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Fetal Growth and Development

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Between the third and sixth month of pregnancy, your baby will grow very quickly! At the beginning of this trimester, your baby is about 3 inches long and weighs only 1 ounce, but by the end of the trimester he or she will be 11 to 12 inches long and will weigh up to 1½ pounds.

At 14 weeks:

If you could see your baby:

• You would probably be able to recognize if it's a boy or a girl.
• The umbilical cord that connects you and your baby is thickening and continues to carry blood and nutrients.
• The baby is passing urine, and meconium (the baby's first stool or feces) is beginning to collect in the baby's intestines.
• The lanugo, a fine, downy hair, covers the body.
• Hair is starting to grow on the scalp, and tiny eyelashes and eyebrows appear.
• Vernix caseosa, a creamy white substance that protects the skin from long exposure to the amniotic fluid in the uterus, covers the body.

You should start to feel your baby moving sometime between 18 and 22 weeks as its muscles become more active. At first, the fetal movements feel like fluttering or "butterflies." As your baby grows and becomes stronger, its movements will also become stronger.

At 20 weeks:

As your baby continues to develop past 20 weeks gestation:

• The skin is wrinkled, red, and shiny.
• The eyelids now have tiny eyelashes and can open and close.
• Little hands have fingernails and fingerprints. The baby can also suck its thumb and grip firmly with its hand.
• You may be able to feel the baby hiccupping.
• The lanugo, the fine, downy hair, begins to disappear, especially from the face.
• Vernix caseosa, the white creamy substance that protects your baby's skin, still covers the body.

You may notice that your baby kicks and stretches more. Your baby can hear your voice or other nearby sounds and might respond to a loud noise by kicking. Amazing as it may seem, your baby will recognize your voice and your partner's voice right after birth if you talk to the baby daily while you are pregnant.

Prenatal Testing Options

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During your pregnancy, there are many kinds of prenatal tests that can help you learn more about your baby's health. All prenatal testing is optional, though many kinds of tests are a routine part of every pregnancy. We can discuss your options and decide which tests might be a good option for you.

Routine prenatal tests and screening

These are tests that we recommend for all pregnancies to check the health and development of your baby. These routine prenatal tests are safe for you and your baby. During your second trimester we may recommend tests for:

• Anemia 
• Rh blood antibody screen (second test)
• Diabetes

In addition, we routinely offer an ultrasound test during your second trimester of pregnancy.

Optional prenatal screening

Certain blood tests can help you find out if you have a higher or lower chance of having a baby with certain birth defects, but they can't make a definitive diagnosis. These are optional prenatal tests, and are very safe for you and your baby. Serum-integrated screening, sequential integrated screening, and quad tests are examples of optional screening tests. These tests are most effective when done at a certain stage of fetal development. Depending on which trimester you are in, we can discuss which screenings are available for you.

Prenatal diagnostic tests

While there is no test that can detect all potential problems, these tests can diagnose certain kinds of birth defects. Prenatal diagnostic tests are more invasive than other prenatal tests, and there is a very small associated risk of miscarriage. Some women choose diagnostic tests based upon their family history, or their age during their pregnancy. Examples of diagnostic tests are amniocentesis and chorionic villus sampling.

Benefits of Breastfeeding

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Breast milk is the perfect food for your baby. There are many health benefits for you and your baby. According to the American Academy of Pediatrics, breast milk is the only food that your baby will need during the first 6 months of life. We recommend that you continue to breastfeed your baby for up to 1 year if you are able to. Even after you introduce solid foods, you can continue breastfeeding for as long as you wish.

Breastfeeding decreases your baby's risk for many types of infections and allergies. Benefits include:

• Fewer ear infections
• Less risk of respiratory infections and asthma
• Fewer urinary tract infections
• Less diarrhea and constipation
• A lower chance of childhood obesity
• A lower risk of certain childhood cancers
• Improved development of the baby's immune system
• Better digestion
• Improved brain growth

Benefits to you may include:

• More rapid recovery from your delivery
• Decreased blood loss after delivery if you breastfeed immediately after the baby is born
• More rapid loss of pregnancy weight
• Increased sense of well-being
• More opportunity for mother-baby bonding
• No need for preparation, heating, refrigeration, or sterilization of breast milk and a significant cost savings when compared to formula

There are rare medical conditions where breastfeeding is not advised. We can talk further if this applies to you.

Preparing for Breastfeeding

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You and your baby will be more successful at breastfeeding if you are prepared. You can begin preparing now and continue throughout the last weeks of pregnancy. Suggestions for how to prepare include:

Learn all you can about breastfeeding

Take a class, read a book, or read our article on breastfeeding for more information. Talk to women who've had successful breastfeeding experiences. Remember, breastfeeding is a learned skill and takes practice.

To locate classes near you, search our health class directory or contact your local Health Education Center or department.

Think about how long you would like to breastfeed

Breastfeeding does take time, but it is time well spent. You're giving your baby the best possible food, holding your baby close, and making a strong connection. Breast milk is the best food for your baby and has all the nutrition your baby needs for the first 6 months of life. The longer you breastfeed, the greater the benefits will be for you and your baby.

Make a list of breastfeeding resources

Get phone numbers of hospital lactation consultants, your local Pediatric Department, or members of your local La Leche League. Have these numbers ready so you can call after you and your baby go home from the hospital. For breastfeeding questions, call the 24-hour helpline at 877-4-LALECHE.

Learn about expressing your milk

Expressing and storing your breast milk allows you to get extra milk from your breasts that can be given to your baby when you're not there.

Ask for help

All new mothers will need help in the beginning, so ask your friends and family to plan to help out. After the baby arrives, they can assist with meals, shopping, and the care of older children. This will allow you to spend plenty of time with your new baby.

Determining Your Nipple Type

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If you're preparing to breastfeed (or just thinking about it), the second trimester is a good time to recognize your nipple type. Some nipple types require extra preparation so that you can breastfeed successfully. Our article on breastfeeding has more information, or ask us if you aren't sure what type of nipples you have.

Common Discomforts and Concerns

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I am having problems with constipation.

Pregnancy hormones cause the digestive tract to relax and function more slowly, which can cause constipation. As your uterus enlarges, this can also cause constipation.

What you can do:

• Drink plenty of fluids or add prune juice to your diet. Keep a bottle of water near you during the day.
• Increase your fiber intake (whole-grain foods, fresh fruits, and vegetables).
• Allow a regular time for bowel movements; this will often happen naturally after meals. Avoid straining since this can cause hemorrhoids.
• Please let us know if you think you need a laxative or stool softener.

I’m having problems with heartburn.

Heartburn (sometimes also called reflux) is caused by stomach acid coming up into your esophagus (the tube connecting your mouth to your stomach). Heartburn during pregnancy is caused by a hormone which relaxes the stomach sphincter (valve) that keeps the acid out of the esophagus. This same hormone causes a delay in stomach emptying so that more acid builds up.

What you can do:

• Eat several small meals a day (about 6) instead of 3 large meals.
• Avoid spicy, fried, or rich foods.
• Avoid caffeine. This causes the stomach sphincter to relax even more.
• Do not lie down right after eating. Stay upright for at least 30 minutes.
• Keep the head of the bed higher than the foot of the bed.
• Try an antacid (like Tums or Maalox).

If your heartburn is still a problem, please let us know. There are prescription medications that you can use.

I have difficulty sleeping.

As pregnancy progresses, leg cramps, breathlessness, contractions, the frequent need to urinate, and an active baby may all interfere with your sleep.

What you can do:

You may need to try various options in order to find a comfortable position.

• Use extra pillows to support your legs and back. Try sleeping on your side with pillows between your knees and behind your back.
• Have a light snack or a glass of milk before going to bed.
• Get regular exercise during the day to help you sleep more soundly at night.
• Practice relaxation exercises before going to sleep or if you wake up during the night.
• Take a warm (not hot) bath or shower before going to bed.
• Avoid caffeine, including chocolate, especially late in the day.
• Do not use sleeping pills or drink alcohol because they could harm your baby.

Lying on your side is better for you and the baby now that you are in your second trimester. When you are lying on your back, the weight of your uterus and your baby rests on the vena cava, the largest vein in your abdomen. When there is pressure on that vein, your blood pressure can go down and you may feel dizzy or light-headed.

• Sleep on your side with a pillow between your legs.
• If you find you have turned over onto your back, just roll back onto your side.
• After week 16 of pregnancy, avoid exercises where you have to lie on your back for longer than 3 minutes.

I have leg cramps.

Leg cramps are common in mid to late pregnancy. They usually occur late at night and may wake you up. They may be caused by the pressure of the enlarged uterus on nerves or blood vessels in your legs, from lack of calcium, or occasionally from too much phosphorus in your diet. What you can do to prevent leg cramps:

• Avoid too much phosphorus in your diet. This is found in highly processed foods, such as lunch meats, packaged foods, and carbonated beverages.
• If you’re having frequent cramps (more than twice a week), increase the amount of calcium in your diet or take calcium supplements that don’t contain phosphorus.
• Do leg stretches before bedtime.
• Wear leg warmers at night.
• Exercise moderately every day.
• Take a warm (not hot) bath before bedtime.

What you can do to relieve leg cramps:

• Sit on a firm bed or chair. Straighten your leg and flex your foot slowly toward the knee.
• Stand on a flat surface (a cold surface is even better) and lift your toes up, as if to stand on your heels. Then try walking while keeping your toes up.
• Use a heating pad or hot water bottle to help with the muscle ache.
• Do not massage the calf during the cramp.

I’ve noticed changes in my skin.

As your baby grows, your pregnancy hormones can trigger changes in your skin. These changes should fade away after your pregnancy. These skin changes are not usually treated during pregnancy. If you’re worried, talk to us about your concerns.

• Stretch marks. Your uterus is expanding beyond your belly button and your abdomen is stretching to fit it. This may cause reddish streaks on your abdomen. These stretch marks might also appear on your breasts, buttocks, or thighs. After birth, these will fade to fine silvery lines, which may or may not disappear. Oils, creams, or lotions will make your skin feel better, but they can’t stop stretch marks from forming.
• Linea nigra. You may get a narrow, dark line that extends from your belly button to your pubic bone (the bone just above your vagina). This seems to occur more frequently with those who have dark hair and skin. It’s caused by pregnancy hormones and will disappear or fade after birth.
• Chloasma. You may find brown patches on your nose, forehead, cheeks, and neck. This “mask of pregnancy” is called chloasma and also results from pregnancy hormones. The brown patches may darken in the sun, so use sunscreen. After birth, they should lighten and then disappear.
• Red spots. You may get red spots on your face, neck, upper chest, arms, or on the palms of your hands. These are tiny interconnected blood vessels that are caused by your pregnancy hormones. All redness should disappear after you give birth.

Your Care with Me

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Please call our Appointment and Advice line right away if you're experiencing:

• Pain or dizziness
• Vaginal bleeding
• A bladder infection (pain or blood with urination)

After 24 weeks, please call Labor and Delivery if:

• You have contractions.
• Your water breaks.
• You have vaginal bleeding.

In your second trimester, I'll recommend that you make an appointment to see me each month beginning at 24 weeks gestation. I will also advise you to register for a number of pregnancy-related classes to assist you in having a healthy pregnancy, labor, and childbirth.

During your monthly appointment

I will perform an exam to evaluate your health and the health of your fetus. My staff can schedule you for several recommended classes, including:

• Midpregnancy (at 20 weeks)
• Breastfeeding
• Childbirth preparation
• Infant care

In your second trimester, it's time to complete any prenatal screening or diagnostic tests you’ve requested. My staff will schedule you for any of these tests that you request, and our Prenatal Testing Options online health tool can help you know what to expect during the different types of testing.

Subscribe to our Healthy Beginnings newsletter. The newsletter is delivered to your e-mail inbox every week of your pregnancy, and it has information and answers to common questions as your pregnancy progresses.

The following online Emmi programs may help you as you approach your due date:

• Prepare for your Childbirth
• Pain Relief for Childbirth
• C-Section
• Vaginal Birth After C-Section (VBAC)

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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