THE FIRST TRIMESTER
Conception to 12 Weeks
Each visit you will be given useful information about your pregnancy and your baby’s growth and development. Remember that each pregnancy will be different. You do not have to have the same problem each time.
Changes You May Experience
Morning sickness is the common term that describes nausea and/or vomiting that may occur early in your pregnancy. This usually starts at six weeks and lasts until about twelve weeks after the first missed period. Possible causes for this discomfort may include your body’s reaction to the hormones of pregnancy, too little vitamin B-6 or too little glycogen stored in your liver. Some object to the term morning sickness because this queasy sensation can last all day. You may be helped by eating some dry toast or crackers before getting out of bed in the morning; eating small, frequent meals can also help. This sick feeling can affect your emotions and your emotions can make it worse. Remember that this is a normal condition. Usually it is better to keep active and go on with your usual daily plans as much as possible. Please refer to earlier section on nausea for specific recommendations. Prolonged vomiting is unusual and if present, you should call the office.
Tiredness: Feeling tired is common in pregnancy because of the extra energy that is needed to carry your developing baby and care for your changing body. Tiredness can also be an effect of the hormones of pregnancy or from anemia. The majority of your energy will return after twelve weeks. Get rest but be sure that you exercise daily. Exercise helps your circulation and brings oxygen and nourishment to your entire body. Walking is great exercise for you.
Headaches: Some women experience headaches during pregnancy. Nasal congestion can result in a headache. Alternating (every 15-20 minutes) warm and cold towels over your eyes and forehead may relieve this. Eyestrain can occur because of the increase in volume in your circulation. This is not a good time to get new glasses or contact lenses. Anxiety and tension are other possible causes of headaches. Rest and relaxation are often the best remedies for this problem. Some headaches are caused by the lower blood sugar levels of early pregnancy–tea with sugar or a soft drink can help relieve these. DO NOT TAKE ASPIRIN. You may use Tylenol (acetaminophen).
Breast Changes: During pregnancy, your breasts are getting ready to produce milk. They get larger and the milk glands enlarge. Veins may become visible and your nipples and the pigmented area around your areolae (nipples) will darken and widen. Your nipples can itch, and cream or lotion helps. Change your bra size as needed, don’t try to use too small a bra. Support is important. You may or may not have a clear or milky discharge from one or both of your nipples. This can happen at any time during your pregnancy, so don’t be concerned.
Skin Changes: You may notice changes in your skin and hair. Wrinkles may be less obvious. Gums may soften. Your hair may be less manageable. You can use vitamin E oil for dry and itching skin. Brush your teeth at least twice a day. Use dental floss and massage swollen gums with a soft toothbrush. You might notice your gums bleed very easily. If able, visit your dentist during pregnancy so any changes in your gums can be noted. Call your dentist if you experience pain or excessive bleeding.
Frequently Asked Questions from Our OB Patients
2ND AND 3RD MONTHS
9-13 Weeks
The wonder of human development continues. The fetus is now about 3 long and weighs about an ounce. Teeth are forming in the tiny jawbones and the external ears are developing. Arms, legs, hands, feet, fingers and toes, complete with beginning nails, are all there. By 13 weeks, the male fetus has a penis and testicles, complete with sperm. The female has a vagina, developing internal sex organs and ovaries with eggs.
Changes You May Experience
You may be still having some morning sickness, but hang in there. Most women are over it at the end of this time period. Your clothing is getting a little snug so you need to think about your maternity wardrobe. Also, invest in a good adjustable support bra that allows for later chest expansion. Anticipate for the total weight gain when buying maternity clothes and bras, get a size larger.
Excessive salivation is a problem for a few women. Chewing gum may help keep excessive swallowing under control and several small meals instead of large ones will help as well. You are less likely to feel nauseous if you have something in your stomach. This potentially will reduce acidity and heartburn.
Fatigue continues, but is decreased by exercise and your return to a more normal lifestyle.
Explanation of Initial Prenatal Lab Work
3RD AND 4TH MONTHS
Weeks 14 to 18
Your baby is still very small, weighing about 4-6 ounces. The head appears large compared to the rest of the body. The baby has a strong heartbeat, can suck its thumb and move its muscles.
You are probably feeling better, have more energy and are adjusting to your pregnancy. Congratulations, you are now in your second trimester. You may be beginning to show, so select loose, comfortable clothing.
Nutrition: Usually morning sickness is just about gone. Sometimes women are so grateful about feeling like eating that there is an urge to eat everything in sight. Eat good food from the four food groups: Milk/dairy, grains/cereals, fruit/vegetables, meat/poultry. Monitor your weight gain. A big weight gain now goes to you, not to the baby. Watch dietary fats!
Body Changes: You may notice a dark line (linea negra) down the center of your abdomen. This will fade after the baby is born.
How Many Months am I? To calculate how many months you are, subtract from your due date. For example, if your due date is June 1st:
| June 1 | 9 months | 40 weeks |
| May 1 | 8 months | 35 weeks |
| April 1 | 7 months | 31 weeks |
| March 1 | 6 months | 27 weeks |
| February 1 | 5 months | 22 weeks |
| Jan 1 | 4 months | 18 weeks |
4TH AND 5TH MONTHS
Weeks 19 TO 23
Growth continues. Now your baby weighs 1/2 to I pound and is 10-1 2 long. Baby’s muscles are developing and you can usually begin to feel the exercising that is going on. This feeling of movement is called quickening. The baby is skinny and the skin is clear but fat is starting to develop. Hair may be beginning to grow on the head.
You may be experiencing backaches because of changes in weight, shape and balance. To compensate, you may change the way that you usually sit or stand and this can cause muscle strain. Try to maintain good posture and use your body in a way that does not strain your back. Always squat instead of stooping or bending over. Use a firm, flat mattress. Do not twist your back sideways. Gentle daily exercises can help you relieve some of the strain. Try head rolling and shoulder shifting and rotating to reduce tension and strain of your upper back. Pelvic rocking should help your lower back. Wear comfortable shoes with heels of a height that you are used to. High heels can cause some back discomfort. Sleep with a pillow between your knees. When lying on your side, place a small pillow under your abdomen (belly) for comfort.
Body Changes: You may notice increased sweating, increased nasal congestion and increased vaginal discharge. This is due to increased circulating blood volume and will end after birth. You may notice you are putting on more weight in your buttocks as well as your abdomen. Your naval (belly button) may pop out and stay that way until after the birth. Your chest also expands more this month. You may begin to have shortness of breath because of upward pressure on your diaphragm.
Pelvic discomfort can be caused by changes in the pubic bone and the sacroiliac joints as they relax to allow space for the baby to pass through the birth canal. At times, this can cause pressure on the sciatic nerve, resulting in numbness or pain in the pelvic area, the back and down one leg. Massage is sometimes helpful as well as pelvic rocking. Try different positions to find one that is comfortable for you. You may be comfortable sleeping on your side with your top leg bent forward and supported by a pillow.
Some swelling of legs and hands can be expected because your body tends to hold water during pregnancy. The enlarging uterus also puts pressure on the large blood vessels that return fluid from your legs. Avoid sifting or standing in one place for long periods of time. Do not cross your legs. Nutrition plays a role in helping your body hold or eliminate water. Be sure that your diet is rich in protein but avoid all heavily salted food such as potato chips, pretzels or other salted snacks.
Baby activity: By the end of this month, you should regularly be feeling the fetus move and maybe see some of the movement on your abdomen. Have father place ear next to abdomen to hear and be kicked by the baby. Have father and mother talk to baby.
SPECIAL INSTRUCTIONS FOR THIS MONTH: You should be signing up for prenatal classes.
5TH AND 6TH MONTHS
Weeks 24 to 28
Your baby continues to grow. Height is 11-14 and the baby may weigh from 1 1/2 to 2 pounds. The skin, red and wrinkled, is covered with vernix caseosa, a white cheese or cream-like substance. The eyes are open and sensitive to light. The baby can hear and has hand and footprints.
Stretch marks of some kind are experienced by 90% of pregnant women. They form when the skin is not elastic enough for the rapid stretching required by pregnancy. Most often, they appear on the abdomen but some mothers get them on their breasts and thighs as well. Nothing is guaranteed to help but it is suggested that vitamin E and vitamin C may be of some benefit. Keep the skin soft and supple by lubricating it with cream, vitamin E oil or cocoa butter. This may help minimize the marks. Stretch marks do not disappear totally after delivery but they usually shrink and fade.
Body changes: You may experience: Heartburn – eat smaller, more frequent meals, do not lay down after eating, chew each mouthful of food 30 times (a great deal of digestion takes place in your mouth. You may use antacids, either liquid or chewable, in the amounts recommended by the particular brand. Gum swelling – brush your teeth two times each day. Stitch- like pain down the side of your tummy – this is the uterine muscles stretching, with rest and pillows, it should go away. Your breasts may leak colostrum (milk). Wear breast pads in bra; use ice or cold cloths on breasts if leaking a lot.
Constipation is often a problem during pregnancy because the digestive system is cramped by the growing fetus, and the hormones manufactured by your body during pregnancy can slow down the movement of your intestines. Iron and vitamin supplements can make the problem worse. Be sure to drink several glasses of water daily. Water is a good choice because it does not add extra calories. Eat raw fruits, vegetables and whole grains and drink juices. Do not postpone having a bowel movement once you have the urge. Give yourself enough time and try raising your feet with a telephone book or stool. This angle change seems to make elimination easier. If constipation persists after trying the above, Colace, an over-the-counter stool softener, and Metamucil can be used.
Constipation can aggravate another problem, hemorrhoids, (also known as piles), which are varicose veins in the rectum. They occur because of increased volume of blood in your circulation and the pressure of your growing uterus. Constipation makes them worse. If hemorrhoids are a problem, sit in a warm tub of water on a bath towel for 20 minutes twice a day. It is OK to use an over-the-counter preparation such as Preparation H or Anusol occasionally. If you notice the hemorrhoid becoming bluish, painful or does not respond to this treatment, be sure to tell the doctor or nurse.
At your 28th week visit you will have your blood drawn for:
- Glucose screen to check for gestational diabetes.
- A blood count to check for anemia.
Patients with Rh negative blood types will be given RhoGam at the next visit.
SPECIAL INSTRUCTIONS FOR 5TH AND 6TH MONTHS
6TH AND 7TH MONTHS
Weeks 29 to 33
Your baby is fully developed by the end of this period, weighing about 3 1/2 pounds and measuring about 16 inches long. The baby has developed taste buds, the male’s testicles have descended into the scrotum and all organ systems are developed. Babies born at 28 weeks gestation have a fairly good chance for survival, depending on their weight. The next two months, however, are important periods of growth and maturity and they help assure a healthy entry into the world.
You are definitely looking and feeling pregnant. Artists have tried to capture the beauty and glow that some women have at this time. You are doing a good job, congratulations on taking good care of yourself.
Heart pounding is occasionally a normal response your body makes to meet your baby’s needs and pump the extra volume in your circulatory system. When you feel this pounding, make a conscious effort to relax and let go of all the tension in your body. Take a deep cleansing breath, then breathe easily and comfortably. Also, decrease caffeine in your diet. If you experience pain or have a continuous problem with this, be sure to tell your doctor about it.
Muscle cramps (especially in the legs). The weight of your baby on major blood vessels can slow circulation to the legs and lead to cramps. A lack of calcium in your diet may also cause cramps. To ease a cramp in your leg, try flexing your foot and toes up off the floor towards the ceiling while leaving your heel down.
Breathlessness may be noticed when you climb stairs or exert yourself. The size of your lungs has decreased as your abdomen expands. Maintain good posture when possible.
Contractions: To get ready for labor, the uterus may contract at random times. Some women feel them as early as 4 months; others are unaware of them until near the end. These so-called Braxton-hicks contractions are different from labor in that they are irregular, do not get stronger, and do not result in birth. Just continue your activities, and walking may even soothe them. If the contractions are severe or persist, occurring more than four times in one hour, try lying down and drinking more liquids. This will decrease the irritability of the uterus. If this does not work and the contractions increase or you notice a change in your vaginal mucus, contact the doctor.
Time to choose a pediatrician–ask friends for recommendations. See our brochure for Newborn classes. We also recommend the Breast Feeding class.
7TH AND 8TH MONTHS
Weeks 34 to 37
Your baby is growing! She or he is now about 18 inches long and may weigh as much as 5 pounds. The baby’s fingernails are long and there is lots of activity in your uterus. If born now, the baby’s chances for survival are good. This is the time to talk to the baby who can now hear music and parents’ voices. The baby can be rocked and massaged by gently rubbing your abdomen from your pelvic bone to the navel.
You are probably getting anxious for labor and birth to happen. Some feel as if the time has gone by too fast and others feel they have been pregnant forever.
Faintness: Sometimes a feeling of faintness can occur late in pregnancy. This is from low blood pressure, which can occur if you stand for a long time. When standing for a long time, move around frequently. Give yourself frequent rest periods, put your feet up but avoid lying flat on your back. Faintness may also be from low blood sugar or from too little iron in your blood. Eat healthful foods in small amounts at frequent intervals. If anemia, or too little iron, is detected during an office visit, change your diet to include foods that are rich in iron. Examples are raisins, green vegetables, and whole grains. The doctor may also give you an iron pill to take.
Another discomfort that may be more noticeable at this time is pain in the groin or lower abdomen from the stretching of your ligaments. You may also experience a backache. Good posture and good body mechanics can help.
Heartburn is another frequent visitor during the last months. Frozen yogurt is a healthy remedy for heartburn. Eat six small meals instead of large ones, avoiding spicy, fried foods and fat. Do not eat 2-3 hours before going to bed.
Constipation may also return at this time. Be sure to eat fresh fruits, vegetables and roughage. Drink several glasses of water per day. Metamucil may also be used.
Insomnia (difficulty sleeping) is another problem that is very common at this time. You are not alone. Part of this problem can come from discomfort and part can come from tension or worry. Try a warm bath, relaxing with soft music and try sleeping on your side with a pillow supporting your knee and hip joints. Some feel that waking up at night is to get you ready for early morning feedings with the baby. Sooo… enjoy the dawn (or night). Keep a book or magazine nearby. Better to enjoy a quiet activity for 15-20 minutes than to toss and turn in frustration for an hour.
Special instructions for this month:
Start thinking about your baby’s doctor (Pediatrician), and start thinking about labor.
Ingredients For A Positive Birth Experience
9TH MONTH
Weeks 38 to 42
During this time, your baby is continuing to grow and mature. The baby is gaining weight and no longer is wrinkled in appearance. The skin is red and smooth. By the end of this period, the baby will be 20 inches in length and will weigh about 7 1/2 pounds. The downy hair that was once all over the baby’s body is now only on its arms and shoulders. Sometime during this month, the baby will change position to get ready for delivery. If this is your first baby, the head will drop down into your pelvis and engage in position for birth. That is what people mean when they say, You’ve dropped. If you have had a baby before, this may not happen until you are in labor.
You may be starting to feel that you have been pregnant forever! You have done a good job and it really won’t be much longer. This is the time to talk to the baby who can hear music and parents’ voices. The baby can be rocked and massaged by gently rubbing your abdomen from your pelvic bone to the navel.
Vaginal Discharge
A thick white discharge is normal at this time. Use sanitary napkins if necessary but not tampons. If this discharge becomes bloody, yellow, green, develops a bad odor or causes burning or itching, contact your doctor or nurse.
Special Instructions for This Month:
Review our labor instructions, and start packing your bag.
