Second Trimester Prenatal Care

You are now in your Second Trimester of your pregnancy.  Your second trimester of care is from 13-24 weeks gestation.  You may begin to feel movement at about 16-21 weeks.  Please note the date and let the midwife know.

Date Baby First Moved ____/____/____

If you have not yet registered for your prenatal classes, this is the time to do so.  For those who are smoking, now is the time to quit.  Ask the midwife for smoking cessation material to help you do so.  If you are still undecided about breastfeeding, we have lots of information in the library.  Now is a good time to be reading and thinking about a birth plan.  You may watch videos or visit our patient library.  You may be interested in attending one of the many workshops that we offer.  Check in the newsletter for dates and times or you can check our website at www.jdmh-midwives.com

Sibling Involvement

Children are always welcome to come to your prenatal visit to listen to the baby.  The hospital offers sibling classes and if you have not already signed up you may want to do so now.  If children are to be present during the birth, please talk to the midwife about these plans, as the children need to attend a special class.  We have several videos that are child appropriate, the favorite being "Nicholas and the Baby".

Selecting a Health Care Provider for the Baby

Now is the time to choose a health care provider for your baby.  The nurse midwife will do the initial exam and the APGAR scores on the baby, but you will need to choose a provider to exam the baby soon after birth and to discharge the baby.  We can provide you with a list of pediatricians and family physicians on staff.  If you choose a provider no on staff at JDMH, the hospital records will be sent to their office.  Bring the address with you to the hospital.

Fetal Development

Your baby has been doing a lot of growing in the last few months.  During your fourth month you baby is about 4 inches long and is fed by the placenta and can suck and swallow.  Tooth buds appear and fingers and toes can be seen.  By the fifth month the activity of your 8-10 inch baby is strong enough to be felt.  Hair begins to grow on its head, and brows and eyelashes appear.  At six months your baby is about 13 inches long and weighs about 1 3/4 lbs.  Its skin is thin and shiny but has no fat yet.  Its fingerprints and toe prints can be seen.  Eyelids begin to part and the eyes are open.

Sonograms

You will be offered a prenatal sonogram at about 19-23 weeks for fetal well being.  Our office will try to coordinate this sonogram with your prenatal visit.  An ultrasound using sound waves to look at and take a picture of the baby inside your body.  This test checks the babies growth and development.

Warning Signs

Please remember to notify the midwife immediately if you experience any of the following:

  • Vaginal bleeding
  • Severe swelling of the face, hands and ankles.
  • Sever headache that does not go away.
  • Blurred vision.
  • Less urine output than normal.
  • Pain or burning on urination.
  • Chills, fever, and any other illness.
  • Sharp belly pain that does not go away.
  • Escape of water from vagina.
  • Lack of fetal movement.

AFP

This blood test is done between 16-20 weeks.  This test measures three levels in your blood that are only there when you are pregnant.  It tells if the baby is at risk for birth defects of the brain, spinal cord defects, such as spinal bifida.  It may also indicate if you are at risk for having a baby with Downs.  This is only a screening test and an abnormal result does not mean that your baby definitely has a problem.  If your test is positive, you may be referred for further testing or a level two ultrasound.

Warning Signs of Preterm Labor

Preterm labor is defined as labor before 36 weeks gestation.  Preterm labor is not the same as false labor.  It is important that you contact the midwife immediately if you feel that you may be in preterm labor as it can often be stopped if recognized early enough.

What to watch for:

  • Uterine Contractions - If you feel your uterus tightening up ice or more times in an hour. This may or may not be uncomfortable.
  • Menstrual Like Cramps - These feel like you are having a period and may come and go or be constant.
  • Abdominal Cramps - These are belly cramps with or with out diarrhea.
  • Low Back Ache - This is a backache near your tail bone that comes and goes or is there all the time.
  • Pelvic Pressure - This feels like the baby is pushing down on your vagina.
  • Change in Vaginal Discharge - You may notice a sudden increase in your discharge, or that it becomes more mucousy, watery or a bit bloody.

It is normal to experience many of the above sensations for short periods of time and it may not be premature labor.

First try the following:

  • Lie down on your left side.
  • Drink 2-3 glasses of water or juice.
  • You might want to try a warm bath.

If symptoms are not gone within an hour, call the midwife immediately.

Sexual Intimacy

The second trimester of a pregnancy often is a time when the expectant mother feels good, physically, emotionally, and sexually.  As you move into this stage of your pregnancy, many of the early discomforts may go away.  You may have more energy.  AS you feel better, you may have more sexual desire and activity.  At this stage in your pregnancy, there is more blood flow to your pelvic area, including the vagina.  There is an increase in the amount of lubrication in your vagina.  This normally happens during sexually arousal.  You may be more interested in sex during this trimester.  Changing positions when you have sex can help make you more comfortable.  Many expectant parents are concerned about sexually activity.  As always, it is important that you are open and honest with each other about your feelings.  Talk with your midwife regarding any questions or concerns you may have

Preeclampsia

Preeclampsia is a condition some women get late in pregnancy at about seven months.  It goes away after the birth of the baby.  It is also know as toxemia.  Women with this condition may have:

  • High Blood Pressure
  • Protein in the urine
  • Swelling of the hands and face
  • Lot of weight gain
  • Severe headache that lasts a long time.

 

We do not know why women get this condition but we do know that certain women have a greater risk.  Those at a higher risk are:

  • Women having their first baby
  • Pregnant teenagers and women over 35
  • Mothers with other problems in pregnancy, such as high blood pressure or diabetes.
  • Pregnant women who have very poor eating habits.
  • Women who have had this in the past or have a family history.

Backache

Backache is a common discomfort during pregnancy.  You may try the following measures to alleviate it.

  • Warn, not hot, tub baths not to exceed 30 minutes.
  • Rest on a firm supportive surface.
  • Use massage and relaxation.
  • Use a supportive bra.
  • Wear low healed, supportive and comfortable shoes.
  • Try pelvic rocking, about 10-12 times a day.
  • Pay attention to proper body mechanics.  Avoid heavy lifting.
  • You many want to purchase a maternity girdle.
  • Tylenol
  • General exercise 3-4 times a week for at least 30 min, for example, stretching, walking, swimming, or prenatal exercise class.

The Warning Signs of Preeclampsia are:

  • A lot of swelling especially in your hands and face.  It is common in pregnancy to have swelling in your ankles and feet as they day goes on.  Women with Preeclampsia will wake up in the morning with puffy hands and face.  When the swelling happens, some women have a sudden weight gain.
  • Severe headaches - These do not go away with rest and Tylenol.  Some women see spots before their eyes and have blurry vision.
  • Sever Pain in Upper Abdominal Area or under the ribs that does not go away.  This may be a sign of a serious problem.  This pain is constant and does not come and go like labor contractions.  It does not stop with rest or Tylenol.

If you have any of these symptoms, call the midwife immediately.  Treatment for this condition may consist of bed rest at home or with more sever cases may need hospitalization with medication.  This is very dangerous to you and your baby.

Constipation

If you should experience constipation, try the following recommendations:

  • Stop taking all vitamin supplements until corrected.
  • Stop taking Antacid preparations, for example, Tums.
  • Drink plenty of clear liquids.
  • Eat unrefined carbohydrate foods.
  • Drink prune juice regularly.
  • Avoid foods know to be constipating to you.
  • Eat plenty of vegetables.
  • Get moderate exercise.
  • Set aside a regular time to have a bowel movement.
  • Drink a hot liquid immediately followed by a cold liquid.

Hemorrhoids

This is a common problem during pregnancy.  The following are suggestions to help with this.

  • Sitz Bath (warm or cold) for 15 minutes.
  • Apply ice pack, apply cold compress or use Epsom salt bath to aid in reduction.
  • Astringent compresses such as witch hazel pads and Tucks.  Keep in the fridge for better comfort.
  • Vitamin E capsules (400IU or more) can be introduced into the anal canal at night before retiring to help heal the tissues.
  • Use a stool or other object to elevate feet at the toilet.  This will put the muscles in better alignment and produce less rectal strain.

Round Ligament Pain

By far one of the most common complaints during pregnancy are aches, pains or spasms in the round ligaments.  As the uterus enlarges in early pregnancy, these ligaments can occasionally become cramped, producing a mild to sever discomfort such as a sticking or pulling pain on either side of the pubic area, pains along the sides of the uterus and up thought the navel area.  These sensations can also be experienced in the groin area.  For acute pain, you can bend forward toward the point of the pain and allow the muscle to relax.  Breathe deeply.  If possible lay down on your side until the symptoms subside.  A hot water bottle can also be applied to the area.  Try to avoid sudden movements involving outward movements of the legs, for example when your rising out of bed or getting out of the car.  If you have any pains that you are concerned about, let the midwife know.

Leg Cramps

Many women experience leg cramps during pregnancy.  You should make sure that you are getting adequate supplies of sodium, calcium, magnesium and potassium.  Cramps can be caused by an inadequate intake of salt.  Try to eat foods such as bananas grapefruit, oranges, cottage cheese, yogurt, salmon, sardines, dark greens, soybeans, almonds, and sesame seeds will all help to provide the nutrients needed to avoid leg cramps.  Other suggestions to help with leg cramps are:

  • While sleeping or sitting, elevate the legs higher then the heart.
  • Do not stand in one place too long. Shift your weight from one leg to another.
  • Do not point toes outward, point them inward to relieve cramps.
  • Walk to improve circulation in your legs.
  • You can apply a hot water bottle or a heating pad to the cramping area and apply manual pressure.

If  you should have any additional questions or concerns, please call our office and the midwife will take the time to discuss them with you.  There is also very valuable information in our patient library.

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