Pregnancy in 20th week

Your baby should be about 25.6 cm long this week, which is roughly the size of a banana! Unlike in the previous weeks when your baby was measured from head to bottom, he or she will now be measured from head to toe. This is because your baby was curled up before, but is now stretching out and moving about in the amniotic sac more freely.

Of course, this also means you’ll feel the movement and feel it quite strongly as your pregnancy progresses. It might feel like just a flutter or a light kick this week, but soon you’ll wonder if you’re carrying a football champion in your belly!

There’s now a white and greasy layer of vernix caseosa covering your baby and protecting his or her soft skin from drying out due to contact with the amniotic fluid. This slippery vernix will help your baby slide down the birth canal later as well. Your baby is also likely to be passing meconium now - which is basically the process through which the baby ingests amniotic fluid, turns it into urine (or stool in some cases) and passes it back out through urination. This passing of the meconium might also happen during the process of labour.

Weight gain and increase in the size of your belly are very likely to happen quickly during this period. This is because your baby, the placenta and your uterus are all growing inside you, leading to overall weight gain. Take good care of yourself during this week from hereon even if you haven’t paid much attention before. The care you take now will help you shed the extra kilos faster soon after delivery.

The extra weight might make you feel unbalanced and make simple activities like touching your toes next to impossible (and you shouldn’t strain to do this at this stage of your pregnancy anyway). This might seem overwhelming, but try to take it in your stride because these developments are natural and will continue through the rest of your pregnancy.

If you didn’t go in for an ultrasound during the 18th week of pregnancy or the 19th week of pregnancy, you might want to consult your doctor about getting it done this week. Your obstetrician may ask you for a couple of blood tests to figure out if your alpha-fetoprotein levels are within the range of safety and to check if you have any infections. Both of these are as important as the ultrasound that needs to be done this week.

This ultrasound is known as an anatomy ultrasound, and it is usually done to ensure that your baby is developing and will continue to develop properly. This ultrasound will basically attempt to detect any congenital defects and anomalies, like spina bifida, that might have occurred to the baby. So, this ultrasound does a complete surveillance of your baby’s anatomy and gender to determine if everything is developing properly.

If everything is fine, you should have nothing to worry about. If any anomalies or complications are found, your obstetrician will let you know about the future options for you and your baby. It’s very important to remember that although this ultrasound will check your baby’s gender, you will not be told what it is. This is because sex determination is illegal in India, according to the Pre-Conception and Prenatal Diagnostic Techniques (Prohibition of Sex Selection) Act of 1994.

It’s quite true that you will not be experiencing any morning sickness, but this does not mean that there will be no discomfort or any symptoms during this week. Pregnancy is a nine-month long journey, and there are bound to be a number of symptoms throughout this period at different stages. 

What you need to remember is that no matter the symptom, you should never be in excessive pain or feel like you’re unable to cope. If you do, it’s likely because of a complication, and you should consult your obstetrician sooner rather than later. The following are some of the most common symptoms of the 20th week of pregnancy.

• Round ligament pain: One of the most common complaints of the second trimester, this type of pain occurs in the lower belly. Round ligament pain is either located on one side or can be experienced all across the belly. This is one of the most common complaints in the second trimester, so it’s quite normal. However, if you cannot bear the pain or it appears to be too much, do consult the doctor immediately.
• Sleep problems: A number of pregnancy symptoms can lead to sleep-related problems: back ache, leg or limb pain, leg cramps, indigestion, heartburn, constipation, frequent urination, etc. These can make getting a good night’s sleep very difficult to achieve, which in turn can cause exhaustion, fatigue, lack of concentration, etc. It’s best to consult a doctor about this issue so that you can find out a simple yet safe and effective method of getting some sleep.
• Fatigue: Your body is pumping more blood, your weight has increased, there’s a life growing inside you and you still have to remain active and make sure your daily functions are performed. Added to that, you might also not be getting enough sleep. Fatigue is quite natural under these circumstances, and don’t beat yourself up about it. Instead, make sure you get enough rest, get undisturbed sleep and eat well.
• Sciatic nerve pain: This periodic type of pain might be occurring in your legs. The sciatic nerve is the biggest in the body, and runs under the uterus and all the way down your legs. With the added weight and pressure of the womb on this nerve, sciatic nerve pain is quite normal during pregnancy - especially the second and third trimesters. The best thing to do about it is to rest as much as possible.
• Other symptoms: Apart from the above-mentioned symptoms which are typical in the second trimester, you might still experience some symptoms from the first trimester during the 20th week of pregnancy. These symptoms are heartburn, indigestion, bloating, constipation, sore breasts as your body prepares for breastfeeding, bleeding gums, swollen gums, headaches, nosebleed and mood swings.

There are a few complications of pregnancy that might show up in the 20th week of pregnancy. The following are some complications you should be aware of:

• Miscarriage: Although getting to the 20th week might indicate that your baby is growing well and the risk of a miscarriage has lowered, there’s still a chance that a miscarriage can happen during this week. If you experience any contractions or vaginal bleeding during this week, contact the doctor immediately. A miscarriage can be a very traumatic event for a woman, and so psychological counselling is a must for couples who have lost a baby to miscarriage.
• Obstetric cholestasis: This condition affects the liver and is very rare during pregnancy. But since Indian and Asian women are more at risk of obstetric cholestasis than Caucasian women, it’s important that you take note of any symptoms showing up during this week - especially if the skin on your hands and feet itch, particularly during the night. If you see any symptom of this condition, contact your doctor immediately. 
• Hypertensive diseases: High blood pressure is never a good thing to have, but it can pose quite a number of difficulties during pregnancy. The list of hypertensive diseases which might plague you includes preeclampsia, eclampsia, gestational hypertension and chronic hypertension. You should take any and all of these very seriously and follow the treatment protocol recommended by your doctor.
• Subchorionic hemorrhage: Since you aren’t supposed to experience any vaginal bleeding during the pregnancy, bleeding due to a subchorionic hemorrhage can be alarming. Depending on the size of the hemorrhage, the bleeding can be light or heavy. This type of hemorrhage can happen due to placental abruption, and you should consult your doctor immediately if any signs show up.

If you’ve had your foetal ultrasound and other recommended tests done, then the best thing you can do this week is to sit back, relax and enjoy the fact that you’ve reached the halfway mark of your pregnancy. If you’re a working woman who can claim maternity benefits, then submit a copy of the ultrasound report at your workplace and discuss the rest of your pregnancy at work and maternity leaves with your employers.

If there’s one thing pregnancy teaches you for a lifetime, it’s to take your health very seriously. Keeping that in mind, stick to your healthy diet and stay away from risky foods like raw fish, raw seafood, undercooked meat and fish, soft cheeses, etc. These can put you at risk of infections like salmonella and listeriosis. (Read more: Is it safe to eat fish during pregnancy?)

Make sure you don’t exhaust yourself during exercising or any other activity. Get fitted for the perfect maternity bra and slip into loose-fitting and comfortable maternity clothes. Apart from your physical health, take a note of your mental health too. Communicate your needs, fears, expectations, etc with your partner, family, friends and a maternity club or prenatal class (if you have access to one). Don’t brush symptoms of depression under the rug.

You’ve started feeling your baby kick and move about, and you’ve completed half the journey until the day you get to meet your baby. This makes the 20th week of pregnancy a pretty good time, especially if you’ve had the ultrasound and other check ups done. Yes, you still have to deal with many symptoms of pregnancy, but It all feels easier to deal with as your pregnancy progresses. 

What you have to remember to do is to maintain communication with your obstetrician, because your doctor wants the best outcomes for you and your baby. This is also the reason why you should always get your doctor’s approval before starting with a medication, and stick to the dosage recommended to you. This apart, take your mental health very seriously and ensure that you have enough support and get enough time to relax and de-stress every day.