Pregnancy: Symptoms and emotions in the second trimester

The second trimester of pregnancy often brings a renewed sense of well-being. The worst of the nausea has usually passed, and your baby isn't big enough to crowd your abdominal organs and make you uncomfortable. Yet dramatic physical and emotional changes are on the horizon. Here's what to expect.

Your body

As your pregnancy progresses, you may notice physical changes from head to toe.

• Larger breasts. Stimulated by estrogen and progesterone, the milk-producing glands inside your breasts get larger. A small amount of fat may also accumulate in your breasts. The result may be as much as 1 pound of extra breast tissue or up to two additional cup sizes.
• Growing belly. As your uterus becomes heavier and expands to make room for the baby, your abdomen expands right along with it. Expect to gain up to 4 pounds a month until the end of your pregnancy.
• Braxton Hicks contractions. Your uterus may start flexing to build strength for the big job ahead. You may feel these warm-ups, called Braxton Hicks contractions, in your lower abdomen and groin. They're painless and come and go unpredictably. Contact your health care provider if the contractions become painful or regular. This may be a sign of preterm labor.
• Skin changes. As blood circulation increases, you may enjoy the healthy glow associated with pregnancy. Certain areas of your skin may become darker as well, such as the skin around your nipples, parts of your face and the line that runs from your navel to your pubic bone.
• Nasal and gum problems. As pregnancy expands your circulation, more blood flows through your body's mucous membranes, causing the lining of your nose and airway to swell. This can restrict airflow and cause snoring, congestion and nosebleeds. Increased blood circulation can soften your gums as well, which may cause minor bleeding when you brush or floss your teeth.
• Dizziness. Your blood vessels dilate in response to pregnancy hormones. Until your blood volume expands to fill them, you may experience occasional dizziness. Lower blood pressure due to your rapidly expanding circulatory system also may play a role. Avoid prolonged standing, and rise slowly after lying or sitting down.
• Leg cramps. During the second trimester of pregnancy, pressure from your uterus on the veins returning blood from your legs may cause leg cramps, especially at night. Stretch the affected muscle or walk your way through the cramps.
• Heartburn and constipation. During pregnancy, the movements that push swallowed food from your esophagus into your stomach are slower. Your stomach also takes longer to empty. This slowdown gives nutrients more time to be absorbed into your bloodstream and reach your baby. Unfortunately, it may also lead to heartburn and constipation.
• Shortness of breath. Your lungs are processing up to 40 percent more air than they did before your pregnancy. This allows your blood to carry large quantities of oxygen to your placenta and the baby — and may leave you breathing slightly faster and feeling short of breath.
• Vaginal discharge. You may notice a thin, white vaginal discharge. This acidic discharge is thought to help suppress the growth of potentially harmful bacteria. Contact your health care provider if the discharge becomes strong-smelling, green or yellowish or it's accompanied by redness, itching or irritation. This may indicate a vaginal infection.
• Bladder and kidney infections. Hormonal changes slow the flow of urine, and your expanding uterus also may get in the way — both factors that increase the risk of bladder and kidney infections. Contact your health care provider if you need to urinate more often than usual, you notice a burning sensation when you urinate, or you have a fever, abdominal pain or backache. Left untreated, these infections may increase the risk of preterm labor.

Your emotions

Pregnancy is a psychological journey as well as a biological one. During the second trimester, you may feel less moody and more up to the challenge of preparing a home for your baby. Strike while the iron is hot! Check into childbirth classes. Find a health care provider for your baby. Read about breast-feeding. If you plan to work outside the home after the baby is born, get familiar with your company's maternity leave policy and investigate child care options.

As your pregnancy progresses, changes in your body's shape and function may affect your emotions. Some women feel a heightened sexuality during pregnancy. Others feel unattractive — especially as their bellies grow. If you're struggling with your body image, share your concerns with your partner. Express love and affection in ways that help you feel most comfortable.

While anticipation mounts, worries about labor, delivery or impending motherhood may preoccupy you. Remember that you can't plan or control everything about your pregnancy. Instead, focus on making healthy lifestyle choices that will give your baby the best start.

Appointments with your health care provider

During the second trimester, your prenatal appointments will focus on your baby's growth, confirming your due date and detecting any problems with your health.

Your health care provider will begin by checking your weight and blood pressure. He or she may measure the size of your uterus by checking the fundal height — the distance from the top of the uterus (called the fundus) to your pubic bone. Pelvic exams are often unnecessary during the second trimester, unless something unusual needs to be explored.

At this stage, the highlight of your prenatal visits may be listening to your baby's heartbeat with a special device called a Doppler. Your doctor may suggest an ultrasound or other screening tests this trimester.

Be sure to mention any signs or symptoms that concern you, even if they seem silly or unimportant. Talking to your health care provider is likely to put your mind at ease.