The Three Trimesters of Pregnancy: A Checklist of To-Dos

| Pregnancy |


For any journey you take, breaking it up into pieces, sections, or parts (except for long layovers in airports!) makes the trip a whole lot more tolerable. Knowing you are halfway done or three-quarters into it can often give you the needed umph to kick it into high gear and finish the race.

In many ways, pregnancy and the three trimesters are no different. Looking at a pregnancy from start to finish can be daunting.  Not only does the overall distance feel shorter when viewed as thirds, but also what you need to expect and do changes as you inch closer to your due date. We share with you our take on the trimester system known as pregnancy.

While your body will look most similar to itself during the first trimester (most won’t even know you are pregnant), it is usually the most emotionally challenging. The prospect of pregnancy brings a lot of fear and anxiety. It’s just like how you feel in the first couple miles of a race or points in a match; you are working on finding your footing. Getting a sense of the course, your opponent, and yourself can take some time.

 The first trimester of pregnancy is no different; your body is testing this gestating thing out. Don’t be alarmed by odd sensations: cramping, bloating, breast tenderness, fatigue, and an increased urge to eat, drink, and pee are totally normal (so is a decreased need to poop—constipation is super common). You won’t feel like yourself very early on in the game; as the pregnancy hormone levels rise, so do the changes. Be kind to your body, and don’t beat yourself up if you need to take a break. There is a lot going on.

 In addition to the changes your body is experiencing, it is also in a state of flux over if this pregnancy is going to be a go—meaning, does the embryo that is growing inside you have what it takes to make a baby (e.g., does it have the right number of chromosomes, are there major organ problems, are there other functional issues)? The body is smart, and when things are not right, in many cases it knows pretty quickly and a miscarriage will follow.

To make sure that your body is not sleeping on the “checking job,” a host of genetic screening tests are performed in the first trimester. They will give insight into what’s up with the pregnancy in terms of chromosome number (a.k.a., are there 46 chromosomes?). In addition to the blood tests, in the latter half of the first trimester, an ultrasound that measures the thickness of the back of the neck (medically termed the nuchal translucency) is performed. The nuchal is not the place where more is better—a thicker nuchal is associated with chromosomal abnormalities (most commonly Trisomy 21, a.k.a. Down’s).

There is a lot to do and a lot that can be done in the first trimester, particularly making sure that we have an accurate due date (it is based off the first day of your last menstrual period) For this reason, the earlier you go to see your OB, the better. While you don’t need to be seen the day you pee on the stick, you do want to get in within the next few weeks. Early evaluations can pick up things and point you in the right direction early (for example, do you need a high-risk OB?).

At the first visit, there is usually a lot of talking. Minus the awkward silences, in many ways, it is like a first date. Do you like your OB, and do you want to commit to him or her and their group for the next nine months? We will ask a lot of questions about your past and family’s past during this meeting so that we can make a game plan for the rest of the pregnancy. We need to know it all: the good, the bad, and the ugly. Honesty is key to a good OB-pregnant lady relationship.

Following the gab session, we will start the exam (height, weight, blood pressure, and pelvic exam). In most cases, the icing on the cake during this first visit is the ultrasound to check for fetal size and heartbeat. If all looks good, the next stop is the lab for blood tests (cover your eyes if you don’t like needles; we will take a lot of blood at the first meeting). Things like your hemoglobin level, your blood type, your immunity status (are you immune to things like chicken pox, the measles, and the mumps?), thyroid level, and what (if any) inherited genetic conditions you are a carrier for are essential for a safe pregnancy. We will also screen you for STDs such as HIV, Hep B, Syphilis, Gonorrhea, and Chlamydia. The menu of tests is not fixed. Based on your background and history, we will add in a few “specials”—this is why the convo that we commenced with is so key!

Basically the beginning third of pregnancy is marked by a lot of unknowns and unpleasant sensations, like nausea and vomiting. Things will start to sort themselves out as you hit the 13-week mark. We will also use this time to give you the lowdown on all things pregnancy—vitamins, food, fitness, sex, travel, habits, and medications. There will be a lot of information, so try to take it one step at a time. In most cases, things will get smoother and more second nature as the weeks pass. It just takes some time to sort itself out. Trust us, we’ve got you covered!

At almost every visit, your doctor will do the following: check your blood pressure, weigh you (oh joy!), check your urine for an infection, assess for protein and blood, measure the size of your uterus, check the baby’s heartbeat, chat about the last few weeks (travel, illness, stressors), and ask you about fetal movement (second and third trimesters). Think of these like the OB checklist. Hitting each mark will ensure that both you and your baby are hanging in there. They will be maintained throughout the tris, and you should expect them every time you pass through your OB’s door.

Okay, one-third down and two-thirds to go. The second trimester is like the sweetheart phase, the newlywed phase, and the “Wow, pregnancy is really wonderful phase.” And while it is fairly short lived (about 13 weeks to be exact), for most women, it is a pretty positive time. Going back to our sports analogy, you are now in the groove. The kinks have been worked out, your body is warmed up, and you are in the zone. While your visits to the OB will become slightly more frequent (about once every three weeks to a month), it is by no means onerous. Your schedule is still pretty free. Most activities are still doable (with modifications), and your eating habits have returned to normal. (You are no longer a carbohydrate-ingesting machine.) You are comfortable sharing your news with others and more easygoing about the process.

The highlights of the second trimester include the anatomy scan, the onset of fetal movement (first kicks are pretty incredible), the gender reveal moment, and the popping of your belly—hello, world, I am pregnant! You can also expect some more blood tests from your OB, most notably one that looks for neural tube defects (commonly spina bifida). If problems were identified on the anatomy scan (which is traditionally done at about five months of pregnancy), there may be follow up recommended (a closer peek at the heart, a fetal MRI, or a meeting with a high-risk OB). The anatomy scan gives all the organs more than a once over, and for this reason, this is the most common time that abnormalities are identified. While most pregnancies are uncomplicated and enter the home stretch without a hitch, the ones that are becoming more problematic usually let us know around this time.

Coming around the bend, you enter the third trimester and are inching towards the end. This is when things feel real and many women start to get really uncomfortable. Your baby is getting bigger, and your uterus is pushing on everything from your bladder to your back to your diaphragm. It’s hard to find a position that feels comfortable. The third trimester is a strong dose of reality hitting. I may never sleep past 6 a.m. on a Sunday morning for another 5 years! Given the proximity of your due date, you start to see your OB every other week to every week. They will want to check that the baby is in the head-down position and he or she is not over the weight limits for a vaginal entry into this world. Babies that are measuring very large may need to take the abdominal route out, that is, a C-Section. We will once again check your blood levels. This time, there is one that follows a sugary orange drink that makes most of us want to vomit (checking for diabetes in pregnancy, or gestational diabetes).

A GBS (Group B beta-hemolytic streptococcus) test is performed on every pregnant woman in the latter half of the third trimester. GBS is a common culprit for neonatal sepsis/meningitis (life threatening infections). Women who are colonized with GBS need antibiotics while in labor to prevent passing GBS to their baby. Screening for GBS in the third trimester has drastically reduced the incidence of disease in newborns.

Last, get ready for some of the most uncomfortable pelvic exams of your life (sorry, we just want to be truthful!). As the weeks march on, your OB will check your cervix every week to make sure that it’s ready to give its passenger the all clear to exit. If it is not, we may need to talk about scheduling an induction.

The end of pregnancy is also the time to talk seriously about your next beginning. Preparing you for what labor will be like is key to demystifying an understandably frightening experience. While your labor may not follow your birth plan script, having a good idea about what you want the plot to be will help you make decisions when the time comes. While pregnancy seems long, it will be done before you know it. For those who loved it, you will be eagerly anticipating the next time you are expecting, and for those who sort of hated it (and you are not alone), you will be contemplating if you will ever do that again. Either way, getting to the end of those ten months (yes, pregnancy is ten months!) is a major accomplishment.

And once the bell rings and labor starts, you may still have a couple of days ahead of you. In many ways, these days are longer than all of the trimesters combined. Labor and delivery are not easy. But just think: when that final push is over, you will have the greatest gift anyone could bestow upon you. Holding that baby will trump any push present your mind could dream of! You are a mother, and your life will forever be changed. Let us be the first to welcome you to the club; there is truly no greater.

Written by Jaime M Knopman & Sheeva Talebian

Friends and colleagues for more than ten years, Dr. Knopman and Talebian have both completed their M.D. degree at Mount Sinai School of Medicine, and Residency in Obstetrics and Gynecology at NYU School of Medicine. Their areas of medical specialty include: treatment of menstrual irregularities, assisted reproductive technologies, in vitro fertilization, oocyte cryopreservation, oncofertility, same sex reproduction, and third party reproduction. In addition to their love of medicine, they have a true passion for writing, and owns a blog Truly MD where they share their professional, yet heartwarming insights for new Moms and Moms-to-be.