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Feeling Baby Move? A Midwife Explains the Second Trimester · Meaningful Medicine with Novant Health

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  Melanie Cole, MS (Host): Welcome to Meaningful Medicine, a Novant
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  Health podcast bringing you access to leading doctors who answer
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  questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Melanie Cole.
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  And are you feeling your baby move?
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  A midwife is here to explain the second trimester.
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  Joining us is Ginny Gaulden.
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  She's a midwife with Novant Health.
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  Ginny, thank you so much for joining us today.
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  So as we get into this exciting time in a woman's life, why do many
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  providers call that second trimester the really sweet spot of pregnancy?
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  Ginny Gaulden: Well, honestly, it's because in the first trimester, you
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  have so much nausea from the hormones that are happening in pregnancy.
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  And then, in the third trimester, you have mechanical things that are
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  happening, such as back pain or having to get up in the middle of the night
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  to go to the bathroom, or baby's moving down into the birth canal and you're
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  just feeling a lot of pelvic pressure.
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  So, the second trimester, you're starting to feel better from that nausea, you're
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  getting a little more energy back, but you haven't quite got to the point
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  in pregnancy where those mechanical problems are causing you discomfort,
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  not allowing you to sleep well at night.
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  Melanie Cole, MS: That was an excellent explanation and very true.
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  I remember how it felt just so much more comfortable and exciting and easy.
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  So, milestones for that second trimester, what are some of
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  the ones we're looking for?
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  Ginny Gaulden: Well, in the second trimester, you know, baby starts
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  moving, which gets exciting because now you have that reassurance
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  that baby's starting to move.
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  Organs are developing completely.
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  We're able to do that anatomy scan and see all parts of
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  baby during that anatomy scan.
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  So, those are like the big milestones that you'll accomplish in the second trimester.
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  Sometimes providers will do that glucose tolerance test, which is the gestational
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  diabetes test, as early as 24 weeks.
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  So, you may be doing that as early as in the second trimester as well.
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  Melanie Cole, MS: So when is it that we can expect to feel our babies move?
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  I mean, kind of between the first and second trimester, when is it we're going
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  to expect to see that or feel that?
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  Ginny Gaulden: I would say, you know, anywhere from 18 to 20 weeks.
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  Now, a lot of factors go into when that baby will move.
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  Where is the placenta at, located in the uterus?
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  Or is this a first-time mom who's never felt this feeling, and so they don't
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  really know what they're looking for?
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  They're like, "Oh, was that a little gas bubble or was that my baby moving?"
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  So until they get the nice, strong, consistent movements,
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  first-time moms have a hard time differentiating between the two.
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  Second-time moms, they know what that feeling feels like, so they may feel it
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  a little sooner than the first-time moms.
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  And then, the placenta is what we call anterior or in the front.
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  Sometimes that can make movement a little bit more difficult to feel.
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  Melanie Cole, MS: What does the movement feel like?
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  Ginny Gaulden: So, it can feel like a gas bubble or it can feel like butterflies.
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  It's called quickening.
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  So, it's just like almost these little flutters that are
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  happening when they first start.
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  And then, as baby continues to grow, gets more consistent movements, then you'll
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  feel, you know, the kicks and the jabs.
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  You'll know what those are feeling.
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  But before that, it's kind of just like, "Oh, it's almost like a tickle."
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  Melanie Cole, MS: Well, I mean, I just got chills when you said that,
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  because I remember the first time my first child moved, and it does feel
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  like a tickle or little butterflies.
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  It's just an indescribable feeling, and it's just so exciting for parents-to-be
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  to know that kind of means things are moving the way that they should.
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  So, how much movement is normal in the second trimester?
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  Should we be feeling that baby moving every day?
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  Tell us a little bit about that.
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  Ginny Gaulden: So, movement varies as baby gets bigger and you actually
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  know what you're feeling for.
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  And as they get bigger and as their brain develops and they start having
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  more consistent movements, then you'll know what you're feeling.
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  And I always tell patients, I give them reassurance, you know your
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  baby and your body the best and you know what you've been feeling.
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  And when I worry is when those movements that you've been
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  feeling all of a sudden disappear.
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  That's when it's worrisome.
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  Otherwise, you just kind of expect a little bit more consistent and stronger
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  movements as the pregnancy develops.
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  Now, as you enter the third trimester, then we'll give you a little bit more
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  feedback on how often and when you should be feeling those movements.
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  But until you hit the third trimester, we really just kind of go by mom's feelings
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  and make sure that they're not decreasing.
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  Melanie Cole, MS: Okay.
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  So, that leads well into the next question.
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  When do we get concerned about that decreased movement?
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  As you said, in the third trimester, there's more parameters about that,
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  and you go with the mother and her feelings and her instincts.
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  In that second trimester, when do we get concerned?
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  Ginny Gaulden: I get concerned when my mom's concerned.
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  When my patient tells me, "Hey, I've been feeling my baby move every day and today
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  I haven't felt my baby move at all."
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  And that would be concerning to me because that's not the normal pattern that
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  you've been used to in your pregnancy.
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  And you can always call your doctor's office and say, "Hey, my
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  baby, I haven't felt them move all day and I usually feel them move
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  in the morning or in the evening," whatever time you usually feel them.
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  And you just want to come in for a little reassurance and
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  some, a little heart tone check.
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  I think that's acceptable.
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  Paying attention to when your baby moves and the consistency of movement
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  is, you know, the best way to track movements in the second trimester.
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  Moms know when their babies move, I can tell you that.
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  Melanie Cole, MS: Well, that is reassuring that we can call whenever we need that
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  little extra reassurance and support, because it can be a little bit scary.
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  Now, is it normal in the second trimester for some of these symptoms?
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  You mentioned that some of them wane off, some of the nausea, you know, some
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  of the things that go with that first trimester wane off a little in the second.
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  Is it normal for some symptoms to disappear completely?
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  Ginny Gaulden: Yeah.
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  So, you know, as you're entering into the second trimester, you have
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  two hormones that kind of decrease, which is estrogen and your hCG levels.
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  They decrease about nine to 11 weeks, which makes you start feeling
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  better about 12 to 14 weeks with the nausea symptoms and the fatigue.
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  Because ultimately, if your nausea is going away, then you're increasing
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  your food intake, which increases your energy level and allows you
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  to get up and exercise and just makes you feel overall better.
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  Melanie Cole, MS: I remember that feeling, that second trimester, having a little
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  bit more energy and feeling just a little bit better than you did before.
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  So, you mentioned that there's hormones that are then decreasing.
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  So, is that why we feel that little bit of extra energy?
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  And also our nausea's gone, we're eating a little bit more,
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  but are we sleeping better?
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  Is there any also physiological reason we feel just that much better?
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  Ginny Gaulden: Yeah.
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  I mean, ultimately you're not up vomiting all night or day.
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  You're getting the good calorie intake that you need, which will allow more
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  energy throughout your daily life.
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  And ultimately, a lot of patients will stop exercising in that first
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  trimester, and then all of a sudden they're getting this energy from being
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  able to actually consume food, the hormone changes, and things like that.
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  And then, they're exercising, which also increases their energy level.
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  They just overall feel better.
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  Melanie Cole, MS: It's a really exciting time.
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  So, what does a typical second trimester appointment look
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  like with you, with a midwife?
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  Ginny Gaulden: So with a midwife, I would say, and the first thing I do with
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  my patients when I see them is I'll be like, "Hey, how are things going so far?
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  Do you have any questions for me before I start giving you information?"
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  And that way, it doesn't overwhelm the patient, and they feel like they
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  get their questions answered before I give them information that they
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  have to do on top of those questions that they already want answered.
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  And then, we talk about steps whether it's we need to go over genetic
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  testing that they had completed or their anatomy scan that they had done,
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  make sure we, you know, do everything that needs done for the anatomy scan,
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  whether it was a normal anatomy scan or whether we need follow-up with that.
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  And then, we talk about what our next steps are.
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  So, we see each other every four weeks, which is about monthly, and you know,
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  what they can expect at that next visit and things that they can do at home to
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  prepare for that next visit, such as doing like a tour for the hospital and
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  kind of like getting that information.
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  You know, knowing where they're going to deliver relieves a lot of
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  anxiety, and just seeing where they're going to be able to deliver and
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  what access they'll have to things.
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  So, a tour is a great thing to do at the beginning of the pregnancy in the second
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  trimester while you're waiting to get closer to that third trimester for the
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  childbirth classes and the breastfeeding classes just to do some education.
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  Melanie Cole, MS: What are the biggest concerns that you help moms
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  navigate during this second trimester?
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  Ginny Gaulden: It depends on whether this is first pregnancy or second pregnancy.
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  First pregnancy concerns are just reassurance that everything is going
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  according to plan or what steps we need to take because they don't know.
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  They've never been through this, and they don't know what's normal
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  and what's not normal in pregnancy.
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  So, that's probably one of the biggest concerns for first-time moms
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  is just figuring out what is normal.
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  And then second-time moms, just providing them, you know, reassurance
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  of balancing a life with, you know, little ones at home, with bringing
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  a new baby into that environment.
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  And then, like, any steps with testing that may come back abnormal, providing,
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  you know, information about that, and just educating them on those kind of things.
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  Melanie Cole, MS: Well, along those lines then, Ginny, how do midwives support
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  the emotional wellness during pregnancy, and especially since we're talking about
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  the second trimester during that time?
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  What are you doing to help moms figure all of that stuff out?
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  Ginny Gaulden: Emotional wellness is such a huge part of pregnancy.
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  I mean, if you are not feeling well as far as anxiety, depression, whatever
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  is going on you're just not going to feel good in your pregnancy, and your
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  pregnancy just will not go as well.
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  So, we want to make sure that you feel supported in that.
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  And whether you need therapy or medication or whatever you may need,
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  we do depression scores in the office each trimester to make sure that you
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  are, you know, within the normal range, or if we need to do some adjustments.
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  And then, you know, if patients come in already on those anxiety and depression
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  medicines, a lot of patients have that fear that they need to come off of it
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  during pregnancy, which is not the case.
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  It is safe to be on those medications during pregnancy.
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  And we work very closely with psychiatry and therapy to make sure
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  that the patient is well cared for, so that not only is her pregnancy
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  supported, but also her postpartum period, she'll be supported as well.
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  Postpartum depression can occur anywhere in that first year after she has the
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  baby, and it's very important for her to feel supported at that time.
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  Melanie Cole, MS: Thank you for pointing that out about medication and the
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  importance of good mental health and emotional wellness during that time.
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  It's such a rollercoaster, right?
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  It's so exciting and yet a little bit scary.
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  Now, you mentioned touring labor and delivery as something
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  that you can do to prepare.
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  What else should moms do to start getting ready, not only for labor
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  and delivery, but also for new baby?
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  Is it too early to, you know, find a pediatrician?
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  Is it too early to take childbirth classes?
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  What should we be doing to get ourselves and our family to be ready?
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  Ginny Gaulden: There are so many classes that are offered, which for a first-time
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  mom, they want to take all of them, right?
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  Because this is the first time they've ever been exposed to something like this.
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  And so, like, Novant Health has an amazing class system, whether it's they
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  do a yoga class, there's breastfeeding class, there's childbirth class, there's
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  postpartum, preparing for infant CPR.
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  There's so many classes, that can feel overwhelming.
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  And then, as they try to squeeze all that into the third trimester, it can be a lot.
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  So, taking those classes that are not necessarily you need them at the end,
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  like the childbirth and the breastfeeding, but, like, doing the infant CPR, you can
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  take that at any point in your pregnancy.
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  Preparing to bring baby home, you can do that at any point in your pregnancy.
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  Figuring out a pediatrician, you know, everybody's different on what
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  their choices are for a pediatrician and what they're looking for.
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  So, doing that research in the second trimester, that takes something off your
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  plate so that you're not overwhelmed.
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  And once again, we're never sure that we're going to make
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  it to a full-term in pregnancy.
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  So, being able to do as much as you can before that third trimester is beneficial,
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  especially considering you're not seeing us as often in that second trimester.
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  You're only seeing us every month, versus, like, in the third trimester,
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  you see us every two weeks or even weekly which, you know, can take up
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  some of your time when you're not able to do those things as well.
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  Melanie Cole, MS: You've given us a lot of good information, a lot to think
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  about, and those classes are so important.
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  And as you say, to get some of them out of the way is always
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  kind of a bit of a relief.
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  And then, you feel like you're just a little bit more knowledgeable,
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  especially if it's your first pregnancy.
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  So Ginny, as we get ready to wrap up here, if every pregnant mom could
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  do one thing during that second trimester to support her healthy
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  pregnancy, what would you tell her?
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  Give us your best advice here.
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  Ginny Gaulden: There's a few things I kind of, you know, educate patients on.
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  Nutrition is one.
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  And that's whether you feel like your weight gain is too much or not enough.
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  We have great nutritionists that we partner with in Novant that I will
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  send a lot of my pregnant patients to just to make sure that they're
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  taking in healthy calories versus, like, the fattier cake, ice cream,
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  or not taking in enough protein.
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  They will look at their overall diet and come up with a diet plan for them, and
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  they're a great partner for patients.
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  And while you have that extra energy level in the second trimester, the,
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  you know, the good trimester, make sure you have a regular exercise routine.
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  And it's just going to make you feel so much better, you know,
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  mentally, physically, all around.
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  And ultimately, your labor goes better when you're in a healthy state.
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  And the biggest thing I could harp on for all patients is please drink enough water.
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  There is this extra requirement for pregnant patients for drinking water.
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  And you will call and say, "I have cramping, I have headaches.
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  You know, I'm not feeling overall."
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  And I'll ask you, "How much water are you drinking a day?"
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  And the majority of the time it's just not enough.
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  And they drink water and they're like, "You were so right.
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  I just needed to increase my water intake."
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  And it's just physiologically demanding for water intake in pregnancy.
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  Melanie Cole, MS: What great advice.
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  And maybe if we do up our water intake, which is so important.
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  We might pee a little bit more.
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  But that's okay too, because it means that you're, you know, really taking in
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  what you need for yourself and for baby.
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  Ginny, you've given us so much great information.
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  Thank you so much for joining us today and sharing your expertise for moms-to-be.
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  And to find a physician, you can visit novanthealth.org.
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  And for more health and wellness information from our experts,
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  please visit healthyheadlines.org.
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  That concludes this episode of Meaningful Medicine, a podcast from
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  the specialists at Novant Health.
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  I'm Melanie Cole.