Second Trimester

Anatomy scan

The anatomy scan is done between the 18th and 20th week of pregnancy.  It is an option to have this scan and also optional to find out the sex of the baby.  This scan is longer than the nuchal 12 week scan and thoroughly looks at all the organs, especially the heart.  It also looks at the position of the placenta which is important.  Sometimes the placenta will be low-lying and you will need a follow up scan at 32 weeks.

The overall opinion is that a scans in pregnancy are safe although excessive scans in the first 10 weeks has the most potential for side effects because of the developing baby.

There is some evidence to suggest an association between non-right-handedness in males (5+scans). The significance of these handedness studies is the higher risk of an association of left handed in infants and lowered intellectual abilities (Kieler et al 2005).  However, it is important to remember that we do not notice any obvious differences and some women need regular scans due to complications.

Kieler H, Haglund B, Cnattingius S et al 2005 Does prenatal sonography affect intellectual performance? Epidemiology 3:304-310

Exercise

Exercise during pregnancy has different meanings for different people.  Some women view it as gentle stretching like Pilate’s and Yoga to prepare for labour and birth.  While others, it means recreational sport or general fitness like swimming, cycling, walking and team sports.  There is some new research on the psychological and physiological effects during pregnancy and everyone agrees that there are benefits.  If you go to the gym then it is advisable to talk to a personal trainer to set an appropriate program for you.  If you go to classes then tell your instructor you are pregnant and they can advise if any changes are necessary.

Basically you have to listen to your body and take it easy if you are becoming breathless and overheated. Also drink plenty of fluids and maybe shorten the duration.  With Yoga the recommendation is no inverted poses.

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Exercise-During-Pregnancy-and-the-Postpartum-Period

Constipation

Yes this is part of most pregnancies! It is partly due to an increase in hormones (progesterone), especially in the first and last trimesters.  Also your increase in water absorption leading to dryer stools and as your baby and belly grow your intestines get displaced.

Signs:  If you have not had a bowel motion for 3 days then you need to do something about it as the toxic buildup is unhealthy.  Bloating, straining, hard and painful stools are all part of it.

Self Care: Drink at least 6 – 8 glasses a day of fluid (not fizzy) but water or milk (dairy, soy, rice or almond) are the best choices. Also increase fibre in the diet which is found in wholegrain breads (not white bread), nuts, cereals, fruits and veggies.  Try eating at least 3 kiwi fruit a day.  Kiwi Crush available from a supermarket is safe to use if needed.  You do not want to use strong herbal laxatives as there may be risk of stimulating uterine contractions.  Daily exercise (a half hour) aids in digestion and helps you feel good.  A glycerin suppository may be okay to use but see GP or Midwife for more information.

www.whattoexpect.com

Sex

During pregnancy some women have a strong sex drive while others do not.  Either way it is up to you how long and how often.  It is generally safe but we do recommend being very gentle and finding comfortable positions.  In pregnancy the cervix may bleed easier so sometimes there is a small amount of blood after sex.  Please still contact your midwife about the bleeding as it may need investigation and you may need an anti – D injection if you are a negative blood type.

Some positions to try are: side lying and sitting on top of your partner.

Bladder infection (UTI and Cystitis)

This occurs when bacteria infect your bladder and cause inflammation (swelling, often with irritation) of the bladder lining.  It is more common in pregnancy and can easily progress to kidney infection (pyelonephritis). Contact your midwife ASAP if any symptoms!

Signs and symptoms:  burning or stinging when passing urine; need to pass urine more often; passing only small amounts of urine at a time; fever, feeling unwell, chills, vomiting; blood in the urine; smelly or cloudy urine; pain in lower back and/or very low stomach.

Self Care: drink 2-3 glasses of water at start of symptoms and continue to drink as much as possible; go to bed or rest; avoid caffeine and fizzy drinks; do not have sex until symptoms are gone; start vit.C tablets up to 2000mg a day and cranberry tablets or cranclense to reduce infection; see herbalist for herb tea or tincture that is safe to use in pregnancy.  If pain becomes severe and radiates around your back then you may have a kidney infection and need antibiotics so call your midwife ASAP!

Heartburn

An extremely common part of pregnancy which presents as an uncomfortable burning sensation due to acid passing up from the stomach into the oesophagus.

Self Care: Chewing gum helps a lot of women!  Try to eat smaller amounts more often and avoid spicy and fatty foods. A glass of milk can help as well as chewing a few raw almonds until they are gone.  A gentle walk after dinner/tea works for some.  You may find using a supplement called BioBowel Aloe Soothe is helpful (available at a health shop). Chewable or tablets of Slippery Elm and/or papaya are excellent as well.  Some people find a tsp of baking soda in a glass of water works wonders. Also chewing gum works for some. One final remedy is a Tbs of apple cider vinegar in warm water with a spoon of honey mixed in for taste if necessary. If possible try to avoid or limit “quickies”, Mylanta and Gaviscon as overuse may be damaging to the kidneys and stomach lining.

Leg cramps

These cramps are usually in the calf at night time and very painful! Most leg cramps are caused from the fatigue of carrying around extra weight in pregnant. As you gain more weight, your leg cramps may increase. Cramps can also be aggravated by the expanding uterus putting pressure on blood vessels that return blood from your legs to your heart and the nerves leading to your legs. There is some speculation that too little calcium, potassium, or too much phosphorus can cause leg cramps. There are no good studies that support these theories at this time. However, it is a good idea to increase your calcium intake during your pregnancy and to avoid phosphorus (found in processed meat, snack foods and soda), which will combat any problems that a lack of calcium could cause. Phosphorus has the same effect as not getting enough calcium because it can prevent your body from absorbing the calcium you do ingest.

Self Care: don’t stand or sit with your legs crossed for long periods of time and stretch your calf and leg muscles during the day and before bed. Rotate your ankles and wiggle your toes when you are sitting.  Try to take a walk each day, even if it is only 10 minutes it can help. Also lie on your left side to improve your circulation and rest when you are tired with your legs elevated. Sometimes wearing supportive stockings may help which are available online or at pharmacy. A warm bath before bed is a great way to help relax your muscles and helps you sleep better as well. Of course drinking plenty of water is a necessity.  You can take a magnesium supplement in addition to your prenatal vitamin (if you are taking one). Magnesium has been proven to be beneficial in the treatment of leg cramps.

Nutrition and weight gain

By this trimester your appetite should increase slightly to support the growth and development of your baby.  Your energy requirements will be increasing by 12% a day. You can meet this by eating one extra sandwich, or an extra serving of yoghurt and fruit with a snack of cheese on crackers.

Pregnancy is the perfect chance to decrease the amount of processed foods eaten and to ensure each meal has colour in it, not just brown and white!  Some snack ideas are fruit, vegetable sticks, low sugar cereals, whole grain bread, popcorn, rice cakes, plain yogurt, low-fat milk and water.

More importantly is the need for greater vitamin and mineral intake, such as:

Iron: At least a 2 – 3 times increased intake is required for your growing baby and to increase your blood iron carrying capacity. Sources include: lean red meats, chicken, fish, beans and lentils, eggs, dried fruit, nuts & seeds, green leafy veggies.  Make sure you have 500mg of Vit. C with your iron supplements for better absorption and avoid milk and caffeine 1 hour before and after your supplement.  Constipation is very common with the Ferrous Gradumet tablet so try taking a different one or this one every other day.

Zinc: Found in whole grains, mushrooms, beans, beef, lamb and crab. 15mg a day is needed for all phases of growth, and tissue development for your baby.  You also need it for your immune system and most women are low in it.  Studies have found that zinc deficiency in pregnancy increases premature birth, pre-eclampsia and low birth weight babies.

Calcium: 3 servings a day for the development of bones and teeth for baby and the maintenance of your skeleton. Sources include: Dried fruit and nuts, green veggies, cheese, milk and yogurt, canned salmon and sardines

Magnesium: Cashews, green leafy veggies

Vitamin C: oranges, kiwi, red peppers and strawberries are good natural sources.  The minimal intake is 85mg a day. Vit. C is water soluble so it is difficult to overdose unless you have kidney problems.  There is conflicting evidence and advice on the safe level to take in pregnancy but the agreement is up to 2000mg a day. Check this interesting site on high levels of Vit. C

http://www.vitamincfoundation.org/forum/viewtopic.php?f=3&t=8012

Omega 3 Oil: found in oily fish like salmon, sardines, mackerel, anchovies.  Other sources are in flax, sunflower and canola oils as well as walnuts and dark leafy vegetable. It is necessary for the development of your baby’s brain, eyes and nervous system.  More benefits for you are a decrease in pre-eclampsia, postnatal depression and preterm birth.  Ideally 250mg a day are needed from the beginning of pregnancy.

http://www.pregnancy-info.net/omega3.html

http://pregnant.thebump.com/pregnancy/nutrition-exercise.aspx?MsdVisit=1

Weight gain is a normal part of pregnancy and dieting is not recommended.

Weight gain recommendations in pregnancy are

 Pre-pregnancy BMI (kg/m2)  Total weight gain  
Range in kg Range in lbs
Underweight (<18.5) 12.5 – 18 28 – 40
Normal weight (18.5 – 24.9) 11.5 – 16 25 – 35
Overweight (25 – 29.9) 7 – 11.5 15 – 25
Obese (>30) 5 – 9 11 – 20

Reference: 2009 IOM Weight gain during pregnancy: Re-examining the guidelines