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The Second Trimester
As your pregnancy progresses, you'll be happy to know that many of the earlier discomforts resolve. You'll have more energy than before, and you may be able to fit through tight spaces for a few more months!

Quickening, which is the first awareness of fetal movement, occurs between 18 and 23 weeks of pregnancy. You might notice a small fluttering below your belly button, or have the sensation of gas. To me, quickening felt like "butterfly wings." As your baby grows, the movements will become more distinct, and your partner may begin to feel small kicks by your 24th week of pregnancy.

Stretch marks (striae gravidarum) develop in many women as the connective tissue of your skin is stretched. You may like the feel of lotions or oils on your growing belly, but they have not been shown to prevent stretch marks from occurring. Their development is related to your rate of growth, weight gain, and your own skin's natural stretchiness. After pregnancy, they'll fade in color somewhat.

Skin pigment changes result from higher levels of "melanocyte stimulating hormone" during pregnancy. The line below your belly button will darken, which is called the linea nigra. Similarly, some women have a darkening on their facial skin called chloasma. The skin around your nipples, called the areola, will likely darken during pregnancy, too. Many of these changes fade somewhat after the pregnancy is over.

Back pain is common as your growing uterus puts more and more strain on your spine. As your baby grows, the uterus will become heavier and your lower back may arch, causing low back pain. Exercise may help, particularly swimming and yoga. Use care when lifting; squat down, bend with your knees and keep your back erect. And ask for help when lifting heavy objects. Wear comfortable, low-heeled shoes that give adequate support. You could try wearing a maternity girdle or back brace; I found this very helpful during my third pregnancy.

Swelling in the lower legs is common and varicose veins may become prominent. Support pantyhose can help to decrease edema (leg swelling) and varicose veins if they are waist high. Knee high stockings will exacerbate the situation. To reduce edema, your legs must be elevated higher than the level of your heart. Some women place blocks under the foot of their bed to allow their legs to be higher at night.

Numbness and tingling of your fingers results from circulatory changes. Carpal tunnel syndrome, which causes pronounced numbness in the thumb and first two fingers, can result from compression of your median nerve in the wrist. This will resolve itself after the baby is born. If your symptoms are severe, there are wrist braces that hold your hands in a better position, which may help temporarily and can be especially helpful at night.

Heartburn results from stomach acids which are pushed up into the esophagus as your uterus enlarges. It helps to sit up after meals, sleep slightly propped up, and to avoid spicy and acidic foods. Try small, frequent meals, and avoid liquids at meal times. You may try antacids (such as Maalox, Mylanta) or calcium carbonate (Tums), which is also a great source of calcium. But avoid baking soda, which contains too much sodium for you. Some of my patients have also found relief by taking papaya enzyme tablets or slippery elm throat lozenges.

Hemorrhoids are varicose veins that are located around the rectum which often become symptomatic as the pregnancy progresses. Eat a diet rich in fiber so your stools will be soft and regular. Warm water soaks can be soothing, and applying cotton balls soaked in witch hazel helps. An anesthetic ointment may be used, as well. (Anusol, Preparation H).

Leg cramps in the back of your calves is common, and may wake you up at night. Massaging your lower leg or flexing your foot to stretch the calf muscle may help. Calcium supplements taken before bedtime may help to prevent the cramping.

Round ligament pain occurs between 15 and 22 weeks of pregnancy, when the ligaments on either side of the uterus are stretched during movement. You may notice this as an acute aching in the right or left lower abdomen, especially with turning or being active. It is not harmful and resolves when the uterus is larger and less mobile.

Weight gain is a natural part of pregnancy. Give yourself permission to enjoy your changing body shape. If you are eating a balanced diet and exercising, your growing belly is a sign of a healthy baby. If you have had trouble with your body image in the past, gaining weight may be a difficult issue for you. However, this is not the time to diet; your baby needs adequate calories to grow and needs a healthy mommy, too.
Laura E. Stachel M.D. Obstetrician & Gynecologist