Pregnancy Unpacked: Weeks 9-12 Pregnancy with Midwife Trystan | 96

Okay, you guys, we're going to unpack your pregnancy. So 8 to 12 weeks is what we're talking about today, and it's a two punch part. I'm going to chat with my friend Tristan, who I'm so excited about. She was a labor and delivery nurse that I worked with for many years on night shift. We got into some trouble together, so I'm super excited about having her here, and I know you guys are going to love her. 


Hello, everyone. I am, I know it, never mind. I say this every episode, but I really truly am so stinking excited about this episode. I have a friend of mine that I've known for a very long time and haven't seen for a long time. Who is going to join me today on part two of Pregnancy Unpacked, where we're going to talk about your pregnancy from week 8 to 12 and Tristan, I, it's funny you guys, I had to confirm her last name because we worked together years and years ago when I was a newbie labor and delivery nurse and I only have that last name cemented in my head, but please welcome Tristan White, and I'm going to let her tell a little bit about herself. 


Hi, 


Trish: Now we have a long time experience. 


Trystan: Oh, I get to the labor and delivery desk now, and I go. Oh, y'all are such babies now, but I love it. 


Trish: I love it. Back when we worked together, Tristan was a labor and delivery nurse and we worked on the night shift and we had such a fun crew. 


Trystan: We did. We really did. And there's a few of the crew left. Very few. At night? We had, there's a couple, there's a couple left but they're not all night 


Trish: shifting Okay. 


Why am I choosing night shift? It was awful. And then it was it was so wonderful. Oh my gosh. So Tristan is no longer a labor and delivery nurse. Tell them about you. So 


Trystan: I did labor and delivery for about 16 years in some different roles, charge nurse, management, did some education for the nurses for a while. 


And then two and a half years ago now I finished midwifery school. And I'm now a CNM working with a great group of other nurse midwives. And we deliver in the hospital and it's great. And how old is your son? He's 


Trish: nine now. That, so I knew he was neck to neck with Grayson. Yes. Cause Grayson's nine. 


He turned nine in December. So Jace turned 


Trystan: nine in October. 


Trystan: I think so too. Cause you've got that wealth of knowledge behind you. 


Trish: Yeah. And you know all about the 3 a. m. dances and the weird things we do and all those things. So yeah. 


Trystan: The night shift has to carry on 


Trish: with you. Yes. Yes. Absolutely. So tell everyone a little bit about your story with Jace. 


Trystan: We became parents by adoption. We, I always knew. I had reproductive issues, growing up and knew that pregnancy was probably not going to be the route that I was going to become a mom. 


And, eighteen hours later we were walking into the unit where I worked, funnily enough to meet this little boy and he was 24 hours old at the time and he has rocked our worlds and kept us running ever since. 


Trish: I bet that walk into the unit that day was like, Something you'll just never forget. 


Oh, it's, it 


Trystan: was a difference cause I've walked onto that unit so many times at that time and it was just different knowing that I was walking in about to meet my child. Yeah. That's it. I'm going 


Trish: to tear up thinking about it. No, it gives me chills because I remember. Meeting Sitara, my daughter, who's adopted the first time and it's making me, oh my gosh, I'm getting emotional myself now. 


Trystan: That man is amazing. Oh 


Trish: my gosh, you guys, so I, we both lived in Chattanooga and there is a man who is just a saint when it comes to adoptions. 


And several of my friends were adopting locally while I was waiting for Satara. And some of them got two babies home before I got Satara home because international adoption is so difficult. But that was where my daughter was born. And I knew it. I knew beyond knowing that's where she was. But it was such a difficult journey and Mike Jennings was my lawyer, but we did not do it locally. 


I had to ask you that when you said it was quick. I was like, I know who got I know. He's just he's amazing. Yeah. Anyway, and it's not quick for everyone. No. But it just. A lot of people it is. 


Trystan: Yeah. Sometimes it does. It surprises you. 


And I was like skin would be fine. Any skin. Any red. Yeah. And that was. And, yeah, that's how we were. Like I just felt very strongly the right baby would be matched with us. And I was so appalled by those questions. And I think that when you go into to, The adoption world and this is my personal opinion, I may get some hate over this, but I feel I know Satara was my daughter, and she was born in another country, but it was only Satara, and I didn't have to worry about all the details that I was going to find her and she was going to find me. 


And so she was the only baby that literally they opened for me and closed for me that's how I feel so anyway that story so so you became a midwife and you are now doing that which is so different but similar yes now you can break water and all the things we couldn't do 


Trystan: yes but also get to see people in the office and develop that relationship across the pregnancy and even, when they're not pregnant, across the GYN care and, just a lot across the lifespan. 


Trish: So I, we joke inside of my my birth community with my birth students and stuff that there's medwives and there's midwives. I pretty much know which one you lean into because I've worked with you, but would you agree that there are some midwives that are really no different than doctors? Yes, 


Trystan: I will. 


I'm just going to leave 


for women to have a resource because you know how it feels. And sometimes, everybody has a different learning style. Some people want to consume reading things and some people want to hear things, and I thought it would just be fun to, to talk to a midwife about some of these questions. 


So I have some questions for you. And I figured we would start with, so last episode or series I talked about zero to four weeks, finding out you're pregnant. Although I would say there are some people who find out between eight and 12 weeks. Would you say 


Trystan: that? Yes. Yeah. If you've got irregular periods or you're breastfeeding and you don't know when your last period was or, there's a lot of reasons that you're going to find out a little bit later. 


Okay. Bye. Bye. 


Trystan: It changes in appetite, nausea, vomiting, so those are two of the biggest ones. I would say probably breast tenderness. And fatigue or, to the next, would be the next top two. 


Trish: For me, for my pregnancies, I felt like I had you know how when your foot goes to sleep and then it's waking up? That's what my breasts felt like. And then, I could not stay awake to save my life. And I, it's funny, I was just having a team meeting. I have three doulas that work with me and I was just meeting with them and we were talking about the differences between my husband and I, which, my husband Steve, who I was not married to back then, but he's amazing and he is just so emotionally mature and he cries during movies way more than me and that, because I don't know, like I'm just not a movie crier. 


Trystan: Prenatal care is really important with pregnancy outcomes. We talk about with pregnancy, a lot of people focus on the end result of labor or delivery and getting that baby. But in order to have that healthiest outcome at the end, you've really got to start the care early on because early care can identify some of the risk factors that may pop up later in pregnancy. 


Gestational diabetes risk, high blood pressure risk, anything genetically, or do you have a family history of things that could just complicate your pregnancy? And so we can mitigate those risks early on and prepare for those. 


Trish: Okay, so when would you suggest that someone, starts choosing a provider and how do they go about that? 


What's the normal process? So 


So Start, asking your friends who they see, why they like their provider and calling around and seeing who's accepting, new OB patients at that for that time or your insurance That's a big one. A lot of providers are in network or out of network If your insurance doesn't have maternity care It may be a state's insurance that you're having to get on and so some Providers are going to be more accepting of that insurance than others So there's a lot of factors that go into choosing a provider right in the beginning. 


Trish: What about choosing based on where you want to deliver? Do people do that? 


But you get there and we are affiliated with that hospital, but maybe we just do surgeries at that hospital, but we prefer to deliver it at this other hospital. So that's something that you would want to add to your list of questions at your 1st prenatal visit. Okay. 


Trish: And if they say they prefer to deliver at A, but you want to deliver at B, do you think a lot of providers are, have some wiggle room on that? 


Do you think they're pretty hardcore on that or does it depend? 


Trystan: It would really depend. It would be a conversation of sometimes say for instance, here in town, we've got a hospital we prefer but we have privileges at another hospital. Primarily we go to that other hospital. If you have, if your insurance requires you to go to that hospital, that's why we have those privileges there. 


We prefer another hospital mainly because we're right across the street from there. And we prefer that because we can be more present. We're right there during the day. 


Is there anything they need to know or to bring? So 


Trystan: bring your insurance cards. When you come, because we're going to, the billing department is going to run your insurance and, bring your list of questions. Most providers at first appointment, you're going to have an ultrasound. We're going to confirm that your dates that baby's measuring. 


Match up with your last period make sure that everything looks good. Or have a baby that's in the uterus. And a lot of people aren't prepared for sometimes it's an abdominal ultrasound. Sometimes it's a transvaginal. 


Trish: I was just heading in that direction, but what's really. 


Trystan: I've had several people come and go, did not expect that. Yeah. 


Trish: I just got violated. 


Trystan: Yeah, so they, we can't see Abdominally. Yeah, 


We're gonna go in vaginally with an ultrasound one to see baby and confirm heartbeat and things like that. 


Trish: Yeah. I love that. Tristan's a, like a labor delivery person because I'm very real and blunt around here, but the thing that was so funny to me, I remember laying there and the lady was putting a condom on it, , and I was like. 


I was like, my eyes were like darting around like a deer trapped in a, whatever they get trapped in. And I was like, what is happening? No one prepared me for that. I had no idea that was coming. And I was so shocked. Yeah. Yeah. So just so you guys know, it looks like a giant sex toy. 


Trystan: It does. It 


Trish: does. 


And then what are you going to do when you come in? 


Trystan: So when I come in, I sit down and I go over the ultrasound. Yeah. Everything's great with that ultrasound. My first question to them is, what are your biggest questions? Cause majority of the time they come in either looking like a deer in the headlights because it wasn't something that's planned and they're like, I have no idea what I'm about to do. 


Or people come in with a laundry list of Everything, but we're going to review, what foods are recommended, what, have you started a prenatal vitamin? What symptoms are you currently having? How are you currently managing that nausea? If you're having it. We're going to go over blood work. 


Trish: And I know that they also are going to start their normal things that they're going to be having at every visit as well, correct? 


So what are some of the things that will begin, like blood pressure and urine and Blood pressure, 


Trystan: urine, weight. We're going to be checking weight. It makes sure we're not losing too much weight if you're having a lot of nausea vomiting. We also, you know towards the end of pregnancy don't want to be gaining too much weight, but we're gonna be doing weight blood pressure urine dip so expect to pee in a cup every time you go. 


Trish: Yeah Don't pee right before you walk in the office like i've done before but sometimes you can't help it. You can't wait You see 


Trystan: we'll give you a cup of water. We know you're gonna have to go in about 15 more minutes Yeah. So when 


Trish: you say dipping urine, explain that because some people don't know what that means. 


There's a lot of things that with pregnancy can affect your kidneys and we want to make sure your kidneys are functioning well. And one way we can do that is looking at your urine. Okay, 


Trish: so they've done those things, they're probably gonna get a lot of labs done at the first visit. 


Trystan: Yes, a lot of blood work, people go, oh my word, how many tubes of blood are you gonna draw for me? 


We're like little vampires. 


Trish: Yeah, so you're gonna get all of those things done, they're gonna get your blood type, she, you're gonna take a history, I would assume. 


Is there any history of birth defects? Is there anybody that's a carrier for, thank you. Recessive traits of, any kind excuse me all of that plays, different genetic factors. We want to make sure, baby's not going to be affected by any of that culturally and ethnicity can play a role in how developmental. 


And birth defects as well. So we're going to be asking those questions. We're going to ask about your sexual history. So be prepared for those questions. 


Trish: Yeah. So if you don't want him to hear. Exactly. You need to know it's coming. Yes. 


Trystan: No, that's coming. Because we want to know that we're starting out with a clean sexual history free of any STDs that can affect a developing fetus. 


Trystan: Okay, yeah. 


Trish: Okay. Okay. Okay. Which is so weird. Yeah. 


Trystan: So people have heard about preeclampsia. 


And more and more research that is being done with preeclampsia is actually looking into the father's genetics playing a role in causing preeclampsia. So if, his previous partner had preeclampsia, you possibly are going to be at risk for preeclampsia in this pregnancy because of. That research that has come about of father's genetics. 


Trish: So it, do you guys flag them if that you do find this out? We 


Trystan: do. We do. We will mark that on there, just to see how the other kids was there any complications in with those deliveries? I'm like, okay, let me just mark that. Yeah. Mark that 


Okay. So what about, so we are talking about up to 12 weeks. So one thing I wanted to talk about is some of the genetic tests. Some of the blood tests, the nuchal scan. If you could talk about what are those tests and what are you guys looking 


Trystan: for? You'll get asked a lot about do you want to do any of the genetic screenings or even carrier screenings, especially if it's your first baby I'll start with carrier screening. 


So carrier screening is just blood work. None of these are invasive. So carrier screening will. Check you to see if you are a carrier for cystic fibrosis, vital muscle atrophy, or a fragile X syndrome. Those are recessive traits that if you're a carrier for one, we would want to test the father baby about one in 30. 


Where we do just another blood draw, more blood check chromosomes. And we look at the chromosomes of baby, primarily for trisomy 13, trisomy 18, and trisomy 21. Most people know trisomy 21 is Down syndrome. We also look at the sex chromosomes in that test. We can tell gender. With that test, a lot of people like, yes, I want to do that because I can know the gender of the baby as early as 10 weeks. 


You have to be 10 weeks for this particular test to be run. But it's so much more than that, because you get a lot of information off that test. So your provider is going to talk to you about that as well. And why it might be a good reason for you to do that based on, whatever risk factors pop up in your history. 


And if any of those are off, they'd probably talk to you about going to see a high risk doctor during your pregnancy. 


Trish: So do you see more people? So let me rewind. When I was pregnant with Grayson, some of those blood genetic tests were pretty new and you had to pay out of pocket. You didn't get them included. 


So are they more included now by insurance, some of 


Trystan: them? Yes a clog, the governing body of the obstetricians and gynecologists are actually recommending them as screening tests now. So they're more widely covered by insurance. They're not completely, they're not completely covered where there's no cost, depending on your insurance carrier. 


If you do not have insurance at all of your self pay and you want these additional tests, they do have assistance for these types of tests as well. Okay, 


Trish: so now they have done all of that. Let me ask you this because I think it's funny. Do you think a lot of people choose to do it to find out the gender? 


Oh, yes. 


Trystan: One hundred percent. 


Yeah, who named it that I don't 


Trystan: know a man named it that so the first thing I try to do is b6 and unisong is my go to So there's a prescription medication called day collegious that is the same ingredients and so this is definitely something that you need to talk to your own provider about, but is something that I recommend to my patients. 


Vitamin B6 is great. With for nausea, and so we'll try that over the counter 1st before going on to prescription medications, but also things like sour candies and small frequent meals and always tell my patients, especially if they're throwing up 1st thing in the morning, if you're. Waking up in the middle of the night, like you gotta go pee in the middle of the night, keep some crackers or a small snack by your bed. 


Unfortunately, sometimes 


Trish: yes, it's the same. One, what works with one pregnancy may not work with the other, but I did the same thing. I kept crackers by my bed, and if I had to get up to go, I wouldn't even open my eyes. I would just grab one, feel for it, grab it, eat it, and then go to the bathroom and then come back. 


I was so sick that I'm feeling a little nauseous right now talking about this. Because it's literally trauma. I have PTSD. When you're that sick, I was so sick. So as far as what, let's say you have a mama who it's going beyond the normal sickness. What do you call that? And what do you, okay. And what do you do for that? 


There's a little, hyperthesis is a different beast and I feel so bad for my patients that have to deal with it. Yeah, 


Trish: can you imagine I can't imagine I have a really good friend who went through it, but I have a coaching group now where I coach women, especially in the birth space that want to turn their business into an online business. 


But wow, what a especially, I know I have a lot of students who Went through a lot of IVF or whatever they did to get pregnant and then they're so sick and then they hate their pregnancy and then they're struggling with emotions and guilt and all the things and they just can't be happy about it. 


So if you're out there struggling with that, we are so sorry and. Make sure you're getting the help and it's okay to take the medications and all of that. Okay, so What about diet? What do you because you mentioned that you'll talk to them about things to eat things not to eat things not to drink 


Trystan: I Take a very simple approach when I'm talking about what to eat and what not to eat in pregnancy First thing I'm like don't start drinking alcohol if you've never Been a drinker and stop if you are a drinker, first of all, don't drink in pregnancy. 


But first trimester, if it sounds good and you can hold it down, eat it. I don't care if it's a bag of Cheetos, okay? I really don't. If it sounds good and you hold it down, it's caloric intake at that point. But it's protein. It's Fruits and vegetables, and if it's cooked, eat it, wash your fruits and vegetables if it's pasteurized, eat it just make safe food choices, as I try to keep it as simple as possible. 


So I'm like, I'm 42. I'm overly scared about everything, and I had a few miscarriages prior to that, so I was just a nervous wreck. But I remember calling her and I was like, all I can keep down are the, what are those like orange peanut butter crackers, you know what I'm saying? That is legit, yeah, all I could keep down. 


Just whatever you can keep down. Okay. So what about For these moms as far as going forward, what would their checkup? Like their next visit, like when would that be? And do they normally see the same provider? Or what would that? 


Trystan: And so as far as visits, normally visits are every four weeks until you get to the 28 week mark. 


And so when you hit third trimester, you start being seen every two weeks. And then when you hit 36 weeks, you're generally seen weekly until you have a baby. As far as who you see each of those visits, that's a question that you need to ask your provider at that very first visit, how do visits work? 


So those are all questions to. Write down and ask your provider that very first visit, how their call structure works. 


Trish: Okay. And what about choosing to see a midwife or to see the obstetrician and can everyone choose that or how does that work? 


Trystan: So if you are generally healthy and don't really have a whole lot of health issues, you can absolutely choose a midwife. 


Transcribed Things that may knock you out of choosing a midwife is if you've had a previous C section. Depending on your location of where you're choosing to deliver certain hospitals may have different policies, certain offices may have different policies where they want you to see the obstetrician if you're trying for a VBAC or something. 


Trish: So now I'm curious, do you do VVACs? 


Trystan: We, some of our providers, we do. But not your midwives? just because of how the hospitals have their policies 


Trish: set up. Which you're probably still antiquated if I know Tennessee. 


Yeah. Yeah. I can get in trouble because I'm not employed by a hospital at this point, but I don't know if but I have a birth course that is just for VBACs, the VBAC lab. I spend a lot of time doing research with these mamas, and it's funny here in Nashville, we have home birth midwives that do VBACs, so you just have a range. 


Oh, yeah. 


Trystan: A range. And across the state, it's vastly different, and I've worked at different places across the state as a labor nurse, 


Trystan: I did do some 


Trish: after, both. I thought so. Both before and after. Because I, I feel like you were traveling when I first started or you had just come back from a travel assignment when I first started. 


Trish: Yeah, I think, I feel like you came back after I started there. 


And I, it probably put, you probably the reason. You put the bug in me. 


Trystan: I'm probably, I'm responsible for a lot of 


Trish: that. It's just I learned of course I went from where we were working, where we were doing all sorts of shit backwards. So many things. God, do you remember the rates we used to push? 


Potosin, again, side note. Holy smokes! And that was in a lot of other hospitals too. But not in California. Not in 


Trystan: California, 


I'm going to lose my license. This is not okay. 


Trystan: Oh, yeah. Oh, girl, there, there were worse places than where we have worked together because there was some places I've been to that I was like, oh, can this be over? Can this be over? 


Trish: I did most of mine in California, they're union, mostly union hospitals, so I didn't have to experience that. 


But I remember being there and telling them that we had no doctor in house at night, we had no blood in house at night it was scary and we had just transitioned to high risk, do you remember that? Anyway, side note, okay, so back to the topic at hand, but that's what you get around here, you guys. 


The 


Trystan: urine, the first urine that we do the first visit, they'll run for culture. And if GBS shows up on it, then yes. 


Trish: And then they're positive. That's that. And they're positive. Yeah. Do you agree with that? Can I get you in a little bit of trouble? Because we'll just call you Mitchell. 


Trystan: The jury is out on that one. 


Don't look. Reviews online can be botched at times unless it's a screenshot with someone's name and then I always recommend to go into a Facebook, local mom's Facebook group and ask there. And then I always say, ask who was your OB, who was your provider? And then ask them if they say they loved him. 


Oh, getting a pap smear. We didn't talk about that. That's when you have smear the first appointment, right? Or not 


Trystan: always. No. If you need a pap smear, generally we're going to wait until the second trimester. 


Trish: Is that newer? Cause I don't think, I think they did it with me. The. First one, when I, because I literally am so bad about going regularly. 


And so 


Trystan: that may be a group preference for us as the midwives. You're just more, there's just more bleeding. Things are more vascular, especially the first trimester. So we're not going to go poking around on the cervix at first trimester. 


Trish: We'll always take less poking around if we can take it. 


Okay. All right. I forgot about that. 


Trystan: But if you're date on your pap smear, I'm not gonna go pap you during your pregnancy. 


Can they change? 


Trystan: Yes, you can. You have to remember that you are the one employing your provider. You are the one that. Needs to develop the relationship with that provider throughout your pregnancy. Y'all have to develop a trust in that relationship because this is a big thing. Your pregnancy and delivering a baby is a very big thing. 


It's a big milestone in people's lives. And if you don't jive with that person, you can't develop trust with that person. 


Trish: And you need to trust your provider. And 


So keeping that in mind. 


Trish: And I, that, this is one of the things I teach my mamas is to start asking those big questions early on that are really important to them, even about the delivery, because if you're not in alignment with that, if your provider is not going to support the choices that you have, then it's better to find one earlier. 


Yeah, and her provider, yeah, so she switched. So you can switch, but it was hard. It was a lot of legwork. So you gotta keep that in mind as well. So it's better to really do your due diligence before you choose. And then, And then, and we do have a list of provider questions that you guys can have. 


So if you, we'll link it in the show notes for you for looking for your provider as well. Thank you so much, Tristan. It was so nice to see you. It was so good to see you too. I'm so excited. And thank you so much for coming and sharing all your knowledge with everyone. Anytime. Hey mamas, I hope you enjoyed our chat with Tristan, one of my good friends who is an amazing midwife, and she was an incredible labor and delivery nurse. 


Now I always called mine a baby, I don't know about you, totally, we actually called The baby bean or whatever we decided to call it during week eight, your baby is starting to make some movements, but you're not going to feel them yet. And the baby is about the size of a little tiny kidney bean. And this is sometimes this is where people find out that they are pregnant. 


And like Tristan mentioned, you can also get your pregnancy confirmed with your midwife, with your provider or at the doctor's office. Now, around week 9, your baby has all of their internal organs in the right spots, ready to go. Heart, lungs, liver, brain, kidneys, all the things. Very immature, but they're going to continue to develop. 


Okay, side note. Week 11, the baby's little face bones have begun to are formed and their ears are beginning to develop and their eyes are developing, but they're closed. They're not going to open for a couple more months. And then around week 12, Your little kidney bean is now the size of a plum. 


And if you need help, you're not feeling well, get. Help because you do not have to deal with that on your own. Now, when you go to that first doctor's office, like we were saying, if you don't know when your last period was, this appointment's going to tell you exactly how far along you are, or. pretty close and also give you your due date, which is super exciting. 


Just do what you can, maybe taking a short little daily walk. Make sure you're staying hydrated. And remember to start thinking about those key decisions, like where do you want to birth your baby? Is it at home? And is it a birth center and a conventional hospital? Choosing your provider ASAP, because like we said, you need to go to that first appointment soon. 


All right, you guys, congratulations on your new pregnancy. We will see you again next week. Bye for now.