Title: Healthy YOU Podcast, Episode 10: Pregnancy: What to expect during your first trimester
Host: Frankye Myers, Chief Nursing Officer for Riverside Health System
Expert Guest: Cheryl Sharp, WHNP, CNM, Nurse Practitioner and Nurse Midwife with Riverside Partners in Women’s Health
Frankye Myers: From Riverside Health System, this is the Healthy You Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health.
So let's dive into learn more about becoming a healthier you.
I am Frankye Myers, Riverside Health System Chief Nursing Officer, and I'm really excited to have Cheryl Sharp with me today on the Healthy Youth Podcast. Cheryl is a women health nurse practitioner and a nurse midwife, and she is with Riverside Partners and Women's Health. Hi Cheryl.
Cheryl Sharp: Yes. Hello. Thank you for having me.
Frankye Myers: Thank you for coming. We're always excited to have you. Um, we're gonna be talking about on this episode, pregnancy, what to expect during your first trimester. Okay, great. Okay, so tell me a little bit about yourself, uh, Cheryl, and how you ended up in women's health. Mm-hmm. Um, and, um, nurse midwifery and then achieving your nurse practitioner.
Cheryl Sharp: Yes. Well, I started out when I decided to become a nurse, very interested in helping moms and babies and being a resource to them. So I went from my nursing program. Directly into labor and delivery.
Frankye Myers: Okay.
Cheryl Sharp: And I did that for a little bit and I realized that labor and delivery was actually a very small part of a woman's life.
And so I wanted to expand. Okay? And so I achieved my women's health nurse practitioner in 1991, and then practiced for about 20 years before I decided I still wanted a little more. And that's when I received my certified nurse midwifery. License and now I am doing both and just love it.
Frankye Myers: Okay. For our viewers who may not know what a midwife does mm-hmm.
Tell us a little bit about what, what midwives do. Something that's great. Something that midwives deliver. Babies.
Cheryl Sharp: Yes. And we do. Um, so, so that's great, but it. And, and, and it's really a wonderful question because most of the lay public thinks that if you're with a midwife that you have to deliver at home and you have to deliver without an epidural, right?
And so they don't really even consider what we have to offer, and we do deliver at hospitals. I'm a certified nurse midwife, which is different from a lay midwife. Okay? So all the midwives. At Riverside are certified nurse midwives. That means that you have all the options available that you would have if you delivered with a physician in a hospital because we do deliver at Riverside Hospital, and that includes things like epidurals and anything else that you would like to have during your labor.
I think that patients. Really love seeing a midwife during their pregnancy and for their labor and birth because we are very connected right. To the patient.
Frankye Myers: Absolutely.
Cheryl Sharp: We spend a lot of time with patient education rather than coming in just to catch a baby. We're there a pretty long time laboring with the patient, um, on 24 hour shifts, so it's not us coming in and out quickly.
Right. But really being with a patient, absolutely. We do a great job of that and I think our patients love us. .
Frankye Myers: Uh, that's really awesome. You really get to connect with them and build that rapport.
Cheryl Sharp: Yes. Bond and connection during the pregnancy and for the birth, and then afterwards. The motto really that midwifery has is with women for a lifetime.
So it's before you get pregnant. It's during your pregnancies, and it's on, I've, I have many patients that I have seen, the woman who has delivered the baby. I was with her during her pregnancy and I'm now seeing her. College-aged daughter. Aw. So I've been at this a while.
Frankye Myers: That's, that's great. That's great.
Let's start out by just talking a little bit about what the first trimester encompasses.
Cheryl Sharp: Okay. The first trimester is very important because it's where everything gets started, all of the, um, developing of that fetus. Done in the first trimester. After that, it's more of a feed and grow. There's still continued development, but very important things happen that first trim trimester, which includes to the point where you're 12 weeks and six days, so it is all completely through the first 12 weeks of pregnancy.
Frankye Myers: Okay. Okay. Um, are there things that you would tell our viewer you should really be conscious of during this time period? Um, absolutely. That would be helpful.
Cheryl Sharp: Sure. Um, I know that we've already talked about. Pre-pregnancy. So there are some things you can do before you know that, you know, be actually achieve the pregnancy, right?
But as soon as you do, there are some really important things because basically the way you take care of your body is the way your baby is being cared for, right? So you are creating the environment in which your baby's growing, right? So anything that you take in, whether you're drinking it, eating it, smoking, it, is going to affect your baby, okay?
And it's very important right from the. Right from the beginning of the pregnancy. So we have lots of education that we provide early on to help hopefully achieve really healthy pregnancies.
Frankye Myers: I'm glad you clarified that, cuz sometimes people think it doesn't cross over. Right. Right. But they, you know, almost everything that baby is connected to you and everything that you do.
I, I hear people say sometimes, well, we're not gonna tell anybody that we're pregnant until we get out of the first trimester. Mm-hmm. Um, Are there miscarriages and things that are more common to occur in that time period as to why you think that? Yes. That the thought process of not really, um, going public with that.
With family, family and friends.
Cheryl Sharp: Sure. And of course that's up to the individual woman, but we, we do hear that a lot. And that's because four out of five. Four, one out of every four to five pregnancies does end in miscarriage. So it's actually quite common not to minimize it because it can be very devastating to a woman and her partner, but just to know it's that common is helpful.
So somewhere between eight and 10 weeks, usually if that pregnancy is not viable, if there's something going on there that the pregnancy is gonna make, it is usually when that occurs. Okay, so women will often wait till 12 weeks and a good heartbeat, and then they feel comfortable telling people,
Frankye Myers: I, I can relate to that.
I had a, a really hard. Time getting pregnant. Mm-hmm. Lost several babies
Cheryl Sharp: Mm-hmm. I'm sorry,
Frankye Myers: but I was very fortunate. I do have 2, 2, 2 children. Uh, and the last, I had to stay on bedrest for about six months and had to have her recage. Oh my goodness. I had an in incompetent cervix, my, oh yes. And it was all related to the first pregnancy where I labored a very long time.
And then traumatic forceps delivery. Oh.
Cheryl Sharp: So, um, which is, Leads into another topic, and that's really obtaining early prenatal care. Yes. Because when you have a history with some of the things you've just mentioned or other things, right? Chronic hypertension, not at your ideal body weight, right? All of those things affect the health of a pregnancy and the earlier you get in with a provider and begin your prenatal care, the greater chance we have of being able to get you just.
Properly evaluated, right, and consulted to places if we need to. We use maternal fetal medicine here in the local area a lot for our higher risk pregnancies. But I think especially as a midwife, even when there's a high risk pregnancy, we do like to focus on what is going well, right? What, because pregnancy overall is a state of health most of the time.
Right. So we like to focus, even if you've got a high risk pregnancy, what is going well, right? What is, you know, what can we celebrate?
Frankye Myers: Right? And then the question that always comes up around weight gain and how much should you gain and what is the normal weight gain for pregnancy? I know I fell outside of those parameters.
Yeah. For sure. Um, and then the risk for diabetes associated Absolutely. With that, could you talk a little bit about that?
Cheryl Sharp: Well, that's a huge topic. Yes. I can talk for about an hour on that. Um, so being at your ideal weight before you even get pregnancy, get pregnant right, is huge. Right. Um, that does help reduce risk factors enormously and gestational diabetes, hypertension, even other more serious issues are a problem for women who are overweight when they're pregnant, so, right.
We always try. To talk about that pre pregnant when we Good, good. But we don't also, with that in mind, we don't want you dieting while you're pregnant. So we want you to get all the nutrition you need. So nutrition is very important. We get enough calories in our country, the average person, it's just the nutritional value of the calories we eat is the the big problem.
So a woman who's not at her ideal weight, if she eats more healthy, Foods in that first or second trimester, she may find that she doesn't gain weight at all, or that she even maybe loses a few pounds, right? And sometimes women are frightened of that. And so we talk about that and explain to them, as long as the baby is growing and getting what it needs and you're eating healthy and keeping things down, especially hydration, water is very, very important.
Right? Then the, you will catch up. It'll be okay. Then you mentioned the gestational diabetes. A woman who has a history of that, either with a previous pregnancy or in a family history, or is already diabetic, of course, have greater risk factors. Right. A woman who's older. And what I mean by older is not very old.
Right? Right. 35 or older, we consider advanced maternal age, which I think a man came up with that title because it sounds horrible. Right, exactly. Um, but even 35, we consider advanced maternal age and that puts you at higher risk for things like gestational diabetes, right. Gestational hypertension, uh, maybe even pregnancy induced hypertension.
Right. So there's things like that. There's whether or not this is your first baby's right. There's so many factors that that's the reason even though most, most pregnancies are a state of health. If you connect with a provider early and we have a chance to look at your, your risk factors, right? We can tailor your pregnancy care to hopefully have the greatest outcome possible.
Frankye Myers: Absolutely. Well, we talked a little bit about that, the importance of that prenatal care. Mm-hmm. And so, um, that is so important to having a healthy, healthy baby. For our viewers, when should someone, um, who's experiencing any issues call their ob g yn Oh. Or provider?
Cheryl Sharp: Well, that depends first off of what trimester they're in, right.
So, right. Um, but definitely early on, things like cramping. Okay. And heavy bleeding. Now, some amount of cramping is normal in the first trimester because the pregnancy, once it attaches to the uterus, the uterus literally changes consistency. It goes from being very, very firm to soft. Okay? And as it does that, the uterine muscle itself kind of moves.
Okay. As it's changing consistency and so women can have mild cramping. Okay? So sometimes they're like, oh, I'm cramping and they're scared. Absolutely. The kind of cramping that you should be frightened or give us a call about is pretty intense cramping associated with bright red bleeding, and it's common to have some.
Spotting or dark brown discharge during pregnancy. So the best thing to do is if it's office hours and you're one of our patients, just give us a call. They'll field it, you know, through to somebody who can answer that question. Okay. Um, and then also as you're further along in the pregnancy, that changes.
So second trimester, we have different. Concerns third trimester, we're more worried about leaking fluid, decreased fetal movement. Okay. Vaginal bleeding for a different reason. Okay. So it kind of depends on where you are in the pregnancy. The one good thing that we have with our practice is that we have providers not just on call, meaning they will get a phone call and meet you at the hospital, but we have a nurse midwife and a physician at the hospital.
Hospital 24 7. Okay. So if a woman after 20 weeks needs something and it's a Saturday, she doesn't have to think, oh my gosh, I'm alone. Right? How do I, how do I get an answer to this question? They won't call me till Monday if she thinks she has a bladder infection. Very important for us to know early in pregnancy because things like that can cause preterm labor.
Labor, pregnancy. Absolutely. So a woman after 20 weeks, Can actually speak with a midwife over a night, weekend, Christmas day, if that's, there's someone at the hospital for our practice 24 7. That's great. That's, that's a huge benefit.
Frankye Myers: That's great. Absolutely. Absolutely. Um, when is the first ultrasound done?
Cheryl Sharp: Oh, everyone loves the, it's exciting ultrasound. So yes, I've been doing this over 30 years. I'm still the same way. I saw a patient that someone else did the ultrasound, this. Morning and she stopped to show me pictures. Oh. And I was like, oh look, this is my favorite. The side view, you know?
Frankye Myers: So, um, so the first thing, the technology has changed, right? Absolutely.
Cheryl Sharp: Very different than when I did was, was doing well, and when I had my babies, we didn't even do ultrasounds. Everything was, you know, they lift the baby up. Now everyone knows what we have, you know? Right. So the first ultrasound is done for the purpose of dating. Okay. And that's hopefully done between eight and 10 weeks.
Okay? Because that's the best time to date a pregnancy. Um, sometimes it's outside of that a little bit, and as long as it's the first trimester, that's great. Okay? If it's a little bit later, then that, sometimes that has to happen, but that first one is done for that reason. Okay? So sometimes patients will call in there four weeks, they just got their pregnancy test and they want an appointment tomorrow, and we can't see anything.
Okay, so we really do try to wait until you're eight to 10 weeks to get that ultrasound and you'll be happy you did, because. This particular couple I was telling you about, the ultrasound I did with them was only at five and a half, six weeks, and it looked like a piece of rice with a heartbeat, right?
And then they had one done today at 10 weeks and she said, oh, it was, there were arms and legs. Oh, I could see the baby moving. And I'm like, isn't it amazing? In four weeks? So yes. Yes. So that's when the first ultrasound is done. And then the next one that is routinely done is at 20 weeks when we take a really good look at the spine, the liver, the kidney, the heart.
We look at blood flow in and out through the heart, and we measure the long bone of the leg, the ab. Abdominal circumference and head circumference, make sure baby's growing appropriately in all areas and more. We look at the umbilical cord and the way it's inserted, we can actually do a cross section of that to make sure there's two arteries in a vein, which is normal and right if it's their rules out.
So many cardiac anomalies. So it's very, very deal detailed. Lasts almost an hour and so the first one is a little briefer cuz we're not, we're. Really pretty much just looking to date. Right. And then after that, the morphology or anatomy scan really takes a good look.
Frankye Myers: Okay. Good information as it relates to exercise.
Yes. You know, I know, um, sometimes women are, are afraid to do too much. Yeah. Um, too much strenuous activity. Talk a little bit about what exercise. Would be appropriate. And I know for the most part it may be individualized, but yes. Are there things, um, no.
Cheryl Sharp: That's another great question. I actually love it when my patients bring that up.
It is something I talk about at the new ob b visit with every patient. I think we all do, and that's because we do want you staying active. Right? One thing that we know about pregnancy is that it. Increases your risk for things like deep vein blood clots mm-hmm. In your legs or your lungs. And so we, we used to many years ago, put women on bedrest for different things and now we avoid that with at all cost almost.
Um, so we do want you moving in active. Okay. I really think that walking and swimming are probably the best forms of exercise. Right. And a lot of people that you know, will say, well, I'm doing a lot more than that and I'm lifting weights, or I'm doing this, or I'm doing that. And so we do have a few things to let women know.
One. And some of that has to do with the fact that you have increased progesterone during pregnancy. You also have a hormone called relaxing. So what happens is your ligaments and joints literally relax, which is a miraculous way that allows the baby to move down through the pelvis. So it's actually very necessary, but it happens throughout the pregnancy, not just in labor and delivery.
So that is already happening. So if you have loose joints and you're running on those loose joints, you could injure yourself. So it's really more about that, about injury. So the few things that we ask. Or that as you're exercising, you keep your heart rate at or below 140 beats a minute. Okay, that's, you probably could go a little higher than that.
We don't know at what point, but we know it's safe at that point. Right. And certainly if you're exercising and you look down and you go, oh, I'm 150, don't just stop you. Just back down a little bit. Right. Slow it back up a little bit. Right. We also ask that you don't lift, push, or pull more than about 2025 pounds.
Okay. And that you keep it low impact for the reason I mentioned, which is that. You know, the joints, you could do joint or ligament damage, and then you're miserable, right? And you can't do the things you wanna do. So, so those are the limitations. The only other one is that we keep you from doing exercises that cause you to lay flat on your back or include your abs, okay?
Because of course, the abdominal muscles are wrapped around the uterus, especially after 20 weeks. And if you've got your abs tightening, it's very. Easy to get your uterus. A little irritable and tightening too. And it's just way too early for that.
Frankye Myers: Absolutely. Uh, my mother used to always say, don't. Reach for anything too high or been too low.
Yeah. Is there any validity to some of those things?
Cheryl Sharp: No. That, that, I'll tell you what they used to say about that. Cuz remember I've been at this over three years.
Frankye Myers: I didn't wanna say it, but I wanted to see if you knew.
Cheryl Sharp: Oh, yes, I did. I I pretty much heard it all by now, I think. But no, they used to say that if you do that, you'll tie the baby's quarter around neck, round, neck, neck.
Right. You know, people, they didn't know where the cord was attached, so I never did it right. So, no. Um, so what, what it is, is that the placenta itself is about the size of a dinner plate by the time that you get all the way to term. Okay. And normally it comes out of the center, the umbilical cord, but that is attached actually to the uterine wall.
Okay. And so what you do with your arm has no effect on that corn. Okay. It just doesn't connect. That's good to know. So, so, right. So you're safe doing that, but, um, no, but it's a good question and it still comes up. Okay. You know, and, and, uh, it's funny because. Almost always, it'll say my auntie told me that's how it starts. Or my grandma told me. Right.
Frankye Myers: So I know, uh, one of my pregnancies I found out I was pregnant cause I fell asleep at work. Yes. So talk a little bit about why are you so tired?
Cheryl Sharp: So, you know, women are young and healthy, run around doing all the things that we do cuz we're strong and we get a lot done.
You know, we multitask all the time and then you're like, I'm just. 10 weeks pregnant, how could I possibly feel this, this tired? And you think, oh my gosh, is this gonna worsen as I get further along? And that's, that's really a symptom usually of the early pregnancy. Okay. And then the very, very late pregnancy, especially around here in.
Summertime. But what happens is you have hormonal changes that occur during pregnancy and they start right away. Right, right, right. Progesterone especially, it's a progesterone dominant state, and I told you already about all that. Relax and that's being released, right? Released and so be other things that are going on have to do with your cardiovascular system.
Okay. So there's 40 to 50% more blood volume produced during pregnancy and your body now has to. Pump that. So it's working. It's working. It has to pump harder over time. Exactly. And your blood vessel walls are more relaxed. Right. And so it's harder for it to do its job. Your body is making this baby and it's also undergoing changes to, you know, many of your organs.
And that's a lot to accomplish. Right. And so your body adapts to that eventually and usually feel much, much better by the time you get 12 to 14 weeks. Okay. But initially it is kind of scary for young people who are not used to Right. You know, looking eyes open a nap. What their grandmother does, she knows
Frankye Myers: Right.
That in addition to the nausea. Yes. Which is truly miserable.
Cheryl Sharp: Yes, yes. Truly miserable. But we have so much, back when I was pregnant, we had nothing. It was like, well, tough it out eventually when the baby crack spoilers
Frankye Myers: something right. Put goes away. Right. Keep 'em
Cheryl Sharp: by the bed. Yes, yes. Some of that helps, but we've got, you know, for, we have a lot of natural parents now.
Okay. That, that really want to do the healthy, there's lots of things that you can do. We have medications that can help. Absolutely. Okay. Okay. We have some that are over the counter, some that are prescription, but we also have things like, as a midwife, I use a lot of peppermint. Okay. So if it's a true essential oil, like peppermint, and it's not just peppermint flavored water, right?
Um, if you put a drop on your hands, if it's a true essential oil and you rub 'em and you take a slow, big, deep breath in, um, you can do that as many times as you want during the day. You can carry that pep, that peppermint oil whiskey you. Oh, that's good to know. And so if you're at a. Store and you're like, oh, I don't have my medicine with me.
Right. Or you don't want to take medicine. A lot of our patients are looking for alternatives that, um, are not medications. Right. That they feel safer using for their babies. And so we have so many ideas on that one that do not suffer with that. Right, right.
Frankye Myers: That's good to know. Um, what about the prenatal vitamins?
I know I, they're big. They're large. Oh, they are? Yeah. Um, and so you see that sometimes people will try to take other things in lieu of that particular vitamin. Yeah. Are there any issues with doing that or does it provide a couple of different things?
Cheryl Sharp: Um, one, if some of them. Really like the, um, the chewable kinds.
Right? And there's no iron in that, which they may not need iron, so it might be okay. A lot of patients really work very hard on their diet, and if you're eating a healthy diet, that might be enough, right? And if you're not anemic, that might be enough. Okay. The, the, um, pills themselves are larger because, In order to get what we need in them.
Right. They just have to be bigger. Right. Right. And so you can try a tubal one and if you're getting otherwise good diet, you're probably okay. But for the most part, those are important. But I would say, especially if, if you're struggling with it your first trimester, I just tell patients, don't worry about it.
Just keep something down and stay hydrated right by your second trimester. Let's try it again.
Frankye Myers: That's good feedback. That's good. Good feedback. And I think that also just. Really just, um, solidifies the importance of prenatal care. Absolutely. And looking at your labs and all of those things to make sure, sure.
That you're getting the nutrients that you need. So if somebody wanted to reach out to you Yes. Contact, you just found out they were pregnant, trying to find themselves, um, a provider. Yes. A midwife. Mm-hmm. Um, how, how could they contact. You,
Cheryl Sharp: well, the call center does appointments for us, so the Riverside Call Center does, and or also calling the OB G y N Clinic, which is Partners for Women's Health.
Okay. And, um, we have a great team. Okay. Um, I'm, I, we're all busy, but I would. Feel very comfortable with someone making an appointment with anybody. I think yes, we are ultimately looking at healthy moms and healthy babies and getting a great outcome for the pregnancy, but we are also very, very, very interested in it being a good experience for you.
Okay? You only do it a couple times in your life. Right. Let's make it something that was very special.
Frankye Myers: Absolutely. Okay. Well, thank you so much.
Cheryl Sharp: Oh, you're welcome.
Frankye Myers: Um, just, I learned so much. Is there anything that you think would be helpful for our viewers to know today? Uh, before we wrap up?
Cheryl Sharp: I, I would just mention moods.
Okay. I know that's not part of it, but we used to think that postpartum depression was a big problem. Oh, yes. And it certainly is, but we now know that 50% of the time it happens during the pregnancy. So some women are like, I'm having this. Great baby. I'm excited about my pregnancy. I've got all this support.
What's wrong with me? Right. And it could be just hormones. Yes. Please be honest with your provider. And if it's during the postpartum period, I just, the more we get this message out, that postpartum period doesn't just include the six weeks till your visit. Right. We now know that the postpartum period is an entire year.
Okay. So that would be just getting that out. So if it's not the person listening to this, maybe they know someone.
Frankye Myers: Aw. Thank you so much. You're welcome. Do you know how many babies you've delivered or, or supported delivery?
Cheryl Sharp: About? Delivery. Oh, supported. I have no idea, but delivered myself over 500, so.
Frankye Myers: Yeah. Well that's awesome. Yeah. Thank you so much. Amazing. And we'd love to have you come back, um, and we continue to talk about That'd be great. The additional trimesters. Okay, well thank you for having me cycle. Thank you. All right. Bye-bye. Thank you for listening to this episode of Healthy you.
We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
