2nd Trimester of Pregnancy | Doctor Ryan - Family Medicine

2nd Trimester of Pregnancy

INTRODUCTION

Congratulations on your second trimester of pregnancy.  For those who don’t know, the 2nd third of your pregnancy is week 14 through week 26 (months 4 through 6).  This is typically the favorite pregnancy trimester.  The fatigue and nausea are often times gone, and that baby bump is starting to show!   It’s typically easy to find the baby’s heartbeat during your clinic visits and by week 20 you are often feeling the baby move!

The 2nd trimester is also a good time to check into prenatal education classes. Amma Parenting Center provides a vareity of classes to meet your needs.

http://ammaparentingcenter.com/

CLINIC VISIT INFORMATION
Routine pregnancy visits every 4 weeks (more often if your physician recommends it)

Labwork: We offer the optional “Quad Screen” testing- a blood test usually done between 15 and 18 weeks that can tell you the odds of the baby having a chromosome abnormality (such as Down’s Syndrome).  It’s a simple blood test and something that you and your partner should discuss before having done.  I usually spend at least 10 minutes in clinic discussing the pros and cons of getting this testing done and you should do the same with your provider.  Here are a few good website links courtesy of the mayo clinic, webmd, and american pregnancy to help you make your decision.
http://www.webmd.com/baby/guide/quad-marker-screen
http://www.americanpregnancy.org/prenataltesting/quadscreen.html
http://www.mayoclinic.com/health/quad-screen/MY00127

-Blood sugar and hemoglobin testing

At some point after 24 weeks, I have you drink an extra-sweet liquid that contains glucose (sugar) and then check your blood sugar one hour later. This checks for diabetes that can develop during pregnancy. While the thought of diabetes can be a little scary, it fortunately can be treated so that it does not affect you or the baby.

Your hemoglobin level shows the amount of red blood cells that travel through your body, supplying oxygen to your organs and the baby. It is common to see this level slowly drop during pregnancy. I check this level to make sure that your levels have not dropped too low and that you are getting enough iron in your diet.

2nd Trimester Imaging Test: Your 2nd Trimester Ultrasound
Usually done around 20 weeks of pregnancy.  This is the best way to look at the baby’s growth, the development of the baby’s heart and other organs, and know the baby’s gender.  This is the best chance of you knowing whether the baby is a boy or girl!

 

COMMON 2ND TRIMESTER QUESTIONS
1)  What can I do right now to give myself the best chance of a healthy 2nd trimester?
This is a good time to look at my suggestions for your 1st trimester, if you haven’t been to that webpage quite yet.

Start your Kegel Exercises!
Kegels are exercises that you should do during  and after pregnancy that help strengthen the muscles around your cervix, uterus, and vagina.  It improves healing around the vagina after delivery and reduces problems with leaking urine.  It can also help reduce hemorrhoids and make intercourse more enjoyable.
The easiest way to perform a Kegel exercise is to  If you’re not sure you’ve got it, check your technique by inserting a clean finger into your vagina before doing a Kegel. If you feel pressure around your finger, then you’re on the right track. You should keep your abdomen muscles relaxed.

At the beginning, you will only able to hold a Kegel for a few seconds at a time, but eventually should be able to hold one for 10 seconds at a time.  Start slow by performing a few in a row, eventually working up to 30 kegels per day.

Updating yourself with any important vaccines, such as your flu shot!  It’s possible that it was not available during your 1st trimester, but now it is!

-NO SMOKING! Have you tried to quit yet? How many cigarettes are you down to? Has your partner started his process to quit? See the link below from “Babycenter.com” for tips and tricks!
http://www.babycenter.com/0_quitting-smoking-during-pregnancy-compare-your-options_1406034.bc

Continue to eat healthy foods when you’re hungry and exercise for 30 minutes most days of the week!  Always discuss your exercise schedule with your doctor and stay well hydrated! 

Continue taking your prenatal vitamin

Wear your seatbelt!  Now with a noticeable pregnancy, you will wear the lower lap belt BELOW the “baby bump

 

2) What are contractions?  What do contractions feel like?

You might already know that you uterus which holds the baby is one big muscle.  This muscle will sometimes tighten causing a contraction.  Often times a mild contractions will feel just like random mild tightening of your entire abdomen or generalized pressure.  If you are in true labor, these contractions become very regular occurring every couple minutes and increasingly uncomfortable.

Braxton-Hicks contractions: This is a term typically used for irregular contractions that feel like abdominal tightening for 20 seconds or so.  They often appear during your 2nd trimester and 3rd trimester.   They go away with resting.  They do not cause your cervix to dilate and do not bring about your delivery.

True Labor contractions:This is a term used for contractions that cause your cervix to dilate and lead to the delivery of your baby.  They are usually regular, initially starting out 10 minutes apart but eventually occur every 2 minutes or so.  They often times last 30 seconds or longer.  They are mild at first (just tightening), but become more uncomfortable as time goes on.  They do not go away with resting.

ALWAYS call your provider OR the hospital if you are not sure if you are having Braxton-Hicks or true labor contractions. 

When do I call my doctor for contractions during the 2nd trimester? 

If you have tightening that occurs 6 times or more in one hour, any painful contractions, or contractions that don’t go away with rest, you should CALL LABOR AND DELIVERY RIGHT AWAY.  A nurse will ask you questions about your symptoms and help you with your concerns. 

3)  What are common symptoms during the 2nd trimester

  • Improved Energy!  This often is the best 3 months of a pregnancy.  The fatigue and nausea of the 1st timester has often resolved.  Most times this is the most comfortable time to travel during a pregnancy.
  • “Charley horses” or cramping in the back of your legs is very common in the 2nd trimester and while uncomfortable, they usually can be addressed with stretching.  The best stretch is to lie down and have a partner slowly and gently push your toes toward your knee.  Have him or her hold this stretch for 20 seconds at a time and repeat as often as necessary.
  • Nausea and vomiting.  Hopefully this is improving by now (since this is much more common in the 1st trimester) but these symptoms still can linger around during the 2nd trimester as well.
  • Emotional symptoms. You might feel moody, forgetful or unable to concentrate. All of these symptoms can be quite normal. However if you feel like your moodiness is getting in the way of you enjoying your normal daily activities, your relationships, or your performance at work, then it’s time to mention this to your doctor.
  • Constipation. Pregnancy hormones typically slow down your digestive tract which can help you absorb nutrition, but also back you up. The extra iron in your prenatal vitamin doesn’t help either. Certain types of stool softeners can be helpful, but talk this over with your doctor first.
  • Acid reflux. Your digestive tract is relaxed and food stays in your stomach longer, which may cause heartburn. You can reduce the amount of heartburn by eating small, frequent meals and avoid laying down for about 1-2 hours after a meal or snack. Many women also find that avoid spicy and acidic food and drinking a glass of milk also reduces heartburn.  Prop up your head and back with any extra pillow when laying down.  Talk to your doctor about using “Tums” or other medication if the above suggestions are not working.
  • Visible veins. The blue veins in your belly, breasts and legs may become more noticeable as your body makes extra blood and your heart pumps faster to meet the needs of pregnancy. This is quite normal and most of the time goes away after the pregnancy.
  • Breast changes.You may have already noticed some changes in your breasts. Many women experience an increase in breast size, tenderness, and changes in skin color of the nipple and areola. It is also common to notice some fluid leaking from your breasts. Sometimes it’s a lot and for some women they won’t leak at all. Both are very normal.
  • Vaginal changes. Often times, women notice thin, whitish discharge, which is normal during pregnancy. If you have significant vaginal itching/pain or any other rash in that general area, its a good thing to call your doctor about.
  • Round ligament discomfort. About midway through your 2nd trimester you may notice sharp pains on either one or both sides of your stomach. This is often caused your ligaments being pulled as stretched as your baby and uterus grow. Most women often notice this pain when they have been moving for awhile or even if they are making a simple position change. If you notice this pain try to sit and relax for a few minutes. The pain should be brief and not last for more than a few minutes. If the pain continues and you begin to notice other symptoms such as contractions, cramping, or bleeding call your doctor right away.

4) Can I have sex?

Usually; but when in doubt, ask your doctor.  Most pregnant women can have intercourse without concern.  It is one of the pieces of maintaining a normal healthy relationship.  However, on a very rare occasion, if a woman has symptoms of labor that is too early (pre-term labor), we discuss holding off on intercourse for a while.

I do tell couples that sometimes their sex life can change with pregnancy.  A woman’s attitude toward sex can be affected by how her body changes and how her hormones change during the pregnancy. And as her body changes finding a comfortable position might be a little more challenging too. So its important for couples to be patient and at times creative during the 2nd and 3rd trimesters.

4) Can I travel in the 2nd trimester?

99% of the time the answer is yes.  I always appreciate it when my patients let me know that they’re going on a big trip (cross country or international).  It gives me an opportunity to review how the pregnancy is going and review your activity plans.  Fortunately, it is very rare that I need to place any restrictions on vacation plans.

It’s important to stop the car every couple hours to get the blood in your legs moving.  This rule also applies to airplane flights.  If you are travelling abroad, you always want to clear this trip with your doctor at a separate visit and review any travel vaccine updates that might need.

5) WHEN TO CALL YOUR DOCTOR There really isn’t a bad time to call me when you have a medical concern. On occasion I will have a patient who states how worried they have been about a medical issue, but felt bad calling about it. If you are worried about something, then it is worth calling about. Below are some general guidelines that includes the very important signs of preterm labor.

  •  Contractions that are:
    Regular. (occurring 6 or more times in an hour)
    Uncomfortable. (discomfort beyond mild pressure)
    Concerning to you. When in doubt, CALL SOMEONE, this is not the time to guess on whether you are in labor or not. Call me or labor and delivery.  See other symptoms of preterm labor below. 
  •  Leaking fluid.  If you feel a small gush below and you think your “bag of waters” might be leaking, call someone ASAP.
  • Fever of 100.4 or higher.  Often times can be caused by a viral illness, but it’s worthy reviewing your symptoms.
  • Nausea and vomiting that is constant and keeping you from drinking fluids regularly.
  •  Daily mood changes (sometimes in the form of depression or anxiety) that prevent you from getting work done, allowing you to enjoy your normal daily activities, or interfering in your relationships.

Signs of preterm labor

  • Your abdomen tightens up every 10 minutes and especially if this happens more than 6 times in 1 hour.
  • Change in vaginal discharge such as leaking fluid or any vaginal bleeding
  • Pelvic pressure. It might feel like the baby is pushing down
  • Low dull backache
  • Period-like cramps
  • Abdominal cramps that may or may not include diarrhea.

If you begin to experience any of these symptoms, stop what you are doing. The lay down on your left side and drink 2-3 glasses of water. If the symptoms continue after an hour of laying down, call me RIGHT AWAY!

For more information about preterm labor check out the March of Dimes website below.

http://www.marchofdimes.com/pregnancy/preterm_indepth.html