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What to Expect When You're Expectingby Heidi Murkoff
Chapter 5 - The First Month
Approximately 1 to 4 Weeks
Congratulations-and welcome to your pregnancy! Though you almost certainly don't look pregnant yet, chances are you're already starting to feel it. Whether it's just tender breasts and a little fatigue you're experiencing, or every early pregnancy symptom in the book (and then some), your body is gearing up for the months of baby-making to come. As the weeks pass, you'll notice changes in parts of your body you'd expect (like your belly), as well as places you wouldn't expect (your feet and your eyes). You'll also notice changes in the way you live-and look at-life. But try not to think (or read) too far ahead. For now, just sit back, relax, and enjoy the beginning of one of the most exciting and rewarding adventures of your life.
What You Can Expect at Your First Prenatal Visit
Your first prenatal visit will probably be the longest you'll have during your pregnancy, and definitely will be the most comprehensive one. Not only will there be more tests, procedures (including several that will be performed only at this visit), and data gathering (in the form of a complete medical history), but there will be more time spent on questions (questions you have for the practitioner, questions he or she will have for you) and answers. There will also be plenty of advice to take in-on everything from what you should be eating (and not eating) to what supplements you should be taking to whether (and how) you should be exercising. So be sure to come equipped with a list of the questions and concerns that have already come up, as well as with a pen and notebook (or What to Expect When You're Expecting Pregnancy Organizer) to take notes with.
One practitioner's routine may vary slightly from another's. In general, the examination will include:
Confirmation of your pregnancy. Your practitioner will want to check the following: the pregnancy symptoms you are experiencing; the date of your last normal menstrual period to determine your estimated date of delivery (EDD) or due date (see page 8); your cervix and uterus for signs and approximate age of the pregnancy. A pregnancy test (urine and blood) will most likely be ordered.
A complete history. To give you the best care possible, your practitioner will want to know a great deal about you. Come prepared by checking records at home or calling your primary care doctor to refresh your memory on the following: your personal medical history (chronic illness, previous major illness or surgery, known allergies, including drug allergies); nutritional supplements (vitamins, minerals, herbal, and so on) or medications (over-the-counter, prescription) you are presently taking or have taken since conception; your family medical history (genetic disorders, chronic diseases, unusual pregnancy outcomes); your personal gynecological history (age at first menstrual period, usual length of menstrual cycle, duration and regularity of menstrual periods); your personal obstetrical history (past live births, miscarriages, abortions2), as well as the course of past pregnancies, labors, and deliveries. Your practitioner will also ask questions about your social history (such as your age and occupation) and about your lifestyle habits (how you eat, whether or not you exercise, drink, smoke, or take recreational drugs) and other factors in your personal life that might affect your pregnancy (information about the baby's father, information on your ethnicity).
A complete physical examination. This may include assessment of your general health through examination of heart, lungs, breasts, abdomen; measurement of your blood pressure to serve as a baseline reading for comparison at subsequent visits; notation of your height and your weight (prepregnancy and present); inspection of arms and legs for varicose veins and edema (swelling from excess fluid in tissues) to serve as a baseline for comparison at subsequent visits; examination of external genitalia and of your vagina and cervix (with a speculum in place, as when you get a Pap smear); examination of your pelvic organs bimanually (with one hand in the vagina and one on the abdomen) and also possibly through the rectum and vagina; assessment of the size and shape of the bony pelvis (through which your baby will eventually try to exit).
A battery of tests. Some tests are routine for every pregnant woman; some are routine in some areas of the country or with some practitioners, and not others; some are performed only when circumstances warrant. The most common prenatal tests include:
What You May Be Feeling
You may experience all of these symptoms at one time or another, or only one or two.
What's important to keep in mind from now on is that every woman and every pregnancy is different; few pregnancy symptoms are universal.
What You May Be Concerned About
Breaking the News
"When should we tell friends and family that we are expecting?"
This is one question only you can answer. Some expectant parents can't wait to tell everyone they know the good news (not to mention a fair number of strangers who happen to pass them in the street or sit next to them on the bus). Others tell only selectively at first, starting with those nearest and dearest (close relatives and friends, perhaps), and waiting until the condition is obvious before making the pregnancy common knowledge. Still others decide they'd rather put off issuing announcements until the third month has passed, just in case of miscarriage (especially if there's been a previous pregnancy loss).
So talk it over, and do what feels most comfortable. Just remember: in spreading the good news, don't forget to take the time to savor it as a twosome.
Telling the Boss
"No one at work knows I'm pregnant yet-and I'm not sure when and how I should tell them, especially my boss. I'm not sure how they'll react."
Since most expectant mothers are also members of the workforce, pregnancy protocol on the job has become an important issue for employees and employers alike. Official leave policies and benefits vary widely from company to company, as do unofficial policies of family-friendliness. In deciding when and how to broach the subject of your pregnancy with the powers that be at your company, you'll need to consider the following:
How you're feeling and whether you're showing. If morning sickness has you spending more time hovering over the toilet than sitting at your desk; if first trimester fatigue has you barely able to lift your head off your pillow in the morning; or if you're already packing a paunch that's too big to blame on your breakfast, you probably won't be able to keep your secret long. In that case, telling sooner makes more sense than waiting until your boss (and everyone else in the office) has come to his or her own conclusions. If, on the other hand, you're feeling fine and still buttoning your waistband with ease, you may be able to hold off on the announcement until later.
What kind of work you do. If you work under conditions or with substances that could be harmful to your pregnancy or your baby (see page 76), you'll need to make your announcement-and ask for a transfer or change of duties-as soon as you find out you're pregnant.
How work is going. A woman announcing her pregnancy at work may unfortunately-and unfairly-raise many red flags, including "Will she still have the stamina to produce while pregnant?" and "Will her mind be on work or on her belly?" and "Will she leave us in the lurch?" You may head off some of those concerns by making your announcement just after finishing a report, scoring a deal, winning a case, coming up with a great idea, or otherwise proving that you can be both pregnant and productive.
Whether reviews are coming up. If you're afraid your announcement might influence the results of an upcoming performance or salary review, wait until the results are in before spilling the beans. Keep in mind that proving you've been passed up for a promotion or raise based solely on the fact that you're expecting (and that you'll soon be a worker and a mother, not necessarily in that order) may be difficult.
Whether you work in a gossip mill. If gossip is one of your company's chief products, be especially wary. Should word-of-mouth of your pregnancy reach your boss's ears before your announcement does, you'll have trust issues to deal with in addition to the pregnancy-related issues. Make sure that your boss is the first to know-or, at least, that those you tell first can be trusted not to squeal.
What the family-friendliness quotient is. Try to gauge your employer's attitude toward pregnancy and family. Ask other women who have been pregnant on the job, if there are any (but keep your inquiries discreet). Check the policies on pregnancy and maternity leave in your copy of the company handbook (if there is one). Or set up a confidential meeting with someone in human resources or the person in charge of benefits. If the company has had a history of being supportive of mothers and mothers-to-be, you may be inclined to make your announcement sooner. Either way, you'll have a better sense of what you'll be facing.
Once you've decided when to make your announcement, you can take some steps to ensure that it's well received:
Know your rights. Pregnant women-and parents in general-have fewer rights in the United States than in most every other industrialized country. Still, some strides have been made on the federal level through the Pregnancy Discrimination Act and the Family Medical Leave Act (see box above), and many others have been made voluntarily by forward-thinking, family-friendly companies. Become familiar with what the law and your company's policies say you're entitled to, so you'll know what you can and probably can't ask for. For instance, some companies offer paid leave, others unpaid. Still others allow you to use sick days or vacation days as part of your leave. All of this should be detailed in a company handbook, if there is one. Or, set up a confidential meeting with someone in human resources or whoever is in charge of benefits.
Put together a plan. Efficiency is always appreciated on the job, and being prepared invariably impresses people. So before you go in to make your announcement, have a detailed plan that includes how long you plan to stay on the job (barring any unforeseen medical problems, including premature labor), how long your maternity leave will be, how you plan to finish up business before you leave, and how you propose that any unfinished business be handled by others. If you would like to return part-time at first, now is when you should propose that. Writing up your plan will ensure you won't forget the details.
Set aside the time. Don't try to tell your boss the news when you're in a taxi on the way to a meeting or when she's got one foot out the door Friday night. Make an appointment to meet, so no one will be rushed or distracted. Try to make it on a day and at a time that is usually less stressful at your office. Postpone the meeting if things suddenly take a turn for the tense.
Accentuate the positive. Don't start your announcement with apologies or misgivings. Instead, let your boss know that you are not only happy about your pregnancy, but confident in your ability and committed in your plan to mix work and family.
Be flexible (but not spineless). Have your plan in place, and open it up to discussion. Then be ready to compromise (make sure there is room for negotiation built into your plan), but not to back down completely. Come up with a realistic bottom line and stick with it.
Set it in writing. Once you've worked out the details of your pregnancy protocol and your maternity leave, confirm it in writing so there won't be any confusion or misunderstanding later (as in "I never said that . . .").
Never underestimate the power of parents. If your company is not as family-friendly as you'd like, consider joining forces to petition for better parental perks. Realize, however, that you and other parents may be met with hostility by childless employees; as family policies become more generous, resentment tends to build among those who can't take advantage of these. Making sure that similar allowances are made for employees who must take time off to care for sick spouses or parents may help unite, rather than divide, the company.
"I'm tired all the time. I'm worried that I won't be able to continue working."
It would be surprising if you weren't tired. In some ways, your pregnant body is working harder even when you're resting than a nonpregnant body is when mountain-climbing; you're just not aware of the exertion. But it's there. For one thing, your body is manufacturing your baby's life-support system, the placenta, which won't be completed until the end of the first trimester. For another, it's adjusting to the many other physical and emotional demands of pregnancy. Once your body has adjusted and the placenta is complete (around the fourth month), you should have more energy. Until then, you may need to work fewer hours or take a few days off if you're really dragging. But if your pregnancy continues normally, there is absolutely no reason why you shouldn't stay at your job (assuming your practitioner hasn't restricted your activity and/or the work isn't overly strenuous or hazardous; see pages 76 and 248). Most pregnant women are happier and less anxious if they keep busy.
Since your fatigue is legitimate, don't fight it. Consider it a sensible signal from your body that you need more rest. That, of course, is more easily suggested than done. But it's worth the effort:
Baby yourself. If you're a first-time expectant mother, enjoy what will probably be your last chance for a long while to focus on taking care of yourself without feeling guilty. If you already have one or more children at home, you will have to divide your focus. But either way, this is not a time to strive for Supermom-to-Be status. Getting adequate rest is more important than keeping your house white-glove-test clean or serving four-star dinners.
Keep evenings free of unessential activities. Spend them off your feet when you can, reading, watching TV, or scouring baby-name books. If you have older children, read to them, play quiet games with them, or watch classic children's videos with them rather than traipsing off to the playground. If they're old enough to pitch in, enlist them in household chores you normally do. (Fatigue may be more pronounced when there are older children at home, simply because there are so many more physical demands and so much less time to rest. On the other hand, it may be less noticed, since a mother of young children is usually accustomed to exhaustion and/or too busy to pay attention to it.)
And don't wait until nightfall to take it easy. If you can afford the luxury of an afternoon nap, by all means indulge. If you can't sleep, lie down with a good book. A nap at the office isn't a reasonable goal, of course, unless you have a flexible schedule and access to a comfortable sofa, but putting your feet up at your desk or on the sofa in the ladies' room during breaks and lunch hours may be possible. (If you choose to rest at lunch hour, make sure you have a chance to eat, too.) Napping when you're mothering full-time may also be difficult, but if you can time your rest with the children's naptime (if they still nap), you may be able to get away with it-assuming you can tolerate the unwashed dishes and the dust balls under the bed.
Let others baby you. Make sure your spouse is doing his fair share (or preferably more) of household chores, including laundry and marketing. Older children can help out, too. Accept your mother-in-law's offer to vacuum and dust the house when she's visiting. Let your folks take the older kids to the zoo on Sunday. Enlist a friend to baby-sit so you can have a night out occasionally.
Get an hour or two more sleep each night. Skip the eleven o'clock news and turn in earlier; ask your spouse to fix breakfast so you can turn out later.
Be sure that your diet isn't deficient. First-trimester fatigue is often aggravated by a deficiency in iron, protein, or just plain calories. Double-check to make certain you're filling all of your Pregnancy Diet requirements. And no matter how tired you're feeling, don't be tempted to rev up your body with caffeine and candy bars. The energy won't last for long, and after the temporary lift, your blood sugar will plummet, leaving you more fatigued than ever.
Check your environment. Inadequate lighting, poor air circulation or quality ("sick building" syndrome), or excessive noise in your home or workplace can contribute to fatigue. Be alert to these problems and try to get them corrected.
Take a hike. Or a slow jog. Or a stroll to the grocery store. Or do a pregnancy exercise or yoga routine. Paradoxically, too much rest and not enough activity can heighten fatigue. But don't overdo the exercise. Stop before that exercise high dissolves into a low, and be sure to follow the precautionary guidelines on page 190.
Though fatigue will probably ease up by month 4, you can expect it to return in the last trimester (could it be nature's way of preparing you for the long sleepless nights you will encounter once the baby has arrived?).
When fatigue is severe, especially if it is accompanied by fainting, pallor, breathlessness, and/or palpitations, it's wise to report it to your practitioner (see Anemia, page 187).
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