WEEKS 14 – 16

You have now completed your 1^st trimester and entered in to the 2^nd trimester of your pregnancy.The 1^st hurdle has been overcome and the initial danger period has been crossed, as the chances of miscarriage are highest during the 1^st trimester.You may actually be feeling good as all the complaints of 1^st trimester have been significantly reduced.You are now looking forward to your pregnancy with great enthusiasm and have every reason to do so.

Common Complaints

This is the time when you will experience a positive change and may feel the "MID-PREGNANCY BLOOM"As they say everything good comes for a price – so does pregnancy!Along with the general good feeling, you might experience a few discomforts like:

1. Increased vaginal discharge, which is perfectly harmless and needs no treatment. Only if you have itching/passing white flakes (like curd) does it indicate that you have what is commonly called Fungal/Candidal infection. It is quite easily treated once you make your physician aware of this problem
2. You may start getting cramps in your legs and the varicosities may increase some common tips to reduce this are:

• Avoid long hours of standing.
• Avoid restrictive / tight waist clothing .
• Reduce / stop smoking if you are a smoker.
• Avoid constipation.     
• Avoid lifting heavy weights.
• Avoid putting on more than advisable weight during pregnancy (By not eating for 2 people as according to the old pregnancy cliché).
• o some lower limb exercises whenever time permits.
• Take vitamin C containing foods like oranges, lemon etc.

6. As the uterus enlarges, you may experience backache, which can be reduced by good posture, sleeping on your left side, local analgesic cream application and a hot water bottle.
7. Nasal stuffiness: Nose bleeds and allergies can increase and if severely discomforting may need medical attention.
8. (e)Due to the increased size of uterus and venous congestion PILES or HAEMORRHOIDS can increase. Pain/ bleeding through piles needs medical attention and preventing constipation.   
9. (f)Bleeding from gums may be seen due to increased blood supply and softening of the gums. Take care to maintain a good level of dental hygiene.

  Foetus / Your Baby Inside

PICTURE OF THE FOETUS

The foetus is around 4 – 6’’ (10 – 15 cms) in length. The skeleton is well developed .The hearing system is well developed and the foetus can hear your heart beating and your stomach rumbling and thus feel at home!

The sex of the foetus can be made out in most cases as a routine ultrasound (though doing any investigation for sex determination, except in medically indicated conditions like sex linked diseases, is illegal in India)

Your Body and You

The enlarged uterus can be definitely felt above the level of your pubic bone.

• Your blood volume and capacity of the heart to function as well as the kidney function has increased.
• You may notice the beginning of a dark line in the midline in your lower abdomen (linea nigra – which disappears after delivery)

Your sex drive, which had diminished during the 1st trimester, is on the increase, and your genitals may appear swollen.Mild swelling of the ankles and legs may be seen .Your emotional state may be same as during the first trimester. Added to that may be the frustration resulting from your inability to fit into your regular clothes even though you do not seem obviously pregnant.

Visit To Your Doctor

In the second trimester your visits will be on a monthly basis.Apart from the examination as before ( ie: wt, BP, pulse, examination of abdomen and other systems.) Your doctor may also start making a note of the size of your uterus. Internal examination is not done unless indicated for some specific reason. You may be now started on Iron, Folic acid, Vit. B 12 and Calcium containing medicines. Weight gain during 2^nd trimester (14 – 28weeks ) is around 1 pound /week or 2 kg/months i.e. total gain of 12 – 24 pounds / 5 –6 kg during this period.These monthly visits will continue till you are around 28 weeks pregnant. During these visits your doctor may also ask you about any complaints and problems as discussed in the earlier section.
It is advisable to keep ready the list of doubts and questions you want to ask before visiting your doctor.

Possible Problems
This is a relatively trouble free period. Some of the problems common to second trimester i.e.: weeks 14 – 28 are:

1. Anemia or reduced hemoglobin level in blood.
2. Haemorrhoids / Piles
3. Late miscarriage and incompetent cervix
4. Bleeding and Abortion
5. Placenta Praevia and separation of placenta
6. Pregnancy induced Hypertension
7. Intrauterine foetal death     
8. Exacerbation of existing medical and surgical illness

Important Instructions
The problems of 1^st trimester are over and the discomforts of late pregnancy have not yet started. This is the right time to make your plans and a schedule for your pregnancy. You can make a list of various things like baby names, baby clothes, and your wardrobe, books to read, music (supposed to stimulate the growing baby inside you) etc…

Some important things to be remembered and followed from are as follows:

• Travel

Once you have completed 16 weeks you are more or less on safe grounds for travel. The 2^nd trimester is the best time for planning a vacation if you intend to take one during your pregnancy. Travelling by railway / air is by far the best travelling by bus is better avoided.

Addenda for Travel

Few tips before starting and during your vacation:

• Inform your doctor and ask regarding do’s and don’ts.
• Walk often while on long rail journeys.
• Take snacks and juices to prevent hunger and ease nausea.
• Eat regular nutritious meals.
• Get adequate rests and avoid a hectic travel schedule.
• Take your medical report along with you.
• Most importantly – keep your plans flexible and in common serve to make travelling a pleasure.

• Job

You can continue to be on your job till as long as you wish, provided it is not physically exhausting.

Few tips for working women are as follows:

• Don’t keep standing for long.
• Take a break every 2 – 3 hours.
• Take a nap if possible after/ during lunch hour.
• Does calf /leg exercises intermittently.    
• If you work involves sitting, then maintain a good posture and keep your leg elevated on a stool/box when possible.
• Listen to your body and slow down when tired.
• Avoid high temperatures, crowded and smoke filled areas and chemicals.
• Take adequate supply of nutritious snacks.
• Empty your bladder frequently.

You may have to give your office adequate notice about your expected date of delivery and maternity leave.

• Sex

Your sex drive, which had waned during the first trimester, is returning back. And sex may become even better than before. The genitals are slightly enlarged and more sensitive there are instances of women achieving orgasm for the first time during pregnancy and also experiencing multiple orgasms.Sex by now is much more safe and fulfilling if practiced with caution and moderation.

A couple may be unduly worried about hurting the baby. But be assured, the foetus is well protected. It is suspended in bag of water (which acts as a shock absorber) which in turn is covered by the uterus which in turn is encased safely in your abdomen. Even deep penetration by the penis will not harm the foetus.Inspite of this if you cannot get over your apprehension, you may try different positions and find ones which are most comfortable.

Some positions that couples find comfortable are the female on top position, female in knee chest position and female lying on her side.Intercourse need not be always the end point. Fondling, caressing, mutual masturbation and oral sex can be fun and sometimes more gratifying.Conventionally sex during 1^st 3 months and last 2 months of pregnancy was considered unsafe .This is no longer so, though it is better to avoid doing it is certain high risk cases sex has also been used to induce labor at term (not scientifically proven)

• Some condition where sex should be avoided are:
• Women with previous miscarriage.
• Women with previous preterm labour.
• In presence of bleeding per vaginum..
• In presence of leaking per vaginum.
• Women with incompetent cervix.
• Women with placenta praevia.
• Woman and men active and painful genital herpes and other sexually transmitted diseases.

• Exercises

You should be diligently following your antenatal exercises.,

These not only help you feel better but also have many other advantages like;      

1. reducing backache
2. easing delivery
3. Helping in toning up your genitalia after delivery as delivery carries laxity of your perineum.

• Music

Good music is soothing to the foetus and also you. You should listen to good music as frequently as possible. It has been seen that the foetus is able to recognize music. Babies exposed to music during their stay in the uterus, recognize the same music when heard after birth and associate it with rest period and may go to sleep on hearing it or become calm and pacified.

• Diet

• Rest and Sleep

You need to get adequate rest and sleep to avoid fatigue. You should sleep 7 – 8 hours at night and another 1 – 2 hours of afternoon siesta, but not immediately after your meals. It is preferable to sleep on your left lateral side as this reduces your backache and increases the blood returning from your lower limbs as the uterus falls off the blood vessels in this position.This also increases the blood supply to your foetus. Keeping a pillow beneath your legs while sleeping will reduce the swelling in your legs and elevated position of the head-side will reduce heartburn.

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