SECOND TRIMESTER
The Body
The second trimester, typically said to last from the beginning of the 13th week of pregnancy until the end of the 27th week, is sometimes called the "golden period" of pregnancy. This label is appropriate because many of the side effects of early pregnancy have diminished, whereas the discomforts of the third trimester, when the growing baby will put increased demands on your body, have not yet begun. During the second trimester, you are likely to find that your nausea is easing off, you are sleeping better, and your energy is returning.
The changes that begin the first weeks of pregnancy increase and accelerate during the second trimester. Of these, your growing uterus is probably the most obvious. By the end of 27 weeks, the foetus will be about four times bigger than it was at 12 weeks. As the uterus becomes too big to fit within your pelvis, internal organs are pushed out of their usual places, and greater tension is placed on surrounding muscles and ligaments.
During the mid-trimester, more blood is produced to supply the placenta with oxygen and nutrients for your baby's growth. Your digestive system slows the rate at which food moves through your system. And every organ system in your body continues to adapt to pregnancy under the influence of increasing hormone levels.
The risk of miscarriage in the second trimester, although it still exists, is lower than that in the first trimester. For this reason, now is the time that many women - especially those who have had a miscarriage before - feel comfortable in spreading the news about being pregnant. Your enlarging abdomen will begin to be much more noticeable by four or five months. You'll need to begin to change your wardrobe during these months and to make plans to prepare your home to welcome your new baby.
The Mind
All women experience an increase in both their levels of sensitivity and creativity during this trimester, as well as bouts of forgetfulness and sleepless nights. All of this is perfectly normal and should be faced with a good sense of humour.
Becoming more sensitive to the world around you may lead to a better understanding of what is really important in life. A feeling of creativity can lead to a beautiful nursery, clothing or toys for your new arrival. It may also help for a boom in your professional reputation. Preparing siblings, home and work responsibilities, relationship changes, and the emotions you have towards your ever-changing body, can result in mind "overload." It is common to have bouts of forgetfulness and sleepless nights. And when you do sleep, it may be disturbed with vivid dreams, some pleasant, others not.
It is helpful to set aside some relaxation time for yourself.
Take a long, warm bath, preferably uninterrupted.
Read something humorous and unrelated to pregnancy.
Take a walk or listen to your favourite music.
Try imagining that you are all alone at your favourite place such as the beach or mountains.
Be good to yourself - each day save a little time for yourself. It will help relieve stress and refresh you.
PROBLEMS AND COMPLICATIONS
The second trimester, however, is not always trouble-free. A whole new set of symptoms and sensations are common during this time, as well as potential problems and complications. Like the changes of the first trimester, those of the second and particularly the way you experience them, will be unique to you. It helps to know about what is normal and what isn't, as well as what routine tests and care may be advised by your doctor.
Aches and Pains
All this growth is likely to result in some discomfort. The common aches and pains of the second trimester mostly stem from the increase in the size and weight of the uterus, as well as from the effects of the hormonal changes during pregnancy.
Back pain
During pregnancy, the joints between your pelvic bones begin to soften and loosen in preparation for the baby to pass through your pelvis during birth. In the second trimester, your uterus becomes heavier, changing your centre of gravity. Gradually and perhaps without even noticing it you begin to adjust your posture and the ways in which you move. These compensations that you make for the change in your centre of gravity can result in back pain, strain, or any other injury.
Another contributor to back pain may be the separation (diastasis) of the muscles along the front of the abdomen (the rectus abdominis muscles). These two parallel sheets of muscles run from the rib cage to the pubic bone. As the uterus expands, these muscles sometimes separate along the centre seam, and can cause the back pain to worsen. Your doctor can evaluate whether the amount of separation is more than usual and may suggest ways to remedy the separation after your baby is born.
What can you do?
To prevent or ease back pain, try to be aware of how you stand, sit, and move:
Practice correct posture. Stand with your pelvis tucked in and your shoulders pushed back.
When standing for long periods, rest one foot on a low step stool if possible.
Sit with your feet slightly elevated, and don't cross your legs.
If you must sit for long periods, take breaks at least every half an hour.
While standing up from a sitting position, lift yourself correctly. Place your feet a shoulders width apart; lower your body by bending at the knees, and not at the waist; and lift by pushing up with your thighs, not with your back.
Don't make sudden reaching movements or stretch your arms high over your head.
When sleeping or resting, lie on your side, with your knees and hips bent. Place a pillow between your knees and another one under your abdomen. This position will take the pressure off your lower back.
Exercises to strengthen the muscles in your abdomen will help minimise back pain.
If none of these measures bring relief, your doctor may recommend a special elastic sling or back brace to support the weight of your abdomen and ease the tension on your back.
Abdominal pain
Pain in the lower abdomen during the second trimester is often related to the stretching of ligaments and muscles around the expanding uterus. A sudden movement or reach can stretch the round ligament, causing a pulling or stabbing pang in your lower pelvic area or groin or a sharp cramp down your side. The discomfort usually lasts for a few minutes and then goes away.
Although this cause of abdominal pain doesn't pose a threat to you or your baby, it's important to report it to your doctor because abdominal pain can be a symptom of ectopic pregnancy, pre-term labour, or other problems.
What can you do?
It may help to sit or lie down when abdominal pain becomes bothersome.
Relaxation exercises may help, as may soaking in a warm bath.
The relatively minor aches and twinges described here are probably nothing to worry about and will diminish as your pregnancy progresses.
If the pain is severe, call your doctor immediately.
Leg cramps
Cramps in the lower leg muscles are fairly common in the second and third trimesters. They often occur at night and may disrupt your sleep. The exact cause of leg cramps is uncertain, but they may be due to an inadequate amount of calcium in your diet, fatigue, or pressure of the uterus on the nerves in your legs.
What can you do?
If you're bothered by leg cramps, try doing exercises to stretch your calf muscles.
Other measures to ease or prevent leg cramps include taking frequent breaks from sitting or standing for long periods.
If you do get a cramp, you might be able to relieve it by straightening your knee and gently flexing your foot upward.
Applying local heat may also help.
If leg cramps persist and are severe, tell your doctor about the problem. On rare occasions, they can indicate that a blood clot has formed in a vein, which would require medical treatment.
Heartburn
Heartburn actually has nothing to do with your heart. It's caused by the contents of the stomach backing up into the esophagus (the tube that carries food from the mouth to the stomach). When this happens, stomach acids irritate the lining of the esophagus. The resulting burning sensation near the level of the heart gives this condition its misleading name.
There are many reasons why heartburn is more common during pregnancy. For one thing, your growing uterus is continually pushing on your stomach, moving it higher and higher up in your abdomen and compressing it. For another, your digestive system as a whole, under the influence of hormones, has been slowed down. The waves like movements of the esophagus that push swallowed food down into your stomach tend to become slower during pregnancy.
Your stomach also takes longer to empty, and food moves more slowly along your gastrointestinal tract. The purpose of this general slowdown is to allow nutrients more time to be absorbed into your bloodstream and to reach the foetus. Unfortunately, it can also cause bloating and indigestion.
What can you do?
Some of the things you did to ease nausea and vomiting during the first trimester may also help your heartburn during the second trimester. For example,
Remember to eat frequent and small meals and not to overfill your stomach.
Avoid movements and positions that seem to aggravate the problem. When picking things up, bend at your knees, not your waist.
Avoid lying flat on your back when resting or sleeping - prop yourself up on pillows.
If heartburn is bothersome enough to keep you from eating properly, your doctor may prescribe an antacid. But do not take any antacid without talking to your doctor first. Some antacids contain sodium, which can cause fluid build up in body tissues during pregnancy.
Rarely, an inflammation of the esophagus may cause heartburn. When this is suspected, a procedure called endoscopy can be done to view the inside of the esophagus. The condition can be treated with medication during pregnancy.
Skin Changes
Skin darkening
The hormones at work in your body during pregnancy can cause several changes in your skin. One of the most common, occurring in 90 percent of all pregnant women, is skin darkening. This symptom is more pronounced in dark-skinned women. Its exact cause is unknown, but it may be related to increased levels of estrogens.
Skin darkening during pregnancy is typically noticeable on or around the nipples, in the area between the vulva and the anus (the perineum) and around the navel. You may also notice it on your armpits and inner thighs. The pale line that runs from the navel to the pubic bone called the linea alba (white line), also often darkens during pregnancy, when it is referred to as the linea nigra (black line).
In some pregnant women, mild skin darkening on the face also develops. This is commonly called the mask of pregnancy or chloasma.
What can you do?
Skin darkening during pregnancy is made worse by exposure to sunlight or to other sources of ultraviolet (UV) light. If you have this problem,
Avoid getting too much sun.
Always wear a sunblock with a skin protection factor (SPF) when outdoors, whether it's sunny or cloudy - the sun's UV rays also reach your skin on overcast days.
A wide-brimmed hat that shades your face will also help.
Skin darkening almost always fades after delivery. If it is extreme, especially on your face, covering makeup can help. But avoid agents that bleach the skin. If yours is a severe case, it might be improved with a medicated ointment that can be prescribed by your doctor.
Other skin symptoms
Below are other common skin changes that usually disappear after delivery:
Red and itchy palms and soles, which may be relieved by using moisturising creams.
Blotchy patches on your legs and feet may appear at times, particularly when you are chilly. They do not signal a problem or cause discomfort.
Skin tags, which are very small, loose growths of skin may appear under your arms or breasts. They usually disappear after birth but can easily be removed if they don't.
Moles may increase, but the ones that appear during pregnancy are usually not the types that are linked to skin cancer. (Just to be sure, though, it is still a good idea to show any new moles to your doctor.)
Fingernails may become brittle and soft. Using nail polish may make them worse. Moisturise your nails as well as your hands with lotion, and wear rubber gloves when working with detergents or cleansers.
Heat rash can be soothed by applying cornstarch after bathing, avoiding very hot baths or showers, and keeping the skin cool and dry.
Constipation
Unfortunately, constipation is one of the most common and uncomfortable side effects of pregnancy. It is due to the general slowdown in the digestive system and to the pressure of the uterus on the lower bowel.
What can you do?
The first strategy in dealing with this problem is evaluation of your diet.
Foods high in fibre will help prevent or ease constipation, as well drinking plenty of fluids. Fruits, vegetables, and whole-grain foods may provide the fibre you need. Fruit juices, particularly the age-old remedy of prune juice, can also ease constipation.
Increasing the amount you exercise will help too. Just adding a little time to your daily walks or other exercise regimen can be effective.
If these measures fail, your doctor may recommend a mild laxative such as milk of magnesia, a bulking agent, or a stool softener. But take these remedies only on the advice of your health care provider. Don't take cod liver oil during pregnancy because it can interfere with the absorption of certain vitamins and nutrients. Also avoid other harsh laxatives and enemas.
The Baby
By 26 weeks, the baby has grown to about 9 inches (about 23 centimetres) long and weighs about 11/2 pounds (670 grams). Fat is being laid down under the red, wrinkled skin, which is covered with fine, downy hair called lanugo. Fingerprints and toe prints, as well as eyebrows and lashes have formed.
By 28 weeks, the baby's eyes open and close, and the baby sleeps and wakes at regular intervals. By that time, the baby will be about 10 inches (25 centimetres) long and will weigh about 2 pounds (about 900 grams).
Feeling the Baby Move
You will probably have begun to feel your baby's movements by 20 weeks. It is normal during this trimester for these movements to be somewhat erratic; later, they typically become more regular. The most active time is between 27 and 32 weeks.
As your baby's activity increases, your pregnancy will begin to seem much more "real" to you. In the first trimester, you may have been constantly reminded of being pregnant because of nausea or other symptoms. But now the reminder begins to take the much more pleasant and exciting form of feeling your baby move. As time goes on, your partner will be able to feel movements through your abdomen.
The Baby's Senses
About the time you begin to feel the baby move, she or he in turn is beginning to be able to hear you. Hearing is well established by 24 weeks, when the baby begins to respond to outside sounds. The baby can now hear your voice and is likely to recognise it after birth. The environment inside the uterus is relatively quiet, but your baby can hear your heart thumping, your blood whooshing through your veins and arteries and the rumblings of your stomach. Whether you can provide additional stimulation at this time that will influence your child's future intellectual development is still not very clear. Though various researches have proved that additional stimulation at this stage does really help.
The rest of your baby's sense organs also continue to develop during the second trimester. Beginning at 16 weeks, your baby is sensitive to light, and by 29 weeks a baby can open his or her eyes and turn the head to find the source of a continuous, bright light.
Vacation While You are Pregnant
If you want to have one last "getaway" before the baby arrives, the second trimester is an ideal time. Travelling is usually safe, but precautions are still advisable.
Whether travelling by train, plane or automobile, get up and walk around frequently to stretch your muscles and get your circulation going.
Try to sit in a position with your feet up at least part of the time.
Drink plenty of fluids and eat sensibly; and bring along some healthy snacks like fruit, crackers or raisins that you can carry in your purse.
Your seat belt, fitted snugly below your abdomen, should be worn at all times.
When choosing a vacation destination, check with your doctor and also check whether there is a doctor readily available, in that destination should an emergency arise.
GOOD FOOD IS MUST FOR PREGNANT WOMEN
In addition to the food which is required by the growing baby, a mother lays down stores of food in her body during pregnancy, mainly in the form of fat. This provides reserves to tide her over a period of breast-feeding, which uses up a lot of nutrients. Because of the increasing body fat, it is normal for a woman to gain 9 to 12.5 kg during pregnancy, and there is often a natural increase in her appetite.
To meet your increasing needs, you will need more calories. These are needed for all bodily processes, and particularly during growth. We get most of our calories from cereals, root vegetables, dairy products and cakes and sweets of various kinds. The cakes and sweets tend to be short of additional nutrients, and are sometimes called "empty calories". Instead of cakes or sweets, fill up with foodstuffs which have other value as well as calories - wholemeal bread, for example, is also a useful source of protein, vitamins and iron.
The developing baby needs a great deal of protein, particularly towards the end of pregnancy. We get about half our protein from animal products (meat, fish, eggs, milk) and the rest from vegetable sources, mainly in bread and other cereals, nuts, peas and beans.
Vitamins are also necessary for your baby's growth and development. The main vitamins are Vitamin A, B C, D and E. On a good diet, you are unlikely to lack any of these, but demand may increase during pregnancy, so you need to take care to guard against deficiency.
Probably, the most common vitamin shortage in a pregnant woman is lack of folic acid, a B-group vitamin which is needed for, among other processes, the making of blood. Folic acid is found particularly in leafy green vegetables - "folic" comes from the same root as "foliage".
Folic acid or folate, and iron tablets are given to many expectant mothers throughout pregnancy. Both folic acid and iron are important in preventing anaemia, and help to build up the iron stores in your baby's liver - stores which must last until he is ready to start mixed feeding, at the age of four or five months. Folic acid is easily lost in cooking, so salads of leafy greens like watercress, endive or raw spinach are valuable.
Several vitamins are lost or reduced during cooking. That is why it is best to eat as much raw vegetables as possible during this period.
Calcium is another special need during pregnancy. It is vital for the bones and teeth. The best sources of calcium are milk and milkproducts such as cheese and yogurt. Take care to ensure that you are getting enough of Vitamin D as it helps in the absorption of calcium.
Keep the above in mind and sensible eating will definitely benefit both the baby and you