Overview

Weeks 13 to 27 of your pregnancy tend to be the favorite period for many expecting moms. This article covers everything you need to know to navigate the second trimester. Your belly will start showing, and you can feel your baby kicking. By this point, morning sickness should be subsiding. You have adjusted to many lifestyle changes to have a healthy pregnancy. Your moods and emotions should be evening out; overall, you should feel like you have more energy. After all of the last trimester’s internal changes, the second trimester brings many physical changes. Learn what to expect at your second-trimester prenatal appointments. Find out what to-do items you should work on this trimester. Plus, get tips on your partner’s role and how they can support you.

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Weeks 13 to 27

The second trimester of your pregnancy goes from week 13 to 27. Generally, the second trimester is the most liked. Morning sickness should dissipate at the start of the second trimester, and you should feel like you have more energy and your bump is making an appearance. This is the trimester to enjoy your pregnancy and get excited about your baby.

Your Growing Baby

Your baby is growing so much this trimester. Their skeleton and bones are developing. Fat stores begin to develop under your baby’s skin, and this will provide energy and help keep your baby warm after birth. A fine, down-like hair called lanugo completely covers their body. Lanugo helps hold the vernix caseosa. This greasy and cheese-like coating protects their delicate skin from abrasions and hardening from exposure to the amniotic fluid. They also have hair on their head and eyebrows. Your baby’s lungs and nervous system continue to mature, and fingerprints and footprints are forming.

As your baby becomes more active, their movements become more coordinated. Your baby is regularly sleeping and waking. They have rapid eye movements, make sucking motions with their mouth, and can swallow. Sometime around week 20, you can feel your baby kick and move around. If this is not your first pregnancy, you may even begin to feel kicks sooner. This is a super exciting experience for your partner. If your baby is moving around, tell your partner to touch your belly so they can feel it, too.

Common Second Trimester Symptoms

Many symptoms can pop up in the second trimester. Some of these are a continuation of symptoms you experienced in the first twelve weeks, and others may be new challenges.

Physical Changes in the Second Trimester

In the first trimester, it seems like most of the changes are internal, and in the second, your body physically catches up. Women vary all over the spectrum on how they feel about their body image during pregnancy. Some mothers feel unattractive, while others love their new curves and growing belly. No matter how you feel, it is on the spectrum of normal.

Weight gain is not linear throughout your pregnancy. In the first trimester, you should only gain a few pounds. You should experience a steady, gradual weight gain throughout your pregnancy in the second and third trimesters. You can expect around one pound per week if you start underweight or at a normal weight and half a pound a week if overweight or obese. See this article on healthy pregnancy weight gain.

Breast Changes

Your breasts go through a lot of changes during pregnancy. If you had tender breasts in the first trimester, you should start feeling better. However, you can still expect them to keep growing. As your body prepares to produce milk, more fat will accumulate in your breasts. You may need to go up a bra size. It may be better to hold off on stocking up on bras until later in your pregnancy because your breasts will keep growing. See this article for an in-depth explanation of the changes you can expect with your breasts during pregnancy.

Skin Changes

For many expecting moms, pregnancy can cause some challenging skin issues. The good news is the majority of these skin issues are temporary and will disappear after your baby is born. See this episode for a breakdown of symptoms, causes, prevention, and treatment of skin issues.

Stretch marks are probably one of the most disliked side effects of pregnancy. These may appear towards the end of the second trimester. Rapid stretching of the skin fibers, hormonal changes, and genetic factors all contribute to stretch marks. The Greeks and Romans used olive oil to try and prevent stretch marks during pregnancy. Unfortunately, no research shows any cream, oil, or magic potion that effectively prevents stretch marks. If you get stretch marks, your skin may be itchy, and keeping your skin moisturized can help with this.

You may be noticing some changes to the pigmentation in your skin. A stripe down the center of your belly called a linea nigra might appear in the second trimester and get darker as your pregnancy progresses. This is common, and it will fade after you have your baby. An increase in melanin production causes some expecting mothers to get melasma. Melasma creates dark patches of skin on the forehead, cheeks, nose, or upper lip. Sun exposure can make this more noticeable, so wear a hat or sunscreen to minimize the sun on your face.

Bleeding Gums

Increased blood circulation can make your gums softer and cause them to bleed when you brush or floss your teeth. You can try switching to a softer toothbrush and see if that helps. Please maintain your dental hygiene during pregnancy and take good care of your teeth and gums while expecting.

Increased Vaginal Discharge

You might notice a lot of discharge, which is normal. It is usually white and acidic, which is thought to help suppress yeast and bacteria growth. You can always use a thin panty liner if this bothers you. Please check in with your care provider if it is green or yellow, has a strong odor, or if you are having pain, soreness, or itching. Those are signs that you could have a vaginal infection.

Complications

A few complications may arise during the second half of your pregnancy. As always, please get in touch with your doctor or midwife if you have any concerning symptoms.

Preeclampsia

Your care provider will take your blood pressure at each prenatal visit. If you have high blood pressure after 20 weeks, your doctor or midwife may perform other tests to rule out or diagnose preeclampsia. This condition is considered high-risk and will involve additional monitoring or treatment to keep you and your baby healthy.

ICP (Intrahepatic Cholestasis of Pregnancy)

Intrahepatic cholestasis of pregnancy is a complication caused by a reduced flow of bile down the bile ducts in the liver, which causes some bile to leak into the bloodstream. This build-up of bile acids in the bloodstream can cause a persistent itch, most often in the palms of your hands or the soles of your feet. It is also possible for it to spread to your belly. This is characterized by severe itching with no rash present. Usually, this occurs late in the second or early in the third trimester, then disappears after you have your baby. Other than the itching, which can be very uncomfortable, there are no risks to the mother. Unfortunately, this condition does increase the risk of some adverse outcomes for your baby.

PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)

PUPPP stands for pruritic urticarial papules and plaques of pregnancy or PEP in the UK (polymorphic eruption of pregnancy). This itchy rash is the most common skin condition in pregnancy. Studies show the incidence is 0.5% in single pregnancies, 2.9 to 16% in twin pregnancies, and 14 to 17% in triplet pregnancies. Thankfully, PUPPP does disappear after birth. If the symptoms are bothersome during pregnancy, there are some remedies to treat it. See this episode for more information and treatment of PUPPP.

Second Trimester Prenatal Appointments

Through the second trimester, you will have appointments with your doctor or midwife every four weeks that focus on how your baby is growing. Remember, there is no such thing as a stupid question, and you should be asking your care provider any questions you have. Check out this article for five tips to make the most of every prenatal appointment.

Anatomy Scan

It is routine for expecting moms to get an ultrasound anatomy scan in the second trimester. Generally, you can expect this done at 18-20 weeks. This ultrasound diagnoses fetal malformation and structural abnormalities, confirms a multiples (twins) pregnancy, verifies dates and growth, identifies excessive or reduced levels of amniotic fluid, and evaluates your baby’s well-being. During this ultrasound appointment, your baby will be measured from crown to rump, around their middle and head. Since this is an anatomy scan, the ultrasound technician will look at the heart’s four chambers, the kidneys, bladder, stomach, brain, spine, and sex organs. You can learn more about ultrasounds in this episode.

Tests

Your doctor or midwife will offer or suggest several prenatal tests during your pregnancy, many of which are in the second trimester. You may feel like you are continually waiting for the result of some test to come back so you can be assured that your baby is healthy. Most tests are routine, and you have a high probability of everything returning normal.

When evaluating your testing options, there are a few things to remember. A screening test gives you the likelihood of a condition and may signal that additional testing is needed. You only know something for sure once you have a diagnostic test. All tests vary in their accuracy. Please discuss your testing options, results, or questions with your doctor or midwife.

Quad Screen

The quad screen is a maternal blood screening test examining proteins or hormones that can indicate your baby’s risk of trisomy 21, trisomy 18, spina bifida, and abdominal wall defects. The optimal time frame for this test is between 16 and 18 weeks, but the window is between 15 and 22 weeks. The quad screen test is slightly less accurate than the first-trimester screen.

Integrated Screening

An integrated screening test combines results from a quad screen test in the second trimester with the first-trimester screen. Combining results from both tests has a higher detection rate for Down syndrome than either of the two tests alone.

Gestational Diabetes Testing

Gestational diabetes is a type of diabetes that occurs during your pregnancy and goes away after the birth of your baby. This condition affects 6-7% of pregnancies. The glucose challenge screening is a preliminary test to evaluate how your body processes sugar. Insulin resistance often starts around week 20, and you take this screening test between 24-28 weeks. While the glucose challenge screening is a standard routine test in the United States, you may test sooner if you are at high risk. During the test, you are asked to drink a sweet liquid of glucose (sugar) within five minutes and then will have blood drawn one hour after having the drink.

If you have a positive result on the Glucose Screening Challenge, you will take a glucose tolerance test. This diagnostic test determines whether the body is using glucose effectively. You will not be permitted to eat or drink anything but sips of water for 14 hours before the test, so it is best to schedule the test for first thing in the morning. You may also want to have someone drive you to and from the test since your energy levels may be low, and there is a slight possibility you may feel lightheaded. Your blood is tested every hour for three hours.

This episode dives into what gestational diabetes is, how it affects you and your baby, the testing methods for gestational diabetes, and examines the risks of the tests and potential alternatives.

Amniocentesis

An amniocentesis is a diagnostic test for chromosome abnormalities, neural tube defects, and genetic disorders. This test will only be offered if a screening test indicates your baby is at high risk for one of these conditions. The test is available between 15 and 20 weeks. An ultrasound-guided needle is inserted through your belly into the amniotic sac to collect a sample of amniotic fluid. The actual collection of fluid takes less than five minutes, but the procedure takes about 45 minutes from start to finish. A lab analyzes the amniotic fluid-containing cells shed by the fetus. Results can take a few days to a couple of weeks.

Like a first-trimester CVS, an amniocentesis has a high level of accuracy at greater than 99%. This is an invasive diagnostic test that does pose potential risks. A systematic review and meta-analysis found the miscarriage rate to be 0.11%. This is the data also referenced by ACOG. The mother may experience sharp pain when the needle enters the skin and again when it enters the uterus. After an amnio, you could experience some side effects, including cramping, leaking fluid, and minor irritation around the puncture site.

RhoGAM

In addition to your blood type, you have a positive or negative Rh factor. If you are Rh-negative and your baby’s father is Rh-positive, your baby may be Rh-positive. This means incompatibility is possible when your blood and your baby’s blood are mixed. Usually, this doesn’t happen. An injury, like a car accident, could cause your and your baby’s blood to come into contact. This can also occur if you have a miscarriage, if you have an external cephalic version, a procedure to try and flip a breech baby, with an invasive test like amniocentesis or CVS, or during the birth process with interventions like using forceps, a vacuum, or a cesarean section.

To prevent incompatibility, RhoGAM is given as a shot at 26-28 weeks to prevent your immune system from attacking your baby’s blood. This works similarly to a vaccine. If you have a negative blood type, please check out this episode on the pros and cons of RhoGAM.

Vaccines

Vaccines are a very controversial and complex topic. The choice to get vaccinated is a decision you should make with your doctor or midwife. If you have questions or concerns about any vaccine, please bring them up with your care provider. Vaccines should be given with informed consent, ultimately, your decision to get vaccinated.

There are multiple vaccines that the American College of Obstetricians and Gynecologists recommend during pregnancy. Vaccines during pregnancy protect you and allow you to pass antibodies to your baby before they are born. Two vaccines (COVID-19 and influenza) are available in any trimester. Some expecting mothers and care providers may avoid vaccines during the first trimester because this period is critical to development. If you decline the flu or COVID-19 vaccine in the first trimester, your doctor or midwife will likely offer or suggest these vaccines in the second trimester.

See this episode for more information on the COVID-19 vaccine during pregnancy. This article examines the evidence on the flu vaccine for the current flu season.

To-Do Items for the Second Trimester

The second trimester is the perfect time to take advantage of feeling like you have more energy and get things done. I know it can be overwhelming to think about everything you need to do to prepare for birth and having a newborn. By knocking out some big items in the second trimester, you can set yourself up to relax and be more prepared for the final months before your baby arrives.

Get Maternity Clothes

As your little one grows and your uterus expands, you should have a baby bump appearing at the beginning of the second trimester. You will hit a point when you can no longer fit into your favorite jeans. You will feel so much better in comfortable clothes. Some hacks make your clothes fit slightly longer, but getting some comfy maternity pieces in your wardrobe is worth it. You may be fortunate to get clothes from a pregnant friend or find second-hand items. You do not need to spend a fortune to get maternity clothes in your wardrobe.

Travel

This trimester should bring relief from some of the uncomfortable first-trimester symptoms. The second trimester is the ideal timeframe if you want to plan a vacation or a babymoon. In the third trimester, you are more prone to have less energy, and everything is bigger, which can make you more uncomfortable overall. As you get closer to your due date, you may be nervous about straying too far from home, your care provider, and the venue where you plan to have your baby. Sometimes, we have to travel on dates out of our control, but the second trimester is ideal if you can pick the time. Whether you are hopping in a car for a road trip, getting on a train, or flying to another country, this episode goes through tips to stay healthy and be as comfortable as possible while traveling when you are expecting.

Learn

The second trimester is a great time to learn more about your birth options and start preparing to be a parent. If you leave all of this for the next trimester, you may feel overwhelmed and stressed out leading up to your due date. This period is an excellent time to read books on pregnancy or parenting.

The Womanly Art of Breastfeeding covers everything and will have you prepared for breastfeeding success. Ina May’s Guide to Childbirth is excellent if you are planning a birth without pain medication or interventions. If you want more of a spiritual book, check out Ancient Map for a Modern Birth. The Your Birth Plan book is a step-by-step guide to creating your birth plan. There are short chapters on your options with the evidence, pros, and cons. There are also sample birth plans for everything from home birth to a cesarean and a template you can download and customize. Pregnancy Podcast Premium members get a free copy of the Your Birth Plan book.

Manage Stress

Pregnancy can be a time of additional stress as you are experiencing many physical changes and preparing for birth and a new baby. Everything you expose yourself to during pregnancy can also affect your baby, and stress is no exception. Stress during pregnancy can affect your baby in many ways. Physiological changes can impact your developing baby. Stress that puts you at a higher risk for some complications can affect the health and development of your baby. How you and your baby are affected by stress is a function of your stress response and ability to turn it off. The good news is that understanding your stress response and learning about evidence-based tools to manage stress will minimize your and your baby’s adverse effects and positively impact your mental health.

Plan for Maternity and Paternity Leave

This is a great time to start looking into your maternity and paternity leave options and plan for childcare if you plan to return to work. You and your partner need to determine how much time you can take off and whether you will be paid during leave. If you are employed, you can start by checking with your employer. Next, look into the policies in your state if you are in the United States. If you are in another country, check with government agencies.

If you or your partner is self-employed, consider putting systems in place to spend some time away from your business. At a minimum, cut down on hours. It can be challenging to take a lot of time away from work, especially if that means losing income. This is a short window of opportunity for you and your partner to be with your new baby. I urge both of you to explore your options and get creative to try and find a way to spend as much time as possible with your new baby. Planning for maternity leave is a big project, and this episode breaks it down into manageable tasks that you can knock out.

Build Your Baby Registry

This trimester is a good time to start shopping for things you need for your baby or build your baby registry. This article discusses considerations when choosing where to register, the pros and cons of the top options, and tips for building your baby registry. It can be overwhelming to think about choosing the right products, how much everything will cost, and where you will put everything. This article will explain exactly what you need for your new baby, whether purchasing items or adding them to a baby registry. Plus, download the Ultimate List of the must-haves, optional items, and what is unnecessary.

Your Partner

If you don’t have a romantic partner or a co-parent, I encourage you to lean on friends and family so you are not going through this phase of your life without support.

Please encourage your partner to attend your doctor or midwife appointments. This allows your partner to be included, have input in major medical decisions, ask questions, and hear everything firsthand. If any complications come up throughout prenatal care or you get some unfavorable test results back, those appointments can be challenging to go through alone. Having your partner by your side can be a fantastic source of support. One of the more significant appointments for your partner to attend this trimester is the anatomy scan ultrasound, where you will see a picture of your baby and hear their heartbeat.

Whether you and your partner want to know about ultrasound safety or what kind of diapers to buy, there is plenty of research to do. Ask your partner to help with some of the research and reading. Check the Pregnancy Podcast website and utilize the search function. Chances are the work has already been done, and you can listen to a short episode or read an article for evidence on any topic.

Make the Most of Your Second Trimester

This is the golden trimester for a reason, and I hope it is treating you well. By this point, you have adjusted to many lifestyle changes to have a healthy pregnancy. Your moods and emotions should be evening out; overall, you should feel like you have more energy. Take advantage of feeling good and knock out some of your to-do items in preparation for your baby. I hope you enjoy your second trimester.

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