Episode 15: Surviving the First Trimester: Balancing Private Practice & Pregnancy
Finding Balance, Embracing Change, and Preparing for Maternity Leave
Hello, Raised to Empower listeners! As many of you know, I recently pulled back the curtains on my personal life and made an exciting announcement—I’m expecting my third child! This pregnancy marks the third time I’ve been pregnant while running a private practice and preparing for maternity leave. Today, I want to dive deeper into my experiences navigating the challenges of the first trimester while managing a private practice. It's important to acknowledge that every pregnancy is unique, and what works for me might differ from your experience. However, I hope sharing my journey will provide some insight and support for those of you in similar situations.
Exhaustion and Nausea: The First Trimester Battle
Let's face it— the first trimester can be brutal. For me, it usually means complete exhaustion, constant nausea, and migraines. I often felt like I was hit by a train every time I entered week six. The morning sickness lasted all day and escalated during meal times. Coupled with hormonal migraines that made me want to hide from any source of light, this trimester felt almost unbearable.
One piece of advice I can offer is to lower your expectations for yourself during these first three months. This may sound simplistic, but it's essential for survival. Accept that you might not function at your best and that's totally okay. Prioritizing rest and self-care is crucial. For me, it was vital to allow myself to sleep whenever possible. I even found myself sleeping on the couch between client sessions. Remember that feeling terrible and needing more rest than usual is a normal part of this phase.
Communicating with Clients
As therapists, we often place our clients' needs above our own. However, during the first trimester, it’s important to listen to our bodies and respect our limits. Communicating about cancellations became a necessity for me. I found it helpful to send a straightforward email with just enough detail to explain why a session had to be canceled, like, "I'm suddenly not feeling well and need to cancel our session today." Each time, my clients were understanding and supportive.
Deciding when to disclose your pregnancy to clients is a personal choice. In my case, I had varied timelines in each pregnancy. I encouraged you to share this news when it feels right for you, not out of obligation or pressure. The well-being of both you and your unborn child is the priority.
Planning for Maternity Leave
Maternity leave in private practice can be daunting, especially when trying to manage client care during your absence. I’ve decided to host a free workshop in July to aid fellow therapists in this journey. Details will be shared on RaiseToEmpower.com/maternityleave, but here are a few quick tips:
Create a Plan Early: Think about how long you want your maternity leave to be and start planning. This gives you and your clients ample time to prepare.
Client Transition Strategies: Establish a referral network or find a colleague who can take over your clients temporarily. This ensures continuity of care.
Financial Preparations: Plan financially for the time you will be away from your practice. This might mean saving up or understanding what financial assistance programs are available to you during this period.
Honoring Your Needs
The most crucial aspect of navigating pregnancy and practice is honoring your needs. Be kind to yourself, reduce your workload if necessary, and don’t hesitate to put yourself first. Skipping sessions, cutting back your schedule, or even considering a mini-sabbatical are all valid choices if that’s what your body requires.
This willingness to prioritize your health and well-being is not just beneficial for you, but it’s also a lesson in self-care for your clients. Frankly, it's about embodying the very principles we often recommend to those we counsel.
Looking Ahead
As I progress into my second trimester, I plan to share more updates and experiences about managing private practice at this stage of pregnancy. Each trimester comes with its own set of challenges, and I’m eager to provide insight into navigating these phases. Let’s take this journey together, supporting one another through the highs and lows.
Thank you for joining me today. If this post resonates with you, I would love to hear your thoughts. Feel free to leave a comment, send me a message on Facebook or Instagram, and share how you have navigated your own experiences. Remember, we are all in this together, empowering and lifting each other up.
Until next time, take care and stay empowered.
Warmly, Ashley Comegys
Transcript for Episode 15
[00:00:00] Ashley Comegys: Hey, Raised , To Empower listeners. As a warning, this episode discusses pregnancy and challenges of the first trimester. Please take care while listening. You are listening to the Raised to Empower podcast. I'm your host, Ashley Comegys, a licensed clinical social worker with a multi-state online therapy practice.
[00:00:21] I have a passion for empowering women and mom therapists to break free of the. Fear, overwhelm and oppressive systems that hold them back from taking action and building the private practice of their dreams. My goal is for you to boldly believe in yourself as a clinician and business owner. If you are looking for a place to learn, practice, building strategy and skill, while also claiming your own power as a woman and a therapist, then you are in the right place.
[00:00:48] Welcome to the show. Hey listeners, welcome to this week's episode of the Raise to Empower Podcast. So this week I'm gonna be getting. [00:01:00] A bit personal and pulling the curtain back on what's been going on in my personal life and in private practice recently. So to help bring context to this episode, um, I'm excited to announce that I'm pregnant.
[00:01:16] Um, this is my third pregnancy, and this will be the third time that I've been in private practice during pregnancy, and will be my third maternity leave in private practice. Now maternity leave in private practice is something that I have seen a lot of therapists ask about and have questions about, you know, how does this work?
[00:01:37] Can I actually do that? What do I plan for? How do I tell clients lots of questions. I'm actually gonna be doing a free workshop in July about preparing for maternity leave and private practice. More details will come, but you can join the wait list. For that training by just going to raise to [00:02:00] empower.com/maternity leave and we'll have the link to that in the show notes in preparation for that free workshop.
[00:02:09] Um, I'm gonna actually be doing a special series in June where I'm gonna be. Speaking with women who have had different experiences in their journeys to motherhood and how they've navigated maternity leave in private practices with their own experiences. So if that's something that's kind of on your radar, stay tuned for that.
[00:02:27] Um, and for those episodes to come today, I wanted to kind of share about my own personal experience about how I've been navigating the challenges of first trimester while still being in practice. And I think one of the things that's important to remember is that each person's experience through pregnancy is different from somebody else's.
[00:02:49] So while this may be how I have felt during my pregnancy or what my experience has been, yours may be different. So just know that, that if you're listening and you're like, this is [00:03:00] not what it's felt like for me, or maybe I should do that, or I shouldn't do this, that's not what this episode is about. One of the questions that I have seen a lot from women who are in private practice is how do you deal with the first trimester and practice?
[00:03:17] Because it can be rough for a lot of women. So again, I just wanna kind of share my experience and how I have navigated this not only in this pregnancy. But in my other two as well, because each of them I have felt a little bit different in them and has kind of contributed to how I have handled communicating with clients about my needs and even in disclosing my pregnancy.
[00:03:44] For me, typically the first trimester will be a series of the following. It's just like utter complete exhaustion where I have zero energy, I just wanna sleep all the [00:04:00] time. And then I also just have this constant feel of nausea that just does not go away. I don't really throw up in my pregnancies. This one.
[00:04:10] I have like gagged to the point that I have vomited a few times, but it's not like I know a lot of other women who have suffered where they're just like living by the toilet bowl. I find I gag and I dry heave a lot, especially like if I'm brushing my teeth. That just makes it even more awful when you just feel sick all the time.
[00:04:33] One of the things I tell people is, When I've been in the first trimester, like I just wanna go to sleep all the time. Not only because I'm exhausted, because when I'm asleep is literally the only time that I don't feel bad, and it made it hard getting out of the bed in the morning to get my kids ready for school and daycare because I would just lay in bed for.
[00:04:54] As long as I possibly could so I didn't have to get out cuz I knew as soon as I got out I would start [00:05:00] gagging and just not feel good. One of the other things that I oftentimes will get in the first trimester, and actually it lasts for me throughout my pregnancy, is I get migraines. My migraines are hormonal and I have had them.
[00:05:16] Since I was an adolescent, I think when I first got my period and when I get my migraines, I will get an aura with them. So like I can't see very well and it's usually like a warning for me of, hey, it's coming. And so if I start to get this aura, I know, okay, the pain is coming and it's. Not really any kind of rhyme or reason when it's gonna happen, but it'll just kind of come on and then I feel awful for the rest of the day.
[00:05:46] And because I'm pregnant, I can't really take much for them except for some Tylenol. There's another medication the doctor has prescribed that doesn't really treat the migraine, but it's just one of these [00:06:00] things you just kind of have to suffer through, or at least I have had to suffer through with pregnancy.
[00:06:06] And then one of the other things for me that happened definitely in the first trimester is this desire to retreat inward. It's the only way that I really know how to describe it, and this has actually happened in all of my pregnancies. I just find like, I don't really wanna talk to anybody. I don't wanna talk about my pregnancy.
[00:06:29] I wanna just kind of be alone. I don't know if it's because like I'm feeling more vulnerable cuz my body's just starting to do weird things. But it's this retreat, this pool away from anybody and everyone. And like I said, this happened in my first pregnancy even more so than I think it has in. Other pregnancies probably because it was my first.
[00:06:55] It's something that definitely impacts me in my business and in my personal life. [00:07:00] And again, like I said before, like the first trimester for me, I can barely do anything besides sleep and lay on the couch. If I was not seeing a client, I was on the couch. And interestingly for me, this pregnancy, it was like, I walked from week five into week six and was just hit by the train of morning sickness, and for me, it lasts pretty much all day.
[00:07:33] It's not like a morning thing. It'll be really bad in the morning. We'll get a little bit better at lunchtime and then hits me pretty, pretty hard around dinnertime too. It was literally like I was fine one day and the next. I wasn't. I was actually really surprised that I was feeling as awful as I was as early as I was this pregnancy because I.
[00:07:56] I feel like with my last pregnancy, I remember it being [00:08:00] maybe closer to like seven or eight weeks, and in my first pregnancy, I think about the same. So I was really surprised that even in week five I was not feeling great. And week six was just like, like I said, a truck hit me. From weeks six to eight was probably the roughest for me, and I had multiple days during that time that I had to cancel my whole day of clients.
[00:08:25] There's some days that. I would cancel all of my appointments that I had scheduled before lunch. So if I woke up in the morning, I would be getting my kids ready for school, and I could usually tell like, okay, is this gonna be a day or at least a morning that I'm feeling okay? And I can navigate by drinking the things that usually help calm my stomach or eating the things that help calm it.
[00:08:48] And if it got to a certain time and it was not subsiding, I usually knew, okay, no, this is just kind of going down here. And I would usually kind of see how I was feeling. [00:09:00] By lunchtime and, and if I was feeling like I could have a session or two, then I would continue on keeping my afternoon schedule as it was originally planned with my clients.
[00:09:12] But if I hit that afternoon after lunch and I was. Not feeling well, then I would have to cancel afternoon sessions too. There were some days where I was fined for the morning and then lunchtime just went downhill and I mean, there was even a couple sessions I remember right before the session was supposed to start and I just, I couldn't even keep my eyes open.
[00:09:33] I was so exhausted. And I had to just cancel that appointment. It's not like I'm able to really do it days in advance cause I don't really know how I'm feeling. It really, for me has been a moment by moment thing. And I know one of the things that a lot of times people ask is like, how do you talk to clients about this?
[00:09:51] What do you tell them if you need to cancel? And at this point, I hadn't disclosed my pregnancy to my clients. So what I usually would do is [00:10:00] send an email with a subject line of need to cancel for today, and then just a brief message, usually saying something like, I'm so sorry that I have to do this last minute, but I'm suddenly not feeling well.
[00:10:10] And I need to cancel your session for today. I'll follow up with you if I have any openings later in the week. Thank you so much for your flexibility and understanding. I have never, in the three times that I've been pregnant in private practice, ever had a client say something to me like, I can't believe you canceled last minute.
[00:10:27] Or, how could you do this to me, or, I'm upset at you for doing this. Every time. It's usually, I hope you feel better. I'll see you next week. Um, I've never had a client be upset with me about having to cancel and I haven't disclosed to them in those emails, Hey, this is cuz I'm pregnant. And sometimes this message was sent a couple hours before someone was scheduled for their session.
[00:10:48] Sometimes it was sent literally like five to 10 minutes before the session, depending on how the wave of sickness or exhaustion hit me. So for me, the first [00:11:00] 14 weeks of this pregnancy, this particular one has been really rough. It. This is probably the sickest I've been in any of my pregnancies during this first trimester.
[00:11:10] If I wasn't in session or picking up kids from school or having to do the most basic things to just keep my kids alive. I was curled up on the couch in the fetal position, just trying to sleep and not vomit when it came to work, and my practice, anything that was not client facing. Totally got put on the back burner.
[00:11:30] I can't even tell you how behind I am on notes. I am playing catch up and I would like to be able to tell you the next time I update you on pregnancy that they're all done. It's been really, really rough for me. Again, I think part of it is that kind of going inward and not even being able to process. Or examine or do anything really outside of just trying to keep myself from growing up.
[00:11:59] Finally, [00:12:00] in the last few weeks, you know, I've actually been able to respond to emails and to some referrals, but it's been really rough. It's been hard, and I just have not had the mental or emotional space or physical space from really anybody outside of my immediate household. And even with that, it's been hard cuz I.
[00:12:18] Have had to create some space between me and my two little kids. Not because I don't want to be around, but because I literally just have either no energy or I feel like I'm gonna be so sick. So it's been hard, you know, it's been rough in our household for this first trimester. We've all been told we need to network in our private practice, but no one actually tells us how to do it or what to say.
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[00:13:26] What I definitely learned after my first pregnancy was, you know, I have to just lower my expectation for myself and just do the bare minimum until I'm able to get out of the first trimester. For me, the first trimester is just survival mode. I think that this is my third pregnancy. I did kind of know a little bit more what to expect.
[00:13:49] And I knew how to prepare myself for that, and I'm so grateful that for me, morning sickness does not last beyond the first trimester. I know for a [00:14:00] lot of women, and maybe for many of you listening, that's not the case and it lasts a lot longer than that, and I am so sorry if that is your experience cuz it's rough, not feeling good.
[00:14:12] Again, for myself, just being able to give myself permission in that first trimester of I just have to do the bare minimum. I just have to get through, fill in the blank, and that is a big part of what has helped me to cope during such a rough time in pregnancy, while also being a business owner and a mom and a wife.
[00:14:36] And so one of the common things that I see a lot of therapists question when they are pregnant and experiencing morning sickness and pregnancy is kind of, how do I talk to clients about this? Or what do I do if I throw up in a session? Or how are you able to still have sessions while feeling so sick?
[00:14:53] And I think one of the things that we really have to remember, regardless of pregnancy or not, we are not good at [00:15:00] putting our needs as a priority before. Clients. A lot of times we put that client's need before ours in pregnancy and especially in that first trimester when you're not feeling good, it's really important.
[00:15:15] Make sure that you have the mental, physical, and emotional space. To hold space for your client. If I feel like I am just trying to hold everything in and just keep it together from throwing up all over the place, or if I can't actually see my clients on screen because I'm having an aura at the onset of a migraine, I'm not actually able to be fully present for my client and to listen to what they're sharing and be able to hold space for them.
[00:15:46] I'm totally focused on just keeping myself together well, and maybe not totally focused, right? Like maybe I can split my time or split my mind in some ways, right? Of like, okay, just keep it together. But [00:16:00] I also, I've gotta listen to what my client's saying. I. But if I'm really honest with myself, those days when I am not feeling well, I'm not being the best therapist that I can for those clients, I feel like I'm doing them a disservice by trying to hold a session for them when I'm not able to actually be the person that they probably need me to be in that moment.
[00:16:23] It's not actually modeling good self-care either, and it's just something that we, you really need to consider of. Am I actually going to be able to be the best therapist that I can right now if I am not feeling well? No, I'm not saying that you have to feel a hundred percent perfect. That's kind of impossible at most times, even if you're not pregnant.
[00:16:46] But I wanna encourage you to listen to your body and trust where you feel like your body is just telling you not today, right? Today is not the day that we're gonna be able to do anything outside of laying down and maybe [00:17:00] having a trash can nearby. If you are not feeling well, it is okay to put your needs first.
[00:17:06] Cancel the appointment if you need to cut your schedule back, if that's what your body is telling you to do for now, it doesn't mean that it has to be like that. It could get better in the second trimester for you, but you need to just honor where your body is right here and right now, and that it is okay to put that before the needs of holding a session for clients.
[00:17:34] One of the other common discussions that I often see come up with therapists during pregnancy is when do I tell my clients, especially if I'm feeling so sick, do I tell them now? Because how else do I explain the vomiting in session or having to end a session early because I am sick and I'm gonna be honest, there's not a right or wrong answer to this.
[00:17:54] This is really gonna have to be a personal decision, one that you have to decide when does [00:18:00] it feel right. To tell them, do I feel like I need to tell them simply because I'm getting sick, even though I don't really feel like I'm ready to tell them? Or do I actually feel ready to tell them and I wanna tell them because it's when I want to, not because when I feel like I'm supposed to tell them.
[00:18:18] I'm just gonna kind of share a little bit of how I've handled those conversations with clients in each of my pregnancies. In my first pregnancy, like I shared earlier, I experienced this kind of deep desire to just turn inward from everyone in my life. I didn't really wanna share with anyone about my pregnancy.
[00:18:39] And I think because honestly I was just trying to understand and reconciling what was happening to my own body. I didn't really wanna hear what others had to say. Cuz that's one of the other things with pregnancy, like, I don't know why people just feel like they can tell you, oh, well this is what you're supposed to do or what you're not supposed to do, or This is what it was for me and this is how you do it.
[00:18:59] It's kind of [00:19:00] said in a factual way versus like, actually little. How are you feeling? Do you need something? So for me, it was just this like deep, deep, deep inward turn of, I didn't really want to open up about my pregnancy with really anyone. Honestly, I don't remember morning sickness being as bad for me in my first pregnancy.
[00:19:20] I don't have a lot of memories of having to cancel many appointments. I know I would oftentimes have snacks nearby, and if I could just keep food in my body, I was able to keep it together. So for me, the morning sickness was not nearly as intense. It would just be like I was having a version to foods.
[00:19:38] Nothing really sounded appetizing unless it was a greasy cheeseburger and french fries. And I was trying to remember as I was preparing for this episode when I told clients with that first pregnancy, and I feel like it was maybe around like 14 to 16 weeks, and honestly, I think a big reason why I told them [00:20:00] then wasn't necessarily because.
[00:20:02] It was like, oh, I, I'm ready to share this, but I just, I couldn't really hide it anymore. At that time, I was only doing in-person sessions, so it was pretty obvious to clients that things were changing. I think it was probably about that time that I was sharing with clients, and I don't think I fully knew at that point what my plans were for maternity leave, but I was just kind of sharing like, Hey, this is happening and this is when I'm due.
[00:20:28] For my second pregnancy, I don't really feel like I, again, I'm trying to recall all of this, but I don't think I had the deep inward pool in quite the same intensity. That I have had in other pregnancies. Um, I didn't quite feel a need to pull away from everyone and keep my pregnancy from everyone, partly because my second pregnancy, when I found out I was pregnant, I, it was actually one month before Covid shut down our state.
[00:20:58] So it wasn't [00:21:00] like I was around a lot of people to begin with. I was already so isolated from everyone. And I was already completely online with my practice prior to Covid, so at that point I was able to keep the pregnancy from clients visually a bit easier than if I was in person. Even though I was able to hide it more and I didn't quite feel the need to just kind of keep it from everyone, I was a lot sicker that pregnancy than I was with my first, and I know I had sessions that I had to cancel because I felt nauseous, but I also had a lot of migraines that pregnancy more than I had in my first and more than I've had with this one so far.
[00:21:41] But if I remember accurately, it was usually just like one to two sessions I was having to cancel during that second pregnancy. It was not nearly the chunks and days that I've had to do with this one. And I don't think that I shared with clients that I was pregnant until I was [00:22:00] actually close to 20 weeks.
[00:22:01] And, and as I've thought back, I don't think that there was any kind of particular reason why I waited. I think it may have just been, I was just more comfortable with where the pregnancy was and, and honestly like where the world was cuz so much was crazy at that time. And no one could tell that I was pregnant because we were online.
[00:22:17] So I just waited until then for whatever reason. That's what felt good for me at that time, and now for this pregnancy. Like I mentioned before, at six weeks, I was just hit by a truck of morning sickness and it just did not stop. At the time that I'm recording this episode, I'm 16 weeks and I still have not shared with my clients yet.
[00:22:39] W when this episode comes out, I will have. Already had a conversation with my clients and I plan to tell them, so I'll be about 17 weeks because I have felt so sick. I've had to adjust my schedule a lot during this pregnancy, and I had actually gone back and forth about disclosing to clients a lot earlier in this pregnancy than I have in others because [00:23:00] my schedules had to be adjusted so much.
[00:23:03] But several factors have held me back from disclosing until now. I honestly had thought about sharing with clients just in the last week or two, but I just hadn't mentally prepared myself for that conversation. So that's honestly the only reason why I have not in the last two weeks, but there were several factors that kept me from making a choice to share with clients until this coming week.
[00:23:29] I'm 37 years old this pregnancy. If you are familiar with what. They call a geriatric pregnancy or advanced maternal age. If you are 35 and over when you're pregnant, you get that title advanced maternal Age. And it's partly just that there's some chances of complications or risks due to age because of some scheduling stuff and, and a variety of things.
[00:23:53] I actually wasn't able to have a doctor's appointment to confirm that I was pregnant until I was, I think, [00:24:00] like 11 or 12 weeks this pregnancy. Like it was pretty, pretty far along. And because I'm older in this pregnancy, there are certain risks and I just wanted to have some kind of confirmation about the viability of this pregnancy before disclosing to my clients.
[00:24:18] I wanted to have time to process what this pregnancy could look like if there were some complications before having that conversation. In full disclosure, the reality of Roe v. Wade being overturned and living in a state with legislation that's attempting to become law that would limit the options a woman has to care for herself and make choices that impact herself and her unborn baby really has played into the decision to hold off telling clients, not that I was having any thoughts of terminating my pregnancy.
[00:24:49] But for me, I just wanted to have some kind of confirmation from the doctor that everything was healthy. I didn't even really feel comfortable telling my friends and family that [00:25:00] I was pregnant because I just wanted to have time to process for myself and my husband. If Tess came back saying that this pregnancy wasn't viable and how I was gonna handle that.
[00:25:12] And so what I think is so important is that the decision of when to disclose to clients that you're expecting a baby, that it is your own decision. It's not a bad thing to get some advice from others who have done that before, but there's not any kind of hard and fast rule of when and how you have to do that.
[00:25:33] If you wanna share right away, as soon as you take a test, there's nothing wrong with that. If you also wanna wait until a few months before you deliver, that is your choice too. Just know that there is not a right or wrong way to do this, but there are some things to help you in thinking about that decision.
[00:25:53] In the preparing for maternity leave and private practice workshop, we will look at different things to consider when disclosing to different [00:26:00] types of clients, even some scripts to use to help you feel comfortable, as well as to help you decide when you want to share and helping your clients to process the news and have time to help figure out their needs while you're on leave.
[00:26:14] So if you wanna learn more and join us for this free workshop, you can go to raise to empower.com/maternity leave. In this episode, I was sharing what it's been like to navigate private practice in the first trimester and how it's impacted me and impacted my business. I do plan to do an episode about the second trimester and then also the third as I get into those and just kind of share the challenges of managing my private practice during those times in pregnancy because they each are different in in different ways, and they each have their own challenges and highs and lows, so, Be looking for those as we approach October when this baby is due.
[00:26:57] Thank you so much for joining me here today. I hope this was [00:27:00] helpful. If you are in the process of navigating that first trimester, if you are trying to conceive and wondering how this will work and what this would look like, I'd love to hear from you. How have you navigated this time in pregnancy and working in private practice?
[00:27:17] You can leave a comment on the episode. You can send me a message through Facebook or Instagram, but I'd love to hear how this has been for you in your journey. I hope you'll be here again next week for a new episode. Thank you so much for listening to the Raise to Empower podcast. Check the show notes for all links and resources mentioned in the show.
[00:27:40] If you found today's episode helpful or inspiring, be sure to share it with your therapist friends, and don't forget to subscribe to the show and leave your five star rating and review. It truly means so much to me and will help us get our message of empowerment out to other women and mom clinicians, and I'd love to connect with you in our Facebook community.
[00:27:59] So check [00:28:00] out the show notes for the link or head to Bitly slash raise to empower to join us. I'll see you back here next week.