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Reviewed by the Faculty of Harvard Medical School

The Second And Third Trimesters

By now you have weathered the adjustments of the first trimester. Most likely, your nausea has subsided. You are beginning to look a little pregnant, and you are finding it easier to eat normally and healthfully. You are finally beginning to feel good physically. Welcome to the second trimester, weeks 14 through 26, where your energy will be at its peak, your mobility will not yet be completely restricted and your spirits will soar. After sailing through these few months, you will move into the suspenseful third trimester, weeks 27 through 40, where new discomforts arrive but are quickly overshadowed by the knowledge that the birth of your baby is imminent. Let's take a closer look at the progress you and your fetus will make during the second and third trimesters.

Most first-time mothers feel their baby's movement around 20 weeks, but there is no reason for concern if you do not feel anything until as late as 24 to 26 weeks. Women who have had a baby before sometimes feel this movement earlier. At 20 weeks, the fetus has just come through a remarkable growth spurt. The fetus now weighs about 12 ounces and, at 10 inches, is about half its expected length at delivery. At this point, the fetus is completely formed and needs time only to grow and allow its internal organs to mature. The legs have grown into proportion with the rest of the body, toenails and teeth have formed and hair and eyebrows are now visible. A fine, soft hairy substance called lanugo covers much of the body. If you have an ultrasound during this period, many of these organs and structures will be recognizable.

This period will bring you a bit of relief. Your body has probably adjusted somewhat to the influx of hormones, and you may feel less fatigued. However, you may experience some backache as your pelvis tilts forward to make room for the baby. Tylenol, massage and gentle heat (a warm shower or heating pad on the lowest setting) may provide relief for any such discomfort. You are visibly pregnant now that the top of your uterus has grown to about the level of your navel. Sometime after the 20th week of pregnancy, you may also notice occasional uterine contractions, which may continue off and on throughout the pregnancy in irregular fashion. Exercise or sexual intercourse may cause these contractions to increase in frequency. Often these early contractions will disappear if you rest or lie down. If these contractions become regular or if, after resting, you experience more than four in an hour at any time in your pregnancy, contact your obstetrical care provider immediately.

At 24 weeks, the baby is not quite the pudgy newborn you are preparing to cuddle. The body is quite thin with wrinkled skin. A creamy substance called vernix covers most of the body. The fully formed baby can now suck its thumb, cough and hiccup. It measures about 13 inches in length and weighs 1-1/4 pounds.

You may notice the baby responds to loud noises and music. Sounds will not bother the baby, even loud noises, as its ears are well insulated within your uterus. Your own weight has probably increased by 15 to 18 pounds at this point. If everything is normal, monthly visits to your obstetrical care provider will continue until about the 28th to 32nd week of pregnancy. From that point, your obstetrical care provider may ask you to come in every two or three weeks and then weekly from 36 weeks until delivery. During these visits, he or she will check your blood pressure and well being, estimate the size of the uterus and evaluate the position of the baby.

At 36 weeks into your pregnancy, your doctor will test to see if you are carrying a particular type of bacteria called group B streptococci (GBS) on your skin in and around the vagina and rectum. About 20% of women carry the bacteria. GBS do not cause problems for adults but, rarely, they can cause serious infections in newborns who may acquire the bacteria when a woman's water breaks or when the baby passes through the birth canal. The test involves swabbing the outside of the vagina and rectum with a Q-tip. If you are carrying the bacteria, you should receive antibiotics when your water breaks or during labor to decrease the chance that your baby will become infected during delivery. If you are having a planned Caesarean delivery, no antibiotics are needed.

The 36-week-old baby is fast approaching full term. Between now and the end of term at 40 weeks, the baby will probably weigh between six and nine pounds and measure 18 or more inches in length. Its body has accumulated more weight, giving it a more rounded appearance. Its skin is smooth and its eyes are open (when awake) and sensitive to light. If the pregnancy were to deliver at this point, the baby would have a better than 99 percent chance of survival.

You are beginning to get the hint that your baby is preparing for birth. You feel kicks from arms and legs, and can often tell just by looking at your abdomen which limb it was that kicked you. Because of its growth, the baby is now tightly confined to a small space within the uterus. As things are cramped in size, the kicks may start to feel more like squirms or wriggles. You may feel short of breath as the uterus presses against your diaphragm.

At some point in the next four weeks, the baby will push down in your pelvis, moving closer to birth. This is often referred to as the baby's "dropping" although don't expect to feel any sudden change. It may, however, be easier for you to breathe now that the baby has moved a bit from under your ribs, but you may also feel more pelvic pressure.

Some other side effects of pregnancy that commonly occur during the second and third trimesters are listed below. Consult with your obstetrical care provider before taking any medications to relieve these symptoms or to discuss any other pregnancy-related health issues.

  • Fluid Retention: Pregnant women can count on gaining about 3 pounds of water during pregnancy. Much of this water settles into the ankles by the end of the day. Elevate your legs at night to help the swelling go down. If the swelling is not relieved by elevating your legs, or if one leg is markedly more swollen than the other, notify your doctor or midwife.
  • Skin Changes: In addition to a darkening of the vulva and nipples, a dark line from the navel to the pubic bone (known as linea nigra) often appears. Stretch marks may appear on the abdomen, breasts, thighs and buttocks, and brown marks may appear on the face as a result of pigment changes. Of these changes, only the linea nigra and pigment changes disappear after pregnancy. Unfortunately, stretch marks usually do not, although they may fade. Unfortunately, no creams or lotions have been shown to help prevent stretch marks.
  • Spider Veins And Varicose Veins: As weight increases and pressure on the blood vessels becomes greater, some women develop spider burst leg veins (spider nevus), a pattern of spider-like bluish veins seen through the skin; varicose veins of the legs and vagina; or hemorrhoids. You can use the usual over-the-counter remedies for hemorrhoids, including witch hazel (Tucks) and steroid creams (Anusol HC).
  • Constipation: Constipation is another common problem later in pregnancy, due to pressure from the growing uterus against the bowel and pregnancy hormones that actually relax the intestines. Milk of magnesia may be an effective remedy.
  • Congestion:Nasal congestion, or sinusitis, is another annoying late-pregnancy symptom some women experience. Nosebleeds can also occur in pregnancy, and like most of the other symptoms, are caused by hormonal changes. Try using saline nose drops to relieve the stuffiness.
  • Mood Changes: Mood changes continue to occur throughout pregnancy, causing occasional episodes of crying, mood swings or depression. Your genuine anxieties about the upcoming birth, your mixed feelings about motherhood and your concern about your body image can be exaggerated by these mood changes. Try to remember that these mood changes are usually temporary. Eventually, you and your emotions should get back to normal. Consult with your doctor, however, if your mood swings or feelings of depression persist or become severe.

Last updated July 2, 2009




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