The Lovers’ Guide takes you through the second stage of pregnancy, the middle months, usually the most enjoyable of all for the mother-to-be.
The middle three months of pregnancy can be the best time of all. Many women feel a new surge of energy and enthusiasm, and some find they are particularly sexy now, the fact that they need not bother with contraception adding to sexual enjoyment.
A woman should check with her doctor or antenatal clinic if she needs advice on what sort of activity is right for her while pregnant, but generally it is safe to continue normal keep-fit routines, if she has one. It is not advisable to start anything too energetic that she is not used to.
During these months, a mother-to-be begins to look noticeably pregnant. Her abdomen appears rounded at first as a result of the enlarging uterus and by the time she is five months pregnant it will probably be obvious to others.
The uterus also moves upwards and the waistline disappears after about 16 weeks. At the end of the fifth month, the fundus (top of the womb) reaches navel level.
The breasts may continue to grow larger, and most women start to gain about a kilogramme every two weeks. The pigmentation on the nipples increases, and the coloured skin around them becomes larger and darker. Almost all women have the linea migra – a dark line down the centre of the abdomen. It may remain after the baby is born, but it usually fades.
Amniocentesis and other tests
During these three months, and until she is 28 weeks pregnant, the mother-to-be will make four-weekly visits to the antenatal clinic. (After that she will need to have a check-up every two weeks until the baby is born.)
Each visit she will be asked how she feels, have a urine test, her blood pressure and weight will be checked and her abdomen examined. As well as a blood test, given at 16-17 weeks, she will be given regular blood tests if anaemia was suspected on her first visit. Amniocentesis test may be carried out if there is a possibility that the unborn child may be handicapped. A woman is usually only offered this test at 16-18 weeks, if she has a known risk of an inherited or genetic disease or if she is over 35, when the chance of having a Down’s Syndrome baby escalates.
Far more common than amniocentesis is ultrasound scanning, which uses sound waves to build up a ‘picture’ of the foetus in the uterus.
During the middle months of pregnancy, a scan can be used to date the pregnancy if there is some doubt about the time of conception. It can establish the presence of more than one baby, and be used as a base for assessing future foetal growth.
Many antenatal clinics test blood for raised alphafeto protein levels (AFP). In some cases a raised AFP will mean that the unborn baby has spina bifida.
In the sixth month, the doctor or midwife will listen for the fetal heartbeat, with a stethoscope. If necessary, special electronic equipment can be used to identify the heartbeat even earlier in pregnancy.
Some time between the 16th and the 22nd week, the baby’s first movements can be felt by the mother-to-be – a stage known as ‘quickening’. There has, of course, been a great deal of activity long before this, but the mother will not be aware of it until the uterus is large enough to come into contact with the abdominal wall, as the baby’s movements are felt through this.
The basic development of the foetus is more or less complete by the end of the third month. It is not until the fourth month, however, that the inside of the mouth is fully formed. During this important developmental stage, the two halves of the palate should fuse together. If they fail to fuse properly, or at all, this will result in a cleft lip, a cleft palate, or both. The lungs undergo major development in the fifth month, although they do not need to function until the baby is born, as all the oxygen the foetus needs enters directly into its blood circulation via the placenta and umbilical cord.
The placenta supplies the foetus with oxygen and nutrients from the mother’s blood via the umbilical vein, and returns fetal waste to the maternal blood through the two umbilical arteries.
Start of rapid growth
At the end of the fourth month the foetus is 20cm in length, and its growth rate begins to accelerate from about this time. A big weight gain or a considerable increase in the size of the uterus from about the 20th week can indicate the presence of twins.
The sixth month stage
By the end of the sixth month, the foetus is about 32cm in length, and weighs approximately 750g. It is still very thin because its fat deposits are not laid down until much later, towards the end of the pregnancy. When compared to a full-term baby, a sixth-month foetus appears small in size, but its facial features and body shape show quite clearly that it is a human being.
It has a light, downy fluff called lanugo all over its body. By the time most babies are born, this has disappeared. In addition, a whitish greasy substance, called vernix, covers the skin. Its function is protective – in a way we do not as yet fully understand – and it remains for many weeks. Most premature babies are covered with it when they are born, and some full-term babies still have traces of it on their bodies.
Babies born very early now have a much greater chance of survival than they used to. The minimum age at which a baby is likely to survive is 24 weeks. Even then, highly specialized medical and nursing care is needed for several months, to keep these tiny premature babies alive outside the womb.