Physical Changes of Pregnancy

As your baby grows, your body undergoes many changes both physically and emotionally. Use the information in this section, grouped by trimester, as a general guide to understanding the changes in your body and the development of your baby while you are pregnant.

First Trimester (Weeks 1-12)

Your baby is completely formed by 8 weeks. At three months your baby is about 3" long and weighs about 1 ounce. You may experience any of the following physical changes.

Bleeding Gums
Bleeding of the gum tissue is probably related to the increased hormone levels during pregnancy. Although this is a relatively normal condition of pregnancy, consult your dentist. It is important to visit your dentist regularly and keep your teeth healthy during pregnancy.

Breast Tenderness
Breasts enlarge early in pregnancy due to increasing hormones. These hormones stimulate the development of milk producing glands and cause breast tenderness.

Cravings
Occasionally, pregnant women may develop an appetite for unusual foods or substances. This is not harmful unless the pregnant woman replaces good nutrition with unhealthy foods or substances. Craving soft substances such as laundry starch or clay may be harmful and should be discussed with your doctor.

Changes of the Uterus

The uterus is a flat, pear-shaped organ. During pregnancy it becomes rounder as it enlarges and becomes softer and thicker. During the third month of pregnancy, it rises out of the pelvis into the abdominal cavity to allow for growth and expansion as your baby develops.

Fatigue
Fatigue is a common symptom early in pregnancy caused by the physical, emotional, and hormonal changes in your body. Fatigue usually subsides after the first few months.

Hearing the Fetal Heartbeat

The heart rate will be heard for the first time between 8 and 12 weeks.

Heartburn
Heartburn is a result of relaxation of the lower end of the esophagus. The pregnant uterus presses upward on the stomach, pushing stomach contents into the esophagus, which causes a burning sensation in the upper abdomen.

Nausea and Vomiting

Nausea and vomiting, also called morning sickness, are early signs of pregnancy. They may appear sometime after the first missed menstrual period and may last until the fourth month of pregnancy. Nausea may occur upon arising in the morning or at any time of the day. Eating small frequent amounts of carbohydrate foods, like crackers, toast, rice and pasta, may help with nausea.

Pelvic Joints
The joints in the pelvic area become more relaxed throughout pregnancy due to a hormone called relaxin which is present during pregnancy.

Urinary Frequency
Pressure of the enlarging uterus on the bladder causes you to urinate more frequently.

Vaginal Discharge
A white, mucous-like discharge may be present early in pregnancy. Daily bathing is essential to keep the area clean.

Second Trimester (Weeks 13-28)

At 6 months your baby is about 12" long and weighs about 1-2 lbs. Your baby does not have a lot of weight gain but does have a lot of development. You may experience any of the following physical changes.

Breasts
The breasts become larger, firmer and more tender. The nipple and areola become darker in color. Tiny glands in the areola enlarge and may appear as little bumps.

Changes of the Uterus

The uterus again changes size and shape. The globular shape changes to an oval shape as it increases in size. It rises to the abdominal cavity reaching the navel at about 20 weeks. The uterus is felt as a firm, fluid-filled sac. As the uterus rises into the abdomen, urinary frequency subsides.

Circulatory System
Blood volume increases during the second trimester. The heart needs to pump about 50% more blood per minute than before pregnancy.

Fetal Movements
Fetal movements, also called quickening, are felt by the mother at intervals throughout the day. The movements are very faint at first, but feel stronger and sometimes can be seen as pregnancy progresses. Your doctor will want to know the first time you felt your baby move.

Heartburn and Indigestion

The enlarging uterus exerts pressure on the stomach, pushing its contents back up to the esophagus. Heartburn and indigestion may be relieved by eating smaller, more frequent meals. Avoid lying flat or bending over immediately after eating.

Linea Nigra
This appears as a dark line extending from the navel to the pubic hair area. It disappears after delivery. The external genitalia may also darken in color.

Mask of Pregnancy
The mask of pregnancy, also called chloasma, may appear as irregular spots or blotches of a muddy brown color on the face. This condition disappears after delivery.

Metabolism
The body's metabolism increases. Fatigue felt in the first weeks of pregnancy disappears. Your energy level rises.

Stretch Marks
Stretch marks may develop on the sides of the abdomen and on the thighs, hips, and breasts. They may appear red in color. After delivery, the marks may remain and take on a silvery white appearance. During pregnancy, good nutrition provides some protection from stretch marks. There is also an increase in the oil and sweat glands of the body

which may cause the skin to itch. Lotions and creams soothe the itching as the abdomen expands.

Spider Veins
Fine blue lines on the body may become more pronounced.

Weight Gain
Weight begins to increase during the second half of pregnancy. Ask your doctor about proper weight gain proportions.

Third Trimester (Weeks 29-40)

Weight gain and growth are rapid for your baby in this trimester. All organs are maturing. At birth the average baby is 18-22" long and weighs 7-8 pounds. You may experience any of the following physical changes.

Ankle Swelling
Swollen ankles during pregnancy are a common condition. Prolonged sitting or standing, warm weather and excessive salt intake increase swelling. Elevate your legs and feet several times a day. If your job requires prolonged standing or sitting or you are planning a long trip, change positions, stretch and walk periodically to stimulate circulation.

Backache
Muscular fatigue and strain may result because the growing uterus causes your body to become off balance. You may even develop a waddle walk if the ligaments of the pelvis soften and cause the bones of the pelvis to be less stable.

Breasts
The breasts continue to enlarge with a feeling of fullness. A yellow to whitish liquid may begin to leak from the nipples. Keep the nipple area clean and dry. Clean with warm water, but do not use soap.

Breathing
As the fetus grows larger, the uterus crowds the abdominal cavity and may cause shortness of breath.

Constipation

Constipation, caused by a decrease in bowel activity, may occur due to the relaxation of muscular structure of the intestines during pregnancy. Constipation can be aggravated by pressure from the uterus on the intestines and from some medications. Decreased bowel activity also causes flatulence, or gas. Eat plenty of fiber, drink eight glasses of liquid, and exercise moderately each day.

Digestive System
Heartburn may reappear due to crowding of the stomach by the enlarging uterus. Eat small, frequent meals.

Faintness
This may occur if you are in a very warm, crowded area. Sudden changes of position or standing for long periods of time can cause a feeling of lightheadedness. Faintness may also be brought on by lying flat on your back and by poor nutrition.

Genital Area
There may be an increase in the thin, mucous discharge from the vagina. Daily bathing is recommended. Do not douche.

Hemorrhoids
Hemorrhoids are varicose veins around the lower rectum and anus. They are caused by constipation and straining during a bowel movement. Hemorrhoids appearing during pregnancy or during pushing in labor usually subside after delivery.

Insomnia
The discomfort caused by a heavy uterus and enlarged abdomen may make sleep difficult. One of the most comfortable positions is lying on your side with a pillow between your legs and under your abdomen.

Leg Pain or Numbness

Pain is often felt down the back of the legs. This is caused by the direct pressure of the baby's head on the sciatic nerve. There is no specific cure. This pain is relieved as the baby's head moves downward.

Uterine Cramping
These mild contractions, often referred to as Braxton-Hicks contractions, are commonly felt during the latter part of pregnancy. They are irregular, fail to increase in strength or frequency and are felt in the lower abdomen. Report any regular contraction pattern to your doctor.

Uterus
The growth of the uterus keeps pace with fetal growth. The walls of the uterus become thinner as it stretches. About two weeks before your due date, the fetus lowers into the brim of the pelvis. This occurrence is sometimes called lightening or dropping.

Urinary Frequency
This condition reappears in the third trimester when the bladder is compressed by the enlarged uterus.

Varicose Veins
This condition is caused by weakening of the walls and valves of the veins. Blood collects in the veins causing poor circulation in the legs and lower abdominal area.

Weight Gain
You will notice a steady increase in weight of approximately one pound each week. If excessive weight gain occurs-three to five pounds in one week- contact your doctor. Gradual weight gain is expected. If you begin to lose weight, contact your doctor.

Not every woman will look like cover model in magazine. Similarly, not every pregnant woman will still look beautiful and svelte than before. Fact. The ugly truth is nine out of ten pregnant women suffer from some kind of physical discomfort, not to mention their fatigued and ungainly appearance - sluggish movement, flabby tummy, arms and legs, thicker waist, excess flab and more. New mothers are already stressed by what they saw in mirrors. It could get worse if they're unable to regain pre-pregnancy looks and yet have to look after a crying baby. Coupled with lack of family support and exhaustion, new mothers could easily fall prey to post-natal depression. Fortunately, many physicians agree that most mothers, once they understand the physiology behind these physical changes, are able to handle them very well and adapt very quickly. Sometimes, medication and counseling are necessary if doctors detect symptoms of disturbances for some mothers. Neglect is never the solution as it may lead to or aggravate post-natal depression. According to obstetricians and gynecologists, if you're pregnant, you would likely experience the following physical changes. It definitely helps you learn to accept these changes if you understand more about them. 1. "I'm tired all the time" Giving birth saps a lot of your energy. So, it is natural that you'll feel weak or dizzy after childbirth. The recovery usually takes from two weeks to two months, depending on your physique. That's why in some countries like Singapore, mothers are allowed maternity leave up to 3 months, to recuperate. The Chinese view this as loss of "qi", therefore you can replenish "qi" by consuming tonics and keeping warm with clothes and socks. Actually, the preventive measure is to build up your blood store before and during pregnancy by consuming adequate iron, folic acid and multivitamins. You may also feel aches in the back and lower pubic bone areas due to the strain on the ligaments and muscles. However, these are only temporary discomfort. 2. "My breasts become bigger" If you find your breasts grow from B to C cup, don't be alarmed - your breasts are getting ready for breastfeeding. Furthermore, hormonal changes during pregnancy cause more melanin to deposit into the skin cells at the nipples and areola, leading to darkening of nipple or areola skin tone.

After breastfeeding, your breasts may not be able to regain their old size and worse still, they may become saggy and loose. This may not be good news to you, especially if you are already a heavy-breasted woman. 3. "What is incontinence?" Incontinence means that you lose control of your bladder or bowel which can be embarrassing. This could be due to physical injury or trauma to the pelvic floor muscles. The likely causes of injury are a difficult forceps delivery, prolonged labour, or vaginal delivery of a large baby. In the case of difficult delivery, use of Caesarean could help to reduce pelvic floor trauma. It is a symptom but not a disease by itself, therefore it can be treated. Don't be afraid to seek medical help. If you delay treatment, you'll run the risk of developing rashes, sores on skin and urinary tract infections. Your social life will also be affected as you'll try to avoid your family and friends for fear of embarrassment. You should follow a well-balanced diet, and avoid food or drinks that may irritate your bladder, such as caffeine, alcohol, carbonated drinks and spicy foods. Citrus fruits and juices must be cut down too. For diabetics, sugar intake must be reduced in your diet so as to control the glucose level. Exercising and strengthening the muscles of the pelvic floor, widely known as Kegel's exercise named after Arnold Kegel, M.D, helps to cure incontinence. 4. "Why are my veins so obvious now?" You may notice more veins become more prominent in your legs during pregnancy. These veins, called varicose and spider veins, appear because the weight of your womb exerts more pressure on the major vein (inferior vena cava) on the right side of the body. This in turn increases the pressure in the leg veins. Increased progesterone levels during pregnancy also cause the blood vessel walls to relax, thereby worsening the problem. Some useful tips are: - Wear support or compression stockings - Don't stand too long - Lift your legs on some cushions when resting

- Lose some weight - Surgery such as sclerotherapy and vein stripping. However, be patient to see if the veins disappear after childbirth. 5. "What are these marks on my body?" They're called stretch marks which are formed as a result of a split in your skin's supportive tissue to accommodate a growing baby. They are initially red and will turn darker. However, after pregnancy, they may turn silvery or blue. The bad news is they're pretty much permanent, though they may fade in intensity. So far, no medication or creams are effective in removing them, but some special techniques do help to speed up the fading effect, if not remove them almost completely. 6. "My hair is falling off!" It is actually normal due to hormonal changes and usually happens three months after delivery. During pregnancy, the hormone cause the hair follicles to delay the fallout of the hair. After delivery, the hormone levels revert to normal and those hair that suppose to drop off previously, now happen all at the same time. That's why you get the impression you are losing more hair than normal. If you're worried, you may just take some multivitamins.

Physical Changes

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Pregnancy causes many changes in a woman's body. Most of them disappear after delivery. These changes cause some symptoms, which are normal. However, certain disorders, such as gestational diabetes (see Pregnancy Complicated by Disease: Gestational Diabetes), develop during pregnancy, and some symptoms may indicate such a disorder. Some symptoms that should be immediately reported to a doctor if they occur during pregnancy include the following:

Persistent or unusual headaches Persistent nausea and vomiting Dizziness Disturbances of eyesight Pain or cramps in the lower abdomen Contractions Vaginal bleeding Leakage of amniotic fluid (described as "the water breaks") Swelling of the hands or feet Decreased urine production Any illness or infection Tremor (shaking of the hands, feet, or both) Seizures Rapid heart rate Decreased movement of the fetus

General Health: Fatigue is common, especially in the first 12 weeks and again in late pregnancy. The woman may need to get more rest than usual. Reproductive Tract: By 12 weeks of pregnancy, the enlarging uterus may cause the woman's abdomen to protrude slightly. The uterus continues to enlarge throughout pregnancy. The enlarging uterus extends to the level of the navel by 20 weeks and to the lower edge of the rib cage by 36 weeks. The amount of normal vaginal discharge, which is clear or whitish, commonly increases. This increase is usually normal. However, if the discharge has an unusual color or smell or is accompanied by vaginal itching and burning, a woman should see her doctor. Such symptoms may indicate a vaginal infection. Some vaginal infections, such as trichomoniasis (a protozoan infection) and candidiasis (a yeast infection), are common during pregnancy and can be treated (see Vaginal Infections: Introduction). Breasts: The breasts tend to enlarge because hormones (mainly estrogen) are preparing the breasts for milk production. The glands that produce milk gradually increase in number and become able to produce milk. The breasts may feel firm and tender. Wearing a bra that fits properly and provides support may

help. During the last weeks of pregnancy, the breasts may produce a thin, yellowish or milky discharge (colostrum). Colostrum is also produced during the first few days after delivery, before breast milk is produced. This fluid, which is rich in minerals and antibodies, is the breastfed baby's first food. Heart and Blood Flow: During pregnancy, the woman's heart must work harder because as the fetus grows, the heart must pump more blood to the uterus. By the end of pregnancy, the uterus is receiving one fifth of the woman's prepregnancy blood supply. During pregnancy, the amount of blood pumped by the heart (cardiac output) increases by 30 to 50%. As cardiac output increases, the heart rate at rest speeds up from a normal prepregnancy rate of about 70 beats per minute to 80 or 90 beats per minute. During exercise, cardiac output and heart rate increase more when a woman is pregnant than when she is not. During labor, cardiac output increases by an additional 10%. After delivery, cardiac output decreases rapidly at first, then more slowly. It returns to the prepregnancy level about 6 weeks after delivery. Certain heart murmurs and irregularities in heart rhythm may appear because the heart is working harder. Sometimes a pregnant woman may feel these irregularities. Such changes are normal during pregnancy. However, other abnormal heart sounds and rhythms (for example, diastolic murmurs and tachyarrythmias), which occur more often in pregnant women, may require treatment. Blood pressure usually decreases during the 2nd trimester but may return to a normal prepregnancy level in the 3rd trimester. The volume of blood increases by 50% during pregnancy. The amount of fluid in the blood increases more than the number of red blood cells (which carry oxygen). Thus, even though there are more red blood cells, blood tests indicate mild anemia, which is normal. For reasons not clearly understood, the number of white blood cells (which fight infection) increases slightly during pregnancy and markedly during labor and the first few days after delivery. The enlarging uterus interferes with the return of blood from the legs and the pelvic area to the heart. As a result, swelling (edema) is common, especially in the legs. Varicose veins commonly develop in the legs and in the area around the vaginal opening (vulva). They sometimes cause discomfort. Clothing that is loose around the waist and legs is more comfortable and does not restrict blood flow. Some measures not only ease the discomfort but may also reduce leg swelling and make varicose veins more likely to disappear after delivery:

Wearing elastic support hose

Resting frequently with the legs elevated Lying on the left side

Urinary Tract: Like the heart, the kidneys work harder throughout pregnancy. They filter the increasing volume of blood. The volume of blood filtered by the kidneys reaches a maximum between 16 and 24 weeks and remains at the maximum until immediately before delivery. Then, pressure from the enlarging uterus may slightly decrease the blood supply to the kidneys. Activity of the kidneys normally increases when a person lies down and decreases when a person stands. This difference is amplified during pregnancy one reason a pregnant woman needs to urinate frequently while trying to sleep. Late in pregnancy, lying on the side, particularly the left side, increases kidney activity more than lying on the back. Lying on the left side relieves the pressure that the enlarged uterus puts on the main vein that carries blood from the legs. As a result, blood flow improves and kidney activity increases. The uterus presses on the bladder, reducing its size so that it fills with urine more quickly than usual. This pressure also makes a pregnant woman need to urinate more often and more urgently. Respiratory Tract: The high level of progesterone Some Trade Names CRINONEENDOMETRIN , a hormone produced continuously during pregnancy, signals the brain to lower the level of carbon dioxide in the blood. As a result, a pregnant woman breathes slightly faster and more deeply to exhale more carbon dioxide and keep the carbon dioxide level low. She may breathe deeper and faster also because the enlarging uterus limits how much the lungs can expand when she breathes in. The circumference of the woman's chest enlarges slightly. Virtually every pregnant woman becomes somewhat more out of breath when she exerts herself, especially toward the end of pregnancy. During exercise, the breathing rate increases more when a woman is pregnant than when she is not. Because more blood is being pumped, the lining of the airways receives more blood and swells somewhat, narrowing the airways. As a result, the nose occasionally feels stuffy, and the eustachian tubes (which connect the middle ear and back of the nose) may become blocked. These effects can slightly change the tone and quality of the woman's voice. Digestive Tract: Nausea and vomiting, particularly in the mornings (morning sickness), are common. They may be caused by the high levels of estrogen and human chorionic gonadotropin (HCG), two hormones that help maintain the pregnancy. Nausea and vomiting may be relieved by changing the diet or patterns of eating. For example, drinking and eating small portions frequently, eating before getting hungry, and eating bland foods (such as bouillon,

consomm, rice, and pasta) may help. Eating plain soda crackers and sipping a carbonated drink may relieve nausea. Keeping crackers by the bed and eating one or two before getting up may relieve morning sickness. No drugs specifically designed to treat morning sickness are currently available. If nausea and vomiting are so intense or persistent that dehydration, weight loss, or other problems develop, a woman may need to be treated with drugs that relieve nausea (antiemetic drugs) or to be hospitalized temporarily and given fluids intravenously (see Pregnancy Complications: Hyperemesis Gravidarum). Heartburn and belching are common, possibly because food remains in the stomach longer and because the ringlike muscle (sphincter) at the lower end of the esophagus tends to relax, allowing the stomach's contents to flow backward into the esophagus. Several measures can help relieve heartburn:

Eating smaller meals Not bending or lying flat for several hours after eating Avoiding caffeine, tobacco, alcohol, and aspirin and related drugs (salicylates) Taking liquid antacids, but not antacids that contain sodium bicarbonate because they contain so much salt (sodium)

Heartburn during the night can be relieved by the following:

Not eating for several hours before going to bed Raising the head of the bed or using pillows to raise the head and shoulders

The stomach produces less acid during pregnancy. Consequently, stomach ulcers rarely develop during pregnancy, and those that already exist often start to heal. As pregnancy progresses, pressure from the enlarging uterus on the rectum and the lower part of the intestine may cause constipation. Constipation may be worsened because the high level of progesterone Some Trade Names CRINONEENDOMETRIN during pregnancy slows the automatic waves of muscular contractions in the intestine, which normally move food along. Eating a high-fiber diet, drinking plenty of fluids, and exercising regularly can help prevent constipation. Hemorrhoids, a common problem, may result from pressure of the enlarging uterus or from constipation. Stool softeners, an anesthetic gel, or warm soaks can be used if hemorrhoids hurt. Pica, a craving for strange foods or nonfoods (such as starch or clay), may develop. Occasionally, pregnant women, usually those who also have morning sickness, have excess saliva. This symptom may be distressing but is harmless.

Skin: Mask of pregnancy (melasma) is a blotchy, brownish pigment that may appear on the skin of the forehead and cheeks. The skin surrounding the nipples (areolae) may also darken. A dark line commonly appears down the middle of the abdomen. These changes may occur because the placenta produces a hormone that stimulates melanocytes, the cells that make a dark brown skin pigment (melanin). Pink stretch marks sometimes appear on the abdomen. This change probably results from rapid growth of the uterus and an increase in levels of adrenal hormones.
Small blood vessels may form a red spiderlike pattern on the skin, usually above the waist. These formations are called spider angiomas. Thin-walled, dilated capillaries may become visible, especially in the lower legs.

Skin Rashes During Pregnancy Two intensely itchy rashes occur only during pregnancy. Pruritic urticarial papules and plaques of pregnancy (urticaria of pregnancy): This rash is common. The cause is unknown. Red, irregularly shaped, flat or slightly raised patches appear on the abdomen. The patches sometimes have tiny fluidfilled blisters in the center. Often, the skin around them is pale. The rash spreads to the thighs, buttocks, and occasionally the arms. Hundreds of itchy patches may develop. Itching is bothersome enough to keep the woman awake at night. Typically, the rash appears during the last 2 to 3 weeks of pregnancy and occasionally during the last few days. However, it may occur at any time after the 24th week. Usually, the rash clears up promptly after delivery and does not recur during subsequent pregnancies.

Doctors may have difficulty making a definite diagnosis. Herpes gestationis: The cause is thought to be abnormal antibodies that attack the body's own tissuesan autoimmune reaction. The rash can begin as flat or raised red spots that often form on the abdomen first. Then blisters develop and the rash spreads.The blisters are small or large, irregularly shaped, and fluid-filled. The rash can appear any time after the 12th week of pregnancy or immediately after delivery. Typically, the rash worsens soon after delivery and disappears within a few weeks or months. It often reappears during subsequent pregnancies and sometimes reappears if the woman later takes oral contraceptives. The baby may be born with a similar rash, which usually disappears without treatment within a few weeks. This rash is diagnosed by removing a tiny piece of affected skin and testing it for abnormal antibodies. Treatment: For either rash, applying a corticosteroid cream (such as triamcinolone Some Trade Names KENALOG acetonide) directly to the skin often helps. For more widespread rashes, a corticosteroid (such as prednisone) is given by mouth. Hormones: Pregnancy affects virtually all hormones in the body, mostly because of the effects of hormones produced by the placenta. For example, the placenta produces a hormone that stimulates the woman's thyroid gland to become more active and produce larger amounts of thyroid hormones. When the thyroid gland becomes more active, the heart may beat faster, causing the woman to become

aware of her heartbeat (have palpitations). Perspiration may increase, mood swings may occur, and the thyroid gland may enlarge. However, the disorder hyperthyroidism, in which the thyroid gland truly malfunctions and is overactive, develops in fewer than 0.1% of pregnancies. Levels of estrogen and progesterone Some Trade Names CRINONEENDOMETRIN increase early during pregnancy because human chorionic gonadotropin, the main hormone the placenta produces, stimulates the ovaries to continuously produce them. After 9 to 10 weeks of pregnancy, the placenta itself produces large amounts of estrogen and progesterone Some Trade Names CRINONEENDOMETRIN . Estrogen and progesterone Some Trade Names CRINONEENDOMETRIN help maintain the pregnancy. The placenta stimulates the adrenal glands to produce more aldosterone and cortisol (which help regulate how much fluid the kidneys excrete). As a result, more fluids are retained. During pregnancy, changes in hormone levels affect how the body handles sugar. Early in pregnancy, the sugar (glucose) level in the blood may decrease slightly. But in the last half of pregnancy, the level may increase. More insulin (which controls the sugar level in the blood) is needed and is produced by the pancreas. Consequently, diabetes, if already present, may worsen during pregnancy. Diabetes can also begin during pregnancy. This disorder is called gestational diabetes (see Pregnancy Complicated by Disease: Gestational Diabetes). Joints and Muscles: The joints and ligaments (fibrous cords and cartilage that connect bones) in the woman's pelvis loosen and become more flexible. This change helps make room for the enlarging uterus and prepare the woman for delivery of the baby. As a result, the woman's posture changes somewhat. Backache in varying degrees is common because the spine curves more to balance the weight of the enlarging uterus. Avoiding heavy lifting, bending the knees (not the waist) to pick things up, and maintaining good posture can help. Wearing flat shoes with good support or a lightweight maternity girdle may reduce strain on the back.
For most women the 2nd trimester is the most comfortable phase of their pregnancy. However, this stage can also bring with it its own unique physical changes. For some women the physical changes of the 1st trimester can continue to linger until 14, 16 or even 20 weeks of the pregnancy and beyond. The following is a general overview of some of the more common

physical changes that women can experience during the middle phase of their pregnancies. They can include: Growing belly Breast changes and milk Aches and pains Braxton Hicks contractions Bleeding gums Metallic taste Skin, hair and nail changes Nose bleeds, smells, colds and sinus Restless legs Swelling, fluid retention Vaginal changes Libido Growing belly. After about 12 weeks of the pregnancy, your uterus grows up and out your pelvis, to accommodate your baby's growth. Now your caregiver can actually feel the top of your uterus, also known as the 'fundus'. By about the 20th week of pregnancy your fundus will be felt at around the level of your navel. As your waistline thickens and your pregnancy becomes more obvious, wearing tightwaisted clothing will no longer feel comfortable. Usually by about 20 weeks you will need to start considering wearing more stretchy or loose outfits. You can read more in maternity clothing. As you watch yourself change and look more closely at other pregnant women, try to remember that every woman's body is unique in how she changes and responds to her pregnancy. Each woman's belly size and shape will differ according to her height and weight and will also depend on whether this is her first or subsequent baby, as will a woman's weight gain during pregnancy. Breast changes and milk. Breast tenderness, and possibly a slight increase in breast size are common signs of early pregnancy. The nipples often become very sensitive and the veins under the skin more noticeable. Many women increase in bra size as their pregnancy progresses (usually after around 20 weeks or so), but others do not notice much of an increase until after the birth and their breast milk comes in (which is temporary for a week or two). It is possible for a woman to start producing 'colostrum' any time after about 14 to 16 weeks of the pregnancy. Colostrum is the first fluid a woman's breasts produce and is a clear or creamy-yellow substance that is syrupy in consistency. It is possible for some women to hand express colostrum from their nipples during pregnancy, or to slightly leak colostrum occasionally, especially if this is not your first baby. (Be aware that leaking colostrum during pregnancy does not happen for every woman and your milk may not become obviously noticeable

until after your baby is born.) If you are leaking colostrum and it is becoming annoying, you may need to wear breast pads inside your bra. It is normal for some women to notice a small amount of blood mixed with the colostrum that may come away during pregnancy. This comes from within the breast and is caused by the rapid growth of blood vessels in the growing ductal system, in preparation for breastfeeding. Also, drops of blood may also be seen on the bra because the sticky colostrum temporarily 'glues' the nipple to the inside of the bra and a tiny bit of nipple skin is removed with the bra, which does heal. Some women will try and express colostrum from their breasts during pregnancy. If you do it is normal to only to get a few drops out at any one time. This can be done by massaging the breast down to the nipple and then compressing the areola, with your fingers at least a couple of centimetres behind the actual nipple. Some parents express concerns that if they leak colostrum they will not have 'enough' for their new baby when he or she is born. This is a myth, because the breasts are capable of constantly replenishing colostrum and breast milk every 3 to 4 hours or so.

Aches and pains. As the uterus grows and the baby's movements increase in strength, a pregnant woman will experience many strange sensations. These can range from 'stretching and burning' to very mild cramping, to low, heavy aching and 'dragging' or stitch-like pains with tugging and pulling. Various aches and pains can cause great concern and worry, because the feelings are usually unfamiliar and it can be hard to know if they are normal or not. Generally if the pain is not extreme and/or there is no bleeding associated with it, it is usually normal. You can read more about common aches and pains, what is normal and what could be of concern in aches and pains, early and middle pregnancy. Braxton Hicks contractions. After about 20 weeks of the pregnancy many women will experience Braxton Hicks contractions. These are 'practise' contractions of the uterus (also known as tightenings). Braxton-Hicks contractions are the uterus' way of toning this muscle as well as stimulating your baby in utero. Every time your baby feels the uterus tightening around them, it helps to stimulate their circulation, similar to a brisk rub on your own skin, or a massage! Women often describe Braxton-Hicks contractions as a feeling of 'hardness' or a mild cramping of their belly. Some liken it to a tight band being pulled across their uterus that usually eases if they change what they are doing. For

many women the Braxton Hicks contractions are painless. Some women are not even aware they are happening until their caregiver points one out to them while feeling their belly. However, for a few women these 'practise contractions' can be quite strong and even painful or 'labour-like', especially if this is not your first baby. Braxton Hicks contractions are explained in more depth in aches and pains and how they relate to pre-labour and labour. Bleeding gums. During pregnancy, the amount of blood flowing through a woman's body increases by up to 50%. This amazing process starts at about 6 weeks of the pregnancy and peaks by about 32 weeks. The increased blood flow means that a woman's gums have a higher blood supply and are more likely to bleed with vigorous brushing and flossing, making them more prone to becoming inflamed (called 'gingivitis'). You can read more in bleeding gums. Metallic taste. Some women complain of change in their taste sensation during pregnancy, often being a metallic-type taste in their mouth. This physical change is not often formally recognised by caregivers. However, natural therapists believe the metallic taste could be a result of the body releasing toxins through the lymphatic system (your lymph glands transport and produce your body's defence mechanisms against infection). Others believe it is the body's reaction to being run down with stress or the result of more physical demands being placed on a woman's body during pregnancy. You can read more in metallic taste. Skin, hair and nail changes. When a woman becomes pregnant her skin often goes through many changes. What each woman experiences during her pregnancy will be very individual to her. However, it is not unusual for many women to notice different changes during different pregnancies (and this has nothing to do with the sex of your baby!) Some women like the changes they experience. Their skin may look healthier and clearer, even 'glowing' so to speak. But for others, their skin changes are not pleasant because it is oily, more blotchy and perhaps has more blemishes.

Skin changes can be many and varied, with the middle of the pregnancy typically being associated with things like heat and hormonal rashes, oily or dry skin, stretch marks, a darkening (or pigmentation) of the skin in various areas, skin tags and red spider veins. You may also notice changes to your hair and nails. You can read more in skin, hair nails during pregnancy. Nose bleeds, smells, colds and sinus. The lining of the nose has an increased blood supply during pregnancy and tends to be more sensitive. This can cause the nose to produce more mucous and make you more prone to nose bleeds. Some women find they

tend to suffer more from sneezing, allergy and/or sinus problems during pregnancy and if they get a common cold or the flu, this can take a little longer to recover from. Pregnant women also generally have a heightened sense of smell, making them less tolerable of certain odours. You can read more about these in nose bleeds, smells, colds and sinus during pregnancy. Restless legs. Anyone can experience restless legs at any time of their lives. However, some women experience them for the first time during their pregnancy. It is hard to describe what restless legs are but the range of feelings can include:

A sensation that the legs have to move all the time. The legs feeling 'jittery' or like they have 'butterflies' in them. Legs that ache with the woman feeling she has to be constantly walking. These sensations can make it difficult to sit for long periods (for example at the cinema or during meetings), and can stop you from sleeping well at night, especially during the later months of pregnancy. Restless legs are also a little recognised condition, with treatments generally involving natural therapies. You can read more in restless legs.
Swelling, fluid retention. Fluid retention, swelling or 'oedema' affects about 65% of healthy pregnant women with a normal blood pressure and can start at any time after about 20 weeks of the pregnancy. Swelling can be noticed in the legs, feet and hands and you may find that your rings become tight, making it necessary for you to take them off until after your baby is born. Some women notice that their feet swell to the point that they need shoes that are a to 1 size larger. Normal pregnancy swelling is generally more noticeable at the end of the day, although it may be worse on hot days, after a plane trip or if you are on your feet for long periods of time. Swelling can be also associated with varicose veinsof the legs. NOTE: If you notice that you seem to be swelling and you are more than 20 weeks pregnant, you should have your blood pressure checked by your caregiver or local doctor to make sure it is NOT related to high blood pressure in pregnancy. You can read more about lifestyle choices, treatments and therapies for swelling in swelling and fluid retention during pregnancy. Vaginal changes. The hormones of pregnancy affect a woman's entire body, including the environment of her vagina. Many women notice that their

vaginal discharge is different and that there may be more of it. However, pregnancy can also slightly alter a woman's vaginal acidity (or pH), making her prone to annoying fungal infections (such as thrush) or an overgrowth of normal vaginal bacteria (called 'gardnerella'). These types of infections are much more common during pregnancy (as well as in the weeks after the birth). You can read more in thrush or gardnerella. Libido. During the middle phase of pregnancy many women find they have a renewed interest in sex. As energy levels return and as the idea of being pregnant becomes