Pregnancy – A Tale of Three Trimesters: Part Two

Published on: September 10, 2021

In the second of her three-part series on what to expect in your pregnancy here in Bangkok, Emma tells us all about what awaits us in the second trimester.

By Emma McNerlin

The second trimester of pregnancy is defined as week 14 to week 28. This middle trimester is often seen as the ‘Cinderella trimester’, when you bloom with glowing skin and luscious hair, and brim with newfound energy after the exhaustion of the first 13 weeks. It also brings psychological relief as the risk of miscarriage decreases sharply to around 1 to 3% (Miscarriage Association). Thus, many expectant parents feel more confident to share their pregnancy news with friends and family.

By the start of the second trimester, your baby is structurally formed with all of their organs, muscles, limbs, and bones. As baby grows bigger, usually around 18 to 20 weeks, you become aware of their movements. Known as ‘quickening’, this initially feels like ripples or flutters in the lower abdomen. As you progress through your second trimester, these give way to more defined kicks and shuffles. You will also notice baby’s pattern of movement. Any movements are positive and indicate that your baby is receiving enough oxygen and nutrients from the placenta. Any reduction or change in baby’s movements must be investigated at the hospital.

Around the 20-week mark, you will be invited for a detailed ultrasound called an anomaly scan. At this scan, your doctor will check your baby’s organs, the blood flow to the placenta, and where the placenta is located. It is also the scan that can reliably determine the sex of your baby if you did not discover this from NIPT (noninvasive prenatal testing) in the first trimester. Remember to let your doctor know if you do not want to be told the sex of your baby at the scan.

During your pregnancy, your OB/GYN will monitor your blood sugar. Baby is nourished with glucose from your bloodstream, so slightly elevated blood sugar levels in pregnancy are normal to allow the glucose to get to baby (Robson and Waugh). However, it is important to ensure you are not developing gestational diabetes mellitus (GDM), which can mean you will need to monitor and maintain appropriate blood sugar levels to avoid complications for you and baby towards the end of pregnancy. Depending on your risk factors, which include family history and a high BMI, your doctor may screen you for GDM between 16 and 18 weeks, or they may opt to wait for standard screening at 28 weeks. This standard screening involves a simple blood test. If your blood sugar levels are higher than normal for pregnancy, a more controlled glucose tolerance test will be performed.

The second trimester is when you appear visibly pregnant. Mixed emotions about the changes happening to your body, and the impact a baby will have on your life, are all quite normal. Some women welcome these changes; however, others might feel a loss of control over their changing body shape, or anxiety about their pregnancy. One in ten women suffer from depression in pregnancy (Mind.org), so it is important to talk about any negative feelings you may be experiencing. Symptoms include loss of appetite, insomnia, extreme panic/anxiety, and feelings of inadequacy and loss of control. It is very treatable, so if you think you may be suffering from a pre-natal mood disorder, please speak to your OB/GYN for support.

The physical and hormonal changes of pregnancy can also bring some interesting but annoying minor symptoms in the second trimester. Rising progesterone levels cause the relaxation of smooth muscles, which may cause heartburn and acid reflux, constipation as your digestion slows, and UTIs from structural changes to the bladder. Always seek treatment for UTIs as they may cause a more serious kidney infection and sometimes preterm contractions (Myles, 2015).

Leg cramps are another common symptom caused by circulatory changes, extra weight, and dietary deficiencies (Mayo Clinic). Regular, moderate exercise can boost circulation, and eating a balanced diet can help prevent them. Circulatory changes may also cause you to experience dizziness. Avoid swift changes from sitting to standing, and eat well and stay hydrated to help keep your nutrition and iron levels in check. If you experience any severe dizzy spells or fainting, consult with your OB/GYN for in-depth investigation.

Skin changes are also quite normal in pregnancy. Hormonal changes increase melanin production, sometimes resulting in brown patches called melasma on the face and body, and a dark, vertical line down your bump known as a linea nigra. Both typically fade after your baby is born. Pregnancy hormones can also make your skin more sensitive to the sun, so be sure to use a good SPF sunscreen. 

As your skin stretches to accommodate your growing baby, it is normal to experience itching across your bump. Daily moisturising and applying a cool cloth when it flares can help. However, if you experience extreme itching, which is typically worse at night, especially on the soles of your feet and palms of your hands, please contact your OB/GYN. This can be a sign of a condition affecting the liver called intrahepatic cholestasis of pregnancy (ICP). This condition, which affects 1 in 140 pregnant women, typically manifests in the late second trimester and requires extra monitoring for you and baby (NHS).

From 26 weeks, baby can recognise your voice, so you may like to connect with them through abdominal strokes and talking to them. Slowing down to spend time bonding with your baby will be beneficial to both of you. The second trimester is the perfect time to embrace and prepare for your new role as a mother.

**The contents of this article are intended for informational use only and should not be considered as medical advice. Please consult your OB/GYN if you have concerns about your pregnancy. ****

References

Mayo Clinic available online at: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/leg-cramps-during-pregnancy/faq-20057766#:~:text=If%20a%20leg%20cramp%20strikes,Mary%20Marnach%2C%20M.D.

Mind.org.uk resources on perinatal mood disorders available online at: https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postnatal-and-antenatal-depression/

Miscarriage Association statistics and support available online at: https://www.miscarriageassociation.org.uk/information/miscarriage

Myles, M. (2020) Midwifery Textbook for Midwives 17th Edition. Elsevier.

NHS factsheet on intrahepatic cholestasis of pregnancy available online at: https://www.nhs.uk/pregnancy/related-conditions/complications/itching-and-intrahepatic-cholestasis/

Robson S. and Waugh J. (2016) Medical Disorders in Pregnancy: A Manual for Midwives. Wiley Blackwell Press.

About the Author

Emma McNerlin is a UK trained and registered Midwife, First Aid Instructor, and owner of Bumpsy Daisy Café and Community; a cafe and parenting community centre for new and expecting parents offering birthing classes, hypnobirthing, First Aid workshops, and baby classes.


The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects. BAMBI welcomes volunteer contributors to our magazine. Please contact editor@bambiweb.org.

 

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