Title: Healthy YOU Podcast, Episode 17: What to expect during your second trimester
Host: Frankye Myers, Chief Nursing Officer for Riverside Health System
Expert Guest: Kelli MacAdam, Nurse Midwife with Riverside Partners in Women’s Health
[00:00:00] Frankye Myers: From Riverside Health System. This is the Healthy You podcast, where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
[00:00:29] Frankye Myers: All righty. I am really excited to have with me today in the studio for the Healthy You podcast. And I am Frankye Myers, senior vice president and chief nursing officer for Riverside Health System. We have Kelli McAdam. Kelli is a nurse midwife with Riverside Partners in Women's Health and we're going to be talking about what to expect during your second trimester. So welcome, Kelli.
[00:00:55] Kelli MacAdam: Thanks.
[00:00:57] Frankye Myers: Glad to have you.
[00:00:58] Kelli MacAdam: Yeah, I'm happy to be here.
[00:01:00] Frankye Myers: All righty, so we're continuing conversations about the trimesters. We've had the first trimester, so we're going to talk about the second trimester. Kelli, briefly tell me about why you decided to pursue a career as a nurse midwife.
[00:01:13] Kelli MacAdam: So, I started out my nursing career in labor and delivery.
It was one of those rare things that the hospital I applied to, they hired you in as a nurse and then they picked what unit to send you to. And I got sent to labor and delivery, much to my surprise. Right. But after witnessing one birth, I realized this is where I'm meant to be. There are, I think, few times in a person's life that you can really make a difference. And one of those is when someone becomes a mother or watching that family just grow and expand. It's a day that they never forget.
[00:01:48] Frankye Myers: Right.
[00:01:48] Kelli MacAdam: And so to be part of that is incredible.
[00:01:51] Frankye Myers: Absolutely.
I knew very early from my nursing clinical rotations that I could not do labor and delivery. It is such a skilled area. And then I just appreciate all the work that you do in that space. So I applaud you. I do have two children.
What is the difference between a midwife and an OB?
[00:02:20] Kelli MacAdam: Yeah. Between us and the physicians.
[00:02:22] Frankye Myers: Yeah. And the physicians.
[00:02:23] Kelli MacAdam: Right. That is a very common question that I get. So our differences a little bit in the training. For one, my background is nursing, so I started as a nurse, whereas physicians, they go through medical school.
I then went back to school and pursued my master's degree and then my doctorate degree in nursing and then got my certification in midwifery. So we provide care to women from the time that they have onset of menstruation all the way through, even postpartum. So kind of similar to like nurse practitioners, women's health nurse practitioners, we work in that realm, but we also get to do the fun part of delivering babies. So anybody who's having a vaginal delivery in that we have the ability to care for them even if they have some high risk factors in that we will co manage them with the physicians together. And the physicians, their specialty kind of comes in for the surgical side of it. So if a woman needed a C section, then we kind of pass that care over to the physicians.
[00:03:22] Frankye Myers: Okay.That's great information. As a nurse myself, it's so awesome to see nurses being used in expanded roles.
[00:03:31] Kelli MacAdam: Yeah, it is incredible to see. And I think it brings a special background. So, like, take that nursing background and then apply it into a provider role. Just gives it a whole other perspective of it. So it's a valuable, I think, member to that team.
[00:03:45] Frankye Myers: Absolutely. And with all of the shortages, it helps to bridge the gap and opens up avenues for additional access to care that's so needed.
[00:03:55] Frankye Myers: Right. In our previous two episodes in the miniseries on pregnancy, we covered pre pregnancy in the first trimesters. And we're going to be diving into some important things to consider doing second trimesters. So let's start by defining the second trimester. What is the time frame for the second trimester?
[00:04:13] Kelli MacAdam: So the second trimester is roughly about that 13 week to like, the 27th week of pregnancy. So it's kind of in that middle range of them.
[00:04:22] Frankye Myers: Okay.What kind of things can a woman expect with their body changes that may occur during that pivotal second trimester time? Yeah.
[00:04:33] Kelli MacAdam: So one of the perks is that life tends to get a little bit better in the second trimester.
That first trimester can be hard. There tends to be like a lot of that nausea, vomiting, and that fortunately tends to get better into the second trimester. Now, not for everybody, but for a lot of people that kind of subsides away some of that breast tenderness in that, that kind of settles down and gets better.
A lot of times the fatigue that people suffer in first trimester, that tends to resolve in the second trimester. So you get another kind of burst of energy that comes back.
[00:05:08] Frankye Myers: Okay. So some of the things I know for myself and then as I hear women talk about so the weight gain, typically there's a certain trimester when you see the bulk of that, the quickening that's the first time you feel the baby or the flutters, some of those things, absolutely.
[00:05:27] Kelli MacAdam: So the weight gain, there's some weight gain that can happen in that first trimester. Definitely more of it tends to happen into the second trimester and then into that third trimester as well. The second trimester tends to be that time where you tend to notice that you're pregnant.
[00:05:42] Frankye Myers: Right, right.
[00:05:42] Kelli MacAdam: And other people are going to notice that you're pregnant. Your belly is starting to grow. It's starting to look instead of like, maybe I've had an extra donut, I'm pregnant and I'm growing a baby. So that form changes. You start to notice changes in your posture. So the change in the positioning of your lower back kind of happens okay. So it just becomes kind of more noticeable and then like you said, that quickening. So that feeling the baby move, which tends to be a lot of people's most favorite thing, that kind of happens because then you also start to feel like, oh, this is happening. There is a baby that is in there versus only hearing that heart rate when you come to see us at the office.
[00:06:27] Frankye Myers: Okay. And then some of the changes with your skin as far as dryness and maybe itching are there some things that women can do with some of those things. And then we always want to try to avoid the stretch marks and any permanent changes to our bodies. So things that they could do. I know one of the things is control your weight, the less stretching.
[00:06:52] Kelli MacAdam: So if you have more of like that gradual weight gain or kind of keep that weight gain within the realm that we usually discuss with you at the beginning of your pregnancy, that can help because rapid weight gain tends to cause worsening of those stretch marks. Sometimes stretch marks happen because of genetics.
[00:07:07] Frankye Myers: Okay. Right.
[00:07:08] Kelli MacAdam: We can do a lot to control outside factors, but sometimes we just unfortunately don't get the good skin genes right. Everybody doesn't get everything right. But there is a lot of over the counter things that are fine. So those real moisturizing lotions, so like cocoa butter, there's some different oils that are out there that can be helpful to put on after your shower. And those can help with not only preventing maybe some of those stretch marks from happening, but really are more so geared for comfort. So like that itchiness that goes along sometimes that dry skin that goes along.
The other big thing to remember in pregnancy that can happen with your skin is it becomes more sensitive to the sun. So if you're going out for a beach day, you really want to make sure that you're using your sunscreen in pregnancy.
[00:07:51] Frankye Myers: Okay. What about the hyperpigmented line that comes.
[00:07:55] Kelli MacAdam: That comes up your belly, right.
[00:07:57] Frankye Myers: Is that typically around the second trimester?
[00:07:59] Kelli MacAdam: Yeah, usually that's when you're going to start to notice it is in that second trimester. And then it can darken throughout the pregnancy and it can actually last for a little bit postpartum too, and it's just caused from those hormones in pregnancy and then as those kind of subside away in that, that will fade okay. Over time.
[00:08:18] Frankye Myers: That's great information.
And then one of the old wives tales is the heartburn means the baby has a lot of hair and indigestion. Is there any truth to that?
[00:08:29] Kelli MacAdam: It's tough, right? Because people don't do a lot of good research on those kind of things.
[00:08:34] Frankye Myers: Right.
[00:08:34] Kelli MacAdam: There's not great value in it. But definitely I feel like women feel very justified when the baby comes out and it has a head full of hair and they're like, the heartburn was worth it. My daughter has great hair now, but it's hard to say if there's truth to it. But definitely pregnancy causes heartburn.
[00:08:55] Frankye Myers: Okay.
[00:08:55] Kelli MacAdam: And some of that is just physiologic. So those hormones of pregnancy kind of tell that sphincter at the top of our stomach to relax, which can allow that acid to kind of come up. The other thing is that you're growing a baby, and so your uterus is expanding upward, so it's putting pressure on that stomach that's then pushing some of that acid upward.
[00:09:17] Frankye Myers: Makes sense.
[00:09:18] Kelli MacAdam: Absolutely.
[00:09:19] Frankye Myers: Okay, now that we've talked a little about what changes mom can expect to happen to her body, let's talk a little bit about fetal development during the second trimester. What is happening during this period?
[00:09:33] Kelli MacAdam: So the cool thing about the second trimester is that really, by 13 weeks, a lot of the parts to baby are already formed. The major organ development has all happened. So the second trimester is really kind of a growing phase of it. So babies tend to grow to be about two to three pounds by the end of that second trimester. They're roughly anywhere from 13 to 16 inches long by the end of it, their bones are starting to harden. They start to grow their fingernails and their toenails.
But they also have a lot of really cool milestone developments that they get in that they start to be able to hear. So they can hear mom's voice when mom's talking or when dad or other family members are talking to them. And it's very cool because you can see it after delivery that babies recognize those sounds. And that and it's also important to remember that it's loud inside your body.
[00:10:34] Frankye Myers: Right.
[00:10:35] Kelli MacAdam: So we get conditioned to think these babies are used to quiet, but think about how loud all of your inside organs are and things like that. And so that's what babies are listening to every day. The other thing that moms will even start to notice is that babies develop a cycle. So, like, that sleep and awake cycle. Now, you can't sleep train them at this age, but you'll definitely start to notice that, hey, every morning when I get up and I eat my breakfast, the baby is moving like crazy. But then hungry, right.
[00:11:05] Frankye Myers: They know it's time to eat all that.
[00:11:07] Kelli MacAdam: And then in the afternoon, they kind of relax and take a little nap.
[00:11:11] Frankye Myers: You're making me want a baby.
I love babies, and I love being pregnant.
Awesome.
You don't always think that, but you do hear people say, hey, play music, really calming and soothing music that they can hear. And you're right. They'll say that when the baby comes out, they recognize or those sounds or voices are soothing to them.
[00:11:37] Frankye Myers: Right.
[00:11:37] Kelli MacAdam: They start to notice all those things.
[00:11:39] Frankye Myers: All right.
Are there any other things that you think, Kelli, you should highlight as it relates to this time period?
[00:11:48] Kelli MacAdam: I think the second trimester, the other big thing that tends to happen at that time is around that 20 week mark, is when we do a really important ultrasound. And that ultrasound looks at everything from head to toe on your baby. It's looking at brain, at the heart, the spine, the kidneys, the stomach, all the parts of baby, make sure everything has grown and developed appropriately. Everything's kind of where it's supposed to be. And it's also kind of that traditional time where people can find out if they wanted to if it's a boy or a girl. So it makes it that really exciting time for them because they then get to start deciding names and all of that. So a big ultrasound sometimes can take up to 30 minutes, so also can be kind of a lengthier time frame, but that tends to be one of the highlights in the second trimester.
[00:12:36] Frankye Myers: So if you can't visualize it, because if you're doing that ultrasound, usually you can tell the sex by visualization or is it pretty much.
[00:12:45] Kelli MacAdam: So on the ultrasound, it's visualization.
[00:12:47] Frankye Myers: Okay.
[00:12:47] Kelli MacAdam: Right. They're actually looking at baby's body parts. Some people find out earlier and that's in that first trimester, we can do genetic testing. And so sometimes for some people, it's like that confirmation of was that genetic testing correct? Usually it is, but there's sometimes people try to hold out hope that maybe they're going to finally get that boy or girl that they've been holding out for. Yes, but yeah, so if they didn't find out with that blood work, then they typically find out at that ultrasound because that's when we can really visualize it.
[00:13:19] Frankye Myers: Well, the technology has really changed. When I was in the baby years and having ultrasounds, it was very grainy and now you actually can see really detailed.
[00:13:31] Kelli MacAdam: Yeah, it's very clear. There's even like 3D ultrasounds so they can make it look almost you can see like the baby's skin formation. So to really see some of those features of baby and things like that. So ultrasounds have come a very long way.
[00:13:45] Frankye Myers: Awesome. That's great.
All right, by the end of this trimester, remind me again of how big the baby is around this time and how long.
[00:13:57] Kelli MacAdam: It can be about two to three pounds at that time. And every baby is a little bit different. Some people have bigger babies, some people have smaller babies, so it can be a pretty big variance that happens in it. And then they're usually anywhere from 13 to 16 inches long.
[00:14:11] Frankye Myers: Okay, so things have changed so much.
If someone were to go into labor early, could the baby survive at this point?
[00:14:22] Kelli MacAdam: So, yes, right now they talk about the age of viability somewhere between that 23 and 24 weeks, meaning that we have the potential to try to resuscitate baby if they were born that age. It is a long journey for them. Luckily, Riverside has a great NICU team to help take care of them in that. But we do try our best efforts if mom has any sorts of concerns or showing signs of this preterm labor to do everything we can to try to minimize that risk or to do as much as we can to help give baby the best outcome.
[00:14:53] Frankye Myers: All right, well, we've talked a whole lot. We didn't really talk about you talked about the major organs and all the fingernails and everything. So this is a pivotal time for all of those key anatomical things that are going on in the development phase of pregnancy.
All right, what can a woman expect during this time for their visits? What do those at their prenatal visits prenatal visits?
[00:15:19] Frankye Myers: Yeah.
[00:15:19] Kelli MacAdam: So their prenatal visits for one. We are going to talk to you a lot about the different upcoming things in pregnancy. So education kind of helps start you to planning for that labor and delivery experience. So that is a good time to start scheduling like the childbirth education classes or scheduling your tour at the hospital so you know what to expect when you get there.
Also there's the breastfeeding education in that. That's a good time for starting to plan those out. We also at your visits are going to measure your belly because a really cool thing is that if we measure from the top of somebody's pubic bone to the top part of their fungus in pregnancy, once they're over 20 weeks, that matches pretty closely to the number of weeks that they are gestation. So if somebody is 35 weeks, if we measured that it's about 35, give or take one or two in either direction of that, okay.
[00:16:15] Frankye Myers: I breastfed my son, but I didn't my first child. And a lot of it was because generationally my mom didn't do it right. And I'm going to tell you it was the easiest, most rewarding thing that I ever did. I know I didn't have to worry about supply. I didn't have to worry about getting up and warming, making bottles. No, it made it so much easier.
[00:16:37] Kelli MacAdam: I tell people it can be challenging in the beginning, but if you stick with it, I always tell people give it two weeks. Give it your all two weeks, right. And then it gets so much easier. And then you're right, right in the middle of the night, you just pick that baby up and you're able to latch them on. But our lactation consultants at the hospital are fabulous. And so getting that education prenatally to know like this is normal. It's okay, it doesn't feel normal in the moment, but it's going to get better can really be helpful.
[00:17:08] Frankye Myers: I would definitely agree. Those first couple of weeks, I think I tried to give up a thousand times, but it got to the point where I craved to do it when I wasn't able to do it and I had to pump, it was like a yearning and we were so like.
[00:17:23] Kelli MacAdam: Bond with your baby.
[00:17:25] Frankye Myers: It was so special.
[00:17:27] Frankye Myers: Wow.
[00:17:28] Frankye Myers: So great information.
If someone wanted to reach out.
This is the second trimester, but obviously they're planning to start having children. How could they contact you and the group that you support?
[00:17:46] Kelli MacAdam: So yeah, so they could give a call to our office partners in Women's Health. We have four different office locations, soon to be a fifth location that's opening. So we have two that are here in Newport News, and then we have an office up in Gloucester, one in Williamsburg, and we're getting ready to open our office in Grafton. So we have a lot of offices to make it convenient and easy to get in for those appointments. So they could just call to schedule. We have lots of people that end up transferring into us because, of course, living in a high military area, there's a lot of people coming and going from the area. So definitely we take those transfers in. Even in the second trimester.
[00:18:27] Frankye Myers: Yes.
[00:18:28] Frankye Myers: And we deliver a lot of babies.
[00:18:30] Kelli MacAdam: We do.
[00:18:30] Frankye Myers: Over at regional. If I'm not mistaken, it's over 3100 annual, ladies.
[00:18:35] Kelli MacAdam: I think it's roughly in that time frame.
[00:18:37] Frankye Myers: I know a lot of babies.
[00:18:39] Kelli MacAdam: They just recently delivered their 2023 Baby of the Year. So they're 2023rd and it's only September.
[00:18:46] Frankye Myers: Yes.Well, anything else you would like to share with our viewers before we wrap up?
[00:18:53] Kelli MacAdam: No, I think the biggest thing with the second trimester is I think that's a good time to enjoy pregnancy.
[00:18:59] Frankye Myers: Right.
[00:18:59] Kelli MacAdam: Like, it's kind of that sweet spot. Like I said, from the first trimester, things usually are improving. You haven't hit that third trimester where things start to get a little more uncomfortable again.
Your belly is growing, and that mobility changes. So it's really a good time to kind of enjoy that glow of pregnancy that people talk about.
[00:19:21] Frankye Myers: And then one last thing as far as exercise, because you want to stay fit. It's challenging. You have all those great cravings, and so you're trying to stay within the weight parameter. What is a good, safe program? I know they would have to consult with their physicians. Everybody is different, right?
Or their midwife.
[00:19:45] Kelli MacAdam: Yeah. There's lots of great things. So really, if there's something that you have been doing regularly prior to pregnancy, you can absolutely continue doing it in the pregnancy.
I tell people to listen to their bodies, so if something starts to hurt or become uncomfortable, then you need to work with somebody to either modify it or cut that part of the routine out on the same aspect if you hadn't had a regular exercise routine. Walking is one of the greatest things that we can do for our health. So just going out and taking a 30 minutes walk most days out of the week can really improve and help us to maintain our blood sugars and our blood pressures and our weight.
Additionally, people find a lot of comfort in doing things like prenatal yoga because it'll help with that stretching and flexibility that becomes very important also into that third trimester and during labor and delivery.
[00:20:38] Frankye Myers: All right, Kelli, that's great information. It's been a pleasure having you join.
[00:20:43] Kelli MacAdam: Yeah, it's been great. Thanks for having me.
[00:20:47] Frankye Myers: Thank you for listening to this episode of Healthy YOU. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riverside online close.
