What to Really Expect in the First Trimester: Surprising Symptoms, Emotional Changes, and Essential Self-Care

Of all the stages of pregnancy, the third trimester is often the most exciting, when everyone is counting down the days until your baby is born. But it’s the first trimester that is the most important one of all, since it sets the stage for the rest of your pregnancy, both physically and emotionally. Although you might expect some early pregnancy symptoms, there are many other changes that you might not know about — and some of them can be quite surprising. 

Keep in mind that you might experience some, all, or even none of the symptoms below. You might have some of these changes, and that’s completely normal. “None of these happen to everyone, and experiencing — or not experiencing — symptoms does not predict the health of the pregnancy,” says Dr. Sarah Berg, a board-certified OB-GYN and founder of Selfority, a digital education platform focused on delivering evidence-based women’s health information.

The First Trimester Lasts Forever — Or At Least It Feels Like It

Each trimester of your pregnancy lasts about 13-ish weeks, including the first, but for many women, time seems to stand still during the early stages. “The first trimester often feels like the longest year of your life — even though it’s technically just 13 weeks,” says Berg. Maybe it’s because you’re emotionally and physically exhausted, but it tends to drag on and on. 

You Might Be Ambivalent About the Pregnancy

Even if you’ve been proactively trying to conceive, you never know how you’ll react when you see those two little lines on a pregnancy test. Suddenly, it’s all too real, and the news might make you elated—or elicit pure panic, leading to a “What the **** did I get myself into?” moment. 

Don’t worry; it’s normal to be unsure of how you feel about being pregnant, whether your pregnancy was planned or a total surprise. “A newly pregnant woman may not expect to feel ambivalence about the pregnancy,” says Lauren A. Tetenbaum, LCSW, JD, PMH-C, MSCP, a psychotherapist certified in perinatal mental health and peri/menopause.

“You may be wondering: How will becoming a mom impact my career? Or my relationship? Will I be a good parent? How will I afford all of the things I want for my family?”

You Might Tell Everyone — Or No One

There’s something to be said about the sacredness of your first trimester. Before your belly starts to show, being newly pregnant is something special between you and the new life within you. And once you tell a coworker, your cousin, or your best friend, your pregnancy is no longer private, and that might make you feel vulnerable or exposed. 

That said, letting people know when you’re expecting is entirely up to you and your partner. Some people share ultrasound images immediately on Instagram, and others say nothing until they’re safely out of their first trimester (when the risk of miscarriage drops considerably).

“Though many women may keep their pregnancy a secret during the first trimester, it can be wise to bring a partner, friend, or other supportive person to the early appointments, especially if there has been loss or other medical issues previously,” Tetanbaum advises. As you adapt and embrace this new journey, you decide who knows — and when.  

You Might Feel Nausea Or Want to Vomit — Often

By far, nausea is one of the top pregnancy symptoms. That doesn’t mean that everyone experiences it: some women sail through their first trimester without ever gagging on their toothbrush, while others can barely stomach breakfast. “Nausea can range from a constant, low-grade ‘hungover’ feeling to severe vomiting triggered by smells, motion, or seemingly nothing at all,” says Berg. 

There’s hope that you can safely quell the queasiness under the medical guidance of your doctor. “Mild nausea can often be managed with dietary changes, rest, and reassurance, but severe or relentless vomiting is something to bring up with your provider right away rather than waiting for your next scheduled visit.” 

You’re Going to Feel Exhausted

It takes a lot of internal work to make — and house — a little human. Since your body is in overdrive, it might explain why you can barely get out of bed. “Fatigue is often the most underestimated symptom,” says Berg. “Many pregnant people describe it as a bone-deep exhaustion that sleep doesn’t fix.” 

“In the first trimester, the body is laying the foundation for a placenta and building the early structures of a human,” she explains, adding: “You’re literally making organs, arms, and legs from scratch.” So give yourself a break if you can’t get out of bed, but if the exhaustion is impeding you from daily living, speak to your OB/GYN, who might order lab work to rule out anemia, thyroid issues, or other treatable conditions.

Your Boobs Are Going to Get Bigger

No, it’s not your imagination. You went to bed wearing a solid C-cup bra, but overnight, your breasts leveled up to a D. Bigger breasts are one of those early pregnancy symptoms that don’t get as much attention as they should. And it’s not just the size that can be surprising; your girls can feel very sensitive to touch, too. 

“Yes, your breasts can feel tender during the first trimester,” says Berg. And by tender, we mean a sensitivity that rivals period pain. For comfort, size up to a bra that gives your girls room to grow and choose fabrics that feel soothing rather than scratchy against your skin. 

Your First Prenatal Appointment Will Be Long

Come prepared with snacks and water, because your first OB/GYN visit might be longer than you expect. “Prenatal appointments are often exciting — and overwhelming,” says Berg. “They tend to involve a lot of information, so coming with a pen, notes app, or even an extra set of ears can be helpful.” 

Even if you forget to ask something important, you’ll likely leave your first prenatal appointment with paperwork — lots and lots of it. Despite the plethora of pamphlets, samples, and folders, don’t be embarrassed to call your provider with questions that come up afterward. 

Your First Ultrasound Will Be Vaginal

If you’re imagining an ultrasound wand gliding over your belly, think again.  Early ultrasounds are often done transvaginally. “This isn’t because anything is wrong,” Berg explains. “It’s simply the best way to see something that small clearly.” Knowing this ahead of time can help you feel more prepared for the procedure.

Prenatal Vitamins Are Not Pleasant

“Medication and supplement conversations are common early on,” says Berg. “Folic acid is the one supplement recommended for all pregnant and menstruating people because of its role in early brain and spinal development, and most prenatal vitamins contain it.” You might need additional supplements or medications, Berg adds, depending on your health needs. 

That said, prenatal vitamins aren’t exactly enjoyable. For starters, they’re large and are notorious for triggering the gag reflex. You might be able to break them in half depending on the type of vitamin, but be sure to swallow them with plenty of water; if the uncoated side hits your tongue, it’s a lot worse. 

Swallowing a prenatal vitamin is one thing — keeping it down is another. Prenatal vitamins are notorious for causing nausea thanks to their high iron content, according to a National Library of Medicine study. An empty stomach is a surefire way to make nausea worse, so try taking the pill with food (which aids in absorption) or at a different time of day. Having candy or gum on hand can help erase the aftertaste. 

You Might Feel Like You're on an Emotional Rollercoaster (And That's Okay)

“One of the most unexpected aspects of early pregnancy is how emotional it can feel,” says Berg. Hormonal shifts can cause tearfulness, irritability, or heightened anxiety. Feelings may come and go, but be aware if they become concerning. 

“Thoughts of harming yourself or others, feeling unable to function, or persistent hopelessness are not things to push through alone,” advises Berg. “Pregnancy is sometimes a team sport, and it’s okay — and important — to ask for more support when needed.”

Tetenbaum adds that up to one in five women experience a perinatal mood and anxiety disorder during pregnancy. Support matters, and asking for help is a sign of strength.

You Have to Practice Self-Care

Your first trimester is the perfect time to start practicing TLC. Express your needs, take breaks when you can, and don’t feel obligated to explain or defend yourself. “Self-care matters deeply in the first trimester,” says Berg. Self-care benefits both you and your baby, so get that pregnancy massage, take a long walk, or just nap — whatever soothes your soul. 

Your first trimester is an exciting time, but it’s also physically and emotionally intense. Knowing what to expect can help you feel more prepared and grounded during this special time in your life. Because as any seasoned mom will tell you, it all goes faster than you think — and that includes your first trimester of pregnancy.

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