HEALTH COLUMN: The second trimester (weeks 14-26)

Birthing with Bridget

HEALTH COLUMN: The second trimester (weeks 14-26)

Research has shown that exercise needs to be encouraged in pregnancy

Hello all,
I hope you are all safe and well and that you are finding these articles helpful and informative. Remember I am happy to receive feedback or suggestions on topics of interest to you. Just drop me an email at birthingwithbridget@
gmail.com.
This article will look at the 2nd trimester from weeks 14-26, also called the “Golden Trimester”.
This is the favourite trimester for many women because they have more energy, the morning sickness has eased, and the growing bump will start to show.
We will discuss the physical changes happening in the woman’s body, the schedule of care happening in the 2nd trimester, including the anomaly or “big scan”, the diabetic screening test, medically called the glucose tolerance test (GTT) that is recommended for a large percentage of pregnant women and we will also talk about exercise in pregnancy.
Mum’s Physical Changes
in the 2nd Trimester
This is often the time in the pregnancy that women enjoy the most. The morning sickness and excessive tiredness should have eased, and women often report increased energy levels. Family and friends are now aware of your good news and you no longer have that lovely secret to keep.
The 1st trimester was mainly about the hormonal/emotional changes that were happening in your body, all this while you looked the same.
During the 2nd trimester physical changes occur. Your growing womb stretches up from your pelvis to your abdomen from week 12 onwards. While this is happening, you may feel some stretching like lower abdominal cramps, but you should not experience any severe pain or bleeding.
Your womb will continue stretching upwards, as the baby grows inside it until full term. Your baby bump will be noticeable at some stage during the 2nd trimester, when this will occur will depend on your height, weight and how many pregnancies, if any, you have had before.
As your womb grows your skin stretches. This rapid stretching of the skin fibres causes stretch marks. Your hormones and cortisol levels play a part in the production of stretch marks too. Some women, depending on their skin type and physical size are more prone to stretch marks than others.
Some stretch marks can look redder and angrier than others. This stretching of the skin is not a new phenonium- the ancient Romans used olive oil on their skin in an attempt to cure these marks. Unfortunately, there is no magic potion that will make them go away.
There are numerous creams and lotions marketed at preventing and/or lessening these marks. Different women find different creams /lotions beneficial.
Stretch marks can become itchy and the skin may become dry so moisturising your body will help to relieve the itch and dryness. Once the cream/lotion is safe to use in pregnancy and you are not allergic to it. Often women report that the cheap alternatives are just as good as the pricey brands.
If you develop a severe itch, especially to the palms of your hand or the soles of your feet, often without any rash, please consult your GP/midwife. You may require a blood test to out rule something called obstetric cholestasis.
Women may develop a strip down the centre of their belly during the 2nd trimester. this is called linea nigra (black line) and it runs from your belly button to your pubic bone. This pregnancy line is never really black; however, it is brownish and dark in colour.
This line is a natural part of pregnancy caused by hormones and there is nothing you can do to prevent it forming. The good news is that it lessens and fades away shortly after the birth of your baby.
Women may experience leg cramps during pregnancy, these often start during the 2nd trimester. Staying well hydrated, gentle lower leg and foot stretches and a warm bath before bed can help to relieve these cramps.
Some studies suggest that drinking a glass of tonic water can help. I often recommend trying a glass before going to bed especially if the leg/calf cramps trouble you mostly at night.
Dental and oral hygiene is especially important during pregnancy. There is an old wife’s tale suggesting that women lose a tooth per baby, we do not want this to be the case. Pregnancy causes more blood supply to the gums making them bleed easier.
Changing to a softer toothbrush can help. Even though the gums may bleed, good dental hygiene is important. A check-up with your dentist is recommended in pregnancy or shortly after, when you are feeling up to it.
Pregnant women often report an increased vaginal discharge. This is called leucorrhoea. It is common in pregnancy due to excess oestrogen production. Leucorrhoea has an important function, it removes old cells from the vagina, protects the birth canal from infection and maintains a healthy balance of bacteria in the vagina.
If this discharge causes itch or becomes foul-smelling, then you need to speak to your GP/midwife, as this could be a sign of a vaginal infection, rather than normal leucorrhoea.
Quickening is the medical name given to the first baby movements that you feel. These first foetal movements are often described as flutters. Usually you will begin to feel your baby move around 19-20 weeks gestation. Initially, it may be difficult to determine whether this feeling is wind/gas or your baby’s movements.
As the weeks go on, and your baby gets bigger and stronger you will begin to notice a movement pattern. If you are 20 weeks and you do not feel your baby moving, as yet, please do not worry. The way the baby is laying in your womb, the location of the placenta (afterbirth) can affect when you feel your baby move in early pregnancy.
However, foetal movements are very important and a great way of monitoring your baby’s wellbeing later on in pregnancy, especially, from 24 weeks onwards. Babies can survive outside the womb from 24 weeks gestation (they also need to weigh above 500grams, which is just over 1 lb). This is called viability. The women I look after will know, I consider 24 weeks to be a big milestone, but even though babies can survive from then we do not want to see them on the outside world for much longer.
Schedule of Care and The Anomaly Scan
The recommended schedule of care up 28 weeks gestation is for Mum and baby to have a check-up every 4 weeks. The dating scan usually takes place between 10-13 weeks, and apart from this trip to your maternity unit, your GP/midwife will be carrying out these check-ups.
Most maternity units schedule the first antenatal out-patients visit, often called the booking visit, between 14-16 weeks. At this appointment previous pregnancies, medically, surgically and family histories will be discussed.
The women will have her blood pressure and urine checked and a small scan maybe performed by the hospital doctor. If all is progressing well your next hospital antenatal out-patients appointment will likely be around 28 weeks.
Your GP/midwife will perform your check-ups until then. The anomaly scan or big scan usually takes place between 18-22 weeks, and if the maternity unit has a special foetal assessment unit it will take place there. Unlike the smaller scans you have at an out-patient appointment, this is a very detailed scan, performed by a sonographer.
A sonographer is a healthcare professional who specialises in the use of ultrasound imaging devices. Within maternity settings, sonographers are often midwives who are especially trained in scanning.
The anomaly scan will examine your baby’s organs, take measurements of limb lengths, and stomach and head circumstances. This scan will also look at the function and location of the placenta (afterbirth) and the amount of water (also called amniotic fluid or liquor) around the baby.
Women, especially in the 3rd trimester, are often concerned about their baby being too big. However, at the anomaly scan the sonographer wants to establish that the baby is growing adequately, and it is not small for gestation.
Occasionally, a woman may be asked to return for a follow-up foetal assessment scan, to measure the baby again, to check on growth or to get better views or measurements as the baby may have been so active during the first scan. If the sonographer wants a second opinion, or if there is a family history i.e. a strong heart history, the woman may be referred to another hospital, such as the National Maternity Hospital, Holles St, for a follow-up scan.
Exercise in Pregnancy
The second trimester is also called the golden trimester because women feel more energetic than the previous months. This trimester often sees women return to exercise or to begin pregnancy specific exercise classes such as pregnancy Pilates or pregnancy yoga.
We all know that exercise has physical and mental health benefits for us all. Exercise in pregnancy has many benefits for the Mum to be. It can relieve minor disorders of pregnancy including insomnia, fatigue, and backache, reduce joint and muscle pain, enhance feelings of well-being and improve body image.
Research has shown that exercise needs to be encouraged in pregnancy as it can increase a women’s chance of having a vaginal delivery.
Women who exercise prior to pregnancy should be supported to continue to exercise in some form and even the most sedentary woman should be encouraged to begin some form of gentle exercise. Research has shown no difference in injury rates among pregnant and non-pregnant women.
The guidelines state
-women should avoid exercising in the supine position (this means laying flat/or almost flat on your back).
-women should stop when they feel fatigued.
-absolutely avoid contact sports, no scuba diving and no high-altitude training.
Most importantly, and the take home message is that women should not exceed a heartrate of 140bpm and should be able to talk when exercising. The aim for every pregnant woman is 150 minutes of moderate intensity activity every week during pregnancy.
Diabetic Blood Test- Glucose Tolerance Test (GTT)
This screening test is to look for something called gestational diabetes (GDM). This is a form of diabetes that is firstly diagnosed during pregnancy. It can cause the baby to be bigger, and it can cause more fluid production around the baby because the placenta is bigger too. It can also cause the baby’s belly (called the abdominal circumference) to be increased, this can only be seen on scan.
Gestational diabetes will increase the need for induction of labour and may also increase the chance of a C-section birth. There are strict criteria followed by maternity units, and if the pregnant woman meets 1 or more of these then a GTT will be advised around 26 weeks gestation.
The criteria for GTT include- family history of diabetes, raised BMI, maternal age of 35 or above, PCOS, previous big baby, persistent sugar in the urine or Asian ethnicity. If you had GDM in a previous pregnancy, then an early GTT will be recommended.
This will take place between weeks 14-16. It is important to inform your GP/midwife at your booking visit, that you had GDM in a previous pregnancy. The GTT always takes place in the hospital.
A fasting blood sample will be taken, then you will be asked to drink a sweet drink and a blood test will be taken 1 hour and again at 2 hours after this drink.
The level of sugar in your blood tests will determine whether you have developed GDM. If the values are within normal ranges, then you will carry on with your normal schedule of antenatal care. If the values are raised, then the diabetic midwife specialist will contact you and a follow-up plan of care will be commenced.
GDM can often be managed with diet and lifestyle. Women do need to check their blood sugar levels. It is likely that you will move to a separate specialised antenatal clinic, guided by a pregnancy consultant and a diabetic consultant.
Some women with GDM will need oral medication for their diabetes and some will need insulin to control the blood sugar levels. Women with GDM will need regular scans in the foetal assessment unit.
This type of diabetes usually goes away after the baby is born. The mum and baby will need to have their blood sugars monitored in the first few days after delivery. Breastfeeding is beneficial to all mums and babies but especially to mums with GDM. Breastfeeding helps to prevent diabetes.
Women with GDM will be invited back about 12 weeks postnatal to have a GTT to make sure the diabetes is gone. Unfortunately, up to 50% of women with GDM will develop type 2 diabetes in later life.
The GDM should be viewed as a warning sign, however, on a positive note, with a healthy diet, lifestyle and regular exercise type 2 diabetes can be prevented.
The 2nd Trimester and
Your Baby
By the end of the 2nd trimester your baby will weigh between 680-920grams and be around 33cms long. All of your baby’s major organs are formed and lanugo, which is a fine hair, will begin to cover his/her body.
You will be able to see and feel your baby bump and that amazing feeling when baby moves. It is a lovely idea for you and your partner to talk to the baby as they can hear within the womb.
Women often report that their baby moves in response to their voice or the voice of their partner. By talking to your baby, you are starting that wonderful connecting bond.
Finally, remember that this information is a guide. If you are concerned about anything, please speak to your GP/midwife or hospital doctor.

Until next week,
Take care, Bridget the Midwife.

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