2nd trimester counseling

Pregnancy - Second Trimester

14-27.6 Weeks

The second trimester of pregnancy (3 to 6 months) is a period of rapid growth for you and your baby. At the end of the sixth month, your baby is about 9 inches long and weighs 1 1/2 pounds. At this point in the fetal development the baby begins sucking and swallowing amniotic fluid. The fingerprints are developed on the tiny little fingers. The eyebrows and eyelashes grow in during the second trimester as well as the fingernails. The air sacs of the lungs begin to develop. Toward the end of the second trimester the fetus looks more like a newborn as the skin becomes more transparent and fat begins to develop.

Mom will begin to feel tiny movements of the fetus called quickening and as the baby grows the movements become bigger and more easily felt. You will begin to feel the baby move between 18 and 20 weeks of the pregnancy unless the placenta is anterior in location. This is called quickening. Weight gain is faster. A clear fluid ( colostrum) may leak out of your breasts. You may feel small contractions of the womb ( uterus). This is known as false labor or Braxton-Hicks contractions. This is like a practice for labor when the baby is ready to be born. Usually, the problems with morning sickness have usually passed by the end of your first trimester. Some women develop small dark blotches (called cholasma, mask of pregnancy) on their face that usually goes away after the baby is born. Exposure to the sun makes the blotches worse. Acne may also develop in some pregnant women and pregnant women who have acne, may find that it goes away. At the end of the second trimester the fetus has reached about 14 inches in length and weighs about 2¼ pounds.

PRENATAL EXAMS

Blood work may continue to be done during prenatal exams. These tests are done to check on your health and the probable health of your baby. Blood work is used to follow your blood levels ( hemoglobin). Anemia ( low hemoglobin) is common during pregnancy. Iron and vitamins are given to help prevent this. You will also be checked for diabetes between 24 and 28 weeks of the pregnancy. Some of the previous blood tests may be repeated.
The size of the uterus is measured during each visit. This is to make sure that the baby is continuing to grow properly according to the dates of the pregnancy.
Your blood pressure is checked every prenatal visit. This is to make sure you are not getting toxemia.
Your urine is checked to make sure you do not have an infection, diabetes or protein in the urine.
Your weight is checked often to make sure gains are happening at the suggested rate. This is to ensure that both you and your baby are growing normally.
Sometimes, an ultrasound is performed to confirm the proper growth and development of the baby. This is a test which bounces harmless sound waves off the baby so your caregiver can more accurately determine due dates.

Sometimes, a specialized test is done on the amniotic fluid surrounding the baby. This test is called an amniocentesis. The amniotic fluid is obtained by sticking a needle into the belly ( abdomen). This is done to check the chromosomes in instances where there is a concern about possible genetic problems with the baby. It is also sometimes done near the end of pregnancy if an early delivery is required. In this case, it is done to help make sure the baby's lungs are mature enough for the baby to live outside of the womb.

CHANGES OCCURING IN THE SECOND TRIMESTER OF PREGNANCY

Your body goes through many changes during pregnancy. They vary from person to person. Talk to your caregiver about changes you notice that you are concerned about.

During the second trimester, you will likely have an increase in your appetite. It is normal to have cravings for certain foods. This varies from person to person and pregnancy to pregnancy.
Your lower abdomen will begin to bulge.
You may have to urinate more often because the uterus and baby are pressing on your bladder. It is also common to get more bladder infections during pregnancy (pain with urination). You can help this by drinking lots of fluids and emptying your bladder before and after intercourse.
You may begin to get stretch marks on your hips, abdomen, and breasts. These are normal changes in the body during pregnancy. There are no exercises or medications to take that prevent this change.
You may begin to develop swollen and bulging veins ( varicose veins) in your legs. Wearing support hose, elevating your feet for 15 minutes, 3 to 4 times a day and limiting salt in your diet helps lessen the problem.
Heartburn may develop as the uterus grows and pushes up against the stomach. Antacids recommended by your caregiver helps with this problem. Also, eating smaller meals 4 to 5 times a day helps.
Constipation can be treated with a stool softener or adding bulk to your diet. Drinking lots of fluids, vegetables, fruits, and whole grains are helpful.
Exercising is also helpful. If you have been very active up until your pregnancy, most of these activities can be continued during your pregnancy. If you have been less active, it is helpful to start an exercise program such as walking.
Hemorrhoids ( varicose veins in the rectum) may develop at the end of the second trimester. Warm sitz baths and hemorrhoid cream recommended by your caregiver helps hemorrhoid problems.
Backaches may develop during this time of your pregnancy. Avoid heavy lifting, wear low heal shoes and practice good posture to help with backache problems.
Some pregnant women develop tingling and numbness of their hand and fingers because of swelling and tightening of ligaments in the wrist ( carpel tunnel syndrome). This goes away after the baby is born.
As your breasts enlarge, you may have to get a bigger bra. Get a comfortable, cotton, support bra. Do not get a nursing bra until the last month of the pregnancy if you will be nursing the baby.
You may get a dark line from your belly button to the pubic area called the linea nigra.
You may develop rosy cheeks because of increase blood flow to the face.
You may develop spider looking lines of the face, neck, arms and chest. These go away after the baby is born.

HOME CARE INSTRUCTIONS

It is extremely important to avoid all smoking, herbs, alcohol, and un-prescribed drugs during your pregnancy. These chemicals affect the formation and growth of the baby. Avoid these chemicals throughout the pregnancy to ensure the delivery of a healthy infant.
Most of your home care instructions are the same as suggested for the first trimester of your pregnancy. Keep your caregiver's appointments. Follow your caregiver's instructions regarding medication use, exercise and diet.
During pregnancy, you are providing food for you and your baby. Continue to eat regular, well-balanced meals. Choose foods such as meat, fish, milk and other low fat dairy products, vegetables, fruits, and whole-grain breads and cereals. Your caregiver will tell you of the ideal weight gain.
A physical sexual relationship may be continued up until near the end of pregnancy if there are no other problems. Problems could include early ( premature) leaking of amniotic fluid from the membranes, vaginal bleeding, abdominal pain, or other medical or pregnancy problems.
Exercise regularly if there are no restrictions. Check with your caregiver if you are unsure of the safety of some of your exercises. The greatest weight gain will occur in the last 2 trimesters of pregnancy. Exercise will help you:
Control your weight.
Get you in shape for labor and delivery.
Lose weight after you have the baby.
Wear a good support or jogging bra for breast tenderness during pregnancy. This may help if worn during sleep. Pads or tissues may be used in the bra if you are leaking colostrum.
Do not use hot tubs, steam rooms or saunas throughout the pregnancy.
Wear your seat belt at all times when driving. This protects you and your baby if you are in an accident.
Avoid raw meat, uncooked cheese, cat litter boxes and soil used by cats. These carry germs that can cause birth defects in the baby.
The second trimester is also a good time to visit your dentist for your dental health if this has not been done yet. Getting your teeth cleaned is OK. Use a soft toothbrush. Brush gently during pregnancy.
It is easier to loose urine during pregnancy. Tightening up and strengthening the pelvic muscles will help with this problem. Practice stopping your urination while you are going to the bathroom. These are the same muscles you need to strengthen. It is also the muscles you would use as if you were trying to stop from passing gas. You can practice tightening these muscles up 10 times a set and repeating this about 3 times per day. Once you know what muscles to tighten up, do not perform these exercises during urination. It is more likely to contribute to an infection by backing up the urine.
Ask for help if you have financial, counseling or nutritional needs during pregnancy. Your caregiver will be able to offer counseling for these needs as well as refer you for other special needs.
Your skin may become oily. If so, wash your face with mild soap, use non-greasy moisturizer and oil or cream based makeup.

MEDICATIONS AND DRUG USE IN PREGNANCY

Take prenatal vitamins as directed. The vitamin should contain 1 milligram of folic acid. Keep all vitamins out of reach of children. Only a couple vitamins or tablets containing iron may be fatal to a baby or young child when ingested.
Avoid use of all medications, including herbs, over-the-counter medications, not prescribed or suggested by your caregiver. Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver. Do not use aspirin.
Let your caregiver also know about herbs you may be using.
Alcohol is related to a number of birth defects. This includes fetal alcohol syndrome. All alcohol, in any form, should be avoided completely. Smoking will cause low birth rate and premature babies.
Street/illegal drugs are very harmful to the baby. They are absolutely forbidden. A baby born to an addicted mother will be addicted at birth. The baby will go through the same withdrawal an adult does.

SEEK MEDICAL CARE IF:

You have any concerns or worries during your pregnancy. It is better to call with your questions if you feel they cannot wait, rather than worry about them.

SEEK IMMEDIATE MEDICAL CARE IF:

An unexplained oral temperature above 100° F (37.9° C) develops, or as your caregiver suggests.
You have leaking of fluid from the vagina ( birth canal). If leaking membranes are suspected, take your temperature and tell your caregiver of this when you call.
There is vaginal spotting, bleeding, or passing clots. Tell your caregiver of the amount and how many pads are used. Light spotting in pregnancy is common, especially following intercourse.
You develop a bad smelling vaginal discharge with a change in the color from clear to white.
You continue to feel sick to your stomach ( nauseated) and have no relief from remedies suggested. You vomit blood or coffee ground like materials.
You loose more than 2 pounds of weight or gain more than 2 pounds of weight over a weeks time, or as suggested by your caregiver.
You notice swelling of your face, hands, and feet or legs.
You get exposed to German measles and have never had them.
You are exposed to fifth disease or chicken pox.
You develop belly ( abdominal) pain. Round ligament discomfort is a common non-cancerous ( benign) cause of abdominal pain in pregnancy. Your caregiver still must evaluate you.
You develop a bad headache that does not go away.
You develop fever, diarrhea, pain with urination or shortness of breath.
You develop visual problems, blurry or double vision.
You fall, are in a car accident or any kind of trauma.
There is mental or physical violence at home.

Document Released: 04/07/2004 Document Re-Released: 03/14/2011

2nd trimester Prenatal care