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

23 Weeks Pregnant

Pregnant Belly Changes

At 23 weeks pregnant, your uterus continues to grow and expand. It is now 1.5 inches above your belly button. As your baby grows larger, you are going to feel less and less graceful. You may even find that you bump into things more easily. Your center of gravity isn't what it used to be, so you should expect to feel clumsy at this stage in pregnancy.

Your baby has lots of room to move in your uterus, so his or her movements are probably quite strong. You probably will feel lots of flipping and flopping, and may even notice your stomach moving about! This is a wonderful experience, so cherish these moments.

Make sure that you get all the rest that you can. As your belly gets larger, sleeping may become more difficult. There are many reasons you may have trouble sleeping now. Some of the more common problems include frequent urination, an unquiet mind, stress, leg cramps or the inability to get into a comfortable position.

You may be having mixed emotions about your upcoming arrival. If you are a first-time mom, you may worry that you won't be able to be a good parent, or you may be scared about the pain of giving birth. Experienced moms may worry about sibling rivalry and how the other children will react to the new baby. With everything that you are worried about with this new baby, it's no wonder that you are feeling more forgetful and disorganized these days!

Expect a whirlwind of emotions as your pregnancy continues. All those pregnancy hormones can wreak havoc on your emotions. You may feel happy and cheerful one second, and you may be sobbing the next. Be sure to warn your husband or partner: "Never mess with a pregnant lady. You won't win!"

Weight Gain

You are packing on the pounds, now! If you're an average-size, your weight gain at 23 weeks pregnant might be as high as 15 pounds or more. You may have gained more than this by now. But just remember that each woman gains weight differently. Just keep the recommended weight gain for your body size in mind, and aim for that total.

For women who started out pregnancy underweight (according to BMI calculations), you will want to gain between 28 to 40 pounds. Women who are average size should aim for a total pregnancy weight gain of 25 to 35 pounds. If you are overweight or obese, you'll need to gain less than this – preferably only 15 to 25 pounds.

Pregnancy Health Section

Braxton-Hicks Contractions (False Labor Pains)

Now that you are in your second trimester of pregnancy, it won't be long before you start to feel Braxton-Hicks contractions, or false labor pains. You may have already experienced these false contractions. However, these "false" labor pains are more common in the third trimester.

Braxton-Hicks contractions are usually painless, though some women do feel a bit of pressure. It may feel like an irregular tightening of your uterine muscles. The "contractions" come and go, and do not occur at regular intervals. They also will not get closer together as time passes.

Braxton Hicks Contractions VS. True Labor
As your pregnancy progresses, Braxton-Hicks contractions will occur more frequently. Although they can be nerve wrecking to have, because you may not be able to tell them apart from true labor pains, just remember that they are your body's way of preparing for your baby's delivery.

You should learn the difference between true labor contractions and Braxton-Hicks contractions. This will alleviate any of your fears and anxiety. Braxton-Hicks contractions are irregular and do not get closer as time passes. On the other hand, true labor contractions come at very regular intervals and last between 30 and 70 seconds. As time passes, they get closer together.

True labor pains steadily increase in strength with time. Braxton-Hicks contractions are normally weak and don't get stronger. Sometimes, these false labor pains may start out as strong but get weaker with time.

Braxton-Hicks contractions will sometimes stop when you rest, or even change positions. True contractions will not stop, regardless of changing positions or rest.

You often feel Braxton-Hicks contractions in the front of your belly or in your pelvic area. True labor contractions start in your lower back and move to the front of the belly.

When to Call Your Doctor
If you think you are experiencing true labor this early in pregnancy, it's important that you contact your doctor or healthcare provider immediately. Even if you are unsure of whether you are experiencing Braxton-Hicks contractions or true labor, call your doctor anyway. You want to be safe, rather than sorry.

Pre-term Delivery or Premature Birth

Learn about pre-term birth.

If your baby were born prematurely at 23 weeks pregnant, there is a small chance your baby would survive outside the womb, however it is best that your baby stay put! Many women start to wonder what might happen if their baby is born prematurely. A baby born between 24 and 26 weeks pregnant would have a 50 percent chance of survival.

Prematurity survival rates by gestational age (GA) are as follows:

  • Late preterm infants – GA between 34 weeks and 36 weeks and 6 days - 99% survival rate

  • Very premature infants (VPT) – GA between 27 weeks and 32 weeks - 83% survival rate

  • Extremely premature infants (EPT) – GA between 24 weeks and 26 weeks – 50% survival rate

There are babies that are born at one pound that beat the odds and go on to live a fairly normal life, while others unfortunately die due to unexpected complications. The smallest babies may survive but grow up with some mental or motor disabilities as a result of their extreme prematurity.

Every day your baby stays in the womb increases their survival rate by approximately 3 percent during pregnancy weeks 23 and 26. Generally, after 26 weeks pregnant, the survival rate jumps to 80-90 percent.

What causes premature birth?
The following are known causes for you to go into labor early:

  • Uterine Bleeding

  • If you are carrying twins, or multiple babies

  • Infection of the amniotic sac or uterus

  • Stress

There are many problems that a premature baby can have after birth
Early in pregnancy your baby is still developing in the womb. Premature babies have problems because their growth and development is interrupted. Some of the more common problems associated with giving birth early are:

  • Trouble keeping warm – Very small babies lose body heat quickly and can have trouble staying warm.

  • Breathing problems – Premature babies have not developed their lungs fully, making it difficult for your baby to breathe on their own.

  • Heart problems – If your baby is born too early, a blood vessel that should have closed at birth may remain open causing poor circulation.

  • Infection – Babies who are born early are not able to fight off infections as well as a full-term baby.

  • Digestive system problems – Some premature babies have diarrhea, vomiting, and sometimes blood in their bowel movements because of their immature intestines. This complication is seen usually a few weeks after birth.

  • Bleeding in the brain – Babies that are born very early can have a problem with bleeding inside their brain.

  • Jaundice –Jaundice is when the skin or white part of the eye turns yellow. This is a mild premature birth complication that can be treated easily.

Predicting Preterm Birth
Two tests have been identified that may be helpful to predict whether and when premature delivery will occur.

Fetal fibronectin — A substance called fetal fibronectin is found in the amniotic membranes that surrounds the baby (the baby’s sac of water). Doctors have found that if this substance is not present in vaginal discharge in high concentrations, premature delivery is unlikely.

Cervical length — Ultrasound measurement of the cervix length can help to predict the risk of preterm delivery; the shorter the cervical length the greater the chance of premature birth.

You should call your doctor:

  • If you feel a tightening of your uterus, similar to the pains you feel with normal labor

  • If you have an increase in a watery, thick or bloody vaginal discharge.

  • When you feel a pressure sensation in the lower abdomen or pelvis.

  • If you are having an abnormally constant lower back pain.

  • If you notice a change in your bowel habits, such as cramping with diarrhea.

  • If “Your bag of water breaks,” which can be a trickle or gush of fluid from the vagina

Preterm Birth and the Fetal Fibronectin (fFN) Test

Video: Learn About Fetal Fibronectin Test

If you are one of the unlucky women experiencing preterm labor symptoms, or you are at risk for delivering early, your doctor or healthcare provider may recommend that you take a fetal fibronectin (fFN) test.

Fetal fibronectin is a "glue-like" protein that helps bind the amniotic sac to your uterine lining. When it's time to give birth, this "glue" starts to disintegrate and leaks out of your uterus. In a normal, healthy pregnancy, fetal fibronectin starts to break down naturally around 35 weeks of pregnancy.

During a fFN test, your vaginal and cervical fluids are checked for any presence of this "glue-like" protein. Normally you should have no evidence of fetal fibronectin in your vaginal fluids. Only when the test detects the presence of this protein does this indicate that your body is ready for delivery.

What Does a Negative Result Mean?
If you receive a negative result, rest assured that you have a 99 percent chance that you will not go into labor in the next two weeks. On the other hand, if you do get a positive result, your doctor or healthcare provider will create a plan of action to help your pregnancy last longer, if possible. This may include certain medications and being placed on bed rest.

Baby Section

Growth and Development of Baby

At 23 weeks pregnant, your baby is working diligently on maturing. He or she weighs a little over one pound now, and is just less than 11 inches long.

Although you are only halfway through your pregnancy, if your baby was born this week, he or she would have a small chance of survival with the proper neonatal intensive care. With every week that passes that your baby stays in the womb, the better his or her chance of surviving into childhood.

Your baby's nervous and muscular systems are more developed now than in past weeks. Earlier in your pregnancy, your baby sucked his thumb by accident, but now he can choose to do this.

Your baby's entire body is covered with lanugo (soft, downy covering of hair). Lanugo hair is constantly being shed and replaced. It insulates and keeps your baby warm, since he or she does not have a lot of body fat at this point.

In the last weeks of your pregnancy, lanugo hair should be permanently shed and thicker, permanent hair will grow. (However, some babies, such as premature infants, may still have lanugo when they are born). (next week)


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