can get kidney infections, things like that, discharge, all of that really plays a lot into how you are as a pregnant person. But it can also threaten the pregnancy as well, and those are the ones you want to be really aware of.

A lot of things can be treated in pregnancy very safely, but if they go unnoticed, that's where you get into trouble and so, it's always kind of the big ones. Like if you have a new reaction to like an iodine allergy or a seafood allergy and you're just for the first time really eating it in pregnancy, then it becomes how do we safely, you know, treat that? Or is this part of the normal cold and flu season?

We're coming into cold and flu season. You know, what is safe to take? What is not safe? But high fevers, not feeling great, just kind of take the average person and for pregnancy, I always like to say it's almost 10 times worse for the pregnant person, not only because you're pregnant, but because everybody's going to have two cents of, "Oh, you should do this, you shouldn't do that."

And, you know, some of the symptoms are still the same. Unfortunately or fortunately, I don't know which way you phrase that, because of medical technology, we have moms that are a lot sicker getting pregnant, and that changes the landscape of pregnancy altogether and so, the conversations you would have never had with somebody who possibly 20 years ago wouldn't have been getting pregnant can now get pregnant, and you're just dealing with a different human altogether.

And so, for some of those, we have to be kind of medical, you know, detectives and reach out to our colleagues and things like that. So if you're ever worried, go to the ER, go call your doctor, come in for a work-in visit. Let us see you. Let us put our hands on you. Let us see, is this normal? You know, where are you at in that kind of spectrum.

Kara Simpson: Within Novant Health, we actually have OB urgent care facilities. One of our offices, one of our satellite offices actually turns into an OB urgent care in the evening. So from 5:00 to 9:00 PM during the week and 9:00 AM to 9:00 PM on the weekends, that gives patients another access to care and you don't have to sit at the emergency room for hours and hours on end. You're able to get in a little more quickly. Most of them have ultrasound and lab capability and it's really convenient, especially if you can't make it in during our office hours to see us.

Host: That is great. I'm so glad that you pointed that out, Kara, because, you know, the thought of going to the emergency room and sitting there for hours is never fun for anybody. So, thank you both for telling us about those options and it's reassuring for women to hear that you guys are there for them.

Now, I'd like to ask you both to offer some really practical advice for first-time moms in that first trimester, which can be so exciting. So Kara, what is one piece of advice that you give nearly every patient for the first time if they're a first-time mom in that first trimester?

Kara Simpson: Yeah. Try to stay present. Try to enjoy your pregnancy. there are a lot of unknowns, especially until you're able to feel that first little flutter.

Just try to stay present in the pregnancy. Sometimes anxiety can overcome us, and it's normal to be anxious, especially if it's your first time. But what we don't want is for you to be so anxious that you're constantly looking at the bad and what could happen, even if it doesn't happen.

And then, you look back on your pregnancy, and you realize you weren't there at all. You weren't there to enjoy the moments or really take it all in for the experience that it is. So, definitely stay present.

Host: So, that's really great advice. Mistee, what questions should moms be asking their providers when they often forget these things? You mentioned making a list, which is such a great idea, but what do you want them asking you the first time they meet you?

Mistee Formica: I want them to ask for the information. Because in the world we live in, there is a lot of resources where people are not getting correct information and it's not hard to reach out and Novant has a fabulous myChart apps, and we have great triage nurses.

Ask. It is better to come from one of us that know and can give you good, reliable information from good sources so that you can make an informed decision about what's happening to you and your body, and is this actually something for you?

But if you kind of depend on the world right now, it's not the greatest environment, and the information's not always correct. So, just ask the questions. Don't think, "This is not the one I shouldn't have asked," or, "What if I would have said something?" This is a miraculous process, but you only kind of shoot yourself in the foot if you don't ask and you have bad, bad information and all our goal is a healthy mom and a healthy baby. How we get there doesn't matter in the end.

Host: Yeah, that's true and with all the misinformation, it's so nice to have you both that people can ask questions and bringing those lists really help, ladies. So, I want to give you each a chance for a final thought. Mistee, starting with you, if you could leave every expectant mom with one message about that first trimester and how exciting pregnancy can be, what would it be?

Mistee Formica: I think to really just trust the process, which is a hard place to begin for so many women. But trust the process. Trust that your body's going to do the right thing, and that if anything does go wrong, if you get sick, if you get the flu, if you have a miscarriage, it's not your fault.

You do the best you can for you, and we'll help you get the rest of the way and don't take on the world. Do what you can. You know? I like to go back to what I call the mommy mode. Make sure you're eating, you're drinking, you're sleeping. We got to take care of you, too and I think that is of the utmost importance in the first trimester, because they're so focused on everything else. They forget about that. It's like we got to take care of you first.

Kara Simpson: I would say to the new family, the expecting person that's going to be here for us to know that we're always here for you. We have many offices within our specific practice that give many people the opportunity to be cared for in their communities, to be cared for in places that are local to them. We have a variety of providers with different personalities, but our bottom line is to care for you and your family, to make you feel comfortable, to make you feel heard, advocated for, cared for.

And that extends into our urgent care, where we have a different set of providers to care for you, and also into our hospital where we deliver these sweet babies. So, overall, I just want to say that we're here for you. We're here to care for you. We're ready, we're excited, and we can't wait to take this journey with you.

Host: Beautifully said and you're both lovely, and I can hear the passion for what you do and the compassion. Your patients, I am sure, just love working with both of you. So, thank you so much for joining us today and to find a physician, you can visit novanthealth.org and for more health and wellness information from our experts, visit healthyheadlines.org. That concludes this episode of Meaningful Medicine, a podcast from the specialists at Novant Health. I'm Melanie Cole.