Pregnancy information related to 13 - 16 weeks

Enhancing your comfort at 13 - 16 weeks

Pregnancy is a natural process in life that can be enjoyed in good health. Everyday activities continue, but you may have some concerns and discomforts that are common to most pregnant women. Some of these are due to the increase in your hormone levels, and others are due to physical changes in your body.

This information can help you be more comfortable, and sometimes safer, during your pregnancy.
Overall - Avoid standing, sitting, or lying in any one position for any long period of time.
Lying Down - Lying on your back is safe, and probably most comfortable, only early in your pregnancy. Position one pillow so it supports both your head and shoulders, and place another under your thighs. Slightly bend your elbows, and let your knees relax and your legs and feet roll outward.
Posture - For correct standing posture, keep your feet parallel, with weight evenly distributed. Let arms fall naturally at your sides, and keep knees straight but not locked. Tighten your abdomen, pulling in and up, and tuck your buttocks in. Keep your head erect, shoulder level and back straight.
Carrying - Maintain correct posture when carrying anything, and be sensitive to loads that may be too heavy. Divide packages in half to balance their weight. When possible, use two bags with handles to distribute the weight evenly.
Lifting - Avoid lifting as much as possible. Do not bend at the waist to pick something up. This puts too much stress on your back. If lifting is necessary, place one foot forward, keeping it flat on the floor, and lower yourself to the other knee. Then bring the object close to you and rise slowly and carefully.
Bending - Bend knees and slowly lower yourself to a squatting position while you hold onto something stable. Keep your feet and knees well apart and your back straight. Slowly rise, using your leg muscles, while holding on to the stable object.
Clothing - Wear comfortable, loose-fitting clothing. Especially avoid wearing tight bras, belts, garters, panty girdles, and knee socks or hose with tight elastic at the top. Wear a good, well-fitted maternity bra to support your breast and to help prevent backache. Cotton undergarments can help keep the skin outside your vagina dry and free of irritation from any vaginal discharge.
Shoes - Wear well-fitting shoes, paying special attention to the width and arch support. Select low-heeled shoes to avoid putting any extra stress on your back at a time when it`s supporting your increased weight and changed shape.

Exercise and fitness at 13 - 16 weeks

There are many benefits to be gained by exercising and participating in sports while you are pregnant. As in any period of your life, these activities make you feel better and can help you maintain or gain physical flexibility, tone, and strength. Exercise can be an important element in adjusting to the changes your body is going through and in reducing the discomforts of pregnancy.

Discuss exercise and sports with our doctors and nurses, before you begin or continue any activity. They may choose to recommend a specific program for you to follow.

Always follow common exercise and physical activity guidelines. These include maintaining a regular frequency (at least three times a week), beginning any program gradually, including warm-up and cool-down periods, and stopping activity when overexerted or injured.

• Heart Rate

Monitoring your heart rate while exercising becomes even more important when you`re pregnant. Due to your extra weight, you will reach your target heart rate quicker. Check your heart rate every few minutes and do not exceed 140 beats per minute.

• Centre of Gravity

The posture and curve of your spine may change as your abdomen enlarges. This shifts your centre of gravity toward your back and can alter your balance. Use caution when getting onto a bicycle or participating in other sports that require balance.

• Overheating

There is some evidence that high body temperature may cause birth defects. A foetus has no means, such as perspiration or respiration, of releasing heat. Make sure your temperature doesn`t exceed 38,5 degrees C when you`re physically active, and be sure to drink plenty of liquids to prevent overheating and dehydration.

• Symptoms of Maternal or Foetal Distress

Always stop exercising and promptly notify our doctors and nurses if you experience abdominal pain or cramping, vaginal bleeding, or unusual discharge during or after exercise or participation in sports.

Overall, our doctors and nurses do not recommend that you take up new sports when you are pregnant. And, they advise against any sporting activity that may result in a fall. Also be cautious of activity in high altitudes, such as hiking or skiing, where the decreased oxygen level could be harmful to your developing baby.

• Walking

This is usually the most strenuous exercise our doctors and nurses will recommend if you were not physically active before you became pregnant. Walking does not have to be fast-paced and it can be done with your partner and friends.

• Swimming

Because it is not a weight-bearing exercise, swimming is considered an ideal activity during pregnancy.

• Jogging and Tennis

If you participated in these activities before pregnancy, it is usually acceptable to continue them. Be aware, however, that your larger size and the need to urinate more frequently may diminish your usual ability and enjoyment as your pregnancy progresses.

• Snow Skiing

This activity is not recommended because of the risk associated with severe injury or falls (which may be increased by your altered centre of gravity) and the high altitude.

• Water Skiing and Surfing

Because of the increased risk of abdominal injury, falling with terrific force, you should avoid these sports altogether.

Guarding against disease at 13 - 16 weeks

While protecting yourself from disease is important at all times, it becomes especially necessary during pregnancy when a baby is in critical stages of development. Having an infectious disease during pregnancy can result in severe and chronic problems in a newborn.

The following provides an overview of several infectious diseases; openly discuss any relevant history of these diseases or concerns with our doctors and nurses.

Toxoplasmosis is an infectious disease that you can get from eating raw meat or having been exposed to infected excretions of household pets such as cats, rabbits, and birds. For a pregnant woman, this infection may produce no symptoms at all or may include fever, chills, headache, rash, or muscular pain. Diagnosis can be made from a blood test. The impact of Toxoplasmosis is much more severe for your developing baby. This infection can result in miscarriage, stillbirth, or birth of an infected infant who may suffer from vision loss, hearing loss, mental retardation, or abnormal skull or brain development. The following precautions will help you avoid Toxoplasmosis:

• Cook all meat thoroughly.
• Wash your hands after touching raw meat and avoid touching your eyes or mucous membranes while preparing meat.
• Wash all kitchen surfaces with soap that comes in contact with uncooked meat.
• Wear gloves or even better; avoid contact with rabbits, cat faeces (including litter boxes and contaminated gardening soil), and birdcages.

Rubella, or German measles, is a common infectious disease that approximately 15% of women are susceptible to. While the rash and fever from this infection usually pass quickly and complete recovery for the mother is expected, rubella may have serious effects on a developing baby. This includes congenital heart disease, eye lesions such as cataracts and glaucoma, hearing defects and deafness, liver conditions such as jaundice, mental retardation, cerebral palsy, diabetes, blood defects such as anaemia, and genetic problems. Pregnant women who are not immune to rubella are advised to avoid exposure to infected individuals and avoid travel to area of the world where people are not routinely immunized against rubella. If you are not immune, talk to our doctors and nurses about being vaccinated after your baby is born.

Pregnant women often show no signs of having CMV, but infants born with this infection of cellular tissue may experience eye and ear problems, learning disabilities, mental retardation, and liver problems. CMV can be contracted from infected blood, saliva, urine, semen, cervical secretions, and breast milk. No treatment or preventive vaccine is available. Be sure to talk about CMV with our doctors and nurses especially if you:

• Work in a dialysis centre or with patients who have immune system disorders.
• Work in a nursery or day-care centre.
• Plan to breast-feed.

Because of the widespread incidence of Hepatitis B, women are screened during pregnancy for this virus, and newborns are routinely given HBV immunizations as soon as possible after birth. Hepatitis B can cause liver inflammation and related problems. Symptoms include jaundice, lethargy, loss of appetite, vomiting, and fever. HBV may be contracted from infected blood, saliva, and semen. The risk of contracting this disease is increased by the use of illicit intravenous drugs, sexual contact with one or more partners, and blood transfusions. Talk with our doctors and nurses about Hepatitis B if you are:

• A healthcare professional who handles blood, blood products, or body fluids.
• A staff member of an institution for the mentally retarded.
• A kidney dialysis patient or an employee of a dialysis centre.
• A patient with a blood-clotting disorder who receives clotting factor concentrates.
• Living with an HBV carrier.
• Planning to breast-feed.

Sexually transmitted diseases (STDs) are of particular concern to pregnant women. STDs are infectious diseases spread through sexual contact with an infected person. This person may have few or no symptoms and may not realize they are infected. A women can pass a sexually transmitted disease on to her baby at various times, including during pregnancy, while giving birth, or when breast feeding.

The vagina normally contains harmless bacteria. In pregnancy, however, hormonal changes can alter vaginal secretions and leave the vagina susceptible to infection. Three of these include:

• Candida

Candida (yeast infection) is characterized by a cheese-like, white discharge and itching. If you are taking certain prescribed antibiotics during pregnancy, you may be more susceptible to this infection. Be aware, too, that a pregnant woman can have a vaginal yeast infection, yet have few or very mild symptoms. Notify our doctors and nurses if you have even minor irritation or slight changes in vaginal discharge.

• Chlamydia

Chlamydia is the most common sexually transmitted disease. Maternal symptoms of infection are often not present, but may include burning during urination and painful intercourse. Chlamydia may be passed on to a baby during deliver, and can result in an eye infection or pneumonia.

• Trichomonas

Symptoms include vaginal itching and irritation, and yellow, foul-smelling discharge.

Maternal symptoms of gonorrhoea are varied, ranging from none to some yellow vaginal discharge or abnormal vaginal bleeding. The gonorrhoea infection is passed on to a baby during birth and causes an eye infection that could lead to blindness.

A blood test is done early in pregnancy and may be repeated just before delivery to determine possible infection with syphilis (since many women with the disease will have no symptoms). Nearly 100% of babies of syphilis-infected mothers develop the disease, and symptoms can appear at birth or months or years later. These babies can suffer vision damage or loss, dental and bone deformities, brain damage, and even death.

This infection, whose clinical name is Human Papilloma Virus (HPV), is common in pregnancy and may be located in the vulva, vagina, or cervix. Because of hormone changes that occur during pregnancy, warts develop and can grow in size and number, bleed, or make delivery more difficult (Caesarean section is often recommended if warts are present in the birth canal). In a few instances, babies exposed to HPV during birth may develop warts in their eyes or throats, causing vision, vocal, or respiratory problems.

Herpes Simplex Virus (HSV) Type II often exhibits no symptoms when dormant (inactive), but painful blisters or bumps may develop near or inside the vagina or rectum during an outbreak. There is no cure for Herpes II and symptoms may recur again and again. Babies most often acquire this infection at delivery, causing painful blisters on the skin, and damage to eyes, other internal organs, and the brain (leading to mental retardation). If our doctors and nurses suspects you have active herpes lesions, Caesarean birth is most often advised to avoid exposing the baby to the infection.

The often symptomless HIV causes AIDS, which is the life-threatening illness that is the most serious result of this viral infection. The infection poses a great danger to a baby during pregnancy due to placental circulation. Many babies whose mothers have HIV will acquire the infection and develop AIDS during early childhood. HIV has been found in breast milk; therefore, it is safest for HIV-positive mothers not to breast feed. Protect yourself and your baby by openly reviewing all of your important health information and sexual experiences with our doctors and nurses.

Nutrition at 13 - 16 weeks

There are some food and nutrient items that, while of little concern to non-pregnant women, deserve special consideration during pregnancy because they can affect the health of both you and your baby.

Because the recommended daily allowance of almost all vitamins increases by 25% to 50% when you are pregnant, our doctors and nurses often prescribe prenatal vitamins. These can be started as soon as the pregnancy has been confirmed. Prenatal vitamins are a supplement, or addition, to what your daily diet ideally includes. Prenatal vitamins should never be considered a substitute for the vitamins your body will receive naturally from eating the proper foods. (During your pregnancy, avoid excessive use of vitamins and mineral supplements not specifically prescribed or approved by our doctors and nurses. When taken in amounts that are higher than those recommended, Vitamins A, B6, C, and D may lead to problems with both mother and baby).

Getting enough iron during pregnancy is important because it is required for the formation of haemoglobin (the oxygen carrying component of blood) for both you and your baby. In addition, during your last trimester of pregnancy, your baby draws iron from you to store in his/her liver for use after delivery. Increased blood volume and iron stores assist your body with adjusting to the blood loss that can occur when giving birth. Our doctors and nurses may have prescribed an iron supplement for you. Talk to our doctors and nurses about obtaining the best results from these supplements, and about problems that some women experience, such as nausea, stomach upset, or constipation.

Adequate calcium is essential in the formation and development of your baby`s heart, muscles, skeleton, and tooth buds. An inadequate intake of calcium through the diet can result in your body`s stores of calcium being depleted. Our doctors and nurses may prescribe a calcium supplement for you if you can`t tolerate milk, since milk and milk products are the best sources of dietary calcium.

Even though most of the vitamins you require for a healthy pregnancy are supplied through a high-quality, varied diet that is not always the case with folic acid. An adequate folic acid intake is very important when you are pregnant. Too little of this B vitamin increases the risk of neurologic or spinal cord disorders in the developing baby. Folic acid can be found in liver, leafy green vegetables such as broccoli and spinach, lima beans, asparagus, and oranges. Ask our doctors for specific information and recommendations for folic acid supplements.

Little is known about the long-term effects of artificial sweeteners (aspartame and saccharin) on a developing baby. It is best that you avoid them altogether during pregnancy unless otherwise directed by our doctors and nurses.

Caffeine is a drug and stimulant. Caffeine is contained in coffee, tea, chocolate, and some colas and medications. Since the effects of caffeine in human pregnancy are unclear, it is safest that you avoid caffeine altogether or limit your intake to 2 cups of caffeine-containing beverages per day (200 mg).

Herbal teas are often used in place of caffeine-containing beverages. During pregnancy, herbal teas may cause nausea and vomiting or serious problems for your baby. It is safest to avoid herbal teas while you are pregnant.

Adequate fluid intake during pregnancy is very important. Over 7 pounds of a normal 25 - 35 pound pregnancy weight gain is made up of fluid. These fluids are necessary for delivering nutrient, building body cells, developing body systems, and for elimination. Your body needs extra fluids during pregnancy to help with constipation, dry skin, and to keep body temperature constant. Water will also help reduce risk of urinary tract infection. At least six 8-ounce glasses of liquid should be consumed daily, with water being the preferred choice. Other nutritious fluids, such as milk, fruit juices, and vegetable juice should also be part of your diet. Avoid excess caffeinated beverages and all alcohol, including beer and wine. Try to substitute seltzer, club soda, or water flavoured with lemon/lime for artificially sweetened beverages and soda.

Pregnancy pointers at 13 - 16 weeks

The 'pelvic tilt' exercise works to lessen lower back discomfort and to strengthen your abdominal muscles (check with our doctors and nurses before performing any exercise).

Proper auto seat belt use is very important throughout your pregnancy. Use your car`s '3 point restraint system'. The lap belt should be below your abdomen and the shoulder belt should be above you abdomen and between your breasts.

It has been established that only 300 extra calories per day are needed to support a gradual weight gain during pregnancy. It is important that these extra calories are from nutritious food. Avoid foods that are low in nutritional value, but high in calories. For example, two cans of soda or two ounces of chips contain about 300 calories, but few vitamins and minerals.

Tastes, smells, and attitudes toward food often change during pregnancy. It is important to eat a well-balanced diet with a variety of foods. Discuss any concerns you have about your diet with our doctors and nurses.

Prenatal testing at 13 - 16 weeks

Screening tests are performed during various phases of pregnancy. These screening tests may indicate when more in-depth testing is necessary.

At about 16 weeks gestation, the foetus` liver is producing a substance called alpha-fetoprotein (AFP). This substance is found in the foetal bloodstream and enters the mother`s bloodstream through placental circulation. By measuring the level of AFP in the mother`s blood between the 16th and 18th weeks of pregnancy, it is possible to screen for certain abnormalities and chromosomal problems in the developing baby.

An AFP level that is higher or lower than average may mean that further testing is needed. An ultrasound may be performed to determine the following:

• Whether there is a foetal abnormality.
• Whether there is more than one foetus.
• The 'age' of the foetus.
• Foetal well being.

If an ultrasound shows there is one foetus of the expected age and no other problems are visible, an amniocentesis may be performed.

During an amniocentesis, our doctors and nurses use an ultrasound to guide the insertion of a needle through the mother`s abdomen and uterine wall. Fluid is then drawn from the amniotic sac surrounding the foetus. The level of AFP in the fluid is then measured; an abnormally high or low reading may indicate the presence of problems (such as neural tube defects or Down`s syndrome) but will not tell how severe the defect might be. Results of amniocentesis are usually available within two weeks of the testing.

Amniocentesis may be indicated for reasons other than an abnormal AFP reading. When performed between the 16th and 18th weeks (and occasionally as early as the 14th or as late as the 20th weeks), it can be helpful in obtaining foetal cells for chromosomal testing for several inherited genetic diseases. The baby`s sex can also be determined at this time.

Amniocentesis and related genetic counselling may be indicated for:

• Pregnant women over 35 years of age.
• Women who have had children with genetic disorders.
• Women whose family history suggests an increased risk for genetic abnormalities.

In the last trimester of pregnancy, an amniocentesis may be performed to determine the maturity of the baby`s lungs.

Special consideration for seat belt use during pregnancy at 13 - 16 weeks

Just as diet, rest, and exercise take on an extra importance during pregnancy, so does the use of seat belts. Your unborn baby is depending on you to keep him/her safe from harm.

The most common cause of foetal injury or death in an automobile accident is the injury or death of the mother. So, every time you get into an automobile, as either the driver or a passenger, use the car's three-point restraint system. The lap belt should be placed below your abdomen, and the shoulder belt should be placed above your abdomen, between your breasts. Adjust both belts to fit snugly but comfortably.

If a shoulder belt is not available, be sure to wear the lap belt below your abdomen across your hips.

You can help protect your baby by wearing a seat belt anytime you are travelling.

Special prenatal exercises at 13 - 16 weeks

Our doctors and nurses will recommend exercises for you during your pregnancy that will maintain your general fitness and well-being (usually walking or other safe activities) and specifically prepare you for labour and delivery. Prenatal exercise classes are available at most hospitals and many fitness and sports facilities. Probably the most common and beneficial prenatal exercise is the pelvic tilt. It strengthens your abdomen and stretches your lower back to relieve discomfort in that area.

How to do the pelvic tilt :

• Position yourself on the floor on your hands and knees.
• Exhale as you tilt your pelvis up by pulling in your abdomen and then pushing your lower back up toward the ceiling.
• Hold this position while you slowly count to six. Then inhale and relax, returning your back to the initial resting position.
• Repeat 10 times, a few times each day, or as recommended by our doctors and nurses.
• The pelvic tilt can be done anytime your back feels tired. It is a helpful exercise that relieves the tension in the lower back.

Travel during pregnancy at 13 - 16 weeks

In today`s highly mobile society, travelling regularly for pleasure and business is a fact of life. Now that you`re pregnant, however, you need to consider some additional safety and comfort issues.

If your pregnancy is progressing normally, you can travel without added concerns. Do, however, discuss with our doctors and nurses about any trips you may be planning, and then take a few common-sense steps to ensure your safety and comfort.

Talk to our doctors and nurses about your plans, and get a copy of your prenatal health records to take along in case you have to seek help from doctors who aren`t familiar with you or your health history.

Ask our doctors and nurses in advance for the name of a doctor and hospital in the area you`re travelling to. Travel to regions of the world where prenatal health care is not readily available, where there is poor sanitation, or where the incidence of disease is very high is not recommended during pregnancy.

Check your medical benefits plan to determine if full or partial coverage is affected by away-from-home care if it should be necessary.

Pay special attention to and consult with our doctors and nurses about any travel method or a destination that involves high altitudes, 5,000 feet or more. This includes activities such as hiking and flying in private aircraft. Flying in commercial aircraft, whether commuter or major carrier, is usually not a concern for pregnant women because they usually maintain pressurized cabin levels.

Pregnancy may make you more susceptible to the common hazards of travel. Make a special effort to discuss issues such as jet lag, dietary needs, travelling with children, and motion sickness. Do not take motion sickness medication without the approval of our doctors and nurses as it could be harmful to your unborn baby.

• Always wear your seat belt, no matter how short the ride.
• Avoid pushing or lifting heavy baggage.
• Wear comfortable clothes.
• Allow for extra restroom visits, stop the car frequently or take an aisle seat on an airplane for easier access.
• Avoid prolonged sitting, walk around during rest stops, or occasionally stand near your seat and walk in the aisle of the airplane.
• Avoid crossing your legs at the knee. Crossing the ankles, instead of the knees, allows for better blood circulation in the legs.
• Allow plenty of time to get where you are going so you don`t have to rush.

What to expect at your prenatal visit at 13 - 16 weeks

Your second prenatal visit will probably take less time than the first, but some very important information is being collected. You can expect the following to occur:

• Your weight taken.
• Your blood pressure checked.
• Your urine checked for protein, sugar, and ketones.
• Our doctor or nurse will listen to the baby`s heartbeat.
• Your abdomen examined to check your baby`s growth (fundal height).
• A review of laboratory findings from your first prenatal visit and scheduling of other tests if indicated.
• Blood drawn for Alpha-Fetoprotein testing, if you have chosen to have this prenatal test.
• A review of any symptoms, concerns or problems occurring since your last visit.
• Our doctors and nurses may discuss the importance of contacting our office if you experience any of the following symptoms:
  • Vaginal bleeding
  • Persistent vomiting
  • Chills or fever
  • Dimness or blurring of vision
  • Severe cramping or pain in the abdomen or lower back
  • Increase or change in vaginal discharge
  • Fluid leakage from the vagina
  • Persistent or severe headache
  • Pain or burning during urination
  • Unusual swelling of the hands, face, or feet
  • Unusual soreness or redness of the legs

When to call our doctors and nurses at 13 - 16 weeks

Contact our doctors and nurses if you notice any of the following warning signs:

• Menstrual like cramping.
• Vaginal bleeding or a marked change in vaginal discharge (amount/odour/colour).
• Unrelieved abdominal or intestinal cramping, pain, or tenderness (with or without diarrhoea or constipation).
• Vaginal / pelvic pressure.
• Lower backache.
• Pain or burning during urination, or a decrease in the amount of urine.
• Unrelieved vomiting.
• Unrelieved diarrhoea or constipation.
• Chills or fever.
• Soreness or redness in one or both legs.
• Marked swelling or puffiness of the feet, hands or face (oedema), or sudden weight gain.
• Severe or constant headache.
• Visual disturbances such as blurred vision, spots before the eyes, and flashes of light.
• Dizziness or mental confusion.
• Something just doesn`t feel right.

You may notice other symptoms not included in this list, when in doubt, call our doctors and nurses.

The ideal outcome for all patients, of course, is to have an uneventful pregnancy that results in a healthy baby. However, some pregnancies do involve complications that may affect the mother, the baby, or both. Because these complications can be relatively minor to life-threatening, it`s important to recognize possible warning signs.

Remember that you are the most important gauge of your body and, in turn, your pregnancy. Don`t compare your experience with those of friends or relatives. Even if you`ve been pregnant before, this pregnancy will probably be different. Trust your instincts, but don`t attempt to diagnose yourself. If something 'just doesn`t feel right', call our doctors and nurses.

When you call our doctors and nurses:
Write down the information you will need before placing the call, and keep pen and paper ready to write down our doctors and nurses instructions.

Always have the following information on hand:

• Our office and after-hours phone number.
• Hospital name, address, and phone number.
• Emergency room phone number.
• Ambulance service phone number.

Working during pregnancy at 13 - 16 weeks

The majority of women continue to work during their pregnancy, most up until the time of delivery. Your decision to work during pregnancy should be based upon your own personal situation and desire. However, keep in mind that potential work hazards should always be a factor to consider.

Talk to our doctors and nurses about:

• The type of work you do, including the amount of standing or lifting each day.
• The number of hours you work each day and week.
• The length of your commute to and from work.
• Any travel involved in doing your job.
• How physically strenuous your work is.
• Any harmful substances, chemicals, fumes, or radiation you are exposed to in your job.

This information, along with a history of previous pregnancies and knowledge of any complications in your current pregnancy, will enable our doctors and nurses to make appropriate suggestions regarding your work schedule or environment.

Our doctors and nurses may advise you to stop working altogether it if is determined that you have a multiple pregnancy (twins or triplets), experience vaginal bleeding, Preterm labour, or other complications.

If you continue to work during pregnancy:

• Avoid lifting or pushing heavy objects.
• Avoid sitting or standing for long periods of time.
• Minimize climbing stairs when possible.
• Increase rest periods within guidelines.
• Eat nutritious snacks.
• Drink plenty of fluids.
• Empty your bladder frequently.
• Wear comfortable clothing and low-heeled shoes.
• Create a comfortable work environment with lighting, thermostat settings, and a chair that provides good back support.
• Avoid second-hand smoke as much as possible.
• Avoid exposure to harmful substances in your work environment.

Your body's changes and your baby's growth at 13 - 16 weeks

Your baby`s head is now about 1/3 of its total body length. The facial features are being defined. The body is growing quickly and the fingernails are developing. The baby`s sex can usually be identified by this time period. Since the muscles are now functioning, the baby is active.

At about 13 weeks your enlarging uterus can be felt just above your pubic bone. Your pregnancy has begun to "show". At about 14-16 weeks our doctors and nurses can begin to hear the baby`s heartbeat. At 16-20 weeks you will begin to feel the baby move (quickening). You may begin to experience low back pain due to posture and hormonal changes.

Even though others may not yet see the signs, your body is clearly telling you that you`re pregnant! By the beginning of the second trimester, however, 'morning sickness' disappears for many women. If you`re among the few who still find it a problem, remember that:

• Eating several small meals throughout the day may help.
• Crackers first thing in the morning can ease the nausea.
• The nausea will pass in time.

At about the 13th week, your uterus has grown large enough so it can be felt just above your pubic bone. This enlargement will continue gradually throughout your pregnancy, and may be more obvious if you`ve been pregnant before.

Some wonderful experiences are part of this time. One of the most exciting is hearing your baby`s heartbeat for the first time. As early as 14 to 16 weeks, you may be able to hear the heartbeat during a visit to office with an amplifying device called a Doppler.

With such changes come some more symptoms. You may, for example, begin to experience some low back pain due to posture and hormonal changes. If you do, discuss this with our doctors and nurses.

Your baby is in a period of rapid growth. By approximately 13 weeks of pregnancy, internal organs and systems (including the umbilical cord and placenta) are formed and functioning, the head is about 1/3 of its total length, and facial features are defined. The skin begins to be covered by lanugo, a fine, downy hair, and baby`s sex can usually be identified. Typically, a foetus at 16 weeks will weigh about 7 ounces and be 5 ½ inches long.