Second trimester pregnancy: What to expect

Second trimester pregnancy often brings a renewed sense of well-being. The worst of the nausea has usually passed, and your baby isn't big enough to crowd your abdominal organs and make you uncomfortable. Yet dramatic pregnancy symptoms are on the horizon. Here's what to expect.

Your body

During second trimester pregnancy, you may notice physical changes from head to toe.

• Larger breasts. Stimulated by estrogen and progesterone, the milk-producing glands inside your breasts get larger during second trimester pregnancy. Additional fat also may accumulate in your breasts. Although some of the initial breast tenderness may improve, nipple tenderness may continue throughout the pregnancy. A supportive bra is a must.
• Growing belly. As your uterus becomes heavier and expands to make room for the baby, your abdomen expands — sometimes rapidly. Expect to gain up to 4 pounds (nearly 2 kilograms) a month until the end of your pregnancy.
• Braxton Hicks contractions. Your uterus may start contracting to build strength for the big job ahead. You may feel these warm-ups, called Braxton Hicks contractions, in your lower abdomen and groin. They're usually weak and come and go unpredictably. Contact your health care provider if the contractions become painful or regular. This may be a sign of preterm labor.
• Skin changes. As blood circulation to your skin increases, certain areas of your skin may become darker, such as the skin around your nipples, parts of your face and the line that runs from your navel to your pubic bone. Your skin may also become more sensitive to the sun. Use sunscreen.
• Stretch marks. You may notice pink, red or purple streaks along your abdomen, breasts, upper arms, buttocks or thighs during second trimester pregnancy. Your stretching skin may also be itchy. Moisturizers can help. Although stretch marks can't be prevented, eventually they fade in intensity.
• Nasal and gum problems. As pregnancy increases your circulation, more blood flows through your body's mucous membranes. This causes the lining of your nose and airway to swell, which can restrict airflow and lead to snoring, congestion and nosebleeds. Increased blood circulation can also soften your gums, which may cause minor bleeding when you brush or floss your teeth. Switching to a softer toothbrush may help decrease irritation.
• Dizziness. Your blood vessels dilate in response to pregnancy hormones. Until your blood volume expands to fill them, your blood pressure will fall and you may experience occasional dizziness. If you're having trouble with dizziness, drink lots of fluids and rise slowly after lying or sitting down. When you feel dizzy, lie on your left side to restore your blood pressure.
• Leg cramps. Pressure from your uterus on the veins returning blood from your legs may cause leg cramps, especially at night. Stretch the affected muscle or walk your way through the cramps.
• Shortness of breath. Your lungs are processing more air than they did before your pregnancy. This allows your blood to carry more oxygen to your placenta and the baby — and may leave you breathing slightly faster and feeling short of breath.
• Vaginal discharge. You may notice a thin, white vaginal discharge. This acidic discharge is thought to help suppress the growth of potentially harmful bacteria or yeast. You might want to wear panty liners for comfort. Contact your health care provider if the discharge becomes strong smelling, green or yellowish or if it's accompanied by redness, itching or irritation. This may indicate a vaginal infection.
• Bladder and kidney infections. Hormonal changes slow the flow of urine, and your expanding uterus may get in the way — both factors that increase the risk of bladder and kidney infections. Contact your health care provider if you need to urinate more often than usual, you notice a burning sensation when you urinate, or you have a fever, abdominal pain or backache. Left untreated, urinary infections increase the risk of preterm labor.

Your emotions

Pregnancy is a psychological journey as well as a biological one. During the second trimester, you may feel less tired and more up to the challenge of preparing a home for your baby. Strike while the iron is hot! Check into childbirth classes. Find a health care provider for your baby. Read about breast-feeding. If you plan to continue working after the baby is born, get familiar with your employer's maternity leave policy and investigate child care options. In some areas, you can't start too soon looking for child care.

As your pregnancy progresses, changes in your body's shape and function may affect your emotions. Some women feel a heightened sexuality during pregnancy. Others feel unattractive — especially as their bellies grow. If you're struggling with your body image, share your concerns with your partner. Express love and affection in ways that help you feel most comfortable.

While anticipation mounts, worries about labor, delivery or impending motherhood may preoccupy you. Remember that you can't plan or control everything about your pregnancy. Instead, learn as much as you can. Focus on making healthy lifestyle choices that will give your baby the best start.

Appointments with your health care provider

During the second trimester, your prenatal appointments will focus on your baby's growth, confirming your due date and detecting any problems with your health.

Your health care provider will begin by checking your weight and blood pressure. He or she may measure the size of your uterus by checking the fundal height — the distance from the top of the uterus (fundus) to your pubic bone. Pelvic exams are often unnecessary during the second trimester, unless something unusual needs to be explored.

At this stage, the highlight of your prenatal visits may be listening to your baby's heartbeat with a special device called a Doppler. Your health care provider may suggest an ultrasound or other screening tests this trimester. You may also find out your baby's sex — if you choose.

Be sure to mention any signs or symptoms that concern you, even if they seem silly or unimportant. Talking to your health care provider is likely to put your mind at ease.