Pregnancy: What to Expect

Introduction

There are several ways of counting the weeks in pregnancy.  A common method is by gestational age.  With the gestational age method, the first day of a woman’s last menstrual period begins the first day of the first week of pregnancy, even though conception has not taken place yet.  This method of counting allows for differences in ovulation times.  So, during approximately the first 2 weeks of gestation, a woman ovulates and conception takes place.

Please keep in mind that pregnancy symptoms differ from woman to woman and from pregnancy to pregnancy.  The following is a general guideline of possible symptoms and examinations.  What you actually experience may vary and you should discuss any concerns with your doctor.

Week 4

A missed period is one of the first telltale signs of pregnancy.  You may experience spotting when the fertilized egg implants in the uterus.  Some women may experience light bleeding at the time that their period should have occurred.  You may not feel differently at all, or your may experience symptoms that are very similar to those you feel just before your period starts.

Your breasts may begin to feel swollen and tender.  You may start to feel morning sickness, nausea with or without vomiting or an increase in saliva.  Morning sickness may occur at any time day.  You may need to urinate quite frequently as your uterus grows and presses on your bladder.  Your appetite may increase, and you may feel hungry more often than you did before pregnancy.  You may crave certain foods and be repelled by others.  You may have headaches and feel bloated.  Varicose veins may begin to bother you.  You may feel tired or sleepy.

Examinations and Tests
Over-the-counter home pregnancy tests may detect a pregnancy as early as the first day of a missed period.  You may also receive a pregnancy test at your doctor’s office or a clinic.  You should contact your doctor if you suspect you are pregnant or have a positive home pregnancy test.  Your doctor will check your blood pressure, weight, and urine during a prenatal exam.  Your doctor may screen for vaginal infections.  Your doctor will discuss healthy pregnancy eating and exercise, plus prescribe prenatal vitamins if you are not already on them.

Week 8

You may still feel the symptoms that you did during the last four weeks.  At eight weeks, your uterus is about the size of an orange and your waistline may expand a bit.  Your hormones may cause you to break out in pimples.  You may feel emotional, similar to what you may feel with premenstrual syndrome.  Headaches, heartburn, indigestion, constipation, and gas may bother you. As your breasts grow larger, it may help to find a good support bra.

Examinations and Tests
Your doctor will check your weight and blood pressure.  Your urine may be checked for sugar and protein.  Your doctor may perform an ultrasound to measure the size of the embryo and check for a heartbeat.

Week 12

Your growing uterus will shift upward and off of your bladder, so frequent urination should not bother you as much as it did before.  Morning sickness may resolve, and you may begin to feel more energetic.  It is common to experience headaches and light-headedness because of your increased blood volume.  Week 13 starts the second trimester of pregnancy.  Your nipples may be getting larger and darker in color.  As your uterus begins to press on your bowel, you may be bothered by constipation.  Make sure you are drinking plenty of water and eating foods that are high in fiber.  Some women may begin to “show” during this stage of pregnancy.

Examinations and Tests
Your doctor will continue to check your blood pressure, weight, and urine for protein or sugar.  Your doctor will evaluate the size of your uterus and the fetal heartbeat.

Week 16

Your blood volume may increase by 40% to 50%.  Because of this, you may experience a stuffy nose or nosebleeds.  Your baby is growing rapidly, and you may gain about 5 to 10 pounds during this period.  You may feel dizzy, lightheaded, or faint.  This may happen more often when you move from a sitting to a standing position.  Your gums may bleed slightly when you brush them.  Your skin may develop itchy dry spots or rashes.  It may help to use lotion, drink plenty of water, and eat a healthy diet.

Examinations and Tests
Your doctor will continue to check your blood pressure, weight, and urine for protein or sugar.  Your doctor will evaluate the size of your uterus and the fetal heartbeat.  An amniocentesis may be performed between the 16th and 18th weeks of pregnancy for certain individuals.

Week 20

At 20 weeks, your pregnancy is halfway complete!  Your expanding uterus may cause your belly button to change from an “innie” to an “outie.”  A line may develop between your navel and pubic hair.  This line is called linea nigra, and it will fade after delivery.  You may gain more weight as your baby develops.  It is normal for your hands and feet to swell, but make sure that you are drinking plenty of water.  You may feel your baby move.

Examinations and Tests
Your doctor will continue to check your blood pressure, weight, and urine for protein or sugar.  Your doctor will evaluate the size of your uterus and the fetal heartbeat.  An ultrasound may be used at about 20 weeks to help verify fetal age and growth.  It may be possible to determine your baby’s sex at this time.  Your doctor will check your hands and feet for swelling.  Your doctor may test you for Hepatitis B as a routine precaution.

Week 24

At the end of this period, your uterus is about the size of a soccer ball.  You may feel pressure on your back and pelvis and have shooting pains in your lower back and legs.  It may be helpful to rest and change your body position.  Your uterus may feel like it suddenly contracts and relaxes.  These are called Braxton Hicks contractions, and they help prepare your uterus for labor.  You may experience shortness of breath as your uterus is close to your rib cage and your lungs are not able to expand fully.  However, your circulatory system is more efficient now, and both you and your baby are receiving the proper amount of oxygen.

Examinations and Tests
Your doctor will continue to check your blood pressure, weight, and urine for protein or sugar.  Your doctor will evaluate the size of your uterus and the fetal heartbeat.  Your doctor will check the height of your uterus. Your doctor may order a glucose tolerance test between weeks 24 and 28.  This is a test to identify gestational diabetes, a type of diabetes that develops in some women during pregnancy.  Your doctor may recommend a childbirth class for you and your partner to attend.

Week 28

Week 28 starts the third trimester of pregnancy.  As your baby grows, you may experience hemorrhoids, swelling, heartburn, indigestion, itching skin, backache, and leg cramps.  It can be helpful to lie on your left side to decrease blood pressure and improve circulation. 

Examinations and Tests
Your doctor will continue to check your blood pressure, weight and urine for protein or sugar.  Your doctor will evaluate the size of your uterus and the fetal heartbeat.  Your doctor will check the height of the uterus and the position of the baby.  Your doctor may have you complete a birthing plan, which states your ideals and preferences for childbirth.

Week 32

You may continue to experience heartburn, indigestion, constipation, and shortness of breath.  You may feel faint or dizzy at times.  It can be helpful to drink plenty of water and food that is high in fiber.  You may experience stress incontinence, the leakage of urine when you laugh, cough, or sneeze.  The Braxton Hicks contractions may become stronger. 

Examinations and Tests
Your doctor will continue to check your blood pressure, weight, and urine for protein or sugar.  Your doctor will evaluate the size of your uterus, height of the uterus, and the fetal heartbeat.  Your doctor may monitor your condition every two weeks during this period.  At about week 35, your doctor may check your cervix for effacement and dilation.  Your cervix becomes thinner and the cervix opening dilates as you get closer to giving birth.  Your doctor may use ultrasound to see what position your baby is in.  Your doctor may determine if you will need a cesarean section.

Week 36

As your baby continues to grow, you will continue to gain weight—up to 25 to 30 pounds by now.  Your vaginal discharge will become thicker and heavier.  It may contain mucus.  The discharge may occasionally be streaked with red, brown, or pink blood.  Your uterus will move lower, making it easier to breathe but causing frequent urination as it presses on your bladder.  As your baby grows larger, you may feel it squirm more and kick less.  As you near your due date, you may feel quite uncomfortable and have difficulty sleeping.  It may be helpful to lie on your left side and use pillows to support and position your body.

Examinations and Tests
Your doctor will continue to check your blood pressure, weight, and urine for protein or sugar.  Your doctor will evaluate the size and height of your uterus and the fetal heartbeat.  Your doctor will check your uterus for effacement and dilation.  Your doctor may examine you every week during this period.  Your doctor may test you for Group B Strep, an infection that can be life-threatening for newborns if it is not treated.

Week 40

Try to relax as your due date approaches.  Remember that a due date is only an estimated arrival date for your baby.  Babies are not considered “post-due” until the 42nd week of pregnancy.  Your doctor may recommend having your labor induced if your baby is late, but the choice is up to you.

Signs and symptoms of labor include cramps, similar to menstrual cramps, or labor contractions.  You may experience nausea, diarrhea, or indigestion.  You may have lower back pain or a dull lower backache.  Your pelvic floor, thighs, and groin area may ache or feel pressure or tightening.  There may be a change in your vaginal discharge.  Your vaginal discharge may be thin, watery, pinkish, brownish, or contain blood.  You may or may not pass a mucus plug.  A trickle or rush of fluid from your vagina can indicate that “your water has broken,” meaning that the membrane surrounding your baby has ruptured and the amniotic fluid is leaking out.

You should contact your doctor if you suspect you are experiencing labor.  Call your doctor or go to the hospital immediately if you have bleeding with cramps and pain, watery vaginal discharge, or regular contractions that are 10 minutes apart or less.