Midwives pay close attention to emotional health because anxiety, depression and other mental health concerns can affect how someone experiences pregnancy. Gaulden explains that patients are routinely screened throughout pregnancy and may be connected with additional support such as therapy, mental health specialists or medication management when appropriate.

What should I do during the second trimester to prepare for my baby's arrival?

The second trimester can be a good time to learn about childbirth, breastfeeding and infant care before the demands of late pregnancy. Gaulden recommends considering activities such as touring the hospital, researching pediatricians and taking classes like infant CPR. Completing some preparation early may help reduce stress later in pregnancy.

Episode chapters

00:00 Introductions
00:27 Meet Ginny Gaulden, Novant Health Midwife
00:38 Why is the second trimester considered the sweet spot of pregnancy?
00:58 Second trimester milestones: reduced nausea and more energy; anatomy scan
01:32 What are the key milestones in the second trimester?
01:36 When does baby start moving in the second trimester?
01:42 Anatomy scan and fetal organ development
02:00 Second-trimester gestational diabetes screening (glucose tolerance test)
02:11 When should you expect to feel your baby move?
02:18 Movement typically begins around 18–20 weeks (influences)
02:57 Anterior placenta and movement: what it means
03:02 What does fetal movement feel like? Quickening
03:53 How much movement is normal in the second trimester?
04:26 Transition to third trimester: movement expectations
04:54 When to worry about decreased movement (second trimester)
05:05 When to be concerned about movement in the second trimester (doctor's perspective)
06:03 Are some second-trimester symptoms normal to disappear?
06:24 Hormone changes and increased energy in the second trimester
07:44 What does a typical second-trimester appointment look like?
08:12 Genetics testing and the anatomy scan follow-up
08:28 How often are prenatal visits and how to prepare
08:41 Touring the hospital and delivery location
09:11 The biggest concerns for moms in the second trimester
10:06 Supporting emotional wellness during pregnancy
11:36 Getting ready for labor, delivery, and baby: classes and pediatrician
12:01 Classes and infant CPR: planning ahead during pregnancy
13:54 One thing to focus on in the second trimester
13:57 Nutrition, exercise, and water: practical tips
15:46 Closing resources

Melanie Cole, MS (Host): Welcome to Meaningful Medicine, a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

I'm Melanie Cole, and are you feeling your baby move? A midwife is here to explain the second trimester. Joining us is Ginny Gaulden. She's a midwife with Novant Health. Ginny, thank you so much for joining us today. So as we get into this exciting time in a woman's life, why do many providers call that second trimester the really sweet spot of pregnancy?

Ginny Gaulden: Well, honestly, it's because in the first trimester, you have so much nausea from the hormones that are happening in pregnancy and then, in the third trimester, you have mechanical things that are happening, such as back pain or having to get up in the middle of the night to go to the bathroom, or baby's moving down into the birth canal and you're just feeling a lot of pelvic pressure.

So, the second trimester, you're starting to feel better from that nausea, you're getting a little more energy back, but you haven't quite got to the point in pregnancy where those mechanical problems are causing you discomfort, not allowing you to sleep well at night.

Melanie Cole, MS: That was an excellent explanation and very true. I remember how it felt just so much more comfortable and exciting and easy. So, milestones for that second trimester, what are some of the ones we're looking for?

Ginny Gaulden: Well, in the second trimester, you know, baby starts moving, which gets exciting because now you have that reassurance that baby's starting to move. Organs are developing completely. We're able to do that anatomy scan and see all parts of baby during that anatomy scan. So, those are like the big milestones that you'll accomplish in the second trimester. Sometimes providers will do that glucose tolerance test, which is the gestational diabetes test, as early as 24 weeks. So, you may be doing that as early as in the second trimester as well.

Melanie Cole, MS: So when is it that we can expect to feel our babies move? I mean, kind of between the first and second trimester, when is it we're going to expect to see that or feel that?

Ginny Gaulden: I would say, you know, anywhere from 18 to 20 weeks. Now, a lot of factors go into when that baby will move. Where is the placenta at, located in the uterus? Or is this a first-time mom who's never felt this feeling, and so they don't really know what they're looking for? They're like, "Oh, was that a little gas bubble or was that my baby moving?"

So until they get the nice, strong, consistent movements, first-time moms have a hard time differentiating between the two. Second-time moms, they know what that feeling feels like, so they may feel it a little sooner than the first-time moms and then, the placenta is what we call anterior or in the front. Sometimes that can make movement a little bit more difficult to feel.

Melanie Cole, MS: What does the movement feel like?

Ginny Gaulden: So, it can feel like a gas bubble or it can feel like butterflies. It's called quickening. So, it's just like almost these little flutters that are happening when they first start and then, as baby continues to grow, gets more consistent movements, then you'll feel, you know, the kicks and the jabs. You'll know what those are feeling. But before that, it's kind of just like, "Oh, it's almost like a tickle."

Melanie Cole, MS: Well, I mean, I just got chills when you said that, because I remember the first time my first child moved, and it does feel like a tickle or little butterflies. It's just an indescribable feeling, and it's just so exciting for parents-to-be to know that kind of means things are moving the way that they should. So, how much movement is normal in the second trimester? Should we be feeling that baby moving every day? Tell us a little bit about that.

Ginny Gaulden: So, movement varies as baby gets bigger and you actually know what you're feeling for and as they get bigger and as their brain develops and they start having more consistent movements, then you'll know what you're feeling and I always tell patients, I give them reassurance, you know your baby and your body the best and you know what you've been feeling.

And when I worry is when those movements that you've been feeling all of a sudden disappear. That's when it's worrisome. Otherwise, you just kind of expect a little bit more consistent and stronger movements as the pregnancy develops. Now, as you enter the third trimester, then we'll give you a little bit more feedback on how often and when you should be feeling those movements. But until you hit the third trimester, we really just kind of go by mom's feelings and make sure that they're not decreasing.

Melanie Cole, MS: Okay. So, that leads well into the next question. When do we get concerned about that decreased movement? As you said, in the third trimester, there's more parameters about that, and you go with the mother and her feelings and her instincts. In that second trimester, when do we get concerned?

Ginny Gaulden: I get concerned when my mom's concerned. When my patient tells me, "Hey, I've been feeling my baby move every day and today I haven't felt my baby move at all." And that would be concerning to me because that's not the normal pattern that you've been used to in your pregnancy and you can always call your doctor's office and say, "Hey, my baby, I haven't felt them move all day and I usually feel them move in the morning or in the evening," whatever time you usually feel them.

And you just want to come in for a little reassurance and some, a little heart tone check. I think that's acceptable. Paying attention to when your baby moves and the consistency of movement is, you know, the best way to track movements in the second trimester. Moms know when their babies move, I can tell you that.

Melanie Cole, MS: Well, that is reassuring that we can call whenever we need that little extra reassurance and support, because it can be a little bit scary. Now, is it normal in the second trimester for some of these symptoms? You mentioned that some of them wane off, some of the nausea, you know, some of the things that go with that first trimester wane off a little in the second. Is it normal for some symptoms to disappear completely?

Ginny Gaulden: Yeah. So, you know, as you're entering into the second trimester, you have two hormones that kind of decrease, which is estrogen and your hCG levels. They decrease about nine to 11 weeks, which makes you start feeling better about 12 to 14 weeks with the nausea symptoms and the fatigue. Because ultimately, if your nausea is going away, then you're increasing your food intake, which increases your energy level and allows you to get up and exercise and just makes you feel overall better.

Melanie Cole, MS: I remember that feeling, that second trimester, having a little bit more energy and feeling just a little bit better than you did before. So, you mentioned that there's hormones that are then decreasing. So, is that why we feel that little bit of extra energy? And also our nausea's gone, we're eating a little bit more, but are we sleeping better? Is there any also physiological reason we feel just that much better?

Ginny Gaulden: Yeah. I mean, ultimately you're not up vomiting all night or day. You're getting the good calorie intake that you need, which will allow more energy throughout your daily life and ultimately, a lot of patients will stop exercising in that first trimester, and then all of a sudden they're getting this energy from being able to actually consume food, the hormone changes, and things like that and then, they're exercising, which also increases their energy level. They just overall feel better.

Melanie Cole, MS: It's a really exciting time. So, what does a typical second trimester appointment look like with you, with a midwife?

Ginny Gaulden: So with a midwife, I would say, and the first thing I do with my patients when I see them is I'll be like, "Hey, how are things going so far? Do you have any questions for me before I start giving you information?" And that way, it doesn't overwhelm the patient, and they feel like they get their questions answered before I give them information that they have to do on top of those questions that they already want answered.

And then, we talk about steps whether it's we need to go over genetic testing that they had completed or their anatomy scan that they had done, make sure we, you know, do everything that needs done for the anatomy scan, whether it was a normal anatomy scan or whether we need follow-up with that and then, we talk about what our next steps are.

So, we see each other every four weeks, which is about monthly, and you know, what they can expect at that next visit and things that they can do at home to prepare for that next visit, such as doing like a tour for the hospital and kind of like getting that information. You know, knowing where they're going to deliver relieves a lot of anxiety, and just seeing where they're going to be able to deliver and what access they'll have to things.

So, a tour is a great thing to do at the beginning of the pregnancy in the second trimester while you're waiting to get closer to that third trimester for the childbirth classes and the breastfeeding classes just to do some education.

Melanie Cole, MS: What are the biggest concerns that you help moms navigate during this second trimester?

Ginny Gaulden: It depends on whether this is first pregnancy or second pregnancy. First pregnancy concerns are just reassurance that everything is going according to plan or what steps we need to take because they don't know.

They've never been through this, and they don't know what's normal and what's not normal in pregnancy.

So, that's probably one of the biggest concerns for first-time moms is just figuring out what is normal and then second-time moms, just providing them, you know, reassurance of balancing a life with, you know, little ones at home, with bringing a new baby into that environment and then, like, any steps with testing that may come back abnormal, providing, you know, information about that, and just educating them on those kind of things.

Melanie Cole, MS: Well, along those lines then, Ginny, how do midwives support the emotional wellness during pregnancy, and especially since we're talking about the second trimester during that time? What are you doing to help moms figure all of that stuff out?

Ginny Gaulden: Emotional wellness is such a huge part of pregnancy. I mean, if you are not feeling well as far as anxiety, depression, whatever is going on you're just not going to feel good in your pregnancy, and your pregnancy just will not go as well. So, we want to make sure that you feel supported in that and whether you need therapy or medication or whatever you may need, we do depression scores in the office each trimester to make sure that you are, you know, within the normal range, or if we need to do some adjustments.

And then, you know, if patients come in already on those anxiety and depression medicines, a lot of patients have that fear that they need to come off of it during pregnancy, which is not the case. It is safe to be on those medications during pregnancy and we work very closely with psychiatry and therapy to make sure that the patient is well cared for, so that not only is her pregnancy supported, but also her postpartum period, she'll be supported as well. Postpartum depression can occur anywhere in that first year after she has the baby, and it's very important for her to feel supported at that time.

Melanie Cole, MS: Thank you for pointing that out about medication and the importance of good mental health and emotional wellness during that time. It's such a rollercoaster, right? It's so exciting and yet a little bit scary. Now, you mentioned touring labor and delivery as something that you can do to prepare. What else should moms do to start getting ready, not only for labor and delivery, but also for new baby? Is it too early to, you know, find a pediatrician? Is it too early to take childbirth classes? What should we be doing to get ourselves and our family to be ready?

Ginny Gaulden: There are so many classes that are offered, which for a first-time mom, they want to take all of them, right? Because this is the first time they've ever been exposed to something like this and so, like, Novant Health has an amazing class system, whether it's they do a yoga class, there's a breastfeeding class, there's childbirth class, there's postpartum, preparing for infant CPR. There's so many classes, that can feel overwhelming.

And then, as they try to squeeze all that into the third trimester, it can be a lot. So, taking those classes that are not necessarily you need them at the end, like the childbirth and the breastfeeding, but, like, doing the infant CPR, you can take that at any point in your pregnancy.

Preparing to bring baby home, you can do that at any point in your pregnancy. Figuring out a pediatrician, you know, everybody's different on what their choices are for a pediatrician and what they're looking for. So, doing that research in the second trimester, that takes something off your plate so that you're not overwhelmed.

And once again, we're never sure that we're going to make it to a full-term in pregnancy. So, being able to do as much as you can before that third trimester is beneficial, especially considering you're not seeing us as often in that second trimester. You're only seeing us every month, versus, like, in the third trimester, you see us every two weeks or even weekly which, you know, can take up some of your time when you're not able to do those things as well.

Melanie Cole, MS: You've given us a lot of good information, a lot to think about, and those classes are so important and as you say, to get some of them out of the way is always kind of a bit of a relief and then, you feel like you're just a little bit more knowledgeable, especially if it's your first pregnancy. So Ginny, as we get ready to wrap up here, if every pregnant mom could do one thing during that second trimester to support her healthy pregnancy, what would you tell her? Give us your best advice here.

Ginny Gaulden: There's a few things I kind of, you know, educate patients on. Nutrition is one and that's whether you feel like your weight gain is too much or not enough. We have great nutritionists that we partner with in Novant that I will send a lot of my pregnant patients to just to make sure that they're taking in healthy calories versus, like, the fattier cake, ice cream, or not taking in enough protein. They will look at their overall diet and come up with a diet plan for them, and they're a great partner for patients.

And while you have that extra energy level in the second trimester, the, you know, the good trimester, make sure you have a regular exercise routine and it's just going to make you feel so much better, you know, mentally, physically, all around and ultimately, your labor goes better when you're in a healthy state.

And the biggest thing I could harp on for all patients is please drink enough water. There is this extra requirement for pregnant patients for drinking water and you will call and say, "I have cramping, I have headaches. You know, I'm not feeling overall." And I'll ask you, "How much water are you drinking a day?" And the majority of the time it's just not enough and they drink water and they're like, "You were so right. I just needed to increase my water intake." And it's just physiologically demanding for water intake in pregnancy.

Melanie Cole, MS: What great advice and maybe if we do up our water intake, which is so important. We might pee a little bit more. But that's okay too, because it means that you're, you know, really taking in what you need for yourself and for baby. Ginny, you've given us so much great information. Thank you so much for joining us today and sharing your expertise for moms-to-be.

And to find a physician, you can visit novanthealth.org and for more health and wellness information from our experts, please visit healthyheadlines.org. That concludes this episode of Meaningful Medicine, a podcast from the specialists at Novant Health. I'm Melanie Cole.