Pregnancy / 5 October, 2017 / Etienne Horner

The #TBT Debate: What Should You Expect During Your Second Trimester?

We look back on Gynaecologist Dr Etienne Horner’s 2014 piece on all things second trimester related. How did your body change during your second trimester? Did you suffer any second trimester pains or contractions?
We’d love for you to share with us your second trimester stories!

When do I enter the ‘second trimester’ and how long does it last?
A typical pregnancy lasts 40 weeks and therefore each trimester is determined by dividing 40 weeks by 3. Therefore the first trimester is 13.33 which is approximately 13+2 weeks gestation. So you enter the second trimester at 13+3 weeks gestation; calculated by your first day of the last period. The second trimester would therefore end at 26+5 weeks gestation and then you enter the third trimester.

How often will I need to be checked up on during my second trimester and what tests are carried out on my baby and I?  
Once you enter your second trimester you would have had already one or two scans; the first being a dating scan to confirm the baby developing in the right place; the second being the nuchal translucency screen for the risk estimation for trisomy 21.  You also already would have had your booking bloods which would include many tests such as: blood group/antibodies/haemoglobin/syphilis/toxoplasmosis/thyroid profile/glucose/hepatitis B&C and HIV.

In the second trimester you would be seen every three weeks if all is well; each time with weight, blood pressure and urine analysis for you and sonic aid to listen to the babies heart beat. Some obstetricians have their own scans and will show you the heartbeat and movements on the scan. Your next “big” scan would be at 20 weeks which we call the anomaly scan. The scan person will check the whole baby for any abnormalities. No further blood tests are needed in the second trimester.

Are there any extra tests I can opt to have, in the event of pre-existing health conditions affecting me or my family?
You could have an amniocentesis in the second trimester if there is an indication in your nuchal translucency screen or any other special indication; also if there are some abnormalities seen in the 20 week scan. You could also choose a blood test however, to have further information instead of an invasive procedure which potentially has the risk (1%) of losing your baby. Should you have diabetes in your family or having had pregnancy diabetes previously, you would have your sugar test in the second trimester as well.

How will my body change during the second trimester?
Finally, in the second trimester your belly will start growing and people will ask you if you are pregnant. Otherwise you still feel quite well and I always say that the second trimester is the one with lots of energy and a good time to have a holiday before the belly really grows. You also feel less tired than in the first trimester as your energy returns. The breasts are also getting larger stimulated by oestrogen and progesterone.

What are common second trimester pains and will I notice any contractions?
Usually there are not many second trimester pains; the uterus might start contracting. These are mainly muscle spasms and are not painful but you feel them; they are called Braxton Hicks Contractions and are generally in lower belly and groin. They are not dangerous and completely normal. If you have them very often you should take it a little easier as they are more common with stress and physical activities. You could also experience some bladder/kidney pains as hormonal changes slow the flow of urine and the expanding uterus might be in the way too.

Should I be worried if my bump is too big, or too small, and can I reduce my water retention?
The size of your belly depends very much on your body shape, height and weight. Your obstetrician will examine your belly and measure from the top of the womb to the pubic bone and this should approximately correspond to your week of pregnancy; should this not be the case a scan would be of more help to determine if the baby is growing accordingly.

Water retention is usually in the legs, feet and hands and affects approximately 60% of pregnant women after 20 weeks gestation. It is very difficult to avoid swelling however always good to check if salty food intake is not too much; also blood pressure should be checked if the swelling gets worse. Ideally still drinking lots of fluids and certainly no water retention medication to be taken in pregnancy.

When should I be able to feel the baby move? Should I be worried if I haven’t felt my baby move for a few days? Is it normal for my baby to be still?
You would have started to feel the baby moving between 20-23 weeks; very gentle to start with and only with some flutters; nothing regular at all and more towards 26-28 weeks the movements are more regular. You can also have more quiet days and then again an active day and this is still normal. At this stage of the pregnancy I would not advise to start counting the movements. This is more important towards the end of the pregnancy. If you are not sure to feel movements you could always see your obstetrician to have a quick listen to heartbeat of scan.

How should I sleep in my second trimester, am I allowed to lie flat on my back?
You can still sleep on your back if you feel comfortable. The reason to change to the side is that your womb is getting bigger and can start pressing on your big blood vessels which is very uncomfortable for you. Sleeping on the back however, is no harm for the baby. It might be good to start sleeping on one side as a preparation for later in pregnancy when the belly is much bigger and only the side is comfortable.

Will I notice changes to my skin, nails, hair and teeth during the second trimester?
You might find more dark spots around the breast and inner thighs due to the increase of pigment bearing cells. You might also see a dark line in the middle of your belly (linea nigra). You could also develop dark patches on the face and therefore should be careful with sun exposition and always use sun tan. Your nails could also split more easily, however some women feel that their nails become harder during pregnancy. Usually hair becomes thicker in pregnancy due to the hormonal changes so this would be a pleasant side effect for some women. Hormones also affect ligaments and bones in the mouth which could lead to loose teeth. I usually advise women to have a check up with the dentist in the second trimester.

What can I do in the second trimester to ensure my pregnancy continues to go well? Should I refrain from flying, and avoid all painkillers?
Generally I would think you could fly if you feel well and the pregnancy is developing well without complications; your scans are normal and there is no bleeding and the baby is growing well. You should wear pressure stockings for flying and walk around as much as possible with lots of fluid intake during the flight. As for pain killers you can use paracetamol during the whole pregnancy and nothing much else. Should you need stronger pain killers then you definitely need to see your obstetrician. Otherwise healthy eating, some exercises such as swimming or yoga and enough rest should help you to go through the second trimester and to successfully enter the third trimester.

Etienne Horner Obstetrician & Gynaecologist
www.etiennehorner.co.uk