Pregnancy Overview

Welcome to Metropolitan Family Medical Clinics thank you for choosing us for your prenatal care. We understand that pregnancy is an extraordinary time and we are honored to serve the women in our community as they bring their babies into the world.    

 At Metropolitan Family Medical Clinics, our dedicated group of experienced physicians and staff are committed to providing our patients with the best medical care possible throughout your pregnancy. Choosing the right obstetrician to guide you through your pregnancy is an important and personal decision and we prioritize exceptional communication, compassion, and respect between our healthcare providers and patients. 

 Women today have to manage their pregnancies as part of full, busy lives and we want to make sure that the care women receive at Metropolitan Family Medical Clinics  is as accessible as it is excellent. We believe that you should feel like an active partner in your prenatal care throughout your whole pregnancy. From managing first trimester symptoms to formulating a birth plan, we are committed to promoting the health and welfare of our patients with mindful, individualized care. 

Listed below are the most common procedures, medications, teaching and assessment we do throughout your pregnancy. Your obstetrician will personalize and tailor the care to you and your pregnancy. 

• Routine Prenatal Care
• Fetal Surveillance
• Aneuploidy Screening
• Aches & Pains
• Diet & Weight Gain
• Nausea & Vomiting
• Breastfeeding
• Resources
• Cesarean Sections
• Signs of Labor
• Labor Pain Management
• Post Partum Care

 Metropolitan Family Medical Clinics  is dedicated to the women in our community and we want to provide you with the best healthcare experience possible. Thank you for choosing us to partner with you during this very special time in your life. 

Routine prenatal care is an important part of ensuring a healthy pregnancy and the safe delivery of your baby. Pregnancy is a dynamic time and routine prenatal care allows health providers to monitor fetal development and maternal well-being. Usually, routine prenatal care is just that – routine – but if a medical issue arises at any time throughout the pregnancy, regular doctor appointments enable care providers to identify issues early and administer immediate, individualized care. 

The first prenatal care appointment is exciting and busy. A nurse practitioner or doctor will take a detailed medical history including a discussion of any preexisting conditions, medication use, and whether or not changes to your current health regimen need to be made. You will also receive a physical and a pelvic exam and your projected due date will be determined, usually by counting out 40 weeks from your last period. In some cases, an early ultrasound may be needed, though this is not typically provided at the first doctor’s visit.

At your initial pregnancy care appointment, your medical provider will order a series of labs including blood work and urine tests. These are important – but general – tests and not a cause for concern; however, your doctor will discuss options if you want to undergo additional testing for abnormalities. You should always feel comfortable discussing your personal values and desires with your healthcare provider and specifying the kind of pregnancy experience you hope to have.

Your first prenatal care appointment is a great opportunity to find out how to have a healthy pregnancy and discuss specific guidelines for work, exercise, diet, prenatal vitamins, and travel. Come prepared with any questions or concerns you have, and feel free to bring your partner along so they can participate actively throughout the pregnancy, too.

After the first prenatal appointment, you should visit your care provider once every four weeks during the first two trimesters. Upon entering the third trimester, appointments should be scheduled for once every two weeks and visit frequency should increase to once a week for the last month of pregnancy, unless your care provider determines otherwise.

At each prenatal care appointment, medical staff will take your blood pressure, check the fetal heartbeat, and order lab work to ensure that you and your baby are doing well. Toward the end of the second trimester, you will also need to have glucose screening to test for gestational diabetes and your blood count will be evaluated for anemia.

An ultrasound is typically preformed around 18 to 20 weeks to assess fetal development and at this point you can usually find out the sex of your baby. This ultrasound is usually the only one done in a pregnancy unless your doctor determines that you need an additional ultrasound, but that will be determined on an individual basis.

As your pregnancy enters the third trimester, it is recommended that you visit the hospital where you plan to deliver and register for childbirth, newborn care, and breastfeeding classes. It is also advised that as you get closer to giving birth, you should make arrangements regarding important childcare decisions so that everything is in order by the time your baby arrives.

At your last few prenatal care appointments, you will discuss labor signs and review your birth plan. Your healthcare provider will also ask if your baby is moving around frequently and you may have your cervix checked to determine if you are showing signs of going into labor. A vaginal swab is also done on most women to check for Group B Streptococcus, which if positive, requires antibiotics during labor to prevent transmission to your baby.

Every woman hopes that her pregnancy will progress normally, but sometimes health issues do arise. In highly developed countries like the United States, it is easy to forget that pregnancy and childbirth come with some inherent health risks, and there can be significant consequences to not receiving adequate medical services. Fortunately, routine pregnancy care can prevent or manage many complications and it unequivocally reduces health risks to both the mother and child. Make prenatal care a priority in your pregnancy. 

Prenatal care is one of the best things you can do to ensure the healthiest possible pregnancy for both you and your baby, but it also has benefits after you give birth. When you receive vital prenatal services throughout the entire nine months of pregnancy, you develop meaningful relationships with your healthcare providers.  The obstetricians and nurse practitioners who helped you through your pregnancy will have a personal understanding of your whole pregnancy journey, and they will be equipped to help you through your postpartum care, and future family planning choices. 

Fetal surveillance is a broad term that refers to a variety of non-invasive tests that may be administered during a pregnancy in order to evaluate whether or not a baby is thriving in utero. These tests are typically ordered by obstetricians for women who are experiencing high risk pregnancies, and they are an additional means by which to manage and monitor both the mother’s and baby’s health and well-being. 

Fetal surveillance tests are a series of assessments that monitor a pregnancy when certain medical conditions are present or complications arise. Factors that can lead to a pregnancy being considered as high risk are diabetes, high blood pressure, multiple gestation (twins or more), post-term pregnancies (when gestation goes beyond 42 weeks), or women with pre-existing health conditions or previous high risk pregnancies.

However, if a physician orders fetal surveillance testing, it is not necessarily a cause for alarm. These tests should be regarded as an extra measure of vigilance for a mother and baby and are designed to ensure that the pregnancy and birth are as healthy and safe as possible.

The types of tests a pregnant woman can receive as part of fetal surveillance will depend on each specific case. Assessments may include ultrasound, non-stress tests (NSTs), contraction stress tests (CST), and biophysical profiles (BPP). 

 Ultrasounds performed in the case of fetal surveillance may be given periodically throughout a pregnancy and are often used to monitor the development of the fetus and the intrauterine conditions. 

This test measures a baby’s heart rate and fetal movement over a specific period of time without any external factors being applied. For the NST, the fetal heart rate is monitored externally with a sensor that is attached to a belt and placed on the mother’s abdomen. This test poses no risk to the mother or child. 

A Contraction Stress Test measures how a baby’s heart rate responds when the uterus contracts. As with the NTS, this test is administered with a belt sensor, but unlike the NST, contractions are physically or chemically induced and measures are taken under those altered conditions. 

The BPP uses a combination of ultrasound and NST to determine a baby’s fetal heart rate, breathing and body movements, fetal muscle tone, and the amount of amniotic fluid around the baby. 

Fetal surveillance is typically only necessary in certain cases of high risk pregnancies. There is usually no need for such monitoring in low risk pregnancies and women should not feel the need to request these tests since fetal surveillance will only be administered if a doctor sees a need for them.

However, fetal surveillance may be required at any time during the pregnancy if complications should arise in an otherwise normal pregnancy. For instance, a decrease in a baby’s movements over a specific period of time may warrant a period of testing. Likewise, fetal surveillance may be curtailed if a baby is responding well, but if the baby does not respond to the monitoring as expected, additional recommendations will be made and measures taken.

The doctors and staff at Metropolitan Family Medical Clinics, ObGyn share the same goal with the new mothers we serve. It is our desire to see healthy pregnancies through to full term deliveries and fetal surveillance is sometimes a necessary step towards reaching that goal. We understand that it can be worrying to have a pregnancy categorized a “high risk” and to need special tests to ensure the pregnancy progressing as expected, but fetal surveillance should be cause for comfort since they allow our obstetricians to closely monitor and care for mother and child at any point throughout a pregnancy.  

 If you have any questions about your high risk pregnancy or the need for fetal surveillance testing, please contact Kansas City ObGyn today at  info@metrofamilymedicalclinics.net  or  1-800-870-1815.  

 It is the hope and goal of both pregnant women and their doctors that babies are always born healthy and at full-term. Sometimes though, complications during gestation can cause chromosomal anomalies to develop in the fetus, which can result in mild to severe genetic disorders. Aneuploidy screening can detect the possibility of such abnormalities in the chromosomes of cells early on in the pregnancy.

Human beings have their genetic information encoded in 46 chromosomes, but occasionally more or less than that number of chromosomes may occur. This is called aneuploidy, which is not a specific disorder, but rather a broad term that describes the cause of such conditions.

Aneuploidy occurs during cell division when the chromosomes do not separate properly in a developing embryo. These malformed chromosomes can have missing, extra, or altered genes that can cause genetic disorders, birth defects, and diseases. Aneuploidy can be inherited genetically or it can happen randomly. The most common condition that results from aneuploidy in humans is Down syndrome, which is characterized by extra genetic material from chromosome 21.

No, aneuploidy screening is not a diagnostic test. Rather, it is an initial assessment of whether or not a fetus is at an increased risk for genetic disorders. However, in the event that screening indicates that a moderate or high risk for genetic problems is present, further diagnostic testing will be necessary. 

The American College of Obstetrics and Gynecology recommends that doctors discuss aneuploidy screening as soon as possible, most often at the very first prenatal appointment. Since chromosomal abnormalities occur in the earliest stages of fetal development, there is no reason for delay, and women should have access to reliable information about their pregnancies as early as screening allows.

While some chromosomal disorders are inherited, many are not, so all pregnant women are advised to receive the testing regardless of whether or not they have a family history of genetic disorders. For the same reason, women who have had unremarkable pregnancies in the past should still consider screening since aneuploidy can occur in any pregnancy, regardless of previous healthy births.

Women are also encouraged to get screened for aneuploidy no matter their age. Traditionally, pregnant women aged 35 and older were considered to be at a higher risk for having babies with genetic disorders, but chromosomal abnormalities can happen in the pregnancies of women at any age, so a risk assessment based solely on maternal age is not sufficient.

For certain high-risk women, an additional visit to perinatal specialist (maternal fetal specialist) may be recommended. These specialists can offer more information and additional testing pertinent to the specific needs of individuals based on a family history of aneuploidy or other factors.

Non-invasive aneuploidy screening is safe and easy. A blood sample taken between the 11th and 14th weeks of pregnancy can determine if further testing is necessary. Specific ultrasounds that look for anatomical indicators are also available. 

Aneuploidy screening should not be regarded with anxiety. Early and accurate assessments can reduce some of the normal worry that accompanies any pregnancy and should be considered as part of any routine prenatal care.

While aneuploidy screening is strongly recommended by medical professionals, it is an optional screening in your prenatal care. Whether or not to receive genetic screening is a personal decision and it is in a woman’s best interest to consider how such screening will affect her pregnancy depending on the results.

Counseling is available to help women and their families understand the benefits and risks of aneuploidy screening and discuss follow-up diagnostic testing and how to manage a pregnancy in the event of a positive result. The decisions a woman makes regarding aneuploidy screening and further diagnostic testing should be compatible with her individual values, and will be respected by her physicians at Metropolitan Family Medical Clinics.

If you have any questions about what to expect from screening for chromosomal abnormalities, or would like to schedule your aneuploidy screening, 

please contact Metropolitan Family Medical Clinics, today at info@metrofamilymedicalclinics.netor 1+800-8701815.

Pregnancy is a special time in a woman’s life and many women feel energized and excited by the new experience of carrying a child and becoming a mother. Even so, pregnancy is physically demanding and it comes with its own unique aches and pains. Fortunately, though, most of pregnancy’s symptoms are perfectly normal. However, it is still helpful to understand the discomforts of pregnancy, how they might change from trimester to trimester, and how to better cope with them. 

Pregnancy can be exhausting. This is especially true during the first trimester, when the body is experiencing rapid physical changes and supporting critical fetal growth. Fatigue may persist even if you are getting an adequate amount of sleep, but energy levels typically improve around the end of the first trimester or the early part of the second trimester. 

Nausea is common in the early stages of pregnancy. It is often referred to as “morning sickness,” but it can occur at any time of day and is often triggered by certain smells. For some people, nausea is manageable and may manifest itself as mere queasiness, but for others it can be debilitating. If nausea and vomiting persist or interfere with appropriate weight gain or cause dehydration, a physician consultation will be necessary. In most cases, the severity and frequency of nausea will decrease as the pregnancy progresses. 

 Abdominal pain is another common experience of the first trimester. As the uterus begins to grow, it can cause shooting or cramping pain anywhere in the lower abdomen. This is called “round ligament pain.” It can either resolve itself in the second half of pregnancy, or continue off and on throughout your pregnancy.

It is also not unusual to experience light bleeding or spotting after intercourse or strenuous physical activity, but heavy bleeding or bleeding associated with pain needs to be evaluated promptly by a health care provider.

For a lot of women, the second trimester is the easiest part of pregnancy. Many of the first trimester’s symptoms have subsided, and the baby has not yet grown so large as to be consistently uncomfortable. However, pregnancy-related back pain can be an issue at any time, and it is most often experienced in the second and third trimester. Backache can affect any part of the upper, mid, or lower back. The discomfort is caused by enlarged breasts, increased weight on the spine, and changes in pelvic support.

Some back pain can be alleviated by maintaining good posture, propping feet up when sitting for long periods of time, using supportive bras with wide straps, wearing low-heeled shoes, and getting adequate rest. Warm baths or low heat compresses applied to the aggravated area can also help. Regular exercise and appropriate stretching also help. If back pain continues after these measures, talk to your doctor. Women may also consider responsible use of medication and physical therapy. 

While backaches are a very common ailment of pregnancy, severe back pain can be a symptom of a more serious condition. Pain that is centered below the rib cage may indicate a kidney infection or stones, or a shooting pain in the buttock or down the back of the leg may be a sign of an issue with the sciatic nerve. Any of these symptoms should be addressed by your obstetrician 

In the later stages of pregnancy, it is not uncommon for fatigue to return and many women experience gradually increasing pelvic pressure, or discomfort through the lower pelvis caused by the increased size and weight of the baby. Maternity belts can add much-needed support in the third trimester. 

Swelling of the feet and/or legs is also normal and it is not usually a cause for concern if it decreases when the legs are elevated. Similarly, leg and foot cramps or tingling can occur at any time throughout pregnancy. Cramps and swelling can be exacerbated by dehydration. 

Another common feature of the third trimester is shortness of breath. This is caused by hormonal changes in your body and by your baby’s increased size putting pressure on your organs. Do not press yourself physically if you are experiencing trouble breathing. In most cases, shortness of breath is harmless and after you give birth your breathing will return to normal. However, sometimes labored breathing is a sign of a more concerning health condition. If you experience heart palpitations, faintness or dizziness, trouble getting a satisfying breath, or a rapid pulse, contact your doctor. A history of asthma or anemia can also exacerbate breathing issues during pregnancy. 

As you near your due date, you might begin to experience mild cramping or tightening across your abdomen. These are known as “Braxton-Hicks” contractions and they are milder and less consistent than labor pains. Warm baths, breathing exercises, and staying hydrated can help lessen the discomfort caused by these irregular cramps. 

The human body has an incredible ability to adapt to the strains and stresses of pregnancy, and while the aches and pains can be unpleasant, it is helpful to understand that they are a normal part of growing a healthy baby. Remember to be patient with your body and take care of yourself, and be deliberate about getting adequate amounts of rest and exercise and always stay hydrated. Maintain a well-balanced diet, and when your body hurts, listen to it. Take good care of yourself and your body will take good care of you and your baby. 

One of the most common symptoms of pregnancy is nausea and vomiting, and it is often the very first sign a woman gets that she is pregnant. It is most frequently experienced in the initial three months of pregnancy, and in the majority of cases it is unpleasant but manageable.

Pregnancy-related nausea and vomiting is often referred to as “morning sickness,” but that is a misnomer since it is neither contained to the morning, nor is it a sickness. A better understanding of why these symptoms occur in pregnancy often helps women cope more effectively with the resulting discomfort.

Nausea and vomiting in pregnancy is not usually a sign of illness and it is not harmful to the baby. It is a normal, if uncomfortable, physical response to the many changes the body endures in order to support a pregnancy.

Around 80 percent of all pregnant women suffer from some degree of nausea and/or vomiting during their pregnancies, and the cause is thought to be related to a hormone called Human Chorionic Gonadotropin (HCG). The body begins producing HCG at conception and it plays a crucial role in facilitating healthy fetal growth and the successful progression of a pregnancy.

In most cases, pregnancy-related symptoms of nausea and vomiting are mild and they decrease as hormone levels change near the end of the first trimester. However, there is no reason women should suffer unnecessarily. There are many effective methods that can help women manage nausea and vomiting symptoms safely.   

In an effort to cope with nausea and vomiting during pregnancy, it is useful to articulate what triggers the symptoms. For instance, many women are more sensitive to particular smells during pregnancy or experience sudden aversions to flavors. If queasiness is caused by certain odors or foods, it is best to avoid them. However, if eating anything at all induces sickness, try to consume smaller portions or snacks several times throughout the day instead of the traditional three larger main meals. Smaller and more frequent meals are often easier to digest and keep down, and it is always best to avoid heavy dishes and rich, greasy, or highly processed foods, but it is especially helpful if trying to manage nausea. 

Maintaining adequate hydration has many benefits during pregnancy and it can also suppress feelings of nausea and vomiting. The Institute of Medicine recommends that pregnant women drink 10 cups of liquid a day, or about two and half liters. In addition to easing the nausea itself, staying hydrated also helps to prevent other pregnancy symptoms such a headaches or cramping that can make nausea symptoms worse. 

There are many remedies women can try that may help to further allay feelings of nausea and vomiting. Smelling or ingesting lemons or ginger in herbal tea or hot water can mitigate queasiness, as can sucking on peppermint candy or wearing motion sickness acupressure wrist bands. Some studies have also indicated that acupuncture is a useful method for coping with nausea and vomiting.

Another option for dealing with nausea is to take 50 milligrams of vitamin B6 up to three times per day. However, if taking vitamins of any kind, including prenatal vitamins, increases queasiness or vomiting, do not stop taking them outright. Prenatal vitamins are a very important part of a healthy pregnancy. To alleviate nausea or vomiting caused by swallowing pills, try to take them at night right before bed and always avoid taking vitamins on an empty stomach.

In less common instances, nausea and vomiting in pregnancy is severe to the point of becoming physically debilitating. This condition is called Hyperemesis Gravidarum and it can cause exhaustion, weight loss, extreme dehydration, and an electrolyte imbalance. Women who suffer from Hyperemesis Gravidarum may have to go to the hospital for intravenous (IV) fluids. In such acute cases of nausea and vomiting, doctors may prescribe medications to help manage symptoms and protect the health of the mother and baby.

You Will Get Through This

Nausea and vomiting can be a very unpleasant part of pregnancy, but it is helpful to remember that in the vast majority of cases, the queasy feelings are normal, manageable, and temporary. Women should discuss their symptoms with their obstetricians so that they can enjoy every stage of pregnancy while remaining comfortable and productive in daily life.

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A cesarean section (also referred to as a c-section or C/S) is a surgical procedure designed to deliver babies when it is not possible or safe for the birth to take place vaginally (sometimes called “natural birth”). In the United States 32 percent of all babies are delivered via cesarean. C-sections are often planned in advance, but occasionally complications during delivery require an unexpected cesarean section. 

 In many cases, it is possible to plan for a cesarean section prior to labor and delivery. C-sections are often required if the baby is in a breech position (feet or bottom down), is too large, or is a multiple birth (twins or more). Cesarean sections may also be scheduled in advance if the mother has a history of previous c-sections or presents with other medical or obstetric complications.

Occasionally, an issue may develop during labor that necessitates an unexpected cesarean section. For instance, if the labor does not progress properly or the baby’s head does not descend, a vaginal delivery might not be possible. A physician may also decide that a c-section is needed in order to avoid a risk to the mother or if the baby is in distress. 

How a C-Section WorA cesarean section is a significant surgical operation but it is a fairly straightforward procedure. In preparation for a c-section, the woman receives spinal anesthesia. Once the pain medication takes effect, doctors make two surgical incisions, one in the abdomen and a second in the uterus. The incision will most likely be made horizontally across the lowest and thinnest part of the uterus. This is known as a “low transverse incision” or, more commonly, a “bikini cut.” Doctors prefer it because it heals quickly and is less likely to split if the woman wants to try for a vaginal delivery in a subsequent birth. A vertical incision may be necessary if there is a medical reason for it.

The doctor will remove the baby through the uterine incision and parents can hold and bond with their child immediately after a cesarean birth if both the mother and baby are healthy and do not require further medical attention. After the delivery, doctors sew up the incisions using a combination of dissolvable stitches, surgical glue, and/or staples that will need to be removed several days later.  

It takes approximately six weeks postpartum to recover from a cesarean section. During this time it is vital to rest and allow the body to heal. Doctors caution that for the first two weeks after a cesarean section women should lift nothing heavier than a gallon of milk and refrain from driving a car. Recovery from a c-section is more involved than a vaginal birth, so women who are recovering from cesarean section will need extra help with mobility and infant care, especially in the initial days after delivery.  

During the healing process, the c-section incision must be closely monitored to ensure an infection does not develop. The scar should be kept clean, but do not scrub it; simply rinse the incision daily with warm, soapy water and allow to air dry. It may be appropriate to apply a topical antibiotic to the scar, but consult your doctor to determine if this is necessary.

In general, the incision will become less painful as it heals. However, contact your physician immediately if the incision splits open or becomes infected.

Symptoms of infection that require medical attention are:

• A fever of 100.4º Fahrenheit
• Discharge from the incision
• A foul smell
• Redness, swelling, irritation, hardness or increasing pain and tenderness at the site of the incision

 A cesarean section is a common procedure with high rates of success, but it remains a major surgery that brings its own risks, potential complications, and extended recovery time. For these reasons and others, the World Health Organization and the American College of Obstetricians and Gynecologists advise pregnant women to avoid elective cesarean sections for the sake of efficiency or personal preference. It is best if women have c-sections only when it has been determined that there is a medical need for it.

As you approach your baby’s due date, you may begin to wonder how to recognize the first signs of labor. Every labor is different for every woman even if you have had babies before, but as your body prepares to give birth there are some sure pre-labor symptoms that will let you know your baby is on his or her way! 

During the last few weeks of your pregnancy, your doctor may perform a pelvic exam to check for any signs of early labor. Your healthcare provider will typically measure cervical dilation (in centimeters from 0 to 10), effacement (how thin or shortened the cervix is), and station (how low the baby’s head is). The rate at which your cervix dilates and effaces depends on many factors, including the number of previous pregnancies, if you have had a previous vaginal delivery, and whether you are having many contractions.  

The cervix changes its shape and structure to allow the baby to pass through the birth canal. It is usually long, tight, and narrow but as your body prepares to give birth the cervix begins to soften, shorten, and stretch open. This process is called “dilation.” Your baby will also drop down further into the pelvis which puts pressure on the cervix and causes it to thin out. This is referred to as “effacement,” and it is measured in percentages. For example, if your doctor says you are 50% effaced, it means your cervix is half of its normal thickness.

 As the cervix dilates, it is common for women to have vaginal mucous or discharge. This is called “bloody show” and it can be thick or thin with some blood streaks in it. This is not a cause for concern, rather it is a sign that your labor is approaching and the birth of your baby is imminent. 

Contractions refer to the periodic tightening of the muscles of the uterus. As your body prepares to give birth the initial contractions may be so subtle that you are unaware of them. These contractions often occur as a cramping or tightening of the belly and/or lower back. As they progress, they can become increasingly uncomfortable, enough to cause you to have to stop, sit down, and catch your breath.

Individual contractions usually last between 30 to 60 seconds, and may or may not have a pattern. It is possible to have one or two isolated contractions, or your contractions can come six to eight times in an hour or more. However, you are not in “hard labor” until your contractions have established a rhythm of coming every two to three minutes with very little break in between.

As you get closer to delivery, your contractions will build in both frequency and intensity. You may also feel pressure and pain deep in your pelvis, vagina, rectum, or back. Back labor is usually caused by the weight of baby’s head on the back or by its position within the birth canal. Back pain is often most significant during contractions, but it can persist in between them as well.

 Your water breaking is a good sign that you are either in labor, or will be soon. Sometimes, a woman’s water breaks definitively with a large gush of watery fluid, but it can also occur as a subtler trickle. If you are leaking fluid, check it if it smells like urine, since it is common in pregnancy to experience some incontinence.You should also check the color. If the liquid is anything other than clear, you will need to inform your healthcare provider promptly.

Once your water breaks you should contact your doctor and/or delivery center. If you are full term (within three weeks of your assigned due date), you will most likely be instructed to go to the hospital. However, it is possible to go into active labor without your water breaking. Effective contractions and the dilation of the cervix can take place without the breaking of the water but this is not a cause for concern. If your water does not break on its own, your doctor may rupture the membranes in order to progress your labor.  

If you are more than three weeks from your due date and are experiencing any early signs of labor, it is absolutely crucial to contact your health care provider immediately in case you are in pre-term labor. Premature labor and delivery can cause complications for you and your baby, but if treated early it can sometimes be avoided. Likewise, if your baby is not moving normally or if you are experiencing vaginal bleeding, you should consult your care provider since these issues could indicate other problems that require prompt evaluation. 

 Do not hesitate to contact your health care provider if you are unsure whether or not you are exhibiting pre-labor signs or especially if you have any questions or concerns. Every labor is unique and your care providers are best equipped to support you, provide information and let you know when it is time to come to the hospital and have your baby!  

 Many women are understandably apprehensive about giving birth due to fear of labor pain. It can be helpful to be aware of what to expect, and the available pain management options and to consider your choices before you are in active labor. 

Some women decide to use non-medical measures to cope with labor pain. Every woman is different and each labor experience is unique, so it is best to experiment with a variety of pain management techniques to find out which ones work best for you. Slow, controlled breathing, massages to the legs and back, warm baths, calm music, and walking can help with pain during labor. Women who choose to deliver their babies without medication should feel confident to clearly communicate their experience and needs to their healthcare team throughout their entire labor.

If you want to give birth without medication, a predetermined plan is helpful, but you should also feel free to change your approach to your pain at any point during labor. Switching positions, using heat compresses, or sitting on an exercise ball may help, as will continuous encouragement and support of your partner, family member, or doula.

While in labor, women have the option of receiving pain medication through an IV. This pain management option tends to work fairly well in early labor but is less effective later on. IV pain medication can cause drowsiness, and if given too close to delivery it can affect the baby’s breathing right afterwards, so the timing of the medication is important and dosing has to be precise.

Whether or not you have received IV pain medication, you can also have an injection inside the vagina to numb the area. This is called a pudendal block or a saddle block and it is typically given just before the baby is born. The pudendal block will help with pain related to delivery but it will have no effect on contractions.

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Many women choose to have an epidural during their labor. An epidural is usually a combination of local anesthetic and pain medication injected into the space around your spinal cord. While there is no such thing as being “too late” to receive an epidural, if the labor is progressing rapidly, or it is time to start pushing, there may not be enough time to call for an anesthesiologist or have the epidural be effective.

In most cases, the side effects of an epidural are minor and will improve with time, but occasionally some women develop low blood pressure that affects the baby’s heartbeat. The anesthesiologist will discuss the symptoms and side effects of an epidural with you before you receive the medication.

Pain management is a personal choice and there are many options to consider so it is not uncommon for women to still be undecided about which method they would like to pursue when they go into labor. While it is helpful to have a plan before you are in labor, giving birth is a dynamic event so it is absolutely appropriate to wait and see how your labor progresses before you settle on a form of pain management that works best for you. The goal is always the same: a safe delivery and the best possible birth experience for both you and your baby.

To sooth an episiotomy incision, take Sitz baths while you heal. Stitches should dissolve within four to six weeks and do not have to be removed. Over-the-counter or prescription pain medications can also provide relief, but discomfort should decrease daily. However, if any unusual pain develops, call your physician at Kansas City ObGyn.

Initial attempts at nursing can be painful, but tenderness and discomfort should decrease once let-down (a tingling sensation that occurs in the breast right before and when milk comes into the milk ducts, a sign you need to feed your baby) has occurred and should cease altogether within a few days. However, if you have sore, cracked, or bleeding nipples, express a few drops of breast milk on the nipples after nursing and allow to air dry. To prevent future irritation, always keep your nipples clean, change the nursing pads when they become moist and avoid wearing pads with plastic liners.

For a more comfortable breastfeeding experience, experiment with different nursing positions to see what works best for you and your baby. For example, try holding your baby so that he is lying on his side with his head resting in the bend of your arm and make sure that his mouth covers one inch or more of your nipple and areola when sucking. For additional comfort, use pillows to help support your arm and baby.  

If you are not nursing, wear a good support bra at all times while your breasts are engorged.  You may use ice packs under the armpits and to the side of each breast during the first couple of days of engorgement and take Tylenol® or ibuprofen for discomfort. Do not be surprised if you have a slight elevation in temperature for a day or two while your breasts are engorged, and you should expect milk to lbe leaking from the breasts during this period. Read Our article about  breastfeeding more information.

You may start mild exercise after two weeks rest and recovery after giving birth, but more strenuous exercise should be delayed for four to six weeks. Begin with easier exercises and increase them gradually if you are comfortable and it does not cause pain. If you had a Cesarean, do not begin an exercise program for at least six weeks after delivery and with your physician’s permission.

It is important to maintain a healthy and balanced diet while pregnant and you should continue prioritizing your personal nutrition after your baby is born.  Eat a wide variety of foods, emphasizing fruits, vegetables, lean meat, and healthy proteins. Limit processed foods and empty calories from high starch and sugary foods as much as possible.

Do not rush into dieting in an effort to lose your pregnancy weight, but if you are concerned about reducing, cut down on high fat and high sugar foods and alcohol, but do not over-restrict breads and cereals or fruits and vegetables. If you are nursing, you will need to consume a few hundred additional healthy calories a day, and you should continue vitamins taking prenatal.

Sexual intercourse is appropriate when it is comfortable for you, usually six weeks after giving birth, but is preferable to wait until your vaginal discharge is clear. Vaginal tenderness may be eased by using a water-soluble cream (K-Y Jelly®), or a contraceptive foam or cream to lubricate the area, but do not use VASELINE®.

Before intercourse is resumed, you and your partner should consider your contraceptive options. Condoms, foam or vaginal suppositories may be used without a prescription and are compatible with breastfeeding. Be sure to discuss other forms of birth control with your doctor at your postpartum checkup.

After leaving the hospital, call our office if you have any of the following:

· Heavy vaginal bleeding, soaking a pad every hour for three hours

· Severe chills or fever over 100.4º F

· Frequency or burning with urination (emptying your bladder)

· A red, hard, tender area on the breast

· A red, hard, tender or hot area along the leg veins

· Shortness of breath and/or chest pain

 Your healthcare provider at Kansas City ObGyn will need to see you for your postpartum checkup, usually five to six weeks after you give birth. This appointment provides an opportunity to discuss any questions or concerns you have, including contraception, physical recovery, and your emotional well-being. Call our office to schedule a doctor’s visit before leaving the hospital or soon after going home. 

Having a baby is a special time in your life, full of anticipation and joy, but it can also be a time of great stress and anxiety as you adjust to life with a child. In the weeks and months after giving birth, try to be especially attentive to your own emotional feelings and those of your partner. It is perfectly normal to experience complicated and even difficult emotions after you have a child, but be mindful if those feelings become extreme.  

Having a baby is a special time in your life, full of anticipation and joy, but it can also be a time of great stress and anxiety as you adjust to life with a child. In the weeks and months after giving birth, try to be especially attentive to your own emotional feelings and those of your partner. It is perfectly normal to experience complicated and even difficult emotions after you have a child, but be mindful if those feelings become extreme.  

Having a baby is a special time in your life, full of anticipation and joy, but it can also be a time of great stress and anxiety as you adjust to life with a child. In the weeks and months after giving birth, try to be especially attentive to your own emotional feelings and those of your partner. It is perfectly normal to experience complicated and even difficult emotions after you have a child, but be mindful if those feelings become extreme.  

Every expectant mother hopes for a healthy, trouble-free pregnancy, but sometimes pregnancy can become complicated and pose serious health concerns to women and their babies. A pregnancy is considered high-risk whenever it threatens the health of the mother or the fetus, but risks and give women and babies the best chance at a healthy and safe delivery.

There are a variety of reasons a pregnancy might be considered high risk. Pregnancy is physically demanding and the mother’s health, age, genetic background, and lifestyle choices are all consequential factors that contribute to the safety level of a pregnancy. 

Certain health disorders can become further complicated during pregnancy and endanger the health of mother and the fetus: 

• Autoimmune diseases. Sometimes women may find that their symptoms improve with pregnancy, but autoimmune diseases such as multiple sclerosis, lupus, and active Crohn’s disease can increase chances of miscarriage or make carrying a pregnancy to term physically difficult. Additionally, certain medications that treat autoimmune diseases may harm a developing fetus.
  
• Diabetes. High blood sugar can cause developmental defects in the earliest stages of gestation and unchecked diabetes can create significant and even life-threatening health problems for both mothers and babies.
  
• Thyroid disease. Unmanaged thyroid disease can cause issues with fertility and lead to birth defects, low birth weights, and fetal heart failure.
  
• Kidney disease. Women suffering from kidney disease often struggle with infertility and experience higher rates of miscarriage.
  
• HIV/AIDs. Women with untreated HIV/AIDs suffer from many dangerous health complications and can pass the disease on to their babies. However, treatment and Cesarean section delivery significantly decrease the chance of mother to child transmission.  
  
• Polycystic Ovarian Syndrome (PCOS). Women with PCOS may struggle with infertility and experience higher rates of miscarriage.
  
• High blood pressure. Pregnant women with uncontrolled high blood pressure are at an increased risk for developing additional health problems and have a higher chance of giving birth to babies with low birth weights. Women with a history of high blood pressure are also at a greater risk for developing the dangerous pregnancy condition, preeclampsia.

•  Teen pregnancy- Adolescents are at an increased risk of developing high blood pressure and anemia during pregnancy and they have higher rates of preterm labor.

• Advanced Maternal Age- Women who are aged 35 or older experience more complicated pregnancies on average, especially if it is their first pregnancy. Women who are older by gestational standards have higher incidences of having babies with birth defects or genetic disorders and are more likely to experience difficulties in labor and have higher rates of cesarean sections than the general population.

Women who require medical assistance to aid conception experience higher rates of miscarriage. 

Women who are pregnant with more than one fetus at a time have an increased chance of preterm delivery and giving birth to babies with low birth weights.

Being underweight or overweight can cause complications in pregnancy.  Women with a Body Mass Index (BMI) of 30 or above are at a risk of developing diabetes and preeclampsia, and their babies have an increased chance of being born with rare birth defects including spina bifida and other neural tube defects.  Obese women may also have difficulty coping with labor and are more likely to require a cesarean section. 

Women with a BMI of 18.5 or below are considered to be underweight and have higher incidences of miscarriage, particularly in the first trimester.  They also have a greater chance of delivering an underweight baby. 

Pregnant women who consume alcohol, tobacco products, or recreational drugs pose serious health risks to themselves and the fetus, including birth defects, developmental delays, and low birth weights.    

The diagnosis of a high risk pregnancy can be frightening and a cause for worry, but it is not a reason to despair.  The best way to treat a high risk pregnancy is for women to receive regular prenatal care.  Many of the health conditions that cause high risk pregnancies can be determined before conception or early in the pregnancy with an ultrasound and specialized testing.

Early diagnosis and intervention can reduce the risk of a pregnancy to a mother and the developing fetus, and regular fetal surveillance can help high-risk pregnancy specialists monitor a complicated pregnancy and lessen the possibility of health emergencies. 

Women who think they are at increased chance of having a high risk pregnancy should talk with their healthcare provider before getting pregnant so they can prepare in advance to have the healthiest possible pregnancy for their particular medical situation. 

Typically, pregnancies last about 40 weeks, starting the count from the first day of your last period to the date of the baby’s delivery. It is divided into three sections called trimesters. Most people refer to pregnancy as lasting “nine months,” although it is truly 10 lunar months of 28 days more or less, including the two before the egg is fertilized and implanted in your uterus.

If you plan to get pregnant or try to have a baby, these are some things you can be doing to get your body, your family, and your budget ready for the big day when baby arrives.

Consult with the doctor about medications you're taking.

If you take medications to treat a chronic condition, don't stop on your own, but contact the doctor right away and review your medications. Find out what is safe to take as your pregnancy continues. Some medications, vitamin supplements, over-the-counter medicines and even herbal remedies can harm a growing fetus. Many of these should be avoided while you are pregnant.

Smoking cigarettes and taking any “street” drugs, including using marijuana, increases the risk of problems during pregnancy including low birth weight, miscarriage, stillbirth and other serious issues. The fetus is especially sensitive to nicotine, which passes through the placenta and slows its growth. The first trimester of pregnancy is the time when the fetus is most at risk to harm from substances like alcohol, drugs, and nicotine. Ask your partner to stop smoking and using drugs, too, especially around you and the baby. Reducing the risk of birth defects is worth not lighting up whenever possible.

Even one alcoholic drink per day increases the odds of lower birth weight and increases the child’s risk of learning disabilities and hyperactivity disorder. No one knows why this is the case, so it is best to avoid alcohol completely.

American Congress of Obstetricians and Gynecologists studies link high consumption of caffeine to miscarriage and other problems in pregnancy. They advise expectant mothers to limit intake to no more than 200 mg of caffeine per day – about the equivalent of one 11-ounce cup of coffee. Hot tea is a great transition away from that double shot espresso latte.

Ask the doctor to prescribe prenatal vitamins before you get pregnant. Folic acid before conception and during your first trimester of pregnancy is vital to preventing neural tube birth defects such as spina bifida.

Finding and identifying these factors before you get pregnant lets you manage them and increases the chances of having a healthy pregnancy and healthy baby. Your doctor will ask about diet, lifestyle, medical and family history, past pregnancies, medicines and other drugs you take, and they will do a thorough physical.

Your health, nutrition and existing conditions are vital to the growth and development of the embryo during the first few weeks of pregnancy when most of the major body systems and organs form. Medical conditions you have, such as diabetes, high blood pressure, seizures, and depression, can cause problems during pregnancy. These conditions need to be discussed with your doctor before you try to become pregnant.

Nausea and vomiting that gets so severe it prevents you from keeping food or liquid down, even water, juice, prenatal vitamins or medicines is called hyperemesis gravidarum. If your situation becomes this severe, it is time to talk to the doctor. Other times to call the doctor about nausea and vomiting include:

• You have lost two or more pounds
• You develop nausea or vomiting after your ninth week of pregnancy, or it continues into your fifth month of pregnancy
• You vomit blood
• You feel dizzy when you stand
• You show signs of dehydration, including dark urine or infrequent urination
• You have abdominal pain, headache, fever, or swelling in the front of your neck

If your condition gets this severe, the doctor may want you to go to the hospital so you can get IV fluids and medicine.

As soon as you get a positive home pregnancy test, make your first prenatal doctor appointments. Be prepared by noting the date of your last period, as well as any questions you have. Your doctor will educate you about your pregnancy and reassure you about situations that arise during the next months.You will learn about first-trimester screening for chromosomal abnormalities, DNA screening and more. After that, you will probably be seen every four weeks until a month or so before your due date. Most women have between 10 and 15 visits. Attend them all, even if you feel fine. Your doctor will check your health as well as your baby’s. 

One of the most exciting things about being pregnant is keeping track of what is going on with the baby. During your first trimester, everything may seem overwhelming. It all happens quickly. Your hormones are going wild as they tell your body to nourish the fetus even before you know you’re pregnant.  

Although fetal development usually follows a predictable course, beginning at conception, keep in mind that measurements are approximate. Here’s what you can expect during the first 14 weeks of your baby’s development:

Even though the first two weeks are allocated to your pregnancy, conception usually occurs about two weeks after the first day of your last period. To figure out your approximate due date, count ahead 40 weeks from the start of your last period. By doing this, your period is counted as part of your pregnancy, even though you were obviously not pregnant then.Ovulation occurs anywhere from 11 to 21 days after the start of your last period. When intercourse occurs, several hundred million sperm travel from the vagina into the uterus and into fallopian tubes, where they meet the egg. Once a sperm penetrates an egg, they combine to create a zygote – the single-celled basis for what will eventually be a baby.The fertilized egg takes a day or two to travel through the fallopian tube into the uterus, with the cells dividing along the way. During this time, it is called a morula and then a blastocyst as it grows. 

By the time the ball of cells reaches the uterus, it has separated into two layers. The inner layer will become the embryo, and the outer layer will become the embryonic sac and placenta. Once the blastocyst reaches the uterus, about six to 12 days after fertilization, it embeds itself into the lining of the uterus. This begins the embryonic stage of pregnancy. At this time, the embryo goes through a lot of basic growth. The spinal cord, brain, and gastrointestinal tract begin to develop. The ball of cells is now an embryo and about the size of the head of a pin.

Arm and leg buds become visible and look like paddles. The heart begins to beat, and the placenta has started to form. Rudimentary blood is pumped through the main vessels of the embryo’s body. Early structures that become eyes and ears have started forming. Over the next six weeks, all of your baby's organs will start to develop and function. The embryo is now about ¼ inch long.By the end of the fifth week, the embryo is made up of three layers of cells. The top layer becomes your baby's outer layer of skin, parts of the nervous systems, eyes, the inner ears, and some connective tissues. The middle layer of cells becomes the heart and circulatory system. Some of this cell layer becomes the base for the baby's bones, kidneys, muscles, and parts of the reproductive system. The inner layer of cells becomes a tube lined with mucous membranes. From this, the lungs, bladder, and intestines form.

The embryo grows rapidly this week. The neural tube along the baby’s spine begins to close. The heart is beating, and if you have a vaginal ultrasound, you may be able to hear a heartbeat. The brain continues to form, and its complex parts are beginning to develop. The embryo is starting to develop basic facial features such as the jaw and nose. The lungs are also beginning to grow. The baby’s body begins to take on a C-shaped curve. Webbed structures that look like paddles form on the embryo’s hand and foot buds. These eventually become toes and fingers. The embryo measures about ½ inch long.

First Trimester, Week 7 Gestational Age (Week 5 Fetal Development)

When the embryo is five weeks along, or you are in your seventh week of pregnancy, every major organ in the baby’s body has started to form. Even hair and nipple follicles are starting to form, along with eyelids and the tongue. The baby’s trunk has started to straighten, and elbows and toes become more visible. The embryo is about the size of a pencil eraser and weighs less than an aspirin.

During week nine, the baby’s arms grow, and they can bend at the elbow. The eyelids and ears continue to develop, as do the toes. Eyes have formed. The embryo has lost its “tail” and looks more human by this time. The baby is about ¾ inch long.

Ten weeks marks the end of the embryonic period and the start of the fetal period. The fetus measures about three inches long and weighs about one ounce. Genitals have formed into clearly male or female, but they still cannot be distinguished on an ultrasound. The eyelids close, and they do not open again until about the 28th week. The fetus can make a fist. Buds appear in the mouth that will become baby teeth. The head is about half the size of the entire fetus, and it is rounder than before. The baby is starting to develop her neck.

By the 11th week of pregnancy, the fetus still has widely separated eyes and low-set ears. The liver is just starting to produce red blood cells. The baby’s bones are starting to harden. The baby may measure two inches tall from the top of her tail to her bottom, and she may weigh up to ⅓ an ounce. She can even hiccup, although you cannot feel it yet.

At the end of the first trimester, your 14th week of pregnancy or 12 weeks after conception, the baby has developed fingernails. The baby has a more human-like facial profile. At your prenatal checkup, you can probably hear a heartbeat with a Doppler monitor. If you have had an early ultrasound, you have probably already heard it. The baby measures about 2½ inches from the top of her head to her rump and weighs about ½ an ounce.

 This concludes what to expect in your first trimester of pregnancy! Stay tuned for the next article in the series, What to Expect in Your Second Trimester of Pregnancy. 

Your second trimester of pregnancy spans weeks 13 to 27. As a rule, morning sickness goes away, and you start to feel better emotionally and physically. Even by the 27th week, the baby is not big enough to make you uncomfortable. Just two months ago, the baby was a cluster of cells, and now she has muscles, nerves and organs. Now, the baby moves on her own, and may even get hiccups you can feel by the end of the trimester. 

Your hormones are still in high gear, but you have probably adjusted over the past three months. It is normal to feel anxious and worry about how your body will respond after the baby is born. You might have dreams about problems with the baby. These are very normal, too. During your second trimester, you will probably feel less tired, as your morning sickness is gone and you can eat a more balanced diet. Now is an excellent time to focus on making good food and lifestyle choices for you and your baby. You should also sign up for childbirth preparation classes and look for a good pediatrician.

Your body will undergo physical changes during your second trimester, as your baby grows from the size of a lima bean to weighing nearly two pounds. You may experience some standard pregnancy aches and pains. Almost all of these changes are temporary and will disappear once the baby is born. Keep up with your prenatal visit schedule and call the obstetrician if any symptom seems to be a significant problem for you. 

• Backache: As you gain weight over these next few months, it puts pressure on your back and changes your posture. Sleep on your side with a pillow between your legs to try and ease some of the strain on your pelvis. Use chairs that provide good back support and remember to sit up straight. Now is the time to stop carrying heavy things or picking up heavy items. High-heeled shoes are also going to aggravate a backache.

• Braxton Hicks contractions: Usually, these contractions feel mild, more like menstrual cramps or tightness in your belly. They happen more often after physical activities or sex. They are not harmful to you or your baby. If they become painful or regular (time them from the start of one contraction to the start of another contraction), contact your doctor right away. In these cases, they could signal preterm (premature) labor. There are things the doctor can do to stop early labor.

• Dental problems: Pregnancy can make your gums more sensitive or prone to bleeding because of the increased blood volume in your body. Use a softer toothbrush and rinse your mouth with salt water to help lessen the irritation. If you have had frequent episodes of morning sickness, this may have weakened the enamel on your teeth and made them more prone to cavities. Keep your dental checkups as scheduled while you are pregnant so you can catch any problems before they begin.

• Dizziness: Your circulation changes when you become pregnant because you have more blood volume and you are supporting a baby inside you. These changes can cause you to be dizzy, especially if you stand up or change positions too fast. If this is a problem for you, make sure you are drinking enough fluid. Try to change positions more slowly, and do not stand up quickly. Do not stay on your feet for long periods of time if you are having problems feeling dizzy. If you do start to feel dizzy, lie down on your size until the feeling passes.

• Expanding belly and breasts: Your uterus has to grow to make room for your rapidly growing baby. As it grows, your belly expands, too. Your breasts also continue to grow. You need a bra that gives good support. Wide shoulder straps will feel far more comfortable. You may also feel some discomfort or aches in your abdomen as it grows and the uterus and its supporting ligaments stretch. This is normal.

• Heartburn and intestinal problems: Your body makes more of the hormone progesterone during pregnancy. It relaxes muscles, including a ring of muscle in your esophagus that keeps acids and food in your stomach. It also relaxes the muscles that move food through your intestines, causing constipation. You may find relief by eating smaller, more frequent meals and avoiding foods that are greasy, spicy or acidic, such as citrus fruits. If constipation is a problem, eat more fiber and drink extra fluids plus try some gentle exercise like walking to keep your bowels moving regularly.

• Hemorrhoids: Hemorrhoids are a kind of varicose vein that form around the anus. Thanks to the extra blood in your body and the pressure of your growing uterus during pregnancy, these veins may become swollen, painful and discolored. Sitting in a warm tub or a Sitz bath may help relieve the itching and pain from hemorrhoids. Ask your doctor if it is safe for you to use over-the-counter hemorrhoid creams or ointments.

• Leg cramps: As your pregnancy progresses, leg cramps become more common. They often occur at night. Help prevent them by staying active and drinking plenty of fluid. Do calf stretches before bedtime. If you get a leg cramp, stretch the calf muscle gently. Sometimes warm showers or baths, muscle massage or ice massage on the cramped muscle helps relieve the pain.

• Nasal problems: Your body has made more blood to support your baby and your enlarged uterus. You also have increased hormone levels. This combination may cause you to have nose bleeds or a constant feeling of stuffiness in your nose. A saline rinse or saline drops can help keep the inside of your nose moisturized to prevent nose bleeds. Staying well-hydrated, using a humidifier at night, and keeping the skin around your nostrils moisturized also helps prevent problems.

• Sexuality: You may feel more amorous during your second trimester. In part, this is because you feel better all over now that morning sickness has passed, and partly because you are making estrogen at an incredible rate. A pregnant woman’s ovaries make as much estrogen in one day as they will in three years when she is not pregnant.

• Shortness of breath: You may feel out of breath as you progress through your pregnancy. Your uterus is growing and starting to crowd your lungs. Even mild activity like walking might seem more difficult. If you find this becoming a severe problem, talk to the doctor.

• Skin changes: Your hormone changes during pregnancy can trigger changes in the melanin, or pigment cells, in your skin. Some people may see brown patches on their face, called melisma, or a dark line down their abdomen called linea nigra. These changes are common, and they usually fade after the baby is born. They are aggravated by sun exposure, so use a good sunscreen.

• Spider and varicose veins: The extra blood in your body has caused new blood vessels to grow. Some of these vessels may be the tiny red veins, called spider veins, that appear very close to the surface of your skin. These usually disappear after you have your baby. As your pregnancy progresses, the growing uterus puts more pressure on your legs and can slow the blood flow to your entire lower body. Some people develop swollen blue or purple veins in their legs, called varicose veins. To keep these at a minimum, stay active during the day. If you must sit for a long time prop up your legs. Wear support hose or stockings to help push the blood out of your feet and legs, as well. After your baby is born, most varicose veins should improve within about three months.

• Stretch marks: Sometime during your second trimester of pregnancy, you may start to notice reddish lines forming along your abdomen, buttocks, thighs or breasts as these areas grow larger. Stretch marks cannot be prevented by moisturizing the skin. However, most stretch marks eventually fade after your baby is born. As you lose your pregnancy weight, they should become nearly invisible or show as silver or white streaks.

• Urinary tract infections: Pregnant women are more susceptible to bladder infections. Call your doctor if it hurts when you urinate, or if you have a fever and backache. Without prompt treatment, a urinary tract infection can get worse or even become a kidney infection.

• Vaginal discharge: It is normal for pregnant women to have a clear or white and slightly sticky vaginal discharge. If there is an unusual color or strong smell, or if you have pain, soreness or itching in your vaginal area, contact the doctor because this may be an indication of an infection.

• Weight gain: Once your morning sickness ends and your appetite returns in your second trimester, you should begin to gain weight. Your doctor will guide you on much weight you should gain during your pregnancy. You do not need to stuff yourself with extra food, however. An extra 300 to 500 calories of healthy food per day during your second trimester should put you on track to gain the recommended one-half to one pound per week during this time.

 You will probably need maternity clothes early in your second trimester. By the time you reach the end of the second trimester, you will have gained between 16 and 22 pounds. The baby will only weigh about two pounds. Exercise is important during the second trimester, both to help you stay in shape and manage your weight and to help get your body ready for the hard work of labor and delivery. Here are some ideas for pregnancy-appropriate exercises to try during your second trimester. 

• Kegels: Kegel exercises help strengthen the pelvic floor muscles. These will help you push during delivery. Strong pelvic floor muscles also reduce the risk of incontinence after delivery. Practice Kegels by contracting the muscles like you are trying to stop urinating mid-stream. Hold that contraction and then release it. Repeat the exercise. You can do these multiple times every day.

• Prenatal yoga: Prenatal yoga is designed specifically for pregnant women’s changing bodies. You will stretch and strengthen your muscles, practice controlled breathing and learn relaxation techniques.

• Swimming or water aerobics: Both water aerobics and swimming are excellent exercises for pregnant women. They are low-impact, so they will not add stress to your legs, back and lower body. Just the feeling of being almost weightless in the water helps rest your body and relieve pain in your feet and back.

• Walking: Walking gets your blood moving and helps build cardiovascular strength. It burns fat and calories and builds muscle, so you will look and feel better during and after your pregnancy. The lean muscle developed burns off weight gain from pregnancy much faster than weight gained from fat.

Not all exercise in pregnancy is good exercise. Always check with the doctor before beginning any exercise routine, especially if you are pregnant!

• Avoid any exercise that involves heavy lifting or exhaling heavily. This can raise your blood pressure to a dangerous level.
• Do not lie flat on your back while exercising. This position may cause the baby to compress the vena cava – one of the largest blood vessels in your body that carries blood to your baby.
• Eat a small snack for a calorie and energy boost about one hour before you exercise. Stay hydrated by sipping water during exercise.
• Be very careful with your balance during any pregnancy exercises. As your baby grows and your body changes, your balance and coordination change, too. You may be more prone to dizziness, too.

Over these weeks, your baby’s organs will develop, she will begin to swallow and to hear sounds outside your belly. She will begin to move around, and you will begin to feel her move, too. Hair will grow on your baby’s head, and she will develop definite sleep and wake cycles that you can notice. By the end of your second trimester, the baby will be about 14 inches tall and weigh around two pounds, according to the American Pregnancy Association. Follow along with your baby’s development with our week-by-week checklist.