A week-by-week guide to your first trimester covering prenatal care, screening options, symptom management, and the lifestyle adjustments that matter most in weeks 1 through 12.
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Choosing Your OB or Midwife
Research in-network providers and read patient reviews
Most insurance directories list 20-50 providers in urban areas. Narrow your list to 3-5 based on hospital affiliation and birth philosophy before scheduling consultations.
Schedule a meet-and-greet appointment before committing
Many practices offer free 15-minute consultations. Ask about their C-section rate (national average is about 32%) and how they handle after-hours calls.
Confirm the provider delivers at your preferred hospital
Check if the hospital has a Level III NICU, which handles the widest range of newborn complications. About 10-15% of newborns need some level of NICU care.
Verify insurance coverage and expected out-of-pocket costs
The average out-of-pocket cost for a vaginal delivery with insurance is $2,600-$3,400. Call your insurer directly to confirm your plan's maternity benefits and deductible.
First Prenatal Visit (Weeks 8-10)
Schedule your first prenatal appointment between weeks 8 and 10
Call as soon as you get a positive test. Popular practices book 3-4 weeks out, so calling at week 5 or 6 ensures you get a week 8-10 slot.
Prepare a list of your medical history and current medications
Include all prescription drugs, supplements, and over-the-counter medications you take. About 70% of pregnant women take at least one medication, and your provider needs the full picture.
Get baseline blood work done at the first visit
Standard panels include CBC, blood type and Rh factor, rubella immunity, hepatitis B, HIV, and syphilis screening. This typically involves 4-6 vials of blood drawn in one sitting.
Discuss your family medical history with your provider
Write down any history of genetic conditions, birth defects, or pregnancy complications in both your and your partner's families going back 2-3 generations.
Confirm your due date with an early ultrasound
A dating ultrasound at 8-10 weeks is accurate to within 3-5 days. This is more precise than calculating from your last menstrual period, which can be off by 1-2 weeks.
Prenatal Vitamins and Nutrition
Start taking a prenatal vitamin with at least 400 mcg of folic acid
Folic acid reduces neural tube defect risk by up to 70% when taken before and during early pregnancy. If you have trouble swallowing pills, gummy versions absorb just as well.
Ensure your prenatal includes iron (27 mg) and DHA (200-300 mg)
Iron needs increase by about 50% during pregnancy to support increased blood volume. If your prenatal doesn't include DHA, a separate fish oil supplement covers the gap.
Adjust your diet to include folate-rich foods daily
Dark leafy greens, lentils, and fortified cereals each provide 100-200 mcg of folate per serving. Aim for 600 mcg total daily from food and supplements combined.
Eliminate high-risk foods from your diet
Cut raw fish, unpasteurized cheese, deli meats (unless heated to 165°F), and high-mercury fish like swordfish and king mackerel. Low-mercury options like salmon are safe up to 12 ounces per week.
This combined screening detects about 85% of Down syndrome cases with a 5% false-positive rate. Results typically come back in 5-7 business days.
Ask about cell-free DNA testing (NIPT) available from week 10
NIPT screens for chromosomal conditions with over 99% accuracy for Down syndrome and is a simple blood draw. Many insurers cover it for patients over 35 or with risk factors; otherwise expect to pay $200-$500.
Decide whether to pursue carrier screening for genetic conditions
Carrier panels test for 100-200+ conditions like cystic fibrosis, sickle cell disease, and spinal muscular atrophy. Both partners should be tested, and results take 2-3 weeks.
Managing First-Trimester Symptoms
Stock up on nausea remedies before morning sickness peaks at weeks 8-10
Ginger chews, vitamin B6 (25 mg three times daily), and small frequent meals help about 70% of women. Keep plain crackers on your nightstand to eat before getting out of bed.
Plan for fatigue by adjusting your daily schedule
First-trimester fatigue peaks between weeks 8 and 12 due to rising progesterone levels. Going to bed just 1 hour earlier can make a significant difference in daily functioning.
Track symptoms to report at your next prenatal visit
Note frequency of nausea, any spotting, and headache patterns. About 20-30% of women experience some spotting in the first trimester, which is usually harmless but should be reported.
Know the warning signs that require immediate medical attention
Heavy bleeding (soaking a pad in 1 hour), severe abdominal pain, fever over 100.4°F, or persistent vomiting (unable to keep fluids down for 12+ hours) all warrant an urgent call to your provider.
Workplace and Lifestyle Adjustments
Decide when to tell your employer (most wait until week 12-14)
About 80% of miscarriages occur in the first trimester, which is why many wait until after the 12-week mark. If your job involves physical demands or chemical exposure, disclose earlier for safety accommodations.
Review your company's parental leave policy and FMLA eligibility
FMLA provides 12 weeks of unpaid, job-protected leave if you've worked at least 1,250 hours in the past year for a company with 50+ employees. Check if your employer offers paid leave on top of FMLA.
Stop alcohol, tobacco, and recreational drug use immediately
There is no known safe amount of alcohol during pregnancy. Quitting smoking before week 15 reduces preterm birth risk to nearly the same level as a non-smoker.
Reduce caffeine intake to under 200 mg per day
An 8-ounce cup of coffee contains about 95 mg of caffeine. Teas range from 25-50 mg per cup. Staying under 200 mg daily (about 2 small cups of coffee) is considered safe.
Establish a safe exercise routine with your provider's approval
Most women can safely do 150 minutes of moderate exercise per week during pregnancy. Walking, swimming, and prenatal yoga are low-risk options. Avoid contact sports and exercises that involve lying flat on your back after week 16.
Frequently Asked Questions
When should you schedule your first prenatal appointment?
Call your OB or midwife as soon as you get a positive pregnancy test. Most providers schedule the first appointment between weeks 8-10, when a heartbeat can typically be detected via ultrasound. If you have a history of ectopic pregnancy, recurrent miscarriage, or are on medications, your provider may want to see you as early as week 6. Bring a list of all medications and supplements you currently take.
Is morning sickness all day or just in the morning?
Despite the name, nausea during pregnancy can strike at any time of day. About 70-80% of pregnant women experience some nausea in the first trimester, and roughly 50% have actual vomiting. Symptoms typically peak between weeks 8-11 and improve by week 14-16. Eating small, frequent meals every 2-3 hours, keeping crackers by your bed, and drinking ginger tea can help. If you lose more than 5% of your body weight or cannot keep fluids down for 24 hours, contact your provider — you may have hyperemesis gravidarum.
What foods should you avoid during the first trimester?
Skip raw or undercooked meat, fish, and eggs due to bacteria and parasite risk. Avoid high-mercury fish (swordfish, shark, king mackerel, tilefish) — limit tuna to 6 ounces per week. Unpasteurized cheeses (brie, camembert, queso fresco) and deli meats can carry listeria, which is 10 times more dangerous during pregnancy. Limit caffeine to 200 mg per day (about one 12-ounce coffee). Alcohol should be avoided entirely — there is no known safe amount.
How common is miscarriage in the first trimester?
About 10-20% of known pregnancies end in miscarriage, with the vast majority occurring before week 12. Once a heartbeat is confirmed on ultrasound (usually around week 6-8), the risk drops to about 5%. By week 12 with a confirmed heartbeat, the risk falls below 2%. Most first-trimester miscarriages are caused by chromosomal abnormalities and are not preventable through any action of the mother.
What prenatal vitamins should you take in the first trimester?
Start a prenatal vitamin with at least 400-800 mcg of folic acid ideally before conception, but certainly as soon as you learn you are pregnant. Folic acid reduces the risk of neural tube defects by 50-70%. Look for a prenatal that also includes iron (27 mg), calcium (200-300 mg), vitamin D (600 IU), and DHA (200-300 mg). If the vitamin causes nausea, try taking it at bedtime with a small snack, or switch to a gummy formula.