Pregnancy information related to 17 - 20 weeks

What to expect at your prenatal visit at 17 - 20 weeks

If your pregnancy is advancing normally, chances are you`re visiting our doctors and nurses once each month during the 17 - 20 weeks time. This regular schedule allows the doctors and nurses at our office to check the well-being of you and your baby and monitor your baby`s development.

At this time, you will be able to listen to your baby`s heartbeat and clearly hear the rate of the heartbeat. A vaginal exam may be performed at any time during your pregnancy, to determine cervical status or collect vaginal cultures.

You can also expect the follow to occur:

• Your weight taken.
• Your blood pressure checked.
• Your urine analysed.
• Your abdomen measured to check the baby`s growth (fundal height).

Our doctors and nurses may talk with you about the following:

• Findings of prenatal or laboratory tests that have been performed.
• Any medication you are taking.
• Any symptoms, concerns, or problems occurring since your last visit.
• Any medical care you received since your last visit.
• Any activity restrictions or recommended lifestyle changes.
• Nutrition guidelines.

Your responsibility during the prenatal visit is to tell our doctors and nurses:

• When you first felt your baby move.
• Any signs or symptoms that have caused or are causing you concern.
• Any exposure you may have had to an infectious disease.
• About any questions or concerns that you may have.

Remember, your prenatal visit is the ideal time to ask any questions about your pregnancy. Jotting thoughts down on your Prenatal Visit Checklist as they occur between visits helps you remember to ask our doctors and nurses the questions that are important to you.

Dental care at 17 - 20 weeks

Good oral hygiene is especially important for you now because pregnancy can make some dental disorders worse. The combination of hormonal and circulatory changes in your body, in addition to more frequent eating, usually results in the following:

• Increased Salivation

A nuisance more than a health concern, this common problem is thought to be caused by enlarged blood vessels in your tongue and mouth.

• Bleeding gums

Because they`re swollen from increased blood flow, your gums are especially sensitive to brushing and flossing. However, it is important that you maintain regular brushing and flossing. Use of a soft toothbrush may help.

• Plaque Build-up on Your Teeth

Plaque is the invisible, sticky layer of harmful bacteria that constantly forms on your teeth. It produces damaging acids that can lead to both tooth decay and gum disease. Many women eat or snack frequently during pregnancy, to ward off nausea, to prevent constipation through increased fibre intake, or to meet overall dietary needs for good nutrition. This increases the opportunity for plaque build-up. In addition, increased hormone levels may aggravate the way gum tissues react to the irritants in plaque.

• Brush your teeth after every meal and snack.
• Floss at least once every day.
• Use a soft toothbrush and avoid vigorous scrubbing.
• Use fluoride toothpaste.

• Drink fluorinated water, if your water is not fluorinated, our doctors and nurses may choose to prescribe a vitamin supplement.
• Eat a well balanced diet.

• Continue regular dental visits during your pregnancy, letting your dentist and dental hygienist know that you are pregnant. Be sure to tell them about any health or medication changes that occur during your pregnancy.
• Ask your dentist or hygienist to show you how to brush and floss correctly.
• If visiting the dentist makes you more anxious during your pregnancy, discuss the situation with your dentist so special care can be taken to avoid stress.
• Schedule dental visits earlier in your pregnancy, when it may be more comfortable to sit for extended periods.

• Avoid elective dental treatment, such as teeth whitening or bonding, especially during the first three months of your pregnancy.
• Make sure that your dentist takes only X-rays necessary for immediate treatment and that you wear a leaded apron during the procedure
• If you are concerned about the effect that a drug your dentist needs to use will have on your baby, discus your concerns with your dentist and our doctors and nurses to determine the best plan of care for you.

Food cravings, fast food and fibre at 17 - 20 weeks

The good nutrition basics you`ve learned earlier in this pregnancy should continue to serve as a guideline to help promote the health and well being of you and your baby. As your pregnancy progresses, these food facts may be helpful for both your convenience and comfort.

The individual food cravings you may have during your pregnancy are not, usually, a cause for concern as long as your diet is nutritionally adequate. Food dislikes and cravings may come and go. However, if you develop an unusual craving for non-food items such as clay, dirt, starch, ice, or wall plaster contact our doctors and nurses immediately. This condition, known as pica, may indicate a need for iron, calcium, or zinc in your diet.

You can include the convenience of fast food into your diet while you`re pregnant and still stay within nutritional guidelines.

That if you eat out, you select more of these items:

• Baked potato, coleslaw, salad.
• Roast beef sandwich, lean ground beef.
• Roast chicken, taco.
• Broiled seafood platter.
• Frozen yogurt.
• Fruit juice, low-fat milk.

And less of these:

• French fries, onion rings.
• Specialty burgers and cheeseburgers.
• Fried or breaded chicken, nachos.
• Sundae, biscuits, pies.
• Chocolate milk.

The normal changes that your body is going through during pregnancy often causes constipation. Pressure from your expanding uterus slightly moves your digestive organs, particularly your rectum, making it more difficult for stool to pass. At the same time, increased hormone levels cause the muscles of your intestinal wall to contract less strongly, which slows down stool passage. In addition, constipation is a common side effect of iron supplementation, which our doctors and nurses may have prescribed for you. Fortunately, exercising, increasing your intake of fluids, and most importantly increasing the fibre in your diet may relieve constipation.

Fibre, or roughage, promotes normal intestinal function and bowel regularity by stimulating the movement of food through the intestines.

Fibre is a nature ingredient found in plant foods, such as grains, fruits, vegetables, cereals, and legumes (beans and sprouts).

There are two kinds of fibre, soluble and insoluble, and each has a different effect on your body. Soluble fibre helps lower blood cholesterol and may help control blood sugar, which is especially important if you have diabetes. Insoluble fibre relieves constipation and may help prevent colon cancer. Most foods that are good sources of fibre may contain mixtures of soluble and insoluble fibres.

Food that has high insoluble fibre content that will help relieve your constipation include:

• Wheat-bran cereal.
• Whole-wheat bread and crackers.
• Shredded wheat.
• Brown rice.
• Lentils.
• Legumes.
• Potatoes.
• Bananas.
• Brussels sprouts.
• Broccoli. Spinach.
• Other raw fruits and vegetables.

Increasing fibre intake too quickly may result in gas, diarrhoea, and bloating. To avoid discomforts, add fibre to your diet gradually, spread your intake over the day`s meals, and be sure to drink plenty of water and other fluids.

The recommended amounts of fibre you should include in your diet while you`re pregnant is 20 to 35 grams per day.

Remember, fibre alone will not prevent constipation. Increasing your fluid intake is essential.

Pregnancy pointers at 17 - 20 weeks

You should not take any medication, either prescription or over-the-counter, unless instructed to do so by our doctors and nurses. Keep in mind there are alternative comfort measures that may be taken to relieve a variety of symptoms. For example:
Constipation - Walking, drinking fluids, eating high fibre foods.

Walking is an excellent form of exercise for most women during pregnancy. It helps to alleviate discomforts that you may experience, such as leg cramps, constipation, insomnia, and fatigue. Check with our doctors and nurses before starting any exercise program.

If you have children you may involve them in your pregnancy by:

• Taking them to your prenatal visits to listen to the baby`s heart beat.
• Allowing them to feel the baby move.
• Letting them help prepare the new baby`s room, clothes, and supplies.

Dental care is very important during pregnancy. Visit your dentist as soon as possible, and be sure to tell the dentist you are pregnant so proper precautions can be taken if X-rays are necessary. Brush your teeth with a soft bristled toothbrush and floss regularly.

Preterm labour at 17 - 20 weeks

Labour can occur before you expect. Preterm labour is labour that begins any time between the 20th and 37th week of pregnancy. It occurs when regular, frequent contractions of your uterus are present along with changes in your cervix. It is not fully understood why Preterm labour occurs in about 6% to 8% off all pregnant women.

Preterm labour is a serious concern; a baby born prematurely may experience certain problems, and need special medical care in order to breathe, eat, and keep warm.

Discuss your risk factors for Preterm labour with our doctors and nurses, and be aware of the early warning signs of labour.

While it is not clearly understood why some women go into Preterm labour and others do not, good prenatal care appears to lesson your risk. Other factors that have been linked to Preterm labour include the following:

• History of previous Preterm labour or Preterm birth.
• Exposure to the drug DES when your mother was pregnant with you (very few women exposed to DES remain who are of child bearing age today).
• One or more elective or therapeutic abortions.
• Current multiple pregnancy such as twins, triplets, etc.
• Abnormalities of the cervix or the uterus.
• Abdominal surgery during your current pregnancy.

Symptoms of Preterm labour are often subtle and painless. Notify our doctors and nurses immediately if you experience severe pain or vaginal bleeding. Notify our doctors and nurses if any of the following symptoms continue for more than one hour, after resting. Ignoring or waiting too long to report these signs may result in your baby being born too early.

- Low, dull ache across your lower back
Different from what you may have normally experienced during your pregnancy, it could radiate to your sides or front on an irregular or constant basis. Changing your position does not relieve this backache.
 
- Uterine contractions
'Tightening' of the entire surface area of your uterus that occurs more than four times in an hour.

- Abdominal, uterine, intestinal, or menstrual-like cramping
Irregular or constant, with or without diarrhoea or indigestion.

- Pelvic pressure, heaviness, or fullness
May be irregular or constant and is not relieved by changing position. Often described as a feeling that your baby is 'pushing down'.

- Marked increase or any change in vaginal discharge
Different from what you`ve experienced to date in your pregnancy. Discharge may be bloody, pink or brown tinged, mucus like, or watery.

- Overall feeling of 'something is just not right'.

Sexuality at 17 - 20 weeks

By the beginning of the second trimester, the pregnancy process begins to smooth out. While your body is still growing, it has become adjusted to the changes that are a part of pregnancy, making you feel more comfortable. The fatigue, nausea, vomiting, and breast tenderness that you experienced in the early part of your pregnancy have probably lessened by now. In all likelihood you are beginning to enjoy being pregnant and are excited about this time of planning and sharing with your partner.
 
With the increasing change of your shape, you may need special reassurance from your partner that you are still feminine and desirable. Try to talk openly about how you are feeling, physically and emotionally, and about your need for warmth, intimacy, and sexual intercourse.

General factors affecting sexual activity during pregnancy, other than the pregnancy itself, include the following:

• Your age.
• The length of your relationship.
• The quality of your relationship.
• Your sexual relationship prior to pregnancy.

You may experience one of the following sexual desire patterns during pregnancy:

• Sexual desire and activity remain normal constant throughout pregnancy.
• Sexual desire and activity decline over the pregnancy.
• Sexual desire and activity decline in the first and third trimesters, but increase during the second trimester.

Increased sexual pleasure may result from the following:

• Satisfaction stemming from the knowledge that you and your partner were able to conceive.
• Freedom from having to use contraceptives.
• The increased pelvic congestion that often facilitates orgasm in some pregnant women.

Increased sexual pressure or decreased desire may result from the following:

• Mixed emotions about the pregnancy.
• Adjustments to your new shape.
• Concern for the well being of you and your baby.
• Stress factors such as financial and lifestyle concerns.
• Continued physical discomforts.

Unless our doctors and nurses have recommended that sexual activity be restricted, it is generally safe to have sexual intercourse at any time during your pregnancy. If either you or your partner has an infection, don`t have sex until you have received a complete course of treatment and are symptom free.

The basic guide to sex during pregnancy is your comfort. You and your partner may want to try different positions as your pregnancy progresses.

Notify our doctors and nurses immediately if you experience severe pain, vaginal bleeding, or if any of the following symptoms persist more than one hour:

• Unusual vaginal discharge.
• Abdominal cramping or aching.
• Lower backache.
• Contractions, tightening of the uterus, that occur more than four times in one hour.

Telling family and friends at 17 - 20 weeks

Telling those close to you that you are pregnant is a very personal matter. While some women want to tell the world as soon as they themselves know, others are more inclined to wait until the pregnancy has progressed.

The choice to wait may be based upon several factors, including:

• An uncertainty over whether or not your pregnancy will be maintained.
• Wanting to wait for a 'normal' result from prenatal testing procedures such as CVS or amniocentesis.
• Not wanting to 'burden' other family members or friends with concerns related to pregnancy termination or continuation. Uncertainty over others` reaction to the news.
• A desire to become comfortable with the idea of being pregnant before telling others.

Whatever your feelings about sharing the news or keeping it a secret, honour them. Taking care of your emotional well being is very important.

By the time you reach the midpoint of pregnancy, however, your body`s changes may "tell the news" without you saying a word. You may find it helpful to think about your responses in advance. Remember, that while a polite answer is usually preferable, you and your partner owe explanations to no one.

If you have other children, deciding how and when to tell them a new family member is on the way can be a challenge. A good rule of thumb is to tailor the news according to the child`s age. Although children older than five usually can comprehend the events of pregnancy, the concept of 'months from now' is too vague for many under age seven to fully understand. Try to tie the coming birth to something other than a specific date; 'about the time of your birthday' or 'when the leaves on the trees are getting green'. For a child under age two, use only the briefest and simplest of terms.

Many couples do not think it is necessary to tell very young children about a pregnancy, because they don`t believe the children will understand. But even young children will be able to see that mommy`s body is changing because a new baby is growing. Children of all ages, from infants to adolescents, have a great need for educational and emotional support during their mother`s pregnancy. Changes in the parent-child relationship can be stressful for the child and parent. The ages and emotional maturity of the child will determine, in part, his or her behaviour toward a new family member.

Many parents find the midpoint of pregnancy a good time to announce the news. This is usually the time when the mother is physically showing that she is pregnant and many of the early risks and concerns of a healthy pregnancy are resolved. Just don`t tell a child of any age until you`re ready for the whole world to know. That kind of secret is impossible to keep.

The ages of your children will also determine how you answer questions about reproduction, pregnancy, and what the baby will be like that will no doubt follow your announcement. The most important thing to remember is to give a child only the amount of information he or she actually ask for and can handle. A toddler, for example, probably wants to know that 'the baby is growing in a special place inside Mommy and will come out when it`s big enough'. With children of any age, use the correct terminology for body parts and function. Any shyness or embarrassment you may feel about speaking frankly will wear off with repetition, and you will be doing your child a favour, because he or she won`t have to relearn words.

There are now a large number of books available for parents and children on the subject of reproduction and what it`s like to have a baby brother or sister. Many of these are designed to be read together and can be a valuable teaching tool. Remember to be open and honest and willing to answer questions whenever they`re asked. With young children, don`t be surprised if you must repeat your answers several times.

Your children`s questions won`t all be about where babies come from. Children are naturally self-centred, and yours will want to know how this baby will affect their lives. Once a child understands that a real baby will join the family as another child for Mommy and Daddy to love, he or she will begin to worry about being 'replaced' in your affections and perhaps even in your home. The more imaginative the child, the more horrible the fears may be. Talking about the baby in terms of the child, saying, 'you will be a big sister/brother', instead of 'the baby will love you' and speaking of the baby as 'ours' not 'mine', will help. If a baby coming means that the child will move to a big bed or another bedroom, make the change well ahead of time, so that it will be interpreted as growing up, not being pushed out.

Don`t try to break your child of the pacifier or start to potty train just before the new baby is due, and don`t send him/her off to nursery school just then, all for the same reason. Try to be more generous than ever with your hugs and kisses and the special time you spend with your child each day. Bedtime is a wonderful time for a leisurely, loving cuddle that will reassure your child of your love.

• Take even young children with you to a prenatal visit. Hearing the foetal heartbeat can make the coming baby more real and make them feel involved in the pregnancy.
• Answer the questions your child asks clearly and in terms he/she can understand. Don`t over inform or ignore their curiosity.
• When your baby`s activity becomes strong enough to be felt through your abdomen, let your child feel the movement. Talk about how your baby is growing.
• If your delivery hospital or birthing centre offers sibling preparation classes, encourage your child to take part. These sessions are generally age-based discussions of both the birth process and what it feels like to become a big brother/sister.
• If fatigue keeps you from usual activities, plan special times with your children. Changes from normal patterns can be confusing; spending time together can bring back the balance.
• Be aware that your growing bond with the child you`re carrying can, even without your noticing it, cause you to be distracted when you are with your other children. They can feel this. Let each child know how special he/she is and that your love is a constant to be counted on. All children need attention and support from both parents during pregnancy.
• As you prepare the baby`s room, let brother/sister help. Being part of the process helps them deal with the mixed feelings that come with being a sibling and will reassure them that they are not in danger of losing their parent`s love and attention.
• Another way of keeping the older child involved is letting them feel that this is 'their' baby too. Let them know they will be able to help with the baby by doing things like picking out the baby`s clothes for the day, etc.

When to call our doctors and nurses at 17 - 20 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).
• Contractions or uterine tightening (four or more within one hour). 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 range from 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.

Your body`s changes and baby`s growth at 17 - 20 weeks

Your baby`s head, arms, legs, and body are now fully formed. Soft fine body hairs (lanugo) cover the body as well as a cheese-like coating (vernix), which protects the delicate skin. Scalp hair and eyebrows appear. Foetal movement increases.

Your baby`s movement will become increasingly noticeable to you. You may experience muscle cramps in your legs due to changing posture and/or inadequate nutrient intake. Due to circulatory and hormonal changes, your gums may become swollen and bleed more easily. At 20 weeks you`ve reached the halfway point of your pregnancy.

When experienced and expectant mothers talk of pregnancy, they often remark about how quickly… and how slowly!… these nine, special months pass. This may seem especially true now, for as you approach your 20th week of pregnancy, a time when body changes are more evident than ever, the midpoint of your pregnancy is nearing. Celebrating this special milestone can put any discomfort into a more positive perspective!

If you have not felt the small 'fluttery' feeling of your baby`s movement prior to this time, you most likely will between the 18th and 20th week of pregnancy. This is called 'quickening'. The time at which a pregnant woman first feels this sign of new life varies according to her body size and whether or not she`s been pregnant before (second and third time moms often feel it sooner). You may also find that your baby is more active at certain times of the day, and that activity may be highest at night or when you`re resting.

This movement is important in another way, too, for it helps you begin to identify your baby as a separate person. With this realization come new concerns for your baby`s well-being.

Other physical and emotional changes include the following:
- An increase in fundal height (height of the uterus)
This is what our doctors and nurses are determining when they measure your abdomen at your prenatal visits. Your uterus will have grown considerably by this time. At about 20 weeks, your uterus will be approximately at the level of your umbilicus (belly button).

- The presence of colostrum.
A thick, yellowish fluid may be leaking from your nipples. This is an indication that your breasts are getting ready to produce milk.

- A change in self-image.
You are probably wearing maternity clothes by this time, and more people are asking you about your condition. Expect to have some new positive and negative feelings about your body and the pregnancy process.

- Some common discomfort of pregnancy.
These discomforts are directly related to physical changes taking place in your body. They include:

• Constipation

Even if you`ve never had this problem, it may be part of your pregnancy experience. There are several reasons; changes in bowel action due to hormone levels, the enlargement of the uterus, lack of fibre, lack of activity, and even the iron supplement you may be taking. The best solution is prevention. Be sure to:

• Drink six glasses of fluids each day (water is the best choice).
• Eat fresh fruits and vegetables.
• Increase the fibre level in your diet.
• Exercise regularly.
• Establish a regular pattern of daily bowel movements.
• Avoid straining or pushing to have a bowel movement.
• Only take laxatives or stool softeners as prescribed by our doctors and nurses.
  
  
• Haemorrhoids

If you are constipated, the odds of you developing haemorrhoids (enlarged veins in the anal area) increase. These can result in the anal area feeling itchy and inflamed. If you have had a hard bowel movement, you may find a small amount of blood on the toilet tissue in the stool. To help prevent haemorrhoids, avoid becoming constipated, avoid sitting or standing for long periods of time, and don`t strain or push when having a bowel movement.

• Gas

Several of the same factors responsible for constipation and haemorrhoids can result in you feeling gassy or bloated. To lessen the problem, establish a regular pattern of daily bowel movements and avoid or cut down on the following:

• Gas producing foods such as corn, onions, and cabbage.
• Drinking through a straw (extra air is taken in with fluid).
• Chewing ice.
• Drinking carbonated beverages.
  
  
• Round ligament pain

Round ligaments are bands of tissues found on either side of your uterus. Their purpose, quite simply, is to hold the uterus in place. As the uterus enlarges and these ligaments stretch, you may feel a brief tugging sensation in one or both sides of your lower abdominal area. These are most likely to occur when you stand up quickly or turn sharply. If this is your first pregnancy, you may feel this discomfort beginning at 20 weeks of gestation and any time thereafter. If you have been pregnant before, you may feel round ligament pain as early as 10 weeks and it may be even more noticeable.

• Leg cramps

As your uterus enlarges, it places greater pressure on the blood vessels in your pelvis. This can result in muscle cramps in your legs, especially when you are resting. Other causes of cramps include a diet lacking some important nutrients and the pressure of your baby`s head on certain nerves. You may find it helpful to do the following:

• Elevate your legs regularly throughout the day.
• Extend your leg, straighten the knee, and flex your foot upward toward the ceiling for cramp relief.
• Wear support hose, especially if you stand or walk frequently during the day.
• Be certain your diet includes milk, cheese, and other foods high in calcium and phosphorus.
• Keep legs uncrossed while sitting.
  
  
• Backache

If you have had a history of back problems prior to your pregnancy, discuss this with our doctors and nurses. During pregnancy, the increase in weight, breast size and uterine size can contribute to poor posture, back strain, and aches. Following are suggestions to help alleviate these aches:

• Wear a good supportive bra throughout pregnancy.
• Wear comfortable, flat shoes with a good arch support.
• Consider a specially designed mattress or wedge for sleeping comfort.
• Maintain good body mechanics and good posture.

If, however, you experience a low backache (occurring either intermittently or constantly) that seems to wrap around your abdomen to the front, and does not go away within one hour after you change position or rest, promptly notify our doctors and nurses. This could be a warning sign of preterm labour.

By 20 weeks, your baby`s head, arms, legs, and body are fully formed. Scalp hair, eyebrows, and toenails appear. Soft, fine body hairs called lanugo and a protective, 'cheese like' substance called vernix caseosa protects the baby`s delicate skin. The baby now weighs about 1 pound and is about 7 ½ inches in length.