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The Pregnancy Guide

By David M. Priver, M.D., FACOG
2010-05-18 15:13:30

FIRST TRIMESTER
Month One
We can define the first month of pregnancy as the six weeks following your last menstrual period, since conception occurs about two weeks into that time. HCG, a hormone crucial to pregnancy, almost immediately triggers the ovaries to release large amounts of estrogen and progesterone, which, in turn, cause the lining of the uterus to thicken to provide nutrition to the developing embryo.

Shortly after you miss your period, your hormone levels become high enough to cause pregnancy symptoms. Breast soreness is most common, followed closely by frequent urination, fatigue and nausea. The majority of pregnancy tests will turn positive by just three to four days after a missed period. There are, however, almost no visible physical changes, though your body is changing rapidly on the inside. After you have a positive pregnancy test result, call your ob/gyn or midwife to register for care, so you can be seen in month two for your initial prenatal appointment.

Unless nausea is extremely severe, it does not compromise an otherwise healthy pregnancy. In fact, this symptom is quite reassuring as it reflects the production of a large amount of hormone and is associated with an extremely low rate of miscarriage. Hormone levels result in fragility of small blood vessels in the area of the cervix, often leading to slight, harmless spotting, which will usually go away on its own. Check with your ob/gyn or midwife to be sure.

Month Two
By now, your pregnancy symptoms are well established. The main physical change is uterine growth, which is often accompanied by stretching of the ligaments that hold the uterus in place. You might notice sharp abdominal twinges as this occurs, especially if this is your first pregnancy. You should not be concerned, however, unless there is bleeding as well.

At this point, your baby’s organs are being formed, as the cells begin the process of differentiation. For about the next six weeks, the heart, brain and all other organs start to form. You should avoid potentially harmful influences, such as smoking, toxic fumes, alcohol and many drugs. Check with your ob/gyn or midwife before you take any medication.

The majority of substances to which you may be exposed have not been shown to be harmful, but it is impossible to study all these items scientifically. You might find it reassuring that the rate of fetal injury remains low even though we live in a society filled with auto exhaust, cigarette smoke and other waste products.

Month Three
Your hormones have reached the highest level of your entire pregnancy. They will even out and soon begin a gradual decline. The good news is that nausea tends to diminish by the end of this month. Your By the end of the third month, nausea tends to diminish, your uterus grows rapidly and you might be showing uterus continues to grow rapidly, and you might notice that you’re beginning to show. Your doctor can usually hear the fetal heartbeat by this time, so 12 weeks is a good time to bring your partner to an office visit to hear it as well. It is remarkable how much that simple experience can help bond a future father to his developing child.

It is important for you to have established your pregnancy care by now, as there are new tests developing to detect abnormalities this early. If you are expecting twins, it will be apparent now, and your pregnancy care will require a specialized approach.

At the 12-week point, all organ systems are fully formed. Henceforth, only growth and maturity will occur. The risk of toxic exposure is dramatically reduced, so that drug treatments can be administered now with much less concern about effects upon the developing fetus.

SECOND TRIMESTER
Month Four
Your hormone levels stabilize as the fluctuations of the first trimester give way to the development of the placenta, which provides continuous nourishment to your baby.

As the fatigue and nausea finally lift, there is a burst of physical and mental energy. You will develop improved endurance and will be encouraged to engage in stretching and cardiovascular exercises, which will provide you later on with the ability to cope with the intense physical demands of the third trimester. For this reason, we call this segment of pregnancy the “fitness trimester.”

Screening tests to ensure proper fetal development begin, and may include ultrasound and blood tests to determine if more intensive monitoring is required (it’s not usually the case). Your results should be available by the end of this month.

Month Five
By the fifth month nearly all women show. In a fi rst pregnancy, though, abdominal muscles may still be tight, holding the uterus in. In such cases, friends might ask As the second trimester ends, your baby’s growth is much more rapid and noticeable whether the baby is growing adequately. Fetal growth problems rarely occur now, so there’s no need to worry.

Ultrasound can generally reveal anatomic details, including the sex of your baby. By 20 to 21 weeks, you can expect “quickening,” or fetal movement.

Stretching of the “round ligaments” of the uterus is quite common now. It can result in sharp sensations in the groin areas, experienced when you change your position suddenly, such as when you roll over in bed. They are not dangerous and will subside with rest and a warm compress.

Month Six
As the second trimester ends, your baby’s growth is much more rapid and noticeable. You have a change in posture, tending to lean backward for balance. Any fitness exercises you did earlier pay off now, as there can be significant stresses to lower-back muscles, joints and ligaments. You might feel more uncomfortable during fitness exercises, and you should gradually reduce their intensity and duration.

Screening for pregnancy diabetes, which is not rare, will be done. If the tests are positive, managing your diet can usually control the condition, which nearly always ends after pregnancy.

You should start childbirTheducation classes now, which will prepare you and your partner for what to expect in labor, dramatically reducing any anxiety associated with the unknown. You will most likely explore issues such as pain relief options, relaxation techniques and birth alternatives. It’s important not to have very rigid birth plans, as labor is often dramatically different for each woman, requiring differing ways of labor management.

THIRD TRIMESTER
Month Seven
Monitoring you and your baby this month is a major concern. There appears to be an instinctual increase in self-awareness that may make you more sensitive to subtle changes in your baby’s activity pattern and your own symptoms. The fetal surveillance program referred to as “kick counting” begins now, whereby you would spend some time each evening after dinner counting the number of minutes it takes for your baby to move ten times. For most women, this will take 20 minutes or so. If it were to take more than two hours, you would be instructed to go immediately to the hospital where monitoring would determine if a problem exists. Th is program continues daily until the birth of your baby. Studies have shown it to be of major value in heading off fetal problems.

In addition, uterine contractions — which have actually been occurring throughout the pregnancy — become noticeable on a daily basis. Brief and irregular contractions, called Braxton-Hicks, are normal, harmless and easily distinguishable from those of actual premature labor, which are long, regular and painful.

Month Eight
Reducing your activity will make you more comfortable while allowing a redirection of blood fl ow toward the placenta and fetus, which is needed to support your baby’s rapid growth. You should set a date for ending employment no later than the end of this month. Most women become aware that when at rest, there is an increase both in fetal movements and contractions. Th is positive development reflects the fact that resting results in the improved delivery of oxygen and nutrients to both the uterine musculature and the fetus.

The final customary laboratory test — a culture to determine whether a pregnant woman is among the 20 percent who carry the Group B streptococcus bacteria — is carried out this month. If positive, a woman will be treated with antibiotics during labor. Th is innovation of the past 20 years or so has greatly reduced the past major problem of streptococcal infection of the newborn.

Month Nine
The stage is now set for labor and birth as contractions become stronger and more frequent. You will be seeing your ob/gyn weekly, and there will be close monitoring of your blood pressure. Exams to determine your cervical status might be started. You will be encouraged to time contractions to determine length, strength and frequency.

When you cannot carry on a conversation during a contraction, true labor is likely. A slightly bloody mucous secretion, called a bloody show, tends to signal an impending labor, but don’t worry. If there are concerns about your baby’s well-being, a nonstress test may be run. If it’s decided that labor should be induced, brought on artificially, your physician will explain the pros and cons.

Regardless of how the process of birth is carried out, the goal is to present a healthy baby to a healthy mother. It is at this momentous and life-changing event that the true benefits of the preceding months of care become apparent. It is a time to enjoy and celebrate the miracle of life!

San Diego ob/gyn David M. Priver, M.D., FACOG, has been caring for pregnant women for more than 38 years. He has delivered over 8,000 babies, and is the pregnancy expert on www.youandyourfamily.com.

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