Women's Healthcare Topics
James Brann, MD. Ob/Gyn

20 Weeks Pregnant

Pregnant Belly Changes

At 20 weeks pregnant, you are definitely sporting your "baby bump." For most women, there is no more hiding your pregnancy, even if you wanted to.

You have reached your halfway mark - only 20 more weeks until your baby is born! Just keep in mind that only 5 percent of babies will be born on their actual due date. Some women deliver sooner, and others deliver later. A full-term baby may be born anytime between 37 and 42 weeks.

You may now find that standing for a lengthy period of time causes you to feel dizzy or light-headed. This is because standing for prolonged periods of time can cause blood to pool in your legs - dropping your blood pressure.

Inorder to avoid becoming dizzy you should take frequent breaks to sit down and rest. You should also wear low-heeled shoes with good arch support. If your work requires you to stand, you may want to try support stockings and to arrange with your boss for you to take a short break every three hours or so.

In the second trimester, your doctor will always measure your baby's growth at each prenatal visit. Your doctor does this by measuring the fundal height (the distance from your pubic bone to the top of your uterus). As a rule of thumb, your fundal height corresponds to roughly how pregnant you are. So at pregnancy week 20, your fundal height is around 20 centimeters.

In the days of old, before ultrasounds were used, the fundal height was the primary diagnostic tool used to assess your baby's growth. Today, your fundal height is used in conjunction with ultrasounds to ensure that your baby is growing properly. If your fundal height measures are more than two centimeters larger than your week of pregnancy, your doctor will typically perform an ultrasound to find out why.

Possible reasons why your fundal height may be longer than average include:

  • Inaccurate due date

  • Too much amniotic fluid

  • Baby's position is high above your pelvis, possibly due to a breech position or placenta previa

  • Carrying a larger sized baby (called macrosomia), due to gestational diabetes

  • Pregnant with twins or multiples

  • Uterine fibroids

Some women who measure larger than others are carrying perfectly healthy babies who are just bigger than average. Other women may measure smaller. Usually, this does not indicate that there's a problem with your baby. However, a smaller than average fundal height can be a sign of intrauterine-growth restriction (your baby is not growing like he or she should. His or her weight is under the 10th percentile for his or her gestational age).

At 20 weeks pregnant, you've reached the halfway point in your pregnancy. You are probably feeling less dainty and more bulky now. You're definitely showing and looking quite pregnant.

Have you noticed any skin changes yet? You may have noticed your skin darkening in different areas of your body. Your areolas (skin around your nipples) might have already darkened. If you have freckles or moles, don't be surprised if they get darker in color as well. Hormonal changes can lead to a temporary increase in melanin (a pigment that gives color to your skin and hair).

The mask of pregnancy (chloasma) is another side effect of the increased melanin production. You might have noticed darker splotches on your face - around your nose, cheekbones, forehead, upper lip, and chin. The mask of pregnancy is a common pregnancy symptom in the second trimester. The effects of it will fade after you deliver your baby. To minimize your risk of getting chloasma, make sure that you stay away from direct sunlight, UV light can worsen pigment changes.

Braxton Hicks contractions are a normal pregnancy symptom. These false labor contractions are weak, and they come and go by this midpoint of pregnancy. As your pregnancy continues, you'll notice these uterine contractions more frequently.

For most women, Braxton Hicks contractions are painless and they're not a bother. However, you should contact your caregiver or doctor if your contractions become painful or get more regular (i.e. occurring every hour and getting closer together all the time.). Regular contractions might be a sign of preterm labor.

You may be more rested and have more energy in the second trimester, but you’re not immune to sleep problems. Two common sleep problems that plague expectant women in the second trimester include restless legs syndrome, and snoring.

RLS or restless legs syndrome is a frustrating and uncomfortable sleep disturbance. You may find yourself unable to sleep due to a crawling, tingling, or burning sensation in your legs.

The restless legs syndrome (RLS) is quite common in pregnancy. Unfortunately most of the drugs used to treat RLS are not recommended during pregnancy. Some pregnant women find that using hot or cold packs, taking a warm bath, and stretching their legs help.

Snoring is another common sleep problem that is noticed in the second trimester. If snoring bothers you or your partner here are a few tips to help:

  • You may want to keep your head elevated and sleep on your side, rather than on your back. Sleeping on your back can obstruct your air ways leading to snoring. Sleeping on your side improves air flow making it less likely to snore.

  • A wedge-shape pillow with added neck and head support can help open your airways, thereby reducing snoring.

  • Use a lubricating nasal spray which lubricates your airways and reduce the vibrations of throat tissue.

  • You can also try a nasal strip which lifts and dilates nostrils to clear your airway for easier breathing.

Weight Gain

Now that you're halfway through your pregnancy, you're most likely sporting a nice "bump.” For the average sized woman, her weight gain at 20 weeks pregnant might be 12 or 13 pounds, possibly more. Keep in mind that every woman gains her pregnancy weight differently, so you may be far ahead of this weight, or slightly behind. If you can, try to keep the total weight gain for your size in mind (25 to 35 pounds for the normal sized woman).

To ensure that your baby grows strong and healthy, remember to continue eating a balanced diet with a variety of fruits and vegetables, proteins, carbohydrates, and plenty of vitamins and minerals.

Pregnancy Health Section

Are You Having a Boy or a Girl?

Around pregnancy week 20, you'll be having second trimester ultrasound to make sure that your baby is healthy and your pregnancy is progressing normally. At this scan, you may have the opportunity to find out your baby's gender! Is it going to be a boy or a girl?

The decision to find out is up to you. Some parents like the element of surprise of discovering at the baby's birth, and others want to know ahead of time so that they can start decorating their baby's nursery and purchase baby bedding sets!

At 20 weeks pregnant, the ultrasound technician (called the sonographer) can often detect your baby's gender with great accuracy, but there is also room for error. The sonographer's expertise, the quality of the equipment being used, and the position of your baby can all play a role in whether you get an accurate result.

Second Trimester Ultrasound

This second trimester ultrasound is more in-depth than the first trimester ultrasound, because your baby's major organs, limbs, and other body parts are now well-developed and can be clearly examined with an ultrasound.

  • The fluid-filled areas of the brain and the shape of the cerebellum (the back of the baby's brain) to make sure everything's normal. Abnormalities of your baby's head may indicate chromosomal defects, such as Down syndrome.

  • Your baby's spine will be examined for spina bifida and other spinal defects.

  • The arms and legs will be checked to make sure there are no malformations, such as clubfoot or extra toes and fingers. If your baby's arm and leg bones are shorter than average, this may be another marker for Down syndrome.

  • The stomach and diaphragm of the baby will be checked.

  • Your baby's kidneys and bladder will be examined to make sure that he or she has both of the kidneys and there's no blockage of defects in either organs.

  • The umbilical cord is also looked at to make sure that it contains an average number of blood vessels.

  • Your baby's abdominal wall will be examined to make sure there are no defects (hernias).

The second trimester ultrasound will also measure your baby to ensure that he or she is growing normally. At this stage of your pregnancy, crown to rump measurement is no longer used, because your entire baby doesn't fit on the screen anymore. Instead, the doctor or sonographer will determine your baby's size using a series of different measurements. These include the circumference of your baby's head, the circumference of your baby's tummy, and the length of the baby's upper leg bone (femur). Using these measurements, your doctor will be able to tell whether your baby falls within the normal range for growth.

The position of your placenta and the amount of amniotic fluid is also checked in a second trimester ultrasound. If your placenta is seen as low-lying, your doctor will do follow-up scans later in your pregnancy to make sure that you do not have placenta previa (a placenta that covers partially or completely the opening of your uterus). A majority of the time, a low-lying placenta moves upward and away from the opening of your uterus as your pregnancy continues.

For most women their baby is fine and they will get the reassurance that your baby is developing normally. If a problem is detected, you will be referred to specialists who may be able to diagnose or confirm the findings.

Abdominal Itching During Pregnancy

Abdominal Itching During Pregnancy Week 20.

Abdominal itching is often common during this point in pregnancy. Typically, itching occurs as a result of your skin stretching. Consistent application of moisturizers can help reduce irritation.

A very small number of women develop itchy red bumps during pregnancy, and hive-like rashes on their belly, usually in the last couple of months of pregnancy. This type of irritation is often referred to as Pruritic urticarial papules and plaques of pregnancy or PUPP. Usually these bumps are harmless, and serve more as a nuisance than anything. Fortunately, your healthcare provider can prescribe a topical ointment that will help reduce the amount of itching you are experiencing.

Very rarely a woman will develop severe itchiness that is a sign of something more severe, such as a condition called Intrahepatic Cholestasis. This condition is the result of a liver problem that occurs in pregnancy. When affected by intrahepatic cholestasis, bile in the body doesn't flow normally throughout the small ducts of the liver, resulting in accumulation of bile salts in the skin. This can result in excessive itching and red irritated skin.

Your physician will have to conduct some blood tests to confirm whether or not your liver has been affected by this condition. Fortunately intrahepatic cholestasis usually affects less than 2 percent of pregnant women and is easily treated.

Childbirth Classes

Childbirth Classes.

Many women decide to sign up for childbirth education classes during their pregnancy, particularly first time moms. These classes can be particularly beneficial for the labor and delivery process. Childbirth classes are a means to focus on your impending role as a parent, and a means to express your concerns and worries prior to delivery.

Most childbirth classes will teach you the ins and outs of labor and delivery, help you understand what you can expect during the first few weeks of parenthood, and offer vital tips and tricks for coping with fatigue, stress, and other concerns in the postpartum period.

Most classes will instruct you regarding the signs of labor or pre labor, and help you learn relaxation and breathing techniques for labor and delivery. Others will also cover important aspects of labor and delivery such as pain medication options and hospital procedures.

Your instructor may also cover natural birthing options, recovery from a vaginal delivery, and information on c-sections. While most women predict that their labor will go off without a hitch, you simply never know when a c-section might be necessary. Because of this, it is important that you are prepared in the event that you may need one.

For the most part, you will want to dress comfortably for class and bring a pillow and partner. Your partner will help coach you through the relaxation and breathing exercises you need to adopt for labor and delivery.

The two most popular childbirth classes are the Lamaze classes and Bradley Method Classes. Lamaze classes typically emphasize managing your pain through relaxation, meditation, and breathing techniques. Lamaze is a natural approach to birth, but can be used in conjunction with pain relief. The Bradley Method is often considered a comprehensive approach to pregnancy and delivery. Typically, this method emphasizes diet and exercise and teaches deep breathing techniques for labor and delivery.

Some other classes you may find useful include newborn baby care, infant CPR and breastfeeding classes. A breastfeeding class can be invaluable if you plan on breastfeeding your baby exclusively. Your instructor will cover a variety of topics including pumping and storing your breast milk, different latch positions, and methods for coping with problems while breastfeeding. A breastfeeding class may also provide you with contact information for local lactation consultants that can help you with the breastfeeding process after delivery.

Baby Section

Growth and Development of Baby

At 20 weeks pregnant, your baby is still growing strong. Your baby weighs around 10 ounces and measures a about six and half inches from head to bottom.

His or her eyebrows have thickened and are now visible. In only a few weeks, around week 26 of gestation, your baby will open his or her eyes for the first time since the eyelids were fused closed in the first trimester.

Your baby is still very skinny, but he or she has a little more body fat, and lanugo hair has started to cover his or her body. Lanugo hair is fine, downy hair that offers warmth and insulation for your baby. It often will be shed by the time your little one is born, or will be shed within the first few weeks of life.

Your baby's spine is pretty straight now. An ultrasound scan can even show each vertebra in the spine.

This week, your baby is growing more complex skin, with multiple layers (such as the epidermis) forming. Your baby is becoming less transparent as fat starts to develop underneath the skin.

Your baby's tooth buds, for both baby teeth and the underlying permanent adult teeth, are now in place underneath in the gums. After your baby is born, it will take six or eight months before these tooth buds start to appear as baby teeth.

All of your baby's abdominal organs (such as his or her stomach, liver, and intestines) are now completely enclosed in the abdominal cavity.

Your unborn baby is wiggling and stretching his or her hands and feet, however most of the baby's movements are reflex responses at this stage of your pregnancy.

Your baby remains very flexible now, and it's not uncommon for these babies to bring one or two feet up to his or her mouth. (next week)


Doctor's Corner

Pregnancy Week by Week - Women's Healthcare Topics