Kate Pearson appeared to spend most of "Still There" focused on her weight to an obsessive degree, which is a plot point so common on This Is Us that it has become exhausting to watch. She worked out nonstop, looked like she was seeking out weight loss pills, and focused on her Fitbit at the most inappropriate of moments. However, the end of the episode subverted expectations by revealing that Kate was pregnant on This Is Us. Her health concerns were coming from a different place than usual.
While getting a check up and a sonogram in the final moments of "Still There," Kate made it clear that she wanted to do everything right during her pregnancy, especially because her age and weight were concerns for her. That was why she was working out more; it wasn't because she was trying to fit into a dress for an upcoming gig, like Toby thought. And when she went to the drug store, it wasn't for diet pills, it was for prenatal vitamins.
Kate is taking her pregnancy seriously, so it seems to be something she is happy about and fully embracing. But even though the unexpected pregnancy is a good surprise, it's still going to change things for Kate in a major way.
Pregnancy can pose some risks, which was why Kate was so concerned about following her doctor's instructions. She seems to be worried about the possibility of a miscarriage (asking if her fetus was, per the episode's title, "still there"), but at the moment everything is going well. Kate is six weeks along and her pregnancy appears to be progressing smoothly. But despite that, it was obvious that Kate was anxious. That could be why she has told Toby right away.
It doesn't seem like Toby and Kate have discussed having children in a serious way yet (at least not onscreen), but Toby has been dedicated to and supportive of Kate to the point of pushiness. There's no reason to assume he won't be happy about having a child with her. However, if Kate fears a miscarriage, then she might be holding off on sharing the news until she knows for sure the risks have decreased. That's a lot of pressure to put on herself, but it is an understandable impulse.
Kate also has her career to think about as well. She just launched herself down a new path, abandoning her former assistant duties (did she ever give Jami Gertz her two weeks notice?) to chase after her dreams of being a singer. She's been making steady, if slow, progress throughout Season 2, first landing a gig filling in with a band at a bar and then snagging a performance at a bar mitzvah. Having a child could complicate things like it did for Kate's own mother. Rebecca deferred on her music dreams so she could raise her family, and Kate may find herself setting aside her goals too.
There's nothing wrong with Kate choosing to be a mom over choosing to be a singer if that's what she wants. There's also no reason why she can't do both with some creative scheduling and help from Toby; unlike her mother, she won't have three young kids to corral every day. But these questions may come up over the course of Kate's pregnancy as she figures out how to fit everything into her life.
There are a lot of unknowns this early in Kate's pregnancy, but one thing is definite: she seems thrilled about having a child. Kate talked about wanting a family early in Season 1, and now everything is working out for her. She has a partner she loves and a child she wants on the way. Whatever difficulties arise, Kate should be able to handle them.
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