Before there’s a bump, before the world offers congratulations, there’s this quiet, consuming beginning. The first trimester of pregnancy often unfolds in near-complete secrecy, even as it transforms nearly every aspect of your inner world. You might be nauseous, exhausted, overwhelmed, anxious, elated, or terrified—sometimes all in the same hour. And yet, you’re expected to show up to work, care for other kids, attend social events, and carry on as if nothing is happening. It can feel like you’re carrying a massive truth that no one else can see, and that dissonance—between your inner experience and the outer world—can be incredibly lonely.
In those early months, the body begins changing rapidly, often in ways that are deeply uncomfortable. Nausea, vomiting, exhaustion, food aversions, mood swings, cramping, and bloating can take over daily life. For some, these symptoms are manageable. For others, they’re debilitating. You might be silently running to the bathroom between meetings or lying on the bathroom floor while your toddler watches cartoons. And no one around you knows.
The emotional terrain of the first trimester can be equally consuming. People may experience a flood of feelings: joy, shock, fear, grief, anxiety, disbelief. Yet, there’s often no place to process these emotions. We walk around carrying a life-changing reality that remains invisible to others.
Given that 10–20% of known pregnancies end in miscarriage, most often in the first trimester, this stage of pregnancy is often marked by a persistent undercurrent of worry. For those who’ve experienced miscarriage or struggled to conceive, the complexity deepens. There may be cautious joy tangled with dread, or a protective numbness meant to shield against another possible loss. Each day might feel like a fragile hope stitched together with fear. Each cramp or loss of symptoms can spark panic. Every trip to the bathroom may come with a scan for spotting. The mental energy required to live in this liminal space is immense.
In Texas, and in other states where abortion is outlawed or extremely restricted, this uncertainty is made even more frightening by the current legal landscape. Abortion laws here have affected not just access to elective terminations but they also impact the medical management of miscarriages and nonviable pregnancies. Some hospitals have been hesitant to intervene until there is no fetal heartbeat or the patient is in crisis, leaving people in medical limbo and emotional agony. The fear that necessary care might be delayed or denied due to legal constraints only adds to the stress of an already vulnerable time.
Finally, there is the relentless pressure to “do it right.” We’re told the first trimester is the most critical for fetal development. The messaging is everywhere: take your prenatal vitamins, avoid certain foods, manage your stress, get enough sleep, don’t drink too much coffee, exercise, but not too hard, and definitely do not take any risks. The stakes feel impossibly high—and yet, this is also the time when you’re likely to feel the worst. How do you eat a balanced diet when you can’t keep anything down except bagels? How do you sleep when your anxiety wakes you up at 3 a.m. or you have other children keeping you awake? How do you "keep your stress low" when you’re hiding a huge secret, questioning every twinge, and have no access to the resource that could help the most: your community? When these feelings of not-enoughness, of imperfection, come up, who do you turn to?
And still, despite all this, most people in the first trimester are expected to carry on as if nothing is happening. Culturally, we tend to rally around pregnant people once their bellies are visible or when a baby shower appears on the calendar. But in the first trimester—when symptoms can be most intense and emotions most raw—people are often left to cope alone. This lack of community can have real implications for mental health. When you don’t feel seen or supported during such a vulnerable period, it can amplify feelings of loneliness, anxiety, and self-doubt.
Some people decide to “announce” their pregnancy early—and that can be a powerful way to feel less alone. There’s nothing inherently wrong with breaking the “12-week rule.” In fact, it can be a radical act of self-care to let others in during a vulnerable time. Humans are wired for connection, and pregnancy—especially in its earliest, most disorienting stretch—is not meant to be carried in isolation. Emotional support during this time isn’t just comforting; it’s protective. Research shows that connection during pregnancy reduces stress, supports mental health, and can even lead to better outcomes for both parent and baby.
But for others, sharing early doesn’t feel emotionally safe. You might not want your boss to follow up on a pregnancy that has ended. You may not feel ready to talk openly about an abortion, especially in a political climate where those choices are judged or even threatened. Or you may want to shield the young children in your life—your own toddler, a niece, a student—from the confusion and pain of a potential loss. It can feel like you're stuck choosing between isolation and exposure, between keeping it all in or risking vulnerability before you're ready.
The first trimester is real. It is intense. Whether you are navigating this chapter for the first time or the fifth, after loss or after years of trying, you deserve space to be honest about what it’s like. You deserve care, support, attention, and a sense of community.
So seek out that community where you can, when you can, in whatever way it feels safe. That might mean opening up to one trusted friend, joining a support group, talking with a therapist, or simply following people online who speak truthfully about this part of the journey. Even the smallest sense of connection can begin to lift the weight of isolation. You don't have to carry this alone.
When Mother's Day HurtsWhen Mother’s Day Hurts“There is, I am convinced, no picture that conveys in all itsdreadfulness, a vision of sorrow, despairing, remediless, supreme.If I could paint such a picture, the canvas would show onlya woman looking down at her empty arms.”-Charlotte BronteAs Mother’s Day approaches, I’ve been speaking with several of my clients who’ve struggled to become mothers and/or have lost a child in utero about what this day means to them and how they feel. I’d like to share some of the themes that have emerged through our discussions. Unfair. For many women, the veneration of mothers on this day is deeply painful. Feelings of anger, irritation, envy, and confusion arise. Why me? Why haven’t I become a mother after so much effort? Why did I lose this much sought-after pregnancy? The women I see in my practice have typically spent months, sometimes years, trying to birth a healthy baby. They may have sacrificed tremendous time, energy, and spent the reserves of their emotional and financial resources to try to conceive. They may have given birth and held a dead baby in their arms. The legacy of their losses becomes their new reality, and they must learn to navigate the world with the constant presence of someone’s absence. This, my friends, is unfair. Isolation. Infertility and/or pregnancy loss is often a silent struggle. Research reports that women who are struggling to become mothers experience increased feelings of anxiety, depression, isolation, shame, guilt, and loss of control. Depression levels in people with infertility have even been compared with patients who have been diagnosed with cancer, and couples tend to report that infertility or pregnancy loss have been the “most difficult” events in their lives thus far. This silent sorority of women is estimated to affect 1 in 8 couples (or 12% of married) who struggle to get pregnant or sustain a pregnancy (Rooney & Domar, 2018). That’s roughly the size California, folks! And yet, we don’t talk about it enough, and that’s especially true for men. Sadly, when these discussions do come up, well intended yet uninformed family, friends, or coworkers can say thoughtless, hurtful comments. This can further the cycle of silence. Grief/Loss. If you wonder what that constant tension is in your body, that heavy feeling that sits on your chest – it’s grief. Feelings of anger, depression, anxiety, fear – all different colors of grief expressed. Loss is ever present in the stories of those struggling to create their families, and it doesn’t just disappear when a baby arrives. For some of my clients, the losses can be layered, so let’s take a look at some of them:What’s been lost?Loss of the experience of pregnancy and birth – you feel you are missing out on one of the most miraculous events of lifeLoss of sense of belonging – you don’t quite fit amongst your friends, family, or society at largeLoss of being in control – of your body – of your life. This wasn’t how it was supposed to beLoss of feeling healthy and normal – your identity shifts from “healthy person” to “infertility patient”Loss of feeling competent – you feel you can no longer achieve what you set out to doLoss of sexual intimacy, identity, and privacy – what had been the most private and intimate acts is now publicThe Eagles band has a song titled “Hole in the World” and I think it certainly applies here - -There's a hole in the world tonightThere's a cloud of fear and sorrowThere's a hole in the world tonightDon't let there be a hole in the world tomorrowIdentity Disruption. Talking with a client who had experienced three recurrent pregnancy losses in the recent past, she noted how her relationship to mother’s day had not transitioned the way she expected, from honoring your mother figure to honoring yourself as a mother. She further described feeling excluded from parenthood and being relegated to still sit at the “kid’s table.” For so many women, they had constructed (whether conscious or unconscious) a reproductive narrative, a story of the family they would have one day and the role they would play in that family. And this story can be largely influenced by the dominant cultural narrative regarding becoming an adult – separating from your parents, establishing your own residence, taking responsibility for your life, and creating your own family. Being denied these important rites of passage and roles can be experienced as an existential crisis. Who am I? Where do I belong?Heroism. The people that I’ve had the privilege to work with during their parenting journey are nothing short of courageous as they attempt to create life against the odds. Some of those people came home with a baby, while others made the heartbreaking decision to be childless due to financial constraints and/or unwillingness to undergo fertility treatments. Some of them only have pictures of the child that never breathed air. As Dr. Ilona Laszlo Higgins expressed in her book “Creating Life Against the Odds,”The struggle of these individuals to create and nurture children goes well beyond the desire to produce a new generation in one’s own image, or to have a living repository for one’s inheritance. It is about the sense of completion that comes from the conscious commitment to be responsible for the well being of another. It is the wisdom that comes from the ashes of loss, translated into new life. (Intended) parents such as these set an example for all of us about the hard work of love. I couldn’t agree more. Society often pathologizes and judges the lengths these folks go to in order to become parents. I’ve had several clients exclaim, “I would never do that,” and then when faced with no other alternative, start down the path they said they would never go. To me, these individuals aren’t crazy, they’re heroes. They are willing to recreate their story and consider what could be versus what should have been. They grieve their losses and nurture their wounds, then carry on. On this day, it is my hope you can do the following for yourself:Practice being with grief, in whatever form it takes, unconditionally and nonjudgmentally. Be with your deeply wounded self.Acknowledge that there’s a missing piece to your life puzzle. A hole in your world.Take good care of yourself. Far from being selfish, self-care in grief is courageous.Forgive yourself. You did nothing wrong. Create a ritual to acknowledge what or who is missing. Write a letter, bury an object, say a prayer, light a candle, carry flowers, whatever honors the void. Ritual acts, whether private or public, are ways in which we give way to the feelings of love, pain, and connection. References/Recommended further readings:Cacciatore, J. (2017). Bearing the unbearable: love, loss, and the heartbreaking path of grief. Wisdom Publications, Somerville, MA. Fast Facts About Infertility. Available at: http://www.resolve.org/about/fast-facts-about-fertility.html. Resolve: The National Fertility Association. Higgins, I. L. (2006). Creating life against the odds: the journey from infertility to parenthood. Xlibris Corporation. Jaffe, J., Diamond, M., & Diamond, D. (2005). Unsung lullabies: understanding and coping with infertility. St. Martin’s Press, New York, NY. Rooney, K. & Domar, A. (2018). Dialogues Clin Neurosci. Mar; 20(1): 41–47.
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