Pregnancy Weeks

You may have already experienced some of the following:

• Breast tenderness
• Nausea and/or vomiting
• Urinary frequency
• Fatigue
• Skin changes
• Increased vaginal discharge
• Missed period

In the first trimester, many changes will be occurring with your body. This is a difficult trimester; you may experience fatigue, may have a lot of nausea, vomiting, and bloating. You do not look pregnant yet, but you sure feel pregnant! Even though you may feel awful, we want you to continue your prenatal vitamins, try to eat as healthy as you can (lots of small meals and snacks) and keep your fluid intake up. Drinking water is preferred, but whatever will stay down at this point! We would like you to gain about 25-35 pounds during this pregnancy. It is healthy to gain a little more if you are underweight and a little less if you began your pregnancy overweight. We will see you one more time during your first trimester...please write down any questions that you may have in the meantime and bring them with you at your next visit.

What's this visit all about?

At this visit, we will do the following:

• Possible pregnancy test
• Possible sonogram (to check for an accurate due date)
• Gonorrhea and chlamydia (vaginal cultures)
• Pap smear and pelvic exam
• Urinalysis (to check for infection, blood, protein and sugar)

Blood testing that we will draw at this visit are:

• CBC (to check iron stores and for any infection)
• Blood type (To determine what your type is A, B, O, or AB)
• RH (to determine if you are negative or positive blood type)
• Hepatitis B (to find if you have been exposed to hepatitis B)
• Rubella titer (blood test to check for immunity to German measles)
• RPR (to check for syphilis exposure)
• Possible Sickle Cell Screen (blood test to check for Sickle Cell trait)
• HIV/AIDS (to check for exposure)
• Varicella (to check for past exposure to chicken pox)

Baby News!

You are in your first trimester. Your baby has gone through very rapid changes since conception. Once the sperm and egg meet, the baby goes through many stages of development. It is now implanted into the thick endometrial lining (tissue lining the inside of your uterus). The baby is all nestled in the uterus and the placenta is beginning to form. All the major organ systems are formed now. The baby's head is much larger than its body at this time. The baby's heart is completely formed and fingers and toes are already present! At week 8, your baby is about 3/4 inches long; it's about the size of a pinto bean!

You are still in your first trimester and possibly still feeling yucky! Hang in there, baby! It will get better soon...your body is going through a lot of changes—both hormonal and physical. You may experience possible headaches/migraines, acne, sciatic-nerve pain (pain shooting in buttocks or down one leg) and some emotional changes. These occurrences are all normal...if you have any questions about them, please ask at your visit. Remember, if you have cats, your significant other needs to be changing the litter—that's a great job for them to do for the next 9 months! Nutrition is also very important, so eat as healthy as possible for you and your baby- no drugs, alcohol or smoking and continue your vitamins!

Where does the weight go?

• 11 lbs mom stores (fat, protein, other nutrients)
• 4 lbs increased fluid volume
• 2 lbs breast enlargement
• 2 lbs uterus
• 7.5 lbs baby
• 2 lbs amniotic fluid
• 1.5 lbs placenta

Sources of Nutrition

What's happening at this visit?

At this visit we will do the following:

• Possibly another sonogram, depending upon our findings from a previous visit
• Blood pressure
• Weight
• Check your urine for protein and sugar

What changes can I expect?

• Your uterus is about the size of a grapefruit, so you may feel some pulling or cramping at times; this is normal.
• Your waistline may be getting a little thicker.

Baby News

From weeks 8-11 your baby has made rapid changes! During week 8 the eyelids are forming and nerve cells in the retina of the eye are beginning to develop. The tiny tip of the nose is present and the ears are forming inside and outside of the baby. The baby's elbows are present and can bend. Fingers and toes are just tiny buds right now.

During week 9, the fingers are longer, the head is more erect and the neck is more developed. The eyelids cover almost all the eye and the ears are well developed. The baby is now moving its arms and legs!

By week 10, your baby is about 1 1/4 to 1 3/4 inches long and weighs about 0.18 ounces and is the size of a small plum! Most congenital malformations occur before the end of week 10, so it is encouraging to know that a critical part of your baby's development is safely behind us. By the end of week 10, development of organ systems and the body are well under way!

In week 11, the baby has grown to 1 1/2 to 2 1/2 inches and it weighs 0.3 ounces. The baby is about the size of a large lime. During this week, the neck is continuing to develop and the head is almost half of the baby's entire length. Fingernails appear and its genitalia are beginning to show distinguishing features.

Congrats! You have made it into your second trimester! Hopefully you are beginning to feel better; if not, hang in there! During these next few weeks, you may experience skin changes (color changes, dryness, rashes or itchiness)—these are all normal. You will begin losing your waist! So dress comfortably! You may also see a few stretch marks appearing on your tummy, thighs or breasts. There is no magic cure for this (9 out of 10 pregnant women develop them)—consider them our badges of honor! Your breasts are also undergoing many changes at this time; they will become larger, the areola (area around the nipple) will darken and your breasts may begin secreting a yellowish fluid called colostrum. Another area of our bodies that we need to keep in mind at this time are our teeth. During pregnancy, our hormones can make gum problems worse, so keep your regularly scheduled dental exams and see your dentist at least once during your pregnancy. An additional change that you may experience is hemorrhoids. These are caused by hormonal changes and the growing fetus. If you think that you have hemorrhoids, talk with your provider about treatment options.

Caffeine Warning

The FDA has recommended that pregnant women avoid caffeine. Caffeine is a stimulant and found in foods including coffee, tea, various soft drinks and chocolate. We would like you to cut down to TWO (300mg) servings or eliminate it from your diet while you are pregnant. Below are the details of some common foods and how much caffeine they contain.

This Visit

At this visit we will...

• Take your blood pressure
• Review OB labs done previously
• Weigh you
• Check your urine for protein & sugar
• Listen to baby's heart beat
• Discuss Quad Screen and Cystic Fibrosis lab work (16-18 weeks)

What Changes Can I Expect?

• By week 12 your uterus is too large to remain in your pelvis, it may be felt just above your pubic bone
• At week 13,your uterus is definitely at your pubic bone, it will feel like a soft smooth ball
• By week 14 maternity clothes could possibly be a must (depending if this is your first baby or not)
• At week 15, you maybe able to feel your uterus 3-4 inches below your belly button

Baby News

During week 12, your baby is amazing! It weighs between 1/3 to 1/2 oz and is almost 2 1/2 inches long. We will probably be able to hear baby's heartbeat with the Doppler from the outside of your tummy. The baby's skeleton now has some bone formation, fingers and toes have separated and the nails are growing in. A small amount of hair is appearing on the body and the pituitary gland at the base of the brain is beginning to secrete hormones. Your baby is moving inside of you, but you won't feel it quite yet.

In week 13, the baby's head growth finally slows down. The baby's face is beginning to look more humanlike; the eyes are moving closer together, ears are in their normal position and the intestines move to the inside of the baby's abdomen. The baby weighs about 1/2-3/4 oz and is 2 1/2-3 inches long.

Week 14 your baby's neck is getting longer, the chin no longer rests on the chest and development of the genitals continues and it is easier to determine what sex the baby is. The baby weighs almost 1 oz and is 3 1/4-4 inches long.

Fine hair covers your baby's body at week 15. Its skin is thin and blood vessels are easily seen through the skin. The baby's ears continue to form. Bones are getting harder and it is 4-4 1/2 inches long and weighs 1 3/4 ounces.

So ladies, what are you thinking of pregnancy now? It's pretty wonderful don't you think? Hopefully by now you are all feeling great and watching your beautiful body change and grow with that little one inside! If you are headed into your 16th week, your uterus is weighing about 8 3/4 ounces and is about 3 inches below your belly button or you may be closer to the half way point (20 weeks) and you will find your uterus at your belly button. Lots of changes are on the way in the next four weeks. We no longer allow you to lay flat on your back due to decreased blood flow to baby, so left side is best, but either side is OK. During these weeks you may start to experience more back pain; this is due to a hormone called Relaxin. This hormone does exactly what it sounds like- it relaxes your joints, which can cause more pain everywhere! You also may experience an increase in vaginal discharge. This is called leukorrhea. It may be white or yellow and fairly thick, this is also normal. Another normal finding during this second trimester is feeling dizzy at times. This can be caused from lower blood pressure or possibly a change in your blood sugar. We want you to keep on eating healthy, keep your fluid intake up (at least 10 bottles of water per day) and continue your vitamins.

Iron

Iron is very important to you while you are pregnant. A pregnant woman needs about 30mg per day due to the increased in your blood volume. Usually your prenatal vitamin associated with a healthy diet is an adequate source of iron, but not always. We will check your iron level with your first OB labs, again at your 28-week labs and then a final time at 36 weeks. We will start you on iron tablets if we find your level to be too low. Here are some foods high in iron; consumption of these will help keep your levels up and you feeling great!

• Chicken
• Red meat
• Organ meats
• Egg yolks
• Dried fruit
• Spinach
• Tofu

Here are some signs of low iron:

• Tired
• Trouble concentrating
• Headaches
• Dizziness
• Indigestion

This Visit

• Blood pressure
• Weight
• Check urine for protein and sugar
• Discuss results of Quad Screen and Cystic Fibrosis lab work if done previously
• Ultrasound and review

What Changes Can I Expect?

• By week 16, your uterus weighs about 8 3/4 oz and is 3 inches below your belly button.
• By week 17, your uterus is located only 1 1/2-2 inches below your belly button.
• During week 18, your uterus is only one finger below your belly button.
• Week 19, your uterus is 1/2 inch below your belly button and the baby weighs about 7 oz; the amniotic fluid weighs 11 oz and the placenta weighs 6 oz.
• During week 20, your uterus is even with your belly button!

Baby News

During week 16, fine hair covers the entire baby including its head. Fingernails are well formed. During this stage of growth, the legs are longer than arms—which are both moving like crazy! This movement can be seen during your ultrasound and may possibly be felt. It is about 2 3/4 oz and is 4 1/3-4 2/3 inches long.

The baby begins to pack on the fat (adipose tissue) during week 17. This fat is very important to the baby's heat production and metabolism. If you have not felt movement yet, it will happen very soon. Baby is 4 1/2-4 3/4 inches long and weighs 3 1/2 oz.

In week 18, the rapid growth slows down a little and the baby looks more like a baby. Your little bundle of joy weighs about 5 1/4 oz and is 5-5 1/2 inches long.

Week 19 brings the baby's growth to 5 1/4-6 inches long and its weight to about 7 oz. The baby's systems such as the nervous system are continuing to develop.

Congrats!! You are at 20 weeks and have made it to the half-way point! The skin of the baby has arranged itself to form 4 different layers; the white cheesy substance that covers and protects the baby's skin has also begun to form this week. Baby is 5 2/3 long and weighs about 9 oz.

Ultrasound

The measurements done on your baby during your ultrasound will include:

• Evaluation of the fetal spine
• Umbilical cord—make sure there are 3 vessels
• Measurements of the skull
• Rule out obvious birth defects
• Face, lips, chin, nose, ears, eyes
• Measurements of thigh bone
• Abdominal wall
• Four chambers of the heart and heart rate
• Aminotic fluid level
• Placenta

So you have finally made it! You are over half way done with your pregnancy! Your tummy is growing now and you definitely look pregnant! You can find your uterus above your bellybutton now. The baby is completely formed, but the organ systems are continuing to mature. You may start noticing some swelling in your feet, ankles and fingers. This is normal; keep drinking water to help with that. You may also find that your moods are swinging from high to low...don't worry, this is typical for this time in your pregnancy. If you are feeling sad and cant seem to care for yourself or others, let us know, we can help. By week 24, your baby is considered "viable". This means that if born after 24 weeks, with some help from physicians it could live in our world. Obviously, we would like you to stay pregnant for about 15-19 more weeks, but some women have problems with preterm labor. If you have any of the following symptoms, call the office to discuss it with us: a timeable pain (possibly cramping) in your low back, lower abdomen, or upper thighs, just aren't feeling well, and any type of pink tinged discharge.

Sodium

Be careful with your sodium intake during pregnancy...it can cause swelling and bloating. Read food labels to educate your self on the amount of sodium in them. Try and keep your intake to 3 grams (3000 mg) or less a day.

Depression

Depression can occur at anytime during a person's life. Many factors contribute to this. Research shows that 25% of all women have some degree of depression during pregnancy and 10% will have major depression. This should be a happy time in your life, we want you to enjoy your pregnancy. Happy and healthy moms, have happy, healthy babies. Babies born to moms who are depressed are at a higher risk of being smaller or born to early. Please let your provider, family member, or significant other know if you are feeling any of the following so we can get you some help...we are all here for you to keep you as physically and mentally healthy as possible.

• Overpowering sadness that lasts for days and has no cause
• Difficulty sleeping or waking up very early
• Wanting to sleep all the time or great fatigue (more than your normal fatigue)
• No appetite
• Lack of concentration
• Thoughts of harming yourself or others

This Visit

• Blood Pressure
• Weight
• Check urine for protein and sugar
• Talk about Glucola test and Hemoglobin and Hematocrit, which are lab tests done around 28 weeks

Baby News

Between the weeks of 21-25, your baby is measuring 10.5 oz and is 7 1/4" long (week 21) up to 1 1/2 pounds and 8 3/4" long (week 25).

During this time of pregnancy, the baby's growth rate is slowing, and the organ systems are maturing. In the digestive system, the baby is swallowing amniotic fluid, absorbs as much water from it as possible and then the waste is sent to the large bowel. The swallowing of the fluid helps to mature the digestive system and also gives them some essential nutrients.

The fetal liver is also maturing. Even though the baby's liver is developing, it still does not have the full function like an adult liver. It is unable to breakdown bilirubin. Bilirubin is a byproduct from the breakdown of red blood cells. This is what causes some babies to become jaundice. The bilirubin level will be checked daily after delivery while you are in the hospital recovering.

Another organ that is working on maturing is the pancreas. This organ produces insulin, which is necessary to break down sugar in our bodies. When sugar levels are high in the mom (when she is diabetic) then insulin levels are going to be high in the baby. This is why we monitor you for gestational diabetes at your 28 week visit.

Falling

Falling during pregnancy is the most frequent cause of minor injuries. All of you expectant moms need to be really careful especially if you are pregnant during the winter months and have to deal with the nasty ice and snow! Since the uterus is protected in the abdomen and the baby is well protected with the amniotic fluid, usually serious injuries do not happen. If you fall, contact your provider, so we can care for you.

OK ladies! You are either at the tail end of your second trimester or just beginning the start of your third! YIPPEE! You have done so well over these last several months. It is hard work carrying around another person, fighting all that nausea and vomiting, and just feeling yucky! Congratulate yourself and treat yourself to a pedicure or manicure perhaps or maybe a trip to the salon or masseuse. Your tummy is still continuing to grow (which it will, clear up until the end), you may notice more back pain, pressure in your pelvis, leg cramps or headaches. At 26 weeks, your uterus is about 2 1/2" above your bellybutton and your weight gain should be between 16-22 pounds. If you are closer to 29 weeks your uterus is about 3 1/2-4" above your belly button and your weight gain should be around 19-25 pounds. You should be feeling lots of movement by now—pokes, punches, rolls and elbows! Nutrition is more important than ever going into this last trimester...keep eating healthy, taking your prenatal vitamin and extra iron tablet if prescribed. Below is a food chart to help you if you are wondering what kinds of foods to eat and how many servings per day are recommended.

Nutrition

Let's talk about that Placenta...

The placenta is a wonderful, disposable organ that if it did not exist, we would not be able to reproduce. The placenta has many functions: it moves oxygen, carbon dioxide and nutrition to and from the baby, and carries away the waste. By the 7-8th week, it is producing estrogen and progesterone, and by the end of the 12th week it is fully-functioning.

Have you ever seen a placenta? It is a flat round or oval shaped organ and is 6-8 inches around and is about 3/4 to 1 1/4 inch thick. It weighs about 17-24 ounces. Placentas vary in size. The side of the placenta that is attached to the uterus looks beefy or spongy. The side that is next to the baby is smooth and is covered by the amniotic sac or membrane. The umbilical cord is the attachment or lifeline from the placenta to the baby.

This Visit

• Blood pressure
• Weight
• Check urine for protein and sugar
• Talk about your results or draw your blood for the Glucola test and Hemoglobin and Hematocrit

Childbirth Education Classes

Now is the time to start thinking about your own thoughts on how you would like your labor and delivery experience to be. Many birthing options are available for your experience...this is about you and your baby and what method is best for you. Many are available, including Lamaze, Bradley method, Hypnobirthing, and Birthing from Within. These are all different types of childbirth classes which all offer different ways to deal with the discomfort of labor. Please educate yourself and bring your questions with you to your visits.

Baby News

Your baby now has distinct sleep/wake cycles, which if you pay close attention, there may be certain times of the day that your baby is very active and other times very quiet. The baby's 5 senses are also all fully developed at this stage. In week 26, your baby weighs almost 2 pounds and is about 9 1/4 inches long.

In week 27, the eyelids are no longer fused, and the retina, which is the back of the eye, has all the layers fully formed. During this week, the baby weighs a little more than 2 pounds and is about 9 2/3 inches long.

In week 28, the brain is forming amazing grooves and indentations on its surface and the amount of brain tissue is also increasing! Your baby is getting smarter!! The eyebrows and eyelashes are present as well as the hair on its head is growing longer! The baby's body is filling out and getting chubbier! Your baby weighs almost 2 1/2 pounds and is close to 10 inches long! WOW! How exciting!

During week 29, baby is weighing about 2 3/4 pounds and is about 10 1/2 inches long. Baby is continuing to gain weight, the fingernails are grown to the tips of the fingers and their skin is covered in the thick cheesy substance called vernix. The vernix is what protects the skin while the baby is growing inside of you!

Preterm Labor

Be aware of the dreaded preterm labor!! Preterm labor is the start of labor after week 20 and up to week 37. Unfortunately, despite all of the researchers efforts, we cannot pinpoint an exact cause of preterm labor and birth. Please watch for the following signs and symptoms and contact your provider if any occur:

• Painful menstrual-like cramps
• Dull low backache—different than the usual back pain
• Low abdominal pressure or pain
• Change in character or amount of vaginal discharge (thicker, thinner, watery, bloody, brown)
• Contractions—felt more often than every 10 minutes for 1 hour or more—not relieved by position change
• Premature breaking of your water

About you...
You have made it to your final trimester, yeah for you! We are all excited to have been part of this wonderful exciting time in your life. We are just as anxious as you are to see what this little miracle looks like. You are probably getting tired of being pregnant by now and are ready for it to be over- it will be soon, try and be patient. Your uterus and belly continue to grow as well as that little one. It may be hard to believe that you have between 6-10 weeks left. Do you feel like you are running out of room? All this growth and extra weight that you are carrying around will possibly cause extra pelvic pain, pressure and increased swelling in your legs and feet. Another issue that may arise at this time of pregnancy is stress incontinence of urine. You may find yourself leaking a little when you sneeze, cough, lift something heavy like another child or even during exercise. Don't worry, this is normal. Keep doing your Kegel exercises to help with this problem.

Kick counts are important and should be started around 28 weeks. We would like you to pick a time of day when your baby is most active and lay on your left side after you have had something to eat and drink. Once you are in a comfortable position, begin counting how many times your baby moves. We would like you to have at least 10 in an hour. If it takes your longer than an hour to feel 10 kicks, get up, eat and move around before repeating this. If you still cannot count 10 in an hour please let the office know.

Here are a few ideas on what to pack for the hospital. Your insurance card and hospital paperwork, glasses or contacts and supplies, toiletries, loose fitting clothes to wear while in the hospital and go home in. Also, during labor you may want to bring massage oil/lotions, music, books or magazines, hard candy/mints, gum, focal point, friends and families contact numbers.

Your mucus plug...how important is it? This is a buildup of mucus that lodges at the cervix. Its purpose is to act as a barrier into the uterus to protect the baby from bacteria. During these last weeks, you may notice that it has dislodged. It may be pink or brown and very thick... don't fret! This doesn't mean you are going to go into labor, it just means that you have lost your mucus plug! This mucus plug is highly overrated!!

This visit we will check your blood pressure, weight, urine for protein and sugar. We will also listen to the baby's heartbeat and measure your tummy. If not done previously we will discuss your 28 weeks lab results.

About baby...

Your baby is so amazing! During the weeks of 30-34, baby is going to weigh anywhere between 3-5 pounds and will be about 17-19 1/2 inches long! The baby is getting more fat deposits which are beginning to smooth the skin out. The thick cheesy substance called vernix covers the entire baby now. The thin fine hair (lanugo), has disappeared from the baby's face, but is and will be still present on the rest of the baby until delivery. The fingernails have grown clear to the end of the fingers. Your baby has started to "practice" its breathing motions and it now is able to control its body temperature. The baby is also opening its eyes and its pupils are reactive to light. Can you believe your baby can do all of this already?

About you...

Well, you have finally made it to your last month! You have done a great job at being a mama already! You have a lot of decisions to make in this last month or so...where are you going to deliver, what kind of labor and delivery are you hoping for, to circumcise or not, to induce or not to induce...ohh the decisions. Well, our part in all of this is to educate you so you and your significant other can make an informed decision. So, ask us many questions! We will help as much as we can.

I'm sure by now, you are very ready for this pregnancy to be over—do not worry—soon, very soon! Does it feel like you have run out of room? That is because your uterus has grown all the way up under your rib cage! Hopefully this handout will be a good source of information for you in your last few weeks.

Non-stress test monitoring is a test that may be performed during your pregnancy. This is a test that can either be done in the office during office hours or if needed, we may send you to the hospital. This test evaluates how well the baby is tolerating life inside your uterus. Multiple reasons exist for ordering this test. If we order it for you and your baby, we will educate you on the reason for the testing. It is a very simple test that involves hooking you up to a fetal monitor to record the baby's heart rate and we also look to see if any contractions are occurring. When the baby moves, we have you push a button which then records a mark on the paper. This test usually takes about 30 minutes, sometimes a little longer. Depending on your pregnancy, we may only do this test once or perhaps we may order it several times or not at all.

Keep your labor options open. Do your own research and ask questions. These are some of the options to consider: epidural, IV pain medicine, position changes, walking, birthing ball, squat bar, rocking chair. You can also labor and deliver in the tub, do Lamaze breathing, hypnobirth, aromatherapy, massage, use acupressure points and have a doula.

This visit we will be checking your blood pressure, weight, baby's heartbeat, measuring your tummy, checking urine for protein and sugar and also obtaining the beta strep culture.

Group-B Streptococcus (GBS) is a normal bacteria found in a person's GI tract. It is not harmful to you as a woman, but can be harmful to your baby as it comes down and out the birth canal. When you reach 35-36 weeks, we will perform a vaginal/rectal swab and if it comes back positive we will treat you with IV antibiotics while you are in labor, if it is possible. If you test positive you will need to stay in the hospital at least 48 hours so the baby can be monitored.

About baby...

Your baby is preparing for its finishing touches. It has packed on the pounds and development is finished. Your baby has a well rounded tummy and breast buds (boys and girls). In the boys, both testicles should be in the scrotum. The fine hair (lanugo) has disappeared from the entire body and the baby's nails have grown clear over the ends of the fingers and toes. Your baby will be anywhere from 20 1/2 to 21 1/2 inches long and will weigh between 5 1/2 and 7 1/2 pounds.

We wish you luck and look forward to meeting your baby!