Department of Health
John J. Dreyzehner, MD, MPH, Commissioner

1st Trimester

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First Trimester Discomforts and Comfort Measures for Each

Early prenatal care is important because it helps you stay healthy and have a healthy baby. As soon as you think you may be pregnant, it is important that you see a health care provider. If you do not have health insurance or do not have health insurance that covers pregnancy, report to your local health department. There is a type of TennCare just for pregnant women. The staff at your health department will assess whether or not you qualify for this program. Most women who do not have private health insurance will qualify. Staff at the health department can also see if you will qualify for WIC, a federal food voucher program for pregnant women and children.

Many health departments also offer support and prenatal education through a series of home visits.

There are 40 weeks in a pregnancy counting from the first day of the last normal menstrual period (LMP).

You conceived approximately two weeks after your LMP, but since no one can know the day of conception for sure, your health care provider uses the LMP to establish your due date and to count the weeks of your pregnancy. This is why it is important for you to keep track of your menstrual periods. The first trimester is the first 13 and one-third weeks of your pregnancy.

• Pressure on your bladder:
  • Empty bladder frequently
  • Eliminate caffeine
• Breast tenderness:
  • Wear a support bra day and night
• Fatigue and moodiness:
  • Rest
  • Be patient with yourself and others
• Nausea and vomiting:
  • Avoid an empty stomach
  • Eat small frequent meals
  • Try eating crackers in the morning before getting up
  • Wear motion sickness bands
• Excessive amounts of saliva:
  • Mint-flavored toothpaste and mouthwash used frequently
  • Chewing gum or hard candy
• Indigestion:
  • Avoid spicy, fatty foods
  • Don’t lay down with a full stomach
  • Ask your health care provider about an over-the-counter antacid
• Constipation/bloating:
  • Eat fruit daily
  • Increase intake of fluids and fiber
  • Go for a walk daily
• Food aversions and cravings:
  • Avoid strong smells
  • Satisfy food craving as long as it is not excessive or harmful
• Dizzy spells or fainting:
  • Get up slowly
  • Eat regularly
  • Report fainting to your health care provider
• Report fainting to your health care provider.
• Acne:
  • Drink plenty of water
  • Eat a balanced diet
  • Use a gentle daily cleanser
  • Avoid heavy makeup or heavy moisturizers

2nd Trimester

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Things to Look Forward to in the Second Trimester

1. The first trimester fatigue, nausea, and moodiness lifts. You feel like yourself again. You have renewed energy.
2. You are still small enough to get around easily and sleep well.
3. Nighttime trips to the bathroom let up a bit as the uterus rises up off of the bladder.
4. If you had saliva problems in the first trimester, this usually goes away now too.
5. Food will taste especially wonderful though a few food aversions may hang on.
6. You will have a good appetite.
7. You hair grows thicker and your fingernails get stronger and longer.
8. Around 20 weeks, you begin to feel the baby move. It is very soft at first; like butterfly wings or the gentle “pop” of a soap bubble.
9. Your interest in sex will increase. As long as you are having no complications with your pregnancy, you may enjoy your increased libido. In the third trimester you may feel too big and uncomfortable to have sex.
10. If you need to travel, now is the time. In the third trimester, it is wise to stay close to your health care provider.

Aggravations in the Second Trimester

1. While fetal movement is “delightfully distracting” it is not delightful to find yourself forgetting things like being late for appointments, or disorganized. The second trimester brings a “brain fog” that will pass a few weeks after the baby is born. Know that you are at risk of leaving the stove on or failing to lock the door. Be careful and be patient with yourself.
2. Indigestion may begin or get worse due to the pressure of the rising uterus.
3. Vaginal secretions increase and you may need to wear a mini-pad.
4. You may develop dark splotches on your face and a dark line on your abdomen. This will go away a few weeks after delivery.
5. Hair begins to grow in places you don’t expect, like on your face or your belly.
6. Gums may swell and bleed. Don’t neglect them. See your dentist and practice good dental hygiene.
7. Nosebleeds may begin as the mucous membranes that line the nose swell.
8. Your eyeglass or contact lens prescription may change. Do not change your prescription because it may change again after the baby is born.
9. Since you are starting to show, unwanted advice may come from family, friends, and strangers.

3rd Trimester

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The third trimester begins at 26 and two-thirds weeks and ends with the delivery of your baby. Take a childbirth preparation class. Tour your hospital’s labor and delivery area. Finalize your home preparations. Now is a good time to learn all you can about contraception so that you and your partner can decide what would be right for you after the baby arrives. Spacing children is important to your health and to theirs. Experts recommend that women give themselves time to heal by waiting at least six months before becoming pregnant again. Short birth intervals can lead to preterm birth and/or a low birth weight baby. The ideal spacing for the good health of the mother and the children would be to wait 18 to 23 months before becoming pregnant again.

18 Third Trimester Discomforts and Comfort Measures for Each

1. For mild swelling of feet or ankles:
   • Lie down and elevate feet.
   • Rest on your left side.
   • Wear support stockings throughout the day.
   • Drink eight glasses of water daily.
2. Always feeling too warm:
   • Dress lightly or in layers that can be shed as needed.
   • Shower AM and PM.
   • Use deodorant.
3. Clumsiness:
   • Wear flat shoes.
   • Be careful on stairs.
   • Go more slowly.
4. Backache:
   • Rest.
   • Apply gentle heat with a warm moist towel placed in a plastic bag.
   • Back rub.
5. Itchy:
   • Use any lotion you choose.
   • Know that nothing will prevent stretch marks.
   • For severe itching, ask health care provider about medication.
6. Vivid dreams or nightmares:
   • These are common and are not harmful to you or baby.
   • Could be an expression of personal fears or worries.
7. Leg cramps, especially at night:
   • Never point your toe.
   • When cramp begins, pull toes up toward front of leg and make an ‘L’ with leg and foot.
   • Hold this position until cramp passes.
8. Shortness of breath:
   • Move about more slowly.
   • Sit and stand tall to give your lungs more room.
9. Varicose veins:
   • Wear support stockings throughout the day.
   • Elevate legs several times daily.
10. Difficulty sleeping:
    • Use multiple pillows to support your body.
    • Limit daytime naps.
    • Be patient.
11. Hemorrhoids:
    • Ask health care provider about over the counter medication.
    • Keep stools soft by eating more fruit, fluids, and fiber.
    • Exercise such as walking keeps the digestive track running more smoothly.
12. Leaking breasts:
    • Can occur anytime in the pregnancy but especially now.
    • Wear pads in bra.
    • Sleep in a bra.
13. Painful fetal movement:
    • Be patient.
    • Try changing positions.
    • Sometimes getting on hands and knees helps.
14. Indigestion:
    • Small frequent meals.
    • Avoid spicy, greasy foods.
    • Don’t lay down with full stomach.
    • Ask health care provider about antacids.
15. Achy, heaviness in pelvis or hips:
    • Get lots of rest.
    • Move about slowly and carefully.
16. Frequent urination and leaky bladder:
    • Ask your health care provider about Kegel exercises.
    • Mini-pads.
    • Be patient.
17. Braxton-Hicks Contractions:
    • These are essentially painless uterine tightenings sometimes called practice contractions. They do NOT come at regular intervals that can be timed, i.e., five minutes apart.
    • Stop what you are doing, take a few deep breaths, and wait for it to pass.
    • Drink plenty of fluids and rest when you are tired.
    • Any contractions that come at regular intervals that you can time with a clock or watch should be reported whether or not they hurt.
18. Round Ligament Spasms:
    • This is a sharp shooting pain from either side of the uterus down into the groin or thigh.
    • Ask you health care provider about pelvic tilt exercises.
    • These may realign the uterus over the pelvis and decrease the frequency of spasms.
    • Change positions slowly.
    • Get off your feet and rest.

Warning Signs to Report Immediately:

• Bright red vaginal bleeding
• Sudden gush or steady trickle of fluid (water) from the vagina
• Sudden, severe and constant uterine pain
• Loss of or significantly reduced fetal movement
• Unusually severe or persistent headache
• Frequent visual disturbances
• Constant growing upper abdominal pain unrelated to fetal movement
• Sudden and severe swelling of the hands, face, or feet
• Sudden weight gain of five pounds or more in a week
• Very little urination
• Any of the following signs of preterm labor (labor signs prior to completing the 37th week of the pregnancy):
• Menstrual-like cramps
• Cramping with or without diarrhea
• Low back pain
• Constant pelvic pressure or heaviness that feels like your baby is pressing down
• The uterus gets tight and hard (a contraction) four to six times per hour or more whether or not it is painful or happens at regular intervals
• Sudden unexplained dramatic increase in your vaginal discharge especially if blood-tinged or watery
• Any vaginal bleeding

12 Do’s and 5 Don’ts in the Third Trimester

Do:

• Do rest when you are tired or uncomfortable.
• Do wear flat shoes and move about slowly and carefully taking care to avoid falls.
• Do eat frequent small meals.
• Do report any signs of labor that occur prior to completing 37 weeks of pregnancy.
• Do report any decrease or loss of fetal movement or any of the other third trimester warning signs (see above).
• Do learn the signs of true vs. false labor.
• Do call your health practitioner if you are concerned.
• Do pack your bag and prepare for the trip to the hospital.
• Do take childbirth preparation classes and take a tour of the hospital.
• Do write down your goals for your birth experience. This is called a birth plan. Share it with your health care provider.
• Do read and learn all you can about breast-feeding. Take a breastfeeding class.
• Do learn about the different methods of contraception that will be available to you after your delivery.

Don’t:

• Don’t overdo it. Eat, play, exercise and work in moderation.
• Don’t spend your time worrying. Instead, ask questions, read and prepare.
• Don’t listen to negative comments from family, friends, and strangers regarding your size or your shape or the length of your pregnancy.
• Don’t plan to travel far from your health care provider in the third trimester.
• Don’t try to drive yourself to the hospital while you are in labor.
  

Postpartum

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Postpartum is a word used for the time that begins with your baby’s birth. The first six weeks postpartum is a time of healing, learning, and adjusting. It is an exciting time but also a time of anxiety and fatigue.

8 Things you Need to Know About Taking Care of Yourself After Your Baby Is Born

1. Initially you will be very excited and this excitement may get in the way of rest. Hospitals have their routines and these also get in the way of rest. Your baby will need to nurse at all hours of the day and night. Well-meaning visitors can get in the way of rest too. In short, you will soon be very tired even before you go home. You will have to make time to rest. Stay in your pajamas and robe the first week. Sleep whenever the baby sleeps. Unplug the phone. Tell your friends that you will call when you are ready for guests.
2. You are healing from a normal but major life change. Don’t be surprised by your sore aching muscles. Giving birth is hard work. It is important that you eat a healthy, well-balanced diet and drink plenty of fluids. Continue your prenatal vitamins during this time. If you are breastfeeding, you will continue your vitamins until you wean your baby. After that remember, everyone benefits from a multivitamin with folic acid every day.
3. If you have stitches, these will swell and ache too. The vaginal area is referred to as the perineum. If you have stitches in your perineum, you will probably use ice packs off and on for a few days to limit the swelling. Usually your health care provider will order pain medicine for you as well. Later, heat will be recommended to speed healing. This can be accomplished by soaking in a clean tub of extra warm water and then by drying the area with air from a hair dryer on warm setting.
4. The stitches from a cesarean delivery are painful too. When you get home, continue with the instructions that the hospital nurses gave you about deep breathing and coughing and standing up straight.
5. While your baby is learning to breastfeed, your nipples may become sore. As your nipples toughen, this will lessen. But if you are having difficulties you could develop cracked and bleeding nipples. Call your health care provider at once if you and the baby are having any problems with latch-on (getting the baby properly positioned to nurse). Ask to speak to a lactation consultant. The first two (2) to five (5) days, your baby is receiving colostrum from your breasts. This is important nutrition for your newborn. But soon thereafter your milk will come in. When this happens your breasts may feel hard, hot and sore. This is called engorgement. The best cure for engorgement is nursing your baby. Eventually your body will learn how much milk to make for each feeding and you will experience less engorgement. You will need to drink more fluids while you are breastfeeding and eat a well-balanced diet.
6. There are number of other physical changes going on in your body at this time. Your uterus is healing and shrinking down to its pre-pregnant size. This may cause you to feel strong menstrual-like cramps. You will pass menstrual-like blood called lochia until the uterus is healed. Your abdominal muscles have been stretched and will take some months to tighten up again. As you body removes the extra fluid that you carried while you were pregnant, you will urinate more often.
7. The hormones that supported your pregnancy will quickly drop back to pre-pregnant levels. This hormone shift creates feelings of sadness. Add to that, you are sore in various places and very tired. Is it any wonder that you may feel sad or blue? Know that these feelings are normal as long as they last only a few days and respond to rest. Let others help you especially during this time. Let your partner change that diaper in the middle of the night and bring the baby to you to nurse. Let your mother sit with her grandchild while you go for a walk or take a nap. Accept that casserole from your neighbor. You may not need lots of visitors, but you do need lots of help. If your blues last more than two weeks, seem to be getting worse instead of better, or if you are having thoughts or fantasies about hurting yourself or your baby, you may have a condition called postpartum depression. This is more serious than the usual baby blues. It requires professional support and medication. It is nothing to be ashamed of. Please call your health car provider if you are having symptoms of postpartum depression.
8. Believe it or not, you will want to have sex again. Most women feel healed enough and have stopped bleeding enough to consider sex around four weeks postpartum. Know this. You can get pregnant if you have unprotected intercourse at this time. It is not likely, but it is possible. Condoms are a good idea not only for contraception but also for protection against infection since most women are not completely healed until six weeks postpartum. Talk to your health care provider about contraception before resuming sex.

Postpartum Warning Signs

If you develop any of the following signs, call your doctor immediately:

• A fever of 101° Fahrenheit or higher.
• Cracked or bleeding nipples.
• Flu-like body aches.
• Red streaks in your breasts.
• Foul smelling vaginal bleeding.
• Extremely tender nipples or breasts.
• Increasing abdominal tenderness or cramping.
• Unusually sever headache, leg pain, chest pain, or difficulty breathing
• Increasing redness, swelling, tenderness, or pus along any stitches.