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

21 Weeks Pregnant

Pregnant Belly Changes

By 21 weeks pregnant, many expectant moms have already felt their baby's movements. In some cases, these movements may be strong enough for dad to share in the excitement. Let him place his hand on your belly, and let this be an opportunity for the two of you to bond over your impending arrival.

As you continue your pregnancy, you will notice that you become increasingly protective and attached to your baby. This is very true for moms who feel their babies kick and move on a regular basis. Feeling these movements is often one of the most magical parts of being pregnant.

If you have not yet felt your baby's movements, don't worry! Not all women feel their baby's acrobats until later in the pregnancy. Women who are overweight and those with a placenta lying in front of their uterus will feel their baby's movements later.

You shouldn't be too focused on how often your baby moves at this week of pregnancy. It's only around 24 weeks pregnant that your doctor may recommend that you keep track of your baby's movement pattern.

At 21 weeks pregnant, your belly continues to grow and grow. Enjoy sporting that lovely bump for all to see. You may start to experience a few unpleasant pregnancy symptoms now, including the beginnings of stretch marks, and backaches.

Stretch marks may begin to appear on your abdomen now. As your skin keeps stretching and enlarging, pink or purplish indented streaks may appear on your belly, buttocks, breasts and thighs. Hormonal changes, the physical stretching of the skin and genetics all play a role in the development of stretch marks.

Although stretch marks will fade after delivery in a period of months to one or two years, they do not completely disappear. Currently, there is no way to prevent or treat stretch marks, but current research for both prevention and treatment are promising.

You may notice that you're suffering from backaches or back pain more now than earlier in your pregnancy. This is a common problem in the second and third trimesters of pregnancy.

Pregnancy back ache.

Your backache is more of a problem now due to your center of gravity shifting upward, thus when standing you tend to lean backwards to compensate placing a strain on your back muscles.

Though back pain in pregnancy is common, you shouldn't always ignore it. Sometimes, a low, dull backache can be a sign of preterm labor. It's recommended that you speak to your doctor or healthcare provider to get to the root cause of your backaches.

Your doctor may be able to give you suggestions on how to alleviate your discomfort. Common ways to relieve your backaches during pregnancy are listed:

  • Take a warm bath, or apply cold and hot compresses to the area.
  • Get a massage from an experienced therapist who works with pregnant women, or ask your husband or partner to give you a nice back rub or massage.

  • Watch your posture when you are standing. Also, be sure to raise your legs when you are seated.

  • Join a yoga class to gently stretch and strengthen your back muscles.

  • Sleep on your side, not your back. Keep your knees bent when you side-sleep.

Weight Gain

You're probably gaining one or two pounds with each week that passes. The average weight gain at 21 weeks pregnant for the normal sized woman is roughly 13 to 14 pounds. You may have gained more or less than this, but just remember that every woman gains weight differently.

Many pregnant women will experience "growth spurts" at some point in their pregnancy. During a growth spurt, you can gain several pounds quite rapidly. Then, your weight gain will slow down again. This is normal in pregnancy, and it shouldn't worry you unless the rapid weight gain becomes a pattern.

Pregnancy Health Section

Intimacy with your Partner

In your second trimester, it’s not unusual for your libido to return. You may find the second trimester a wonderful time to be intimate with your partner, as you are not too large and uncomfortable yet.

Intimacy during pregnancy is absolutely safe, though you will want to abstain if your doctor has warned you against it.

Exercise during the Second Trimester

Remember to continue to exercise regularly in the second trimester and throughout the rest of your pregnancy. Regular exercise during pregnancy will make you healthier, improve your posture, feel less tired and have fewer backaches – and exercise can even make your delivery a whole lot easier on you and your baby.

It is known that moderate exercise in pregnancy can make your labor shorter and reduce your risk of complications. Exercise will also reduce your risk of serious pregnancy related complications such as, developing gestational diabetes and pre-eclampsia.

According to The American College of Obstetrics and Gynecology, you can exercise moderately for up to thirty minutes per day, and between five to seven days of the week. Limiting your exercise time to just 30 minutes will make sure that your core body temperature does not rise to an unsafe level.

The type of exercise that doctors recommend most in pregnancy is walking and swimming. They are concerned about other types of exercises that may easily lead to a fall or hurt your belly, such as snow skiing, basketball, and other physical contact sports.

When exercising in pregnancy, you should:

  • Avoid lying flat on your back, such as sit ups

  • Make sure to start off a new exercise routine slowly

  • Do not exercise in hot or humid weather

  • Make sure to stay well hydrated and drink plenty of water

  • Support your breasts with a support bra

  • If you get out of breath and can’t talk easily make sure to stop and rest

Exercise activities should include resistance training (weight-lifting), in durance building (walking, jogging or swimming) and flexibility exercises (yoga). Your exercise session should include:

  • Warm-up and stretching period (5 to 10 minutes)

  • Exercise duration (30 minutes)

  • Cool down period (5 to 10 minutes)

It is recommended that you do not follow your heart rate while exercising any more, but use a perceived exertion to gauge your exercise intensity. The simplest test for perceived exertion is the “talk test”. If you cannot carry on a normal conversation while exercising then you should rest. You should also rest if your exercise is associated with sweating or substantial increase in breathing.

You should stop exercising if you have any of the following:

  • Spotting or bleeding

  • Difficulty breathing

  • Feeling light-headed

  • Any chest pain

  • Braxton hick type contractions

  • Fluid leaking

  • Leg swelling or pain in the calf

  • Decrease fetal movement

Summary and recommendations of exercising in pregnancy include:

  • If your pregnancy is uncomplicated exercise has minimal risks to your pregnancy.

  • Competitive athletes should modify their usual exercise routines in pregnancy to avoid complications.

  • Exercising in pregnancy can maintain and improve your physical fitness.

  • Exercise will improve blood sugar levels in gestational diabetes.

  • Your risk of developing gestational diabetes is less if you exercise.

  • Your risk of developing pre-eclampsia is also less if you exercise.

  • Exercising in pregnancy does not cause any harm to your baby if you follow the recommended guidelines.

  • If you are at risk for preterm delivery you should reduce your exercise routine in the second and third trimesters.

Fibroids during Pregnancy

Read about your pregnancy symtpoms at 21 weeks pregnant.

If you've been diagnosed with fibroids during pregnancy, you may be worried about your chance of delivering a healthy baby. Fibroids are benign smooth muscle tumors of the uterus and are most common in women between age 30 and 40.

The majority of pregnant women do not have to worry about fibroids causing problems in their pregnancy. Pain is the most common problem, and there is a very rare risk of miscarriage, delivering early, breech position, and bleeding with multiple fibroids greater than 3 cm.

The previous belief that fibroids increase in size during pregnancy is not true. In the very rare case that a fibroid does increase in size, most of the growth occurs in the first trimester, with little if any further increase in size during the second and third trimesters.

In most cases, fibroids don't require treatment during pregnancy. Most pregnant women with fibroids do not have any complications during pregnancy related to the fibroids. When complications occur, pain is the most common complication.

Baby Section

Growth and Development of Baby

At 21 weeks pregnant, your baby continues to pack on the pounds. He or she is now 12.7 ounces and is longer than 10.5 inches - roughly the size of a small banana! Not bad for someone that is only five months old!

Your baby has started to regularly swallow amniotic fluid, giving his or her maturing digestive system some practice.

As your baby swallows the amniotic fluid, it passes through the digestive system, into his or her kidneys, and comes back out as urine. Yep, that's right. Your baby is now regularly urinating in the womb!

You may start to feel a series of rhythmic movements coming from your baby. These are fetal hiccups! Hiccupping is a normal part of your baby's development, though some babies hiccup more and others less. You may have already felt these hiccups at the end of your first trimester, or early in the second trimester!

Your baby is growing fingernails! The nail beds have already formed, and his or her little nails are starting to grow. At this point, the nails are not hardened yet. This prevents your little one from accidently scratching his or her skin in utero.

Your baby's skin continues to become less translucent and your little one continues to pack on the fat. His or her fat reserves will control temperature and provide your little one with energy after birth.

At this point in your pregnancy, your baby's skin is now covered in a waxy, white protective coating called vernix. This will protect your little one's skin from the constant exposure to the amniotic fluid around him or her. The amount of vernix decreases by the end of your pregnancy, however your baby may be born covered in vernix if he or she is born premature.

Your baby's nerve pathways are starting to mature. Though your little one has little or no control over his movements right now, this will start to change in the following weeks.

If you're expecting twins, you'll be excited to know that your babies are becoming more aware of each other. If, you had an ultrasound scan, you may even see your twins interacting with each other. It's common for twins to kick and try to grab each other in the womb. (next week)


Doctor's Corner

Pregnancy Week by Week - Women's Healthcare Topics