Pregnancy guide week by week

Dr Chrissie Yu Dr Chrissie Yu MBBS (Lond.) MD (Lond.) FRCOG, Consultant Obstetrician & Specialist in Fetal-Maternal Medicine Published March 9th 2023

You’re pregnant. It’s really happening. Get ready for the biggest challenge of your life. You’ll have heard the stories from other mums, but every woman’s experience is different. So what can you expect? And what can you do to help everything go smoothly?

Pregnancies divide into three trimesters – months 1-3, 4-6 and 7-9. Each is quite different from the others. Here’s a rough guide to what you can expect on the journey that leads to your new life as a mum.

Pregnancy varies enormously from woman to woman. For some, the first trimester is a happy time, with few if any downsides. For others, it can be a very different story.

Especially if it’s your first pregnancy, it’s hard not to feel a little overwhelmed at times. Try not to worry too much – you can do this! Even if you have to cope with one or more symptoms like:

  • Tender, swollen breasts. Due to hormonal changes – discomfort will ease over the coming weeks as your body adjusts.
  • Nausea. Morning sickness, which despite the name can come anytime, night or day, typically starts a month into your pregnancy. Try to avoid having an empty stomach – eat small amounts, slowly and often, avoiding fat – and drink plenty of fluids.
  • Need to wee. You’ll likely find you need to wee a lot more than usual. That’s fine.
  • Tiredness. You’ll need lots of sleep. Don’t feel bad about feeling groggy – indulge yourself. Snooze, doze, drop off, sleep when you want to, as long as you want to.
  • Dizziness. If you have problems, drink plenty of fluids, don’t stand for long periods, and when you stand up or change position, take it gently. When you actually feel dizzy, lie on your side.
  • Food weirdness. Everyone’s heard the stories about ice cream with ketchup, and they’re all true! Just how far your tastes diverge from ‘normal’ varies from woman to woman, but if you fancy it and it’s not actively bad for you, snack away. Don’t eat earth or anything that isn’t food – and if you feel the urge, talk to your doctor.
  • Heartburn. Again, down to hormones. If you have problems, eat less, more often, and avoid potential problem foods like citrus fruits or chocolate, or anything fried or spicy.
  • Constipation. Yup – hormones. Fibre in your diet can help, as well as exercise. And drink plenty of water and pulpy fruit juices.

The other major change you’ll probably have to cope with is that with all those hormones swooshing around your body, you’ll be going through emotional ups and downs like you’ve never known before. One moment exhilarated; the next, in despair. Keep in mind that none of this is your fault, and all of it will pass. Try to enjoy the good bits, watch another box set, get someone to bring you a cuppa. And get lots and lots of rest.

You’ll need it. Because you’ll be doing a lot of thinking, and planning, and preparing. It’s all getting serious now, and you’ll be wondering whether you’ll be able to cope, how you’ll be able to afford a baby, whether you’ll be able to juggle work and being a mum – and a hundred other things besides.

This is all absolutely normal. Look after yourself, cut yourself some slack, and look to loved ones for support – practical and emotional. If you feel like having sex, go for it – baby won’t mind. If you don’t, don’t. Mood swings are to be expected, but if they become an issue, and you’re finding them hard to cope with, do speak to your healthcare provider.

Baby dateline…

By the end of the first trimester, you may begin showing a baby bump, and your baby will have knees, ankles and elbows, fingers and toes, even tiny fingernails!

When you do see your doctor, they’ll be looking to get a clear picture of your general health and pinpoint any potential risk factors, so expect searching questions, and answer them openly and honestly. If you’d rather discuss things without your partner there, book a solo appointment. Tell – and ask – anything. You cannot embarrass a health professional!

It’s perfectly normal to find the first trimester quite a slog, and not a lot of fun. Not a lot you can do about it but endure, and get plenty of rest. But call your doctor straightaway – during this trimester or at any other time in your pregnancy – if you suffer from symptoms like:

  • Severe abdominal pain or cramps
  • Severe nausea and/or vomiting
  • Heavy vaginal bleeding
  • Severe dizziness and or visual abnormalities
  • Fever, chills and/or extreme backache
  • Sudden intense thirst

And if no-one takes your call, get yourself to A&E as soon as you can.

Compared to the first, your second trimester should be a breeze. You’ll be pretty much past the nausea by this point, and your baby’s still too small to make you really uncomfortable. But there’ll likely be plenty, mostly down to hormones, to remind you you’re pregnant, including:

  • Big belly, big breasts. As your baby grows, so will you. Larger breasts make a sports bra or other wide-strapped supportive bra essential.
  • Braxton Hicks contractions. Mild, irregular contractions, a slight tightness in your abdomen – mostly afternoon or evening, and/or after sex or other vigorous physical activity. They’re entirely normal, and nothing to worry about. But if they become regular, and/or strengthen, call your doctor now – it could mean preterm labour.
  • Swollen feet and ankles. Suffered by around three quarters of pregnant women, typically from about week 22 right through to delivery. Try to keep active and avoid long periods sitting or standing still. Sleeping on your left side may help. You could also try sleeping with your feet raised on a pillow, if you can get comfy.
  • Skin changes. You may find you develop dark patches or lines from the sun, and/or stretch marks along your abdomen, breasts, buttocks or thighs. Most will fade or even disappear over time.
  • Nose problems. Stuffiness and bleeds can be eased with saline drops or a rinse. Drink plenty of fluids, get a humidifier, and use a little finger to dab Vaseline where you’re bleeding, to help prevent drying/cracking.
  • Dental issues. Talk to your dentist about calcium. Your baby is pinching some of yours – “A tooth a baby,” according to the old saying. If you’re getting bleeding or discomfort, try salt water rinses and/or a softer toothbrush. If you’re vomiting a lot, it can weaken your teeth, so be gentle generally – but do keep up your dental care. If you have an NHS dentist, all treatment is free while you’re pregnant.
  • Dizziness. If you have problems, drink plenty of fluids, don’t stand for long periods, and when you stand up or change position, take it gently. When you actually feel dizzy, lie on your side.
  • Leg cramps. Often worst at night. Try stretching your calf muscles before bed. Generally, stay physically active, drink lots of water, choose comfortable shoes. Hot showers or baths can help, or a massage with an ice-loaded tea towel. And make sure your partner knows how to help if you wake up yelling in the middle of the night.
  • Vaginal discharge. A sticky, clear or white discharge is normal. Contact your health care provider straightaway about any significant changes in colour, amount or discomfort.
  • Urinary tract infections. Common during pregnancy. Contact your health care provider if you become desperate to wee, or get sharp pain when you do; if your urine’s cloudy or has a strong smell; or if you have a fever or backache.

Overall you should be feeling a lot better than you were during the first trimester: less tired, less prone to mood swings, more feeling like you’re on top of things, and up for whatever lies ahead. You may feel sexy and keen – some women do – but you may not. Let your partner know how you’re feeling – be honest and open. Baby’s easy either way.

Around about week 20 you should start to feel your baby moving inside you – even kicking or punching! – and people will probably start asking if you’re pregnant. You’ll soon learn to recognise what’s normal for your baby – if there’s a sudden change, like an unusual lack of the movement you’d expect, talk to your doctor straightaway.

Baby dateline…

During the second trimester, your baby can detect light, hear your voice, have a good workout – pummelling you with feet and hands – and use fingers to grip.

You might want to check out mum & baby classes, and read up on breastfeeding. If you plan to work after your baby’s born, you might want to check out your employer’s maternity leave policy – know exactly where you stand before you tell anyone at work you’re pregnant. And this may be a good time to start thinking about childcare.

Read up, check out YouTube, talk to other mums. Learn as much as you can, feel in control. Stay healthy, be happy. Your appetite will start to return now you’re over the morning sickness – try to maintain a healthy diet with lots of fruit & veg, and don’t over-eat. ‘Eating for two’ is a myth: you only need another 300-500 calories a day at this point, and should be gaining well under half a kilo a week. But don’t beat yourself up if you gain ore – putting on a bit of weight is normal, and unlikely to be medically significant.

When you see your healthcare provider they’ll go through a number of tests and measurements, to make you’re doing well and your baby’s fine, and growing as it should.

You’ll probably be able to hear your baby’s heartbeat for the first time, and it may be possible to tell the sex, if you choose. As ever, any problems or symptoms – no embarrassment, no holding back. They’re there to help you.

The third trimester can feel tiring, uncomfortable, and endless. But think positive – you’re on the home stretch! Soon you’ll be holding your baby in your arms. In the meantime, your baby’s movements will be becoming ever more obvious, bringing wonder, but also often increasing discomfort, along with symptoms including one or more of:

  • Braxton Hicks contractions. Mild, irregular contractions, a slight tightness in your abdomen – mostly afternoon or evening, and/or after sex or other vigorous physical activity. If they become regular, and/or strengthen, call your doctor straightaway.
  • Backaches. You can’t prevent them, but regular exercise can help, along with low-heeled (not flat) shoes with good arch support. Try to choose chairs with good back support. Speak to your doctor if the pain is severe or persistent, or getting worse.
  • Shortness of breath. Your womb may expand upward, squeezing your lungs and making it harder to breath. Take it easy, don’t panic, try to go with the flow.
  • Heartburn. If you have problems, eat less, more often, and avoid potential problem foods, like citrus fruits or chocolate, or anything fried or spicy.
  • Spider veins, varicose veins, haemorrhoids. You might get tiny purple spider veins on your face, neck, and arms, swollen varicose veins on your legs, and/or haemorrhoids. Exercise can help, as well as raising your legs when you’re relaxing. Eat plenty of fibre and drink lots of fluids. A warm bath or witch hazel pads can ease haemorrhoids.
  • Need to wee. As your baby moves deeper into your pelvis, greater pressure on your bladder may leave you needing to wee constantly. It might also cause leakage – especially when you laugh, cough, sneeze, bend or lift. Panty liners can help. If you think you might be leaking amniotic fluid, contact your health care provider now.
  • Balance issues. You may have issues with loose joints and find your sense of balance is less assured than usual, so take care when you’re moving around.
  • General discomfort. Try not to sit or stand too long in one position – keep shifting around, to relieve aches and pains. You may find sleeping on your left side relieves symptoms when you’re in bed.

As you approach zero hour, it’s natural to feel anxious, particularly if this is your first baby. There’ll probably be times when it all gets a bit too much, and you start to worry. How much will it hurt? How long will it take? Will I be able to cope? If you haven’t already, think about taking childbirth classes. You’ll learn a lot, not least from other mums and mums-to-be. Not least that yes, you can cope. One step at a time…

Baby dateline…

By the third trimester, your baby can hear, cry, smile, and suck its thumb, and open its eyes to see. Sing a song to your baby now, and they’ll find it soothing after they’re born. Your partner might be able to hear a heartbeat – and maybe get a kick in the ear!

Some women find it helps to keep a journal, or to plan ahead, sorting out a schedule for all the stuff you need to deal with, quite apart from having a baby! It’s a good time to get supplies in, like maternity clothes, a couple of good supportive bras to make things more comfortable, a nursing bra and breast pump if you’re planning on breastfeeding.

As at earlier appointments, your healthcare provider will check out you and your baby thoroughly, to make sure all’s well. Check up may include screening for conditions like gestational diabetes, iron deficiency anaemia and Group B strep – all common, and easily treated when they’re picked up in time. You’ll probably also be given a shot to help protect your baby from whooping cough until he or she can be vaccinated.

This is the point where your healthcare provider will probably also discuss your plans for labour and preferences for pain management. Obviously you need to tell them if you’re planning anything unusual, like a water-birth or total abstinence from medication. Discuss and agree a birth plan, always bearing in mind the possibility that problems sometimes upset plans, but that your carers will always look to do what’s best for you and your baby.

As your due date approaches, keep asking questions, keep reading, keep talking. The more you know, the more comfortable you are with what to expect, the better your chances of a smooth and trouble-free delivery.

Look after yourself, get plenty of rest, eat well and drink lots of fluids, and all should be well. But call your midwife or doctor straightaway if:

  • You have any vaginal bleeding
  • Your waters break
  • You get strong 30-60 second contractions every five minutes or so
  • You suffer significant pain
  • Your baby’s movement, or lack of it, is worrying you

And again, don’t delay. If you can’t get a response now, go to A&E.

When you reach week 39, pack your bag and get ready. Your baby isn’t actually due for another week, but you never know…

What you do know is, any day now, you’re going to be a mum.

There’s nothing to stop you having sex throughout your pregnancy if you feel the inclination. Your baby certainly won’t mind – indeed some think the rocking and rolling actually helps their baby sleep better!

Regular everyday traveling is fine, though you might want to have a think about potential issues and take simple preventative measures. Plan to stop off at service stations and have a walk around; take a stroll up and down the train corridor. Air travel later in pregnancy may not be the best idea – if in doubt, discuss your options with your healthcare provider.

You don’t need to ‘eat for two’. But you should keep an eye on your eating – and your weight – throughout your pregnancy. Try to eat plenty of fruit & veg, drink lots of water and pulpy fruit juices, and ask your doctor about folic acid, vitamin D and other supplements to keep you healthy and give your baby the best possible start in life.

Bluntly, yes. Smoking is probably the single worst thing you can do for your baby, and as for drinking, official Department of Health guidelines are that ‘no level of alcohol is safe to drink in pregnancy’.

Regular over the counter painkillers are fine, and can be invaluable in helping you through some of the challenges of pregnancy. Just be sure to follow the instructions and not exceed maximum dosages.

Meeting with a professional is always recommended when concerned.

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