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Prenatal Care: Second Trimester: Weeks 13 - 24, and Third Trimester: Weeks 25- 40

Prenatal Care: Second Trimester: Weeks 13 - 24, and Third Trimester: Weeks 25- 40

Common Conditions:

  • Varicose veins
  • Hemorrhoids
  • Foot changes
  • Heartburn
  • Restless sleeping
  • Increased energy
  • Increased sexual desire
  • Dizziness
  • Leg cramps
  • Blood clots
  • Anemia and fatigue
  • Sugar imbalance

Varicose Veins:

Varicose veins are veins that become enlarged, but constricted during pregnancy. Because of pregnancy, your circulatory system really expands, but sometimes the blood flow to your legs is impeded because of the pressure of the baby on your pelvis. This causes the valves in the veins to fail and the veins dilate and bulge. The size of the veins usually decreases after birth.


Hemorrhoids are simply varicose veins in the rectum. They are caused by increased blood volume and pressure from the baby on the veins in your rectum. The veins actually enlarge into firm swollen pouches either inside or outside of your rectum. Most hemorrhoids erupt in pregnancy, or if you are prone to them, pregnancy will make them worse. Constipation can make your hemorrhoids worse, so be sure to manage your constipation appropriately with psyllium and a lot of water. Then it is vital that you evaluate your diet to ensure that you are eating enough fruits and vegetables.

Foot Changes:

You're likely getting tired about hearing what hormones do to your body, but again, they are the culprit here. The higher hormone levels can cause you to retain some water, and your feet will swell. Resting with your feet elevated for 20 minutes a couple times a day can help to restore good circulation. Sleep on your left side to minimize pressure on your vena cava (the largest vein that returns blood to your heart). Your weight gain will worsen this condition, so do be sure to watch what you eat and monitor your weight appropriately. Larger shoes at this point in your pregnancy will add to your comfort. Just do not get shoes that tie, by your third trimester tying them will be a challenge for you.


Heartburn is a burning sensation behind your breastbone and can also cause a bitter, sour taste in your mouth. Many women, who have never had heartburn before, will experience heartburn during pregnancy. Up to 50 percent of women experience heartburn during their second and third trimesters. Again, those pesky hormones have slowed down your digestive process to help your baby get the nutrition he or she needs from you. Food moves more slowly through the intestines, and emptying time for your stomach is delayed. Progesterone causes the smooth muscle tissue of your stomach and esophagus to relax. All of these work together to cause feelings of discomfort.

To minimize your heartburn, break up you meals and eat more, but smaller meals throughout the day. Try not to eat for four hours before going to bed. Foods that are especially full of acid, like tomatoes or citrus fruit should be eaten with a non-acid food to help to absorb the acid. Tomatoes are better on a sandwich than in a salad right now. You will know what gives you heartburn, and avoiding such foods will give you some relief. Do not worry, you will be able to return to your regular diet after delivery.

Restless Sleeping:

As your baby increases in size, your sleeping position will likely change. Some women report getting a lot of advice about not sleeping in certain positions because it is dangerous for the baby. This really is not true. If you are sleeping in such a way as to do your baby harm, your body will know it and you will move to a more appropriate position. If you are still worried, just use a pillow as a wedge to keep you from sleeping on your back. This will become a more natural and comfortable sleeping position anyway as you progress in your pregnancy.

Increased Energy:

After a trimester of all the fatigue and changes your body has been experiencing, you might actually be surprised with how you feel this trimester. Your body has adjusted to its new condition, you are not really very big yet, and your energy is going to amaze you! Most women find their second trimester to be their very best time. The morning sickness has usually stopped, the fatigue is easily manageable, and the baby is not so large that you cannot do the things that you once enjoyed doing. Enjoy this time!

Increased Sexual Desire:

Another interesting bonus you may experience during your second trimester is an increased desire for sex. You are no longer nauseous and much of your energy has come back. Increased blood flow that is a side effect of pregnancy, is a bonus for you, for it makes your vagina feel plumper and tighter and well lubricated. The increased sensitivity in the pelvic area, and the hormone surges that cause feelings of sensuality are both responsible for your heightened sexual desires. Enjoy this time of your pregnancy. Your partner will appreciate it now and later, after the baby comes when time alone together becomes a premium.


From time to time you may experience sensations of dizziness when you go from a sitting to a standing position. When you do this, it takes a little while for the blood that has been collecting in the lower part of your body to be pumped back up to your brain. Minimize the feelings of dizziness by standing up more slowly and carefully. Another cause of lightheadedness or dizziness can be hypoglycemia, or low blood sugar or simple dehydration or hunger. This is an especially good reason to keep yourself well hydrated, and another reason to eat more frequent, but smaller meals.

Leg Cramps:

While not especially serious, leg cramps can be eternally aggravating. They usually occur in your lower legs at night while you are sleeping. It really is an old wives tale that low potassium causes the leg cramps. Doctors really do not know why they occur, but it could have something to do with your decreased vascular circulation when you are at rest. The best remedy is to stand on a cool floor and flex your toes upward stretching your calf muscles.

Blood Clots:

From time to time, a leg cramp can actually be a sign of something far more serious. If the pain will not go away and your leg feels hot, swollen, and tender to the touch, call your doctor right away. There is a chance that you could have a blood clot. A diagnostic ultrasound will evaluate the area. If it is a blood clot, you will be placed on heparin, a blood thinner that is safe for your baby. This is one situation where suffering through the pain is not a good idea.
Want to learn more? Take an online course in Prenatal Care.

Anemia and Fatigue:

Sometimes women in their second trimester are very energetic, then suddenly lose that vigor and are exhausted again. As an expectant mother, you will need more iron than you did before your pregnancy, almost twice as much. After the 20th week, fatigue can generally be attributed to iron deficiency anemia. Your health care provider can check your blood iron level and determine if you need to add additional iron to your diet. This usually occurs during the second trimester because your baby is growing so rapidly that he or she is taking every bit of iron needed and you have to make it up. Untreated anemia is hard on your heart and on your immune system, as well as being dangerous to your baby. If you even suspect you may be anemic, talk to your health care provider.

Sugar Imbalance:

Because gestational diabetes usually has no signs, most women are tested at the very end of their second trimester or the beginning of their third trimester for it.

A glucose tolerance test is performed by having you drink a glucose solution. After an hour, your blood is drawn and the glucose level is checked. About 15 percent of women test high, and need to do the full tolerance test, which is done on an empty stomach. Again, you will drink a premeasured glucose solution, and blood tests are taken at specified intervals over a period of three hours. About 15 percent of these women will actually test positive for gestational diabetes and need treatment.

The reason for treatment is for your health but mostly for the health of your baby. It is essential to keep your sugar under control with diet, exercise, and periodic glucose testing. If these methods do not work adequately, then you may be required to take insulin, which does not cross the placental barrier, and will not harm your baby. Many babies of mothers with gestational diabetes are larger than normal babies and can result in problems at delivery.

Most women return to their non-diabetic state after delivery. If you have previously had gestational diabetes, the chances of you having it again are higher as is the risk of you developing Type II diabetes later in life. Learning to manage your sugar intake with diet and exercise is a good idea for the rest of your life.
Third Trimester: Weeks 25 - 40

Your third trimester is here and just about everyone who has eyes can tell you are pregnant. Hopefully you have experienced a few months of feeling truly wonderful and energetic. Your baby has been growing by leaps and bounds, and will continue to put on weight much more quickly. In fact, your baby will grow the most during this trimester. As a result, you are going to grow much bigger and most of your third trimester concerns will be associated with your increasing size and what it is doing to your body.

By the end of this trimester you will be making weekly visits to your medical caregiver. As you approach your due date, he or she will want to keep a very close eye on you and the baby, watching for signs of trouble, or for signs of labor.

Common Conditions:

  • Lack of appetite
  • Swelling and edema
  • Fatigue and shortness of breath
  • Indigestion and heartburn
  • Increased blood pressure
  • Urinary tract infections
  • Braxton Hicks contractions

Lack of Appetite:

As your baby continues to grow, there will be less and less room in both your uterus and in your abdomen. Your organs are being squeezed in order to give your baby room to grow. This is why you will have less of an appetite, because there simply is not enough room in your stomach to eat a full meal. Most women find that by grazing throughout the day they will be able to manage to maintain adequate nutrition for themselves and for the baby.

Swelling and Edema:

Even in women with healthy pregnancies, swelling occurs. Your rings will begin to feel tight, your shoes feel tight again. Your ankles and wrists may be swollen. Swelling progresses throughout the day and is at its worst by the end of the day. To help alleviate some of the swelling symptoms, sit with your feet propped up above the level of your heart. By morning the swelling usually is gone, only to start up again.

Some women even get symptoms that are worse than just swelling. Their hands begin to tingle and they are unable to hold a pen or pencil long enough to write a check. These symptoms are due to carpal tunnel syndrome brought on by the increased swelling of your body. Most women experience relief after the delivery of their baby.

Fatigue and Shortness of Breath:

Again, your baby's size is having an effect on your ability to take a deep breath. Your rib cage has expanded to accommodate your lungs because your uterus is larger and pushing up against the base of your lungs. From time to time it is difficult to take a full breath. When you become winded, slow down. Take a few deep breaths and your breath should return. Make a good effort to sit up straight and give your lungs as much room to expand as possible. A couple weeks before delivery, your baby will drop and you will get much relief from the added room for your lungs to expand.

For those mothers who suffer from asthma, this can be an especially troubling side effect of pregnancy. Be sure to talk to your health care provider as there are medications that you can safely take during pregnancy to help your asthma.

Indigestion and Heartburn:

Again, your baby's size is the culprit here. Most women have symptoms of heartburn and acid indigestion during their third trimester. Taking TUMS, Maalox, or Mylanta can help you to get some relief. If your heartburn is especially painful, you may want to talk to your primary care provider to see what else you can take that will be safe for your baby.

Urinary Tract Infections:

A number of women experience urinary tract infections during their last trimester. Frequent urination is still your constant companion, but if it is ever tinged pink or red with blood and burns badly, or you have the urge to go to the bathroom, but only a drop or two of urine comes out, you may very well have a UTI. It is important to talk with your primary care giver. A urinary tract infection can affect the health of y our baby and actually cause you to go into preterm labor.

Increased Blood Pressure:

Very increased blood pressure during your third trimester can be an indication of something even more serious. A diagnosis of preeclampsia is made if your blood pressure goes over 140/90 and you spill protein in your urine or have swelling in your hands, face, and feet. This is also called "toxemia". About 7 to 10 percent of all pregnant women develop preeclampsia. The only treatment is delivery and if your disease is severe enough, your doctor may actually prescribe early delivery. The only way to determine if a woman has developed toxemia is to detect it. This is one reason why your weekly checks at the end of this trimester are so vital to our health and that of your baby.

Braxton Hicks Contractions:

These are contractions that are simply practice contractions. They are NOT a sign that labor is about to begin, but a way for your body to prepare for labor. These are usually very mild, and just feel like your uterus is squeezing or hugging your baby on the inside. They last from about 30 seconds to two minutes. Each woman is different and as such, her pregnancy is going to be different, and so not every woman is going to feel them in the same manner. The way to distinguish Braxton Hicks contractions from real ones is to time them. Real contractions are very regular while Braxton Hicks contractions do not happen in any sort of a regular pattern.

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